SENATE BILL 23-167
BY SENATOR(S) Winter F. and Will, Cutter, Exum, Fields, Ginal,
Gonzales, Hansen, Hinrichsen, Kolker, Marchman, Priola, Fenberg;
also REPRESENTATIVE(S) Garcia and Lindsay, Amabile, Bacon, Bird,
Boesenecker, Brown, Dickson, Duran, English, Epps, Froelich,
Gonzales-Gutierrez, Hamrick, Herod, Jodeh, Lieder, Lindstedt, Mabrey,
Marshall, McCormick, Michaelson Jenet, Ortiz, Parenti, Ricks, Sharbini,
Sirota, Snyder, Story, Titone, Valdez, Velasco, Vigil, Weinberg, Winter T.,
Woodrow, Young, McCluskie.
C
ONCERNING THE REGULATION OF CERTIFIED MIDWIVES BY THE STATE
BOARD OF NURSING
, AND, IN CONNECTION THEREWITH, MAKING AN
APPROPRIATION
.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 12-255-102, amend (1)
as follows:
12-255-102. Legislative declaration. (1) The general assembly
hereby declares it to be the policy of this state that, in order to safeguard the
life, health, property, and public welfare of the people of this state and in
order to protect the people of this state from the unauthorized, unqualified,
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. and improper application of services by individuals in the practice of
nursing
AND THE PRACTICE AS A CERTIFIED MIDWIFE , it is necessary that a
proper regulatory authority be established. The general assembly further
declares it to be the policy of this state to regulate the practice of nursing
AND THE PRACTICE AS A CERTIFIED MIDWIFE through a state agency with the
power to enforce this article 255.
SECTION 2. In Colorado Revised Statutes, 12-255-104, amend
(4.5) and (13); and add (3.2) and (7.5) as follows:
12-255-104. Definitions. As used in this article 255, unless the
context otherwise requires:
(3.2) "C
ERTIFIED MIDWIFE" MEANS AN INDIVIDUAL WHO MEETS THE
QUALIFICATIONS FOR PRACTICE AS A CERTIFIED MIDWIFE
, AS SPECIFIED IN
THIS PART
1 AND BY THE AMERICAN MIDWIFERY CERTIFICATION BOARD, OR
ITS SUCCESSOR ENTITY
, AND WHO IS CURRENTLY LICENSED BY THE BOARD .
O
NLY AN INDIVIDUAL WHO HOLDS A LICENSE TO PRACTICE AS A CERTIFIED
MIDWIFE IN THIS STATE PURSUANT TO THIS PART
1 HAS THE RIGHT TO USE
THE TITLE
"CERTIFIED MIDWIFE" AND ITS ABBREVIATION "C.M."
(4.5) (a) "Delegation of patient care" means aspects of patient care
that are consistent with a plan of patient care prescribed by a licensed health
care provider within the scope of the provider's practice and that may be
delegated to a registered nurse or licensed practical nurse within the scope
of the nurse's practice. "Delegation of patient care" includes aspects of
patient care that may be delegated by a licensed health care provider within
the scope of the provider's practice and within the provider's professional
judgment to a licensed or an unlicensed health care provider within the
scope of that provider's practice. Nothing in this subsection (4.5) limits or
expands the scope of practice of any nurse
OR CERTIFIED MIDWIFE licensed
pursuant to this article 255.
(b) For purposes of
AS USED IN this subsection (4.5), "plan of patient
care" means a written plan, verbal order, standing order, or protocol,
whether patient specific or not, that authorizes specific or discretionary
nursing
OR CERTIFIED MIDWIFE action and that may include the
administration of medication.
(7.5) "P
RACTICE AS A CERTIFIED MIDWIFE " MEANS THE
PAGE 2-SENATE BILL 23-167 PERFORMANCE OF SERVICES REQUIRING THE EDUCATION , TRAINING, AND
SKILLS SPECIFIED BY THE
AMERICAN MIDWIFERY CERTIFICATION BOARD, OR
ITS SUCCESSOR ENTITY
, FOR MIDWIFE CERTIFICATION FROM THAT ENTITY .
(13) "Unauthorized practice", for purposes of this part 1, means:
(a) The practice of practical nursing or the practice of professional
nursing by any person
INDIVIDUAL:
(a) (I) Who has not been issued a license under this part 1;
(b) (II) Who is not practicing in this state pursuant to section
24-60-3802; or
(c) (III) Whose license has been suspended or revoked or has
expired;
OR
(b) THE PRACTICE AS A CERTIFIED MIDWIFE BY ANY INDIVIDUAL WHO
HAS NOT BEEN ISSUED A LICENSE UNDER THIS PART
1 OR WHOSE LICENSE HAS
BEEN SUSPENDED OR REVOKED OR HAS EXPIRED
.
SECTION 3. In Colorado Revised Statutes, 12-255-105, amend
(1)(a) introductory portion, (1)(a)(II) introductory portion, and (1)(a)(II)(D);
and add (1)(a)(II.5) as follows:
12-255-105. State board of nursing created - removal of board
members - meetings of board. (1) (a) There is created the state board of
nursing in the division, which is a type 1 entity, as defined in section
24-1-105. The board consists of eleven
TWELVE members who are residents
of this state, appointed by the governor as follows:
(II) Seven members of the board shall be WHO ARE licensed
professional nurses, who are actively employed in their respective nursing
professions, and
WHO ARE licensed in this state, The professional nurse
members shall AND WHO have been employed for at least three years in their
respective categories. Members shall be as follows:
(D) One member shall be WHO IS registered as an advanced practice
registered nurse pursuant to section 12-255-111;
EXCEPT THAT THE MEMBER
APPOINTED PURSUANT TO THIS SUBSECTION
(1)(a)(II)(D) MUST NOT BE A
PAGE 3-SENATE BILL 23-167 CERTIFIED NURSE MIDWIFE;
(II.5) O
NE MEMBER OF THE BOARD WHO IS A CERTIFIED MIDWIFE OR
AN ADVANCED PRACTICE REGISTERED NURSE WHO IS A CERTIFIED NURSE
MIDWIFE
;
SECTION 4. In Colorado Revised Statutes, 12-255-107, amend
(1)(b)(I)(A), (1)(b)(I)(B), and (1)(h) as follows:
12-255-107. Powers and duties of the board - rules - definition.
(1) The board has the following powers and duties:
(b) (I) (A) To examine, license, certify, reactivate, and renew
licenses or certifications of qualified applicants, and to grant to the
applicants temporary licenses and permits, to engage in the practice of
practical nursing and professional nursing,
THE PRACTICE AS A CERTIFIED
MIDWIFE
, or the practice of a nurse aide, as applicable, in this state within
the limitations imposed by this article 255. Licenses and certifications
issued pursuant to this article 255 are subject to the renewal, expiration,
reinstatement, and delinquency fee provisions specified in section
12-20-202 (1) and (2).
(B) The director may increase fees to obtain or renew a professional
nurse license, or
AN advanced practice registered nurse authority, OR A
CERTIFIED MIDWIFE LICENSE
under this part 1 consistent with section
12-30-105 (4) to fund the division's costs in administering and staffing the
nurse-physician advisory task force for Colorado health care created in
section 12-30-105 (1).
(h) To investigate and conduct hearings upon charges for the
discipline of nurses,
CERTIFIED MIDWIVES, and nurse aides in accordance
with article 4 of title 24 and section 12-20-403 and to impose disciplinary
sanctions as provided in this article 255 and section 12-20-404;
SECTION 5. In Colorado Revised Statutes, add 12-255-111.5 as
follows:
12-255-111.5. Requirements for certified midwife licensure -
license by endorsement - questionnaire - fees. (1) O
N AND AFTER JULY
1, 2024, THE BOARD SHALL ISSUE A LICENSE TO ENGAGE IN THE PRACTICE AS
PAGE 4-SENATE BILL 23-167 A CERTIFIED MIDWIFE TO ANY APPLICANT WHO :
(a) S
UBMITS AN APPLICATION CONTAINING INFORMATION THE BOARD
MAY PRESCRIBE
;
(b) S
UBMITS PROOF SATISFACTORY TO THE BOARD , IN THE MANNER
AND UPON THE FORMS THE BOARD MAY REQUIRE
, TO SHOW THAT THE
APPLICANT HAS OBTAINED AND MAINTAINS IN GOOD STANDING A MIDWIFE
CERTIFICATION FROM THE
AMERICAN MIDWIFERY CERTIFICATION BOARD OR
ITS SUCCESSOR ENTITY
;
(c) P
AYS THE REQUIRED FEE; AND
(d) SUBMITS TO A CRIMINAL HISTORY RECORD CHECK IN THE FORM
AND MANNER AS DESCRIBED IN SUBSECTION
(2) OF THIS SECTION.
(2) (a) I
N ADDITION TO THE REQUIREMENTS OF SUBSECTION (1) OF
THIS SECTION
, EACH APPLICANT MUST HAVE THE APPLICANT 'S FINGERPRINTS
TAKEN BY A LOCAL LAW ENFORCEMENT AGENCY OR ANY THIRD PARTY
APPROVED BY THE
COLORADO BUREAU OF INVESTIGATION FOR THE PURPOSE
OF OBTAINING A FINGERPRINT
-BASED CRIMINAL HISTORY RECORD CHECK . IF
AN APPROVED THIRD PARTY TAKES THE APPLICANT
'S FINGERPRINTS, THE
FINGERPRINTS MAY BE ELECTRONICALLY CAPTURED USING
COLORADO
BUREAU OF INVESTIGATION
-APPROVED LIVESCAN EQUIPMENT . THIRD-PARTY
VENDORS SHALL NOT KEEP THE APPLICANT
'S INFORMATION FOR MORE THAN
THIRTY DAYS UNLESS REQUESTED TO DO SO BY THE APPLICANT
. THE
APPLICANT SHALL SUBMIT PAYMENT BY CERTIFIED CHECK OR MONEY ORDER
FOR THE FINGERPRINTS AND FOR THE ACTUAL COSTS OF THE RECORD CHECK
AT THE TIME THE FINGERPRINTS ARE SUBMITTED TO THE
COLORADO BUREAU
OF INVESTIGATION
. UPON RECEIPT OF FINGERPRINTS AND RECEIPT OF THE
PAYMENT FOR COSTS
, THE COLORADO BUREAU OF INVESTIGATION SHALL
CONDUCT A STATE AND NATIONAL FINGERPRINT
-BASED CRIMINAL HISTORY
RECORD CHECK UTILIZING RECORDS OF THE
COLORADO BUREAU OF
INVESTIGATION AND THE FEDERAL BUREAU OF INVESTIGATION AND SHALL
FORWARD THE RESULTS OF THE CRIMINAL HISTORY RECORD CHECK TO THE
DIRECTOR
.
(b) W
HEN THE RESULTS OF A FINGERPRINT-BASED CRIMINAL HISTORY
RECORD CHECK OF AN APPLICANT PERFORMED PURSUANT TO THIS
SUBSECTION
(2) REVEAL A RECORD OF ARREST WITHOUT A DISPOSITION , THE
PAGE 5-SENATE BILL 23-167 BOARD SHALL REQUIRE THAT APPLICANT TO SUBMIT TO A NAME -BASED
JUDICIAL RECORD CHECK
, AS DEFINED IN SECTION 22-2-119.3 (6)(d).
(3) T
HE BOARD MAY ISSUE A LICENSE BY ENDORSEMENT TO ENGAGE
IN THE PRACTICE AS A CERTIFIED MIDWIFE IN THIS STATE TO AN APPLICANT
WHO SATISFIES THE REQUIREMENTS OF THE OCCUPATIONAL CREDENTIAL
PORTABILITY PROGRAM
.
(4) (a) (I) T
HE BOARD SHALL DESIGN A QUESTIONNAIRE TO BE SENT
TO ALL LICENSEES WHO APPLY FOR LICENSE RENEWAL
. EACH APPLICANT FOR
LICENSE RENEWAL SHALL COMPLETE THE BOARD
-DESIGNED QUESTIONNAIRE.
T
HE PURPOSE OF THE QUESTIONNAIRE IS TO DETERMINE WHETHER A
LICENSEE HAS ACTED IN VIOLATION OF THIS PART
1 OR HAS BEEN
DISCIPLINED FOR ANY ACTION THAT MIGHT BE CONSIDERED A VIOLATION OF
THIS PART
1 OR THAT MIGHT MAKE THE LICENSEE UNFIT TO PRACTICE AS A
CERTIFIED MIDWIFE WITH REASONABLE CARE AND SAFETY
. THE BOARD
SHALL INCLUDE ON THE QUESTIONNAIRE A QUESTION REGARDING WHETHER
THE LICENSEE HAS COMPLIED WITH SECTION
12-30-111 AND IS IN
COMPLIANCE WITH SECTION
12-280-403 (2)(a).
(II) I
F AN APPLICANT FAILS TO ANSWER THE QUESTIONNAIRE
ACCURATELY
, THE FAILURE CONSTITUTES GROUNDS FOR DISCIPLINE UNDER
SECTION
12-255-120 (1)(v).
(III) T
HE BOARD MAY INCLUDE THE COST OF DEVELOPING AND
REVIEWING THE QUESTIONNAIRE IN THE FEE PAID UNDER SUBSECTION
(1)(c)
OF THIS SECTION.
(IV) T
HE BOARD MAY DENY AN APPLICATION FOR LICENSE RENEWAL
THAT DOES NOT ACCOMPANY AN ACCURATELY COMPLETED QUESTI ONNAIRE
.
(b) O
N AND AFTER JULY 1, 2024, AS A CONDITION OF RENEWAL OF A
LICENSE
, EACH LICENSEE SHALL ATTEST THAT THE LICENSEE IS IN
COMPLIANCE WITH SECTION
12-280-403 (2)(a) AND THAT THE LICENSEE IS
AWARE OF THE PENALTIES FOR NONCOMPLIANCE WITH THAT SECTION
.
(5) A
CERTIFIED MIDWIFE WHO SATISFIES THE REQUIREMENTS OF
SECTION
12-255-112 MAY BE GRANTED PRESCRIPTIVE AUTHORITY AS A
FUNCTION IN ADDITION TO THOSE FUNCTIONS DESCRIBED IN SECTION
12-255-104 (7.5).
PAGE 6-SENATE BILL 23-167 SECTION 6. In Colorado Revised Statutes, 12-255-112, amend
(1), (3), (4)(b) introductory portion, (4)(b)(I)(A), (4)(b)(I)(D), (4)(b)(I)(E),
(4)(b)(III), (4)(b)(IV), (4)(d), (5), (6), (7), (9), (10), (11), and (12); repeal
(4)(f); and add (4)(a.5) and (4)(b)(V) as follows:
12-255-112. Prescriptive authority - advanced practice
registered nurses - certified midwives - limits on prescriptions - rules
- financial benefit for prescribing prohibited. (1) The board may
authorize
THE FOLLOWING LICENSEES TO PRESCRIBE CONTROLLED
SUBSTANCES OR PRESCRIPTION DRUGS
, AS THOSE TERMS ARE DEFINED IN
SECTION
12-280-103:
(a) An advanced practice registered nurse who is listed on the
advanced practice registry,
WHO has a license in good standing without
disciplinary sanctions issued pursuant to section 12-255-110, and
WHO has
fulfilled
THE REQUIREMENTS OF THIS SECTION AND requirements established
by the board pursuant to this section; to prescribe controlled substances or
prescription drugs as defined in section 12-280-103. OR
(b) A CERTIFIED MIDWIFE WHO HAS A LICENSE ISSUED PURSUANT TO
SECTION
12-255-111.5 THAT IS IN GOOD STANDING WITHOUT DISCIPLINARY
SANCTIONS AND WHO HAS FULFILLED THE REQUIREMENTS OF THIS SECTION
AND REQUIREMENTS ESTABLISHED BY THE BOARD PURSUANT TO THIS
SECTION
.
(3) (a) An advanced practice registered nurse
OR A CERTIFIED
MIDWIFE
may be granted authority to prescribe prescription drugs and
controlled substances to provide treatment to clients within the role and
population focus of the advanced practice registered nurse
OR CERTIFIED
MIDWIFE
, AS APPLICABLE.
(b) (I) An advanced practice registered nurse
OR A CERTIFIED
MIDWIFE
who has been granted authority to prescribe prescription drugs and
controlled substances under this part 1 may advise the nurse's
OR CERTIFIED
MIDWIFE
'S patients of their option to have the symptom or purpose for
which a prescription is being issued included on the prescription order.
(II) A nurse's
OR CERTIFIED MIDWIFE'S failure to advise a patient
under subsection (3)(b)(I) of this section is neither:
PAGE 7-SENATE BILL 23-167 (A) Grounds for any disciplinary action against the nurse's OR
CERTIFIED MIDWIFE
'S professional license issued under this part 1; nor
(B) Grounds for any civil action against a nurse
OR CERTIFIED
MIDWIFE
in a negligence or tort action; nor
(C) Evidence in any civil action against a nurse
OR CERTIFIED
MIDWIFE
.
(4) (a.5) A
CERTIFIED MIDWIFE APPLYING FOR PRESCRIPTIVE
AUTHORITY SHALL PROVIDE EVIDENCE TO THE BOARD THAT THE CERTIFIED
MIDWIFE HAS OBTAINED AND MAINTAINS
:
(I) A
MIDWIFE CERTIFICATION IN GOOD STANDING FROM THE
AMERICAN MIDWIFERY CERTIFICATION BOARD OR ITS SUCCESSOR ENTITY;
AND
(II) PROFESSIONAL LIABILITY INSURANCE AS REQUIRED BY SECTION
12-255-113.
(b) Upon satisfaction of the requirements set forth in subsection
(4)(a) of this section, The board may grant provisional prescriptive authority
to an advanced practice registered nurse,
UPON SATISFACTION OF THE
REQUIREMENTS SET FORTH IN SUBSECTION
(4)(a) OF THIS SECTION, OR TO A
CERTIFIED MIDWIFE
, UPON SATISFACTION OF THE REQUIREMENTS SET FORTH
IN SUBSECTION
(4)(a.5) OF THIS SECTION. The provisional prescriptive
authority that is granted is limited to those patients and medications
appropriate to the advanced practice registered nurse's
OR CERTIFIED
MIDWIFE
'S role and population focus. In order to retain provisional
prescriptive authority and obtain and retain full prescriptive authority
pursuant to this subsection (4) for patients and medications appropriate for
the advanced practice registered nurse's
OR CERTIFIED MIDWIFE'S role and
population focus, an advanced practice registered nurse
OR A CERTIFIED
MIDWIFE
shall satisfy the following requirements:
(I) (A) Once the provisional prescriptive authority is granted, the
advanced practice registered nurse
OR CERTIFIED MIDWIFE must obtain seven
hundred fifty hours of documented experience in a mutually structured
prescribing mentorship either with a physician or with an advanced practice
registered nurse
OR A CERTIFIED MIDWIFE who has full prescriptive authority
PAGE 8-SENATE BILL 23-167 and experience in prescribing medications. The mentor must be practicing
in Colorado and have education, training, experience, and an active practice
that corresponds with the role and population focus of the advanced practice
registered nurse
OR CERTIFIED MIDWIFE.
(D) Upon successful completion of the mentorship period, the
mentor shall provide the mentor's signature and attestation to verify that the
advanced practice registered nurse
OR CERTIFIED MIDWIFE has successfully
completed the mentorship within the required period after the provisional
prescriptive authority was granted.
(E) If an advanced practice registered nurse
OR A CERTIFIED MIDWIFE
with provisional prescriptive authority fails to complete the mentorship
required by this subsection (4)(b)(I) within three years or otherwise fails to
demonstrate competence as determined by the board, the advanced practice
registered nurse's
OR CERTIFIED MIDWIFE'S provisional prescriptive authority
expires for failure to comply with the statutory requirements.
(III) The advanced practice registered nurse
OR CERTIFIED MIDWIFE
shall maintain professional liability insurance as required by section
12-255-113.
(IV) The advanced practice registered nurse
OR CERTIFIED MIDWIFE
shall maintain national certification, as specified in subsection (4)(a)(III) OR
(4)(a.5)(I) of this section, unless the board grants an exception.
(V) T
HE CERTIFIED MIDWIFE MUST COMPLETE AT LEAST THREE
YEARS OF CLINICAL WORK EXPERIENCE AS A CERTIFIED MIDWIFE
.
(d) In order to obtain provisional prescriptive authority and obtain
and retain full prescriptive authority in this state, an advanced practice
registered nurse
OR A CERTIFIED MIDWIFE from another state must meet the
requirements of this section or substantially equivalent requirements, as
determined by the board.
(f) Once an advanced practice registered nurse obtains full
prescriptive authority pursuant to this subsection (4), the advanced practice
registered nurse is not required to maintain or update an articulated plan as
described in subsection (4)(b)(II) or (4)(c)(I) of this section.
PAGE 9-SENATE BILL 23-167 (5) An advanced practice registered nurse OR A CERTIFIED MIDWIFE
who obtains prescriptive authority pursuant to this section shall be assigned
a specific identifier by the state board of nursing. This identifier shall be
available to the Colorado medical board and the state board of pharmacy.
The state board of nursing shall establish a mechanism to assure that the
prescriptive authority of an advanced practice registered nurse
OR A
CERTIFIED MIDWIFE
may be readily verified.
(6) An advanced practice registered nurse
OR A CERTIFIED MIDWIFE
with prescriptive authority pursuant to this section is subject to the
limitations on prescriptions specified in section 12-30-109.
(7) (a) The scope of practice for an advanced practice registered
nurse
OR A CERTIFIED MIDWIFE may be determined by the board in
accordance with this part 1.
(b) The board may consider information provided by nursing,
medical,
MIDWIFERY, or other health professional organizations,
associations, or regulatory boards.
(c) (I) Prescriptive authority by an advanced practice registered
nurse shall be
OR A CERTIFIED MIDWIFE IS limited to those patients
appropriate to the nurse's
OR CERTIFIED MIDWIFE'S scope of practice.
Prescriptive authority may be limited or withdrawn and the advanced
practice registered nurse
OR CERTIFIED MIDWIFE may be subject to further
disciplinary action in accordance with this part 1 if the nurse
OR CERTIFIED
MIDWIFE
has prescribed outside the nurse's OR CERTIFIED MIDWIFE'S scope
of practice or for other than a therapeutic purpose.
(II) Nothing in this section shall be construed to require a registered
nurse
OR CERTIFIED MIDWIFE to obtain prescriptive authority to deliver
anesthesia care.
(9) Nothing in this section shall be construed to permit dispensing
or distribution, as defined in section 12-280-103 (14) and (15), by an
advanced practice registered nurse
OR A CERTIFIED MIDWIFE, except for
samples, under article 280 of this title 12 and the federal "Prescription Drug
Marketing Act of 1987", Pub.L. 100-293, as amended.
(10) An advanced practice registered nurse registered pursuant to
PAGE 10-SENATE BILL 23-167 section 12-255-111 OR A CERTIFIED MIDWIFE is not required to apply for or
obtain prescriptive authority.
(11) Nothing in this section shall limit LIMITS:
(a) The practice of nursing by any nurse, including advanced
practice registered nurses;
OR
(b) THE PRACTICE AS A CERTIFIED MIDWIFE BY ANY CERTIFIED
MIDWIFE
.
(12) An advanced practice registered nurse
OR A CERTIFIED MIDWIFE
shall not accept any direct or indirect benefit from a pharmaceutical
manufacturer or pharmaceutical representative for prescribing a specific
medication to a patient. For the purposes of this section, a direct or indirect
benefit does not include a benefit offered to an advanced practice registered
nurse
OR CERTIFIED MIDWIFE regardless of whether the specific medication
is being prescribed.
SECTION 7. In Colorado Revised Statutes, amend 12-255-113 as
follows:
12-255-113. Professional liability insurance required - advanced
practice registered nurses and certified midwives in independent
practice - rules. (1) It is unlawful for any advanced practice registered
nurse
OR CERTIFIED MIDWIFE engaged in an independent practice of
professional nursing
OR AS A CERTIFIED MIDWIFE to practice within the state
of Colorado unless the advanced practice registered nurse
OR CERTIFIED
MIDWIFE
purchases and maintains or is covered by professional liability
insurance in an amount not less than five hundred thousand dollars per
claim with an aggregate liability for all claims during the year of one
million five hundred thousand dollars.
(2) Professional liability insurance required by this section shall
MUST cover all acts within the scope of practice of an advanced practice
registered nurse
OR CERTIFIED MIDWIFE as defined
DESCRIBED in this part 1.
(3) Notwithstanding the requirements of subsection (1) of this
section, the board, by rule, may exempt or establish lesser liability insurance
requirements for advanced practice registered nurses
OR CERTIFIED
PAGE 11-SENATE BILL 23-167 MIDWIVES.
(4) Nothing in this section shall be construed to confer liability on
an employer for the acts of an advanced practice registered nurse
OR A
CERTIFIED MIDWIFE
that are outside the scope of employment or to negate
the applicability of the "Colorado Governmental Immunity Act", article 10
of title 24.
SECTION 8. In Colorado Revised Statutes, amend 12-255-115 as
follows:
12-255-115. Volunteer licensure - fees - questionnaire. (1) The
board may issue a license to a volunteer nurse
OR CERTIFIED MIDWIFE who
meets the requirements set forth in this section.
(2) A volunteer nursing
OR CERTIFIED MIDWIFE license shall only be
issued to an applicant who:
(a) Currently holds a license to practice nursing, either as a practical
nurse or as a professional nurse,
OR TO PRACTICE AS A CERTIFIED MIDWIFE,
and the license is due to expire unless renewed; or
(b) Is not currently engaged in the practice of nursing
OR AS A
CERTIFIED MIDWIFE
either full-time or part-time and has, prior to ceasing
practice, maintained full licensure in good standing in any state or territory
of the United States.
(3) (a) A volunteer nursing license shall permit the nurse to engage
in volunteer nursing tasks within the scope of the nurse's license.
(b) A
VOLUNTEER CERTIFIED MIDWIFE LICENSE SHALL PERMIT THE
CERTIFIED MIDWIFE TO ENGAGE AS A VOLUNTEER IN THE PRACTICE AS A
CERTIFIED MIDWIFE WITHIN THE SCOPE OF THE CERTIFIED MIDWIFE
'S LICENSE.
(4) An applicant for a volunteer nursing
OR CERTIFIED MIDWIFE
license shall submit to the board an application containing the information
the board may prescribe, a copy of the applicant's most recent nursing
OR
CERTIFIED MIDWIFE
license, and a statement signed under penalty of perjury
in which the applicant agrees not to receive compensation for any nursing
tasks
OR TASKS AS A CERTIFIED MIDWIFE that are performed while in
PAGE 12-SENATE BILL 23-167 possession of the license.
(5) A person who possesses a volunteer nursing
OR CERTIFIED
MIDWIFE
license is immune from civil liability for actions performed within
the scope of the nursing
OR CERTIFIED MIDWIFE license unless it is
established that injury or death was caused by gross negligence or the
willful and wanton misconduct of the licensee. The immunity provided in
this subsection (5) applies only to the licensee and does not affect the
liability of any other individual or entity. Nothing in this subsection (5)
limits the ability of the board to take disciplinary action against a licensee.
(6) The fee for a volunteer nursing
OR CERTIFIED MIDWIFE license,
including assessments for legal defense, peer assistance, and other programs
for which licenses are assessed, must not exceed fifty percent of the license
renewal fee, including all assessments, established by the board for an
active nursing
OR CERTIFIED MIDWIFE license.
(7) The board shall design a questionnaire to be sent to all volunteer
nurses
AND CERTIFIED MIDWIVES who apply for license renewal. Each
applicant for license renewal shall complete the board-designed
questionnaire. The purpose of the questionnaire is to determine whether a
licensee has acted in violation of this part 1 or has been disciplined for any
action that might be considered a violation of this part 1 or might make the
licensee unfit to practice nursing
OR AS A CERTIFIED MIDWIFE with
reasonable care and safety. If an applicant fails to answer the questionnaire
accurately, the failure constitutes grounds for discipline under section
12-255-120 (1)(v). The board may include the cost of developing and
reviewing the questionnaire in the fee paid under subsection (6) of this
section. The board may deny an application for license renewal that does
not accompany an accurately completed questionnaire.
(8) (a) The board shall deny an application for the reactivation of a
practical or professional nurse license for a volunteer nurse if the board
determines that the nurse requesting reactivation has not actively
volunteered as a nurse for the two-year period immediately preceding the
filing of the application for license reactivation or has not otherwise
demonstrated continued competency to return to the active practice of
nursing in a manner approved by the board.
(b) T
HE BOARD SHALL DENY AN APPLICATION FOR THE
PAGE 13-SENATE BILL 23-167 REACTIVATION OF A CERTIFIED MIDWIFE LICENSE FOR A VOLUNTEER
CERTIFIED MIDWIFE IF THE BOARD DETERMINES THAT THE CERTIFIED
MIDWIFE REQUESTING REACTIVATION HAS NOT ACTIVELY VOLUNTEERED AS
A CERTIFIED MIDWIFE FOR THE TWO
-YEAR PERIOD IMMEDIATELY PRECEDING
THE FILING OF THE APPLICATION FOR LICENSE REACTIVATION OR HAS NOT
OTHERWISE DEMONSTRATED CONTINUED COMPETENCY TO RETURN TO THE
ACTIVE PRACTICE AS A CERTIFIED MIDWIFE IN A MANNER APPROVED BY THE
BOARD
.
SECTION 9. In Colorado Revised Statutes, 12-255-117, amend (5)
as follows:
12-255-117. Temporary licenses and permits. (5) The board shall
summarily withdraw a temporary license or permit issued pursuant to this
section if the board determines that the
TEMPORARY license OR PERMIT
holder fails to meet the requirements of this section or section 12-255-109,
12-255-110, 12-255-111.5, or 12-255-114. The holder of a temporary
license or permit summarily withdrawn has the right to a hearing that shall
be conducted pursuant to article 4 of title 24 and section 12-20-403 by the
board or by an administrative law judge at the board's discretion.
SECTION 10. In Colorado Revised Statutes, 12-255-119, amend
(1)(a), (3)(a)(I) introductory portion, (3)(a)(I)(B), (3)(a)(I)(C), (3)(a)(II),
(3)(a)(III), (3)(b), (3)(c)(III), (4)(a), (4)(c)(III), (4)(c)(IV) introductory
portion, (4)(c)(IV)(C), (4)(e), (6), (7), (8)(a), (8)(b), (8)(d), and (10) as
follows:
12-255-119. Disciplinary procedures of the board - inquiry and
hearings panels - mental and physical examinations - definitions - rules.
(1) (a) The president of the board shall divide the other ten members of the
board into two panels of five members each. Members representing the
three
different categories of membership (licensed practical nurses,
professional nurses,
CERTIFIED MIDWIVES, and persons not licensed,
employed, or in any way connected with, or with any financial interest in,
any health-care facility, agency, or insurer) shall be divided between the two
panels as equally as possible.
(3) (a) (I) For the purposes of
AS USED IN this section:
(B) "License" includes licensure for a practical nurse or professional
PAGE 14-SENATE BILL 23-167 nurse, LICENSURE FOR A CERTIFIED MIDWIFE, and licensure for a psychiatric
technician.
(C) "Nurse", "licensee", or "respondent" includes a practical nurse,
a professional nurse,
A CERTIFIED MIDWIFE, and a psychiatric technician as
described in section 12-295-103 (4).
(II) Written complaints relating to the conduct of a nurse licensed
or authorized to practice nursing in this state
OR RELATING TO THE CONDUCT
OF A CERTIFIED MIDWIFE LICENSED OR AUTHORIZED TO PRACTICE AS A
CERTIFIED MIDWIFE IN THIS STATE
may be made by any person or may be
initiated by an inquiry panel of the board on its own motion. U
NLESS THE
BOARD DETERMINES THE COMPLAINT TO BE WITHOUT MERIT OF
INVESTIGATION
, THE BOARD SHALL GIVE NOTICE OF THE COMPLAINT TO the
nurse
OR CERTIFIED MIDWIFE complained of, shall be given notice, unless
the board determines the complaint to be without merit of investigation, by
first-class mail, and
SHALL STATE IN the notice shall state
the nature of the
complaint and shall state that the failure to respond in a materially factual
and timely manner constitutes grounds for discipline. The nurse
OR
CERTIFIED MIDWIFE
complained of shall be given thirty days to answer or
explain in writing the matters described in such
THE complaint. Upon
receipt of the nurse's
OR CERTIFIED MIDWIFE'S answer or at the conclusion
of thirty days, whichever occurs first, the inquiry panel may take further
action as set forth in subsection (3)(a)(III) of this section.
(III) Upon receipt of the nurse's
OR CERTIFIED MIDWIFE'S answer or
the conclusion of thirty days, the inquiry panel may conduct a further
investigation that may be made by one or more members of the inquiry
panel;
IN THE CASE OF A COMPLAINT AGAINST A NURSE , one or more nurses
who are not members of the board;
IN THE CASE OF A COMPLAINT AGAINST
A CERTIFIED MIDWIFE
, ONE OR MORE CERTIFIED MIDWIVES OR CERTIFIED
NURSE MIDWIVES WHO ARE NOT MEMBERS OF THE BOARD
; a member of the
staff of the board; a professional investigator; or any other person or
organization as the inquiry panel directs. The investigation shall
MUST be
entirely informal.
(b) The board shall cause an investigation to be made when the
board is informed of:
(I) Disciplinary action taken by an employer of a nurse
OR CERTIFIED
PAGE 15-SENATE BILL 23-167 MIDWIFE against the nurse OR CERTIFIED MIDWIFE or resignation in lieu of
a disciplinary action for conduct that constitutes grounds for discipline
under section 12-255-120 or 12-295-111. The employer shall report the
disciplinary action or resignation to the board.
(II) An instance of a malpractice settlement or judgment against a
nurse
OR CERTIFIED MIDWIFE;
(III) A nurse
OR CERTIFIED MIDWIFE who has not timely renewed his
or her THE NURSE'S OR CERTIFIED MIDWIFE'S license and the nurse OR
CERTIFIED MIDWIFE
is actively engaged in the practice of nursing OR AS A
CERTIFIED MIDWIFE
.
(c) On completion of an investigation, the inquiry panel shall make
a finding that:
(III) An instance of conduct occurred that does not warrant formal
action by the board and that should be dismissed, but that indications of
possible conduct by the nurse
OR CERTIFIED MIDWIFE were noted that could
lead to serious consequences if not corrected. In such a case, the board shall
send a confidential letter of concern in accordance with section 12-20-404
(5) to the nurse
OR CERTIFIED MIDWIFE against whom the complaint was
made.
(4) (a) All formal complaints shall be heard and determined in
accordance with subsection (4)(b) of this section and section 24-4-105.
Except as provided in subsection (1) of this section, all formal hearings
shall be conducted by the hearings panel. The nurse
OR CERTIFIED MIDWIFE
may be present in person or represented by counsel, or both, if so desired,
to offer evidence and be heard in the nurse's
OR CERTIFIED MIDWIFE'S own
defense. At formal hearings, the witnesses shall be sworn and a complete
record shall be made of all proceedings and testimony.
(c) (III) If the hearings panel finds the charges proven and orders
that discipline be imposed, it shall also determine the extent of the
discipline, which may be in the form of a letter of admonition regarding a
license or suspension for a definite or indefinite period, revocation, or
nonrenewal of a license to practice. In addition to any other discipline that
may be imposed pursuant to this section, the hearings panel may impose a
fine of no less than two hundred fifty dollars but no more than one thousand
PAGE 16-SENATE BILL 23-167 dollars per violation on any nurse OR CERTIFIED MIDWIFE who violates this
part 1 or any rule adopted pursuant to this part 1. The board shall adopt
rules establishing a fine structure and the circumstances under which fines
may be imposed.
(IV) In determining appropriate disciplinary action, the hearings
panel shall first consider sanctions that are necessary to protect the public.
Only after the panel has considered such sanctions shall it consider and
order requirements designed to rehabilitate the nurse
OR CERTIFIED MIDWIFE.
If discipline other than revocation of a license to practice is imposed, the
hearings panel may also order that the nurse
OR CERTIFIED MIDWIFE be
granted probation and allowed to continue to practice during the period of
the probation. The hearings panel may also include in any disciplinary order
that allows the nurse
OR CERTIFIED MIDWIFE to continue to practice such
conditions as the panel may deem appropriate to assure that the nurse
OR
CERTIFIED MIDWIFE
is physically, mentally, and otherwise qualified to
practice nursing
OR AS A CERTIFIED MIDWIFE in accordance with generally
accepted standards of practice, including any of the following:
(C) The review or supervision of the respondent's practice of
nursing
OR AS A CERTIFIED MIDWIFE as may be necessary to determine the
quality of the respondent's practice of nursing
OR AS A CERTIFIED MIDWIFE
and to correct deficiencies therein
IN THE RESPONDENT'S PRACTICE; or
(e) The two-year waiting period specified in section 12-20-404 (3)
applies to any person whose license to practice nursing,
PRACTICE AS A
CERTIFIED MIDWIFE
, or PRACTICE any other health-care occupation is
revoked by any other legally qualified board.
(6) Upon the expiration of any term of suspension, the license shall
be reinstated by the board if the board is furnished with evidence that the
nurse
OR CERTIFIED MIDWIFE has complied with all terms of the suspension.
If the evidence shows the nurse
OR CERTIFIED MIDWIFE has not complied
with all terms of the suspension, the board may revoke or continue the
suspension of the license at a hearing, notice of which and the procedure at
which shall be as provided in this section.
(7) In case any nurse
OR CERTIFIED MIDWIFE is determined to be
mentally incompetent or insane by a court of competent jurisdiction and a
court enters, pursuant to part 3 or 4 of article 14 of title 15 or section
PAGE 17-SENATE BILL 23-167 27-65-110 (4) or 27-65-127, an order specifically finding that the mental
incompetency or insanity is of such a degree that the nurse
OR CERTIFIED
MIDWIFE
is incapable of continuing the practice of nursing OR AS A
CERTIFIED MIDWIFE
, the board shall automatically suspend the nurse's OR
CERTIFIED MIDWIFE
'S license, and, notwithstanding any provision of this part
1 to the contrary, the suspension must continue until the nurse
OR CERTIFIED
MIDWIFE
is found by the court to be competent to continue the practice of
nursing
OR THE PRACTICE AS A CERTIFIED MIDWIFE, AS APPLICABLE.
(8) (a) If the board has reasonable cause to believe that a nurse is
unable to practice nursing,
OR A CERTIFIED MIDWIFE IS UNABLE TO PRACTICE
AS A CERTIFIED MIDWIFE
, with reasonable skill and safety to patients
because of a condition described in section 12-255-120 (1)(i) or (1)(j) or
section 12-295-111 (1)(i) or (1)(j), it
THE BOARD may require the nurse OR
CERTIFIED MIDWIFE
to submit to mental or physical examinations by a
physician or other licensed health-care professional designated by the board.
If a nurse
OR CERTIFIED MIDWIFE fails to submit to the mental or physical
examinations, the board may suspend the nurse's
OR CERTIFIED MIDWIFE'S
license until the required examinations are conducted.
(b) (I) Every nurse
OR CERTIFIED MIDWIFE shall be deemed, by so
practicing or by applying for renewal registration of the nurse's
OR
CERTIFIED MIDWIFE
'S license, to have consented to submit to mental or
physical examinations when directed in writing by the board. Further, the
nurse
OR CERTIFIED MIDWIFE shall be deemed to have waived all objections
to the admissibility of the examining physician's or other licensed
health-care professional's testimony or examination reports on the ground
of privileged communication. Subject to applicable federal law, the nurse
OR CERTIFIED MIDWIFE shall be deemed to have waived all objections to the
production of medical records to the board from health-care providers that
may be necessary for the evaluations described in subsection (8)(a) of this
section.
(II) Nothing in this section shall prevent the
PREVENTS A nurse OR
CERTIFIED MIDWIFE
from submitting to the board testimony or examination
reports of a physician or other licensed health-care professional designated
by the nurse
OR CERTIFIED MIDWIFE to a condition described in subsection
(8)(a) of this section that may be considered by the board in conjunction
with, but not in lieu of, testimony and examination reports of the physician
or licensed health-care professional designated by the board.
PAGE 18-SENATE BILL 23-167 (d) The board may require that a nurse OR CERTIFIED MIDWIFE
submit medical records for review in conjunction with an examination made
pursuant to subsection (8)(a) of this section; except that the records shall
remain confidential, and shall be reviewed by the board MAY REVIEW THE
RECORDS
only to the extent necessary to conduct an investigation.
(10) A physician or other licensed health-care professional who, at
the request of the board, examines a nurse shall be
OR CERTIFIED MIDWIFE
IS
immune from suit for damages by the nurse OR CERTIFIED MIDWIFE
examined if the examining physician or examining licensed health-care
professional conducted the examination and made findings or a diagnosis
in good faith.
SECTION 11. In Colorado Revised Statutes, 12-255-120, amend
(1)(d), (1)(f), (1)(g), (1)(j)(I), (1)(j)(II), (1)(l), (1)(n), (1)(v), (1)(w), (1)(x),
(1)(y), (1)(dd), (1)(ee), and (1)(ff) as follows:
12-255-120. Grounds for discipline - definitions. (1) "Grounds for
discipline", as used in this part 1, means any action by any person who:
(d) Has had a license to practice nursing,
PRACTICE AS A CERTIFIED
MIDWIFE
, or PRACTICE any other health-care occupation suspended or
revoked in any jurisdiction. A certified copy of the order of suspension or
revocation shall be
IS prima facie evidence of the suspension or revocation.
(f) Has practiced nursing
OR AS A CERTIFIED MIDWIFE in a manner
that fails to meet generally accepted standards for the nursing
practice OF
NURSING OR AS A CERTIFIED MIDWIFE
, AS APPLICABLE;
(g) Has violated any order or rule of the board pertaining to nursing
practice,
PRACTICE AS A CERTIFIED MIDWIFE, or licensure;
(j) Has failed to:
(I) Notify the board, as required by section 12-30-108 (1), of a
physical illness, physical condition, or behavioral health, mental health, or
substance use disorder that affects the person's ability to practice nursing
OR
AS A CERTIFIED MIDWIFE
with reasonable skill and safety to patients or that
may endanger the health or safety of individuals under the person's care;
PAGE 19-SENATE BILL 23-167 (II) Act within the limitations created by a physical illness, physical
condition, or behavioral health, mental health, or substance use disorder that
renders the person unable to practice nursing
OR AS A CERTIFIED MIDWIFE
with reasonable skill and safety to patients or that may endanger the health
or safety of individuals under the person's care; or
(l) Has engaged in any conduct that would constitute a crime as
defined in title 18 and that relates to the person's employment as a practical
or professional nurse
OR AS A CERTIFIED MIDWIFE. In conjunction with any
disciplinary proceeding pertaining to this subsection (1)(l), the board shall
be governed by the provisions of sections 12-20-202 (5) and 24-5-101.
(n) Has engaged in any of the following activities and practices:
(I) Willful and repeated ordering or performance, without clinical
justification, of demonstrably unnecessary laboratory tests or studies;
(II) The administration, without clinical justification, of treatment
that is demonstrably unnecessary;
(III) The failure to obtain consultations or perform referrals when
failing to do so is not consistent with the standard of care for the profession;
or
(IV) Ordering or performing, without clinical justification, any
service, X ray, or treatment that is contrary to recognized standards of the
practice of nursing
OR AS A CERTIFIED MIDWIFE as interpreted by the board;
(v) Has failed to accurately complete and submit to the board the
designated questionnaire upon renewal of a license pursuant to section
12-255-110 (3), 12-255-111.5 (4), 12-255-114 (3), or 12-255-115 (7);
(w) (I) Represents himself or herself
ONESELF to an individual or to
the general public by use of any word or abbreviation to indicate or induce
others to believe that he or she is a licensed practical or professional nurse
unless the person is actually licensed as a practical nurse or professional
nurse, respectively; or
(II) Uses the title "nurse", "registered nurse", "R.N.", "practical
nurse", "trained practical nurse", "licensed vocational nurse", "licensed
PAGE 20-SENATE BILL 23-167 practical nurse", or "L.P.N." unless the person is licensed by the board AS
A PROFESSIONAL OR PRACTICAL NURSE
, AS APPLICABLE;
(III) R
EPRESENTS ONESELF TO AN INDIVIDUAL OR TO THE GENERAL
PUBLIC BY USE OF ANY WORD OR ABBREVIATION TO INDICATE OR INDUCE
OTHERS TO BELIEVE THAT THE PERSON IS A CERTIFIED MIDWIFE UNLESS THE
PERSON IS ACTUALLY LICENSED AS A CERTIFIED MIDWIFE
; OR
(IV) USES THE TITLE "CERTIFIED MIDWIFE" OR THE ABBREVIATION
"C.M." UNLESS THE PERSON IS LICENSED BY THE BOARD AS A CERTIFIED
MIDWIFE
;
(x) Practices as a practical or professional nurse
OR AS A CERTIFIED
MIDWIFE
during a period when the person's license has been suspended,
revoked, or placed on inactive status pursuant to section 12-255-122;
(y) Sells or fraudulently obtains or furnishes a license to practice as
a nurse
OR CERTIFIED MIDWIFE or aids or abets therein
IN SUCH ACT;
(dd) Has failed to notify the board, in writing and within thirty days
after a judgment or settlement is entered, of a final judgment by a court of
competent jurisdiction against the licensee for malpractice of nursing
OR AS
A CERTIFIED MIDWIFE
or a settlement by the licensee in response to charges
or allegations of malpractice of nursing
OR AS A CERTIFIED MIDWIFE and, in
the case of a judgment, has failed to include in the notice the name of the
court, the case number, and the names of all parties to the action;
(ee) Fails to report to the board, within thirty days after an adverse
action, that an adverse action has been taken against the person by another
licensing agency in another state or jurisdiction, a peer review body, a
health-care institution, a professional, or nursing, OR CERTIFIED MIDWIFE
society or association, a governmental agency, a law enforcement agency, or a court for acts or conduct that would constitute grounds for disciplinary or adverse action as described in this article 255;
(ff) Fails to report to the board, within thirty days, the surrender of
a license or other authorization to practice nursing
OR AS A CERTIFIED
MIDWIFE
in another state or jurisdiction or the surrender of membership on
any nursing
OR CERTIFIED MIDWIFE staff or in any nursing, CERTIFIED
MIDWIFE
, or professional association or society while under investigation by
PAGE 21-SENATE BILL 23-167 any of those authorities or bodies for acts or conduct similar to acts or
conduct that would constitute grounds for action as described in this article
255;
SECTION 12. In Colorado Revised Statutes, 12-255-121, amend
(1)(a), (1)(b)(I), (2), and (6)(a) as follows:
12-255-121. Withholding or denial of license - hearing -
definitions. (1) (a) The board is empowered to determine summarily
whether:
(I) An applicant for a license or a temporary license to practice as
a nurse
OR AS A CERTIFIED MIDWIFE possesses the qualifications required by
this part 1; whether
(II) There is probable cause to believe that an applicant for a license
or temporary license has done any of the acts set forth in section 12-255-120
as grounds for discipline; or whether
(III) The applicant for a license or temporary license has had a
license to practice nursing,
PRACTICE AS A CERTIFIED MIDWIFE, or PRACTICE
any other health-care occupation revoked by any legally authorized board.
(b) As used in this section:
(I) "Applicant" includes a nurse
OR CERTIFIED MIDWIFE seeking
reinstatement or reactivation of a license pursuant to section 12-255-122,
but does not include a renewal applicant.
(2) (a) (I) If the board determines that an applicant does not possess
the qualifications for licensure required by this part 1, that probable cause
exists to believe that an applicant for a license or temporary license has
done any of the acts set forth in section 12-255-120, or that an applicant for
a license or temporary license has had a nursing,
CERTIFIED MIDWIFE, or
other health-care occupation license revoked by another legally authorized
board, the board may withhold or deny the applicant a license under this
part 1.
(II) The board may deny a license or temporary license to practice
as a nurse
OR AS A CERTIFIED MIDWIFE to any applicant during the time the
PAGE 22-SENATE BILL 23-167 applicant's license is under suspension in another state.
(III) The board may deny a license or may grant a license subject to
terms of probation if the board determines that an applicant for a license has
not actively practiced practical or professional nursing,
HAS NOT ACTIVELY
PRACTICED AS A CERTIFIED MIDWIFE
, or has not otherwise maintained
continued competency, as determined by the board, during the two years
immediately preceding the application for licensure under this part 1.
(b) If the board denies a license to an applicant pursuant to
subsection (2)(a) of this section, the provisions of section 24-4-104 (9)
apply. Upon the denial, the board shall provide the applicant with a
statement in writing setting forth the following:
(I) The basis of the board's determination that the applicant:
(A) Does not possess the qualifications required by this part 1;
(B) Has had a nursing,
CERTIFIED MIDWIFE, or other health-care
occupation license revoked or suspended by another legally authorized
board; or
(C) Has not actively practiced practical or professional nursing,
HAS
NOT ACTIVELY PRACTICED AS A CERTIFIED MIDWIFE
, or has not maintained
continued competency during the previous two years; or
(II) The factual basis for probable cause that the applicant has done
any of the acts set forth in section 12-255-120.
(c) (I) If the board denies a
NURSING license to an applicant on the
grounds that the applicant's nursing or other health-care occupation license
was revoked by another legally authorized board, the board may require the
applicant to pass a written examination as provided in section 12-255-109
as a prerequisite to licensure. The applicant shall not be allowed to take the
written examination until at least two years after the revocation of the
nursing or other health-care occupation license.
(II) I
F THE BOARD DENIES A CERTIFIED MIDWIFE LICENSE TO AN
APPLICANT ON THE GROUNDS THAT THE APPLICANT
'S CERTIFIED MIDWIFE
LICENSE WAS REVOKED BY ANOTHER LEGALLY AUTHORIZED BOARD
, THE
PAGE 23-SENATE BILL 23-167 BOARD MAY REQUIRE THE APPLICANT TO OBTAIN RECERTIFICATION FROM
THE
AMERICAN MIDWIFERY CERTIFICATION BOARD, OR ITS SUCCESSOR
ENTITY
, AS A PREREQUISITE TO LICENSURE. THE APPLICANT SHALL NOT BE
ALLOWED TO OBTAIN LICENSURE PURSUANT TO THIS SUBSECTION
(2)(c)(II)
UNTIL AT LEAST TWO YEARS AFTER THE APPLICANT 'S CERTIFIED MIDWIFE
LICENSE WAS REVOKED
.
(6) (a) At the hearing, the applicant shall have
HAS the burden of
proof to show that:
(I) The applicant possesses the qualifications required for licensure
under this part 1;
(II) The applicant's nursing,
CERTIFIED MIDWIFE, or other health-care
occupation license was not revoked by another legally authorized board; or
(III) The applicant has actively practiced practical or professional
nursing,
HAS ACTIVELY PRACTICED AS A CERTIFIED MIDWIFE , or has
maintained continued competency during the two years prior to application
for a license under this part 1.
SECTION 13. In Colorado Revised Statutes, 12-255-122, amend
(1), (2), (3), (5), (6)(a), and (6)(b)(II) as follows:
12-255-122. Inactive license status - reactivation. (1) A nurse
OR
CERTIFIED MIDWIFE
licensed pursuant to section 12-255-110, 12-255-111.5,
or 12-255-114 may request that the board place his or her
THE NURSE'S OR
CERTIFIED MIDWIFE
'S license on inactive status. The request shall be made
in the form and manner designated by the board.
(2) A nurse
OR CERTIFIED MIDWIFE requesting inactive license status
shall provide an affidavit or other document required by the board certifying
that, immediately upon the conferral of inactive status, the nurse shall
WILL
not practice nursing, OR THE CERTIFIED MIDWIFE WILL NOT PRACTICE AS A
CERTIFIED MIDWIFE
, in the state unless and until
the nurse's OR CERTIFIED
MIDWIFE
'S license is reactivated pursuant to subsection (6) of this section.
(3) Upon receiving the documentation pursuant to subsection (2) of
this section, the board shall approve a request for inactive license status.
However, the board may deny the request if the board has probable cause
PAGE 24-SENATE BILL 23-167 to believe that the requesting nurse OR CERTIFIED MIDWIFE has committed
any of the acts set forth in section 12-255-120.
(5) A nurse
OR CERTIFIED MIDWIFE with a license on inactive status
is not authorized to practice nursing
OR AS A CERTIFIED MIDWIFE, AS
APPLICABLE
, in Colorado. Any nurse practicing nursing while his or her
THE
NURSE
'S license is inactive, shall be
AND ANY CERTIFIED MIDWIFE
PRACTICING AS A CERTIFIED MIDWIFE WHILE THE CERTIFIED MIDWIFE
'S
LICENSE IS INACTIVE
, IS subject to disciplinary action pursuant to section
12-255-119 and criminal penalties pursuant to section 12-255-125.
(6) (a) A nurse
OR CERTIFIED MIDWIFE with a license on inactive
status who wishes to resume the practice of nursing
OR AS A CERTIFIED
MIDWIFE
, AS APPLICABLE, shall file an application in the form and manner
designated by the board and pay the license reactivation fees established
pursuant to section 12-255-107. The board shall reactivate such license
unless subsection (6)(b) of this section applies.
(b) The board shall deny an application for reactivation of an
inactive license:
(II) If the board determines that the nurse
OR CERTIFIED MIDWIFE
requesting reactivation has not actively practiced nursing OR AS A CERTIFIED
MIDWIFE
in another state for the two-year period immediately preceding the
filing of the request for reactivation or has not otherwise demonstrated
continued competency to return to the active practice of nursing
OR AS A
CERTIFIED MIDWIFE
in a manner approved by the board.
SECTION 14. In Colorado Revised Statutes, 12-255-124, amend
(1), (3), and (4) as follows:
12-255-124. Surrender of license. (1) Prior to the initiation of an
investigation or hearing, any licensee or temporary license holder may
surrender his or her
THE INDIVIDUAL'S license to practice nursing OR AS A
CERTIFIED MIDWIFE
.
(3) The board shall not issue a license or temporary license or permit
to a former licensee or temporary license or permit holder whose license has
been surrendered unless the licensee meets all of the requirements of this
part 1 for a new applicant, including,
FOR APPLICANTS FOR A LICENSE,
PAGE 25-SENATE BILL 23-167 TEMPORARY LICENSE, OR PERMIT TO PRACTICE NURSING, the passing of an
examination.
(4) The surrender of a license in accordance with this section
removes all rights and privileges to practice nursing
OR AS A CERTIFIED
MIDWIFE
, AS APPLICABLE, including renewal of a license.
SECTION 15. In Colorado Revised Statutes, amend 12-255-125
as follows:
12-255-125. Unauthorized practice - penalties. (1) It is unlawful
for any person to practice as a practical or professional nurse
OR AS A
CERTIFIED MIDWIFE
unless licensed to practice that profession.
(2) Any person who practices or offers or attempts to practice
practical or professional nursing
OR AS A CERTIFIED MIDWIFE without an
active license issued under this part 1 is subject to penalties pursuant to
section 12-20-407 (1)(a).
SECTION 16. In Colorado Revised Statutes, amend 12-255-126
as follows:
12-255-126. Injunctive proceedings. The board may seek
injunctive relief in accordance with section 12-20-406, but only to enjoin
any person who does not possess a currently valid or active practical or
professional nurse license,
CERTIFIED MIDWIFE LICENSE, or nurse aide
certification from committing any act declared to be unlawful or prohibited
by this article 255.
SECTION 17. In Colorado Revised Statutes, 12-255-127, amend
(1)(b), (1)(c), (1)(d), (1)(e), (1)(f), (1)(g), (1)(p), (1)(q), (2), and (3) as
follows:
12-255-127. Exclusions. (1) This part 1 does not prohibit:
(b) Domestic administration of family remedies or care of the sick
by domestic servants, housekeepers, companions, or household aides of any
type, whether employed regularly or because of an emergency of illness, but
who shall not in any way assume to practice practical or professional
nursing
OR AS A CERTIFIED MIDWIFE;
PAGE 26-SENATE BILL 23-167 (c) Nursing OR MIDWIFERY assistance in the case of an emergency;
(d) The practice of nursing
OR AS A CERTIFIED MIDWIFE in this state
by any legally qualified nurse
OR CERTIFIED MIDWIFE of another state whose
engagement requires the nurse
OR CERTIFIED MIDWIFE to accompany and
care for a patient temporarily residing in this state, during the period of one
engagement, not to exceed six months in length, if the person does not
represent or hold himself or herself out as a practical or professional nurse
OR CERTIFIED MIDWIFE licensed to practice in this state;
(e) The practice of any nurse
OR CERTIFIED MIDWIFE licensed in this
state or another state or a territory of the United States who is employed by
the United States government or any bureau, division, or agency thereof
OF
THE
UNITED STATES GOVERNMENT while in the discharge of official duties;
(f) The practice of nursing
OR MIDWIFERY by students enrolled in an
educational
APPROVED EDUCATION program approved by the board OR
MIDWIFERY EDUCATION PROGRAM
when the practice is performed as part of
an educational
THE APPROVED EDUCATION program OR MIDWIFERY
EDUCATION PROGRAM
prior to the graduation of the student;
(g) The practice of nursing
OR AS A CERTIFIED MIDWIFE by any nurse
OR MIDWIFE WHO IS licensed in any other state, or
any territory of the United
States, or any other country
AND IS enrolled in a baccalaureate or graduate
program, when
IF the practice is performed as a part of the program;
(p) The administration of medical marijuana in a nonsmokeable
form by a licensee LICENSED NURSE in a public school or nonpublic school
pursuant to a policy adopted pursuant to section 22-1-119.3 (3)(d.5);
(q) The training by a licensee LICENSED NURSE of school personnel
or volunteers on the administration of medical marijuana in a nonsmokeable
form in a public school or nonpublic school to a student with a valid
medical marijuana recommendation pursuant to a policy adopted pursuant
to section 22-1-119.3 (3)(d.5).
(2) This part 1 shall not be construed as applying to a person who
nurses or cares for the sick in accordance with the practice or tenets of any
church or religious denomination that teaches reliance upon spiritual means
through prayer for healing, and who does not hold himself or herself out to
PAGE 27-SENATE BILL 23-167 the public to be a licensed practical or professional nurse OR A CERTIFIED
MIDWIFE
.
(3) Nothing in this part 1:
(a) Prohibits any licensee from practicing practical or professional
nursing
OR AS A CERTIFIED MIDWIFE independently for compensation upon
a fee for services basis;
(b) Prohibits or requires the direct reimbursement for nursing
OR
CERTIFIED MIDWIFE
services and care through qualified governmental and
insurance programs to persons duly licensed in accordance with this part 1;
or
(c) Conveys to the practice of nursing
OR THE PRACTICE AS A
CERTIFIED MIDWIFE
the performance of medical practice as regulated by
article 240 of this title 12,
OTHER THAN AS PERM ITTED UNDER SECTION
12-240-107 (1)(f)(I).
SECTION 18. In Colorado Revised Statutes, amend 12-255-128
as follows:
12-255-128. Prescribing opiate antagonists. An advanced practice
registered nurse
OR CERTIFIED MIDWIFE with prescriptive authority pursuant
to section 12-255-112 may prescribe or dispense an opiate antagonist in
accordance with section 12-30-110.
SECTION 19. In Colorado Revised Statutes, 12-255-130, amend
(1), (2)(b), (3)(a) introductory portion, (3)(c), (4), and (6) as follows:
12-255-130. Peer health assistance or alternative to discipline
program - fund - rules. (1) As a condition of licensure and for the purpose
of supporting a nursing
peer health assistance program FOR NURSES OR
CERTIFIED MIDWIVES
or a nurse
AN alternative to discipline program FOR
NURSES OR CERTIFIED MIDWIVES
, every applicant for an initial license or to
reinstate a license and any person renewing a license issued pursuant to this
part 1 shall pay to the administering entity designated pursuant to subsection
(3)(c) of this section a fee in an amount set by the board, not to exceed
twenty-five dollars per year; except that the board may adjust the amount
each January 1 to reflect changes in the United States department of labor's
PAGE 28-SENATE BILL 23-167 bureau of labor statistics consumer price index, or its successor index, for
Denver-Aurora-Lakewood for goods paid by urban consumers.
(2) (b) Money in the fund shall be used to support a nursing peer
health assistance program
FOR NURSES AND CERTIFIED MIDWIVES or nurseAN alternative to discipline program FOR NURSES AND CERTIFIED MIDWIVES
in providing assistance to licensees needing help in dealing with physical, emotional, psychiatric, or psychological problems or behavioral, mental health, or substance use disorders that may be detrimental to their ability to practice nursing
OR TO PRACTICE AS A CERTIFIED MIDWIFE.
(3) (a) The board shall select one or more recognized peer health
assistance organizations or nurse alternative to discipline programs as
designated providers. For purposes of selecting designated providers, the
board shall use a competitive bidding process that encourages participation
from interested vendors. To be eligible for designation by the board
pursuant to this section, a peer health assistance organization or nurse
alternative to discipline program shall:
(c) The board shall designate an administering entity for a program
established pursuant to this section. The entity shall MUST be a nonprofit
private entity that is qualified under 26 U.S.C. sec. 501 (c)(3) of the federal
"Internal Revenue Code of 1986", as amended, and shall
be dedicated to
providing support for charitable, benevolent, educational, or scientific
purposes that are related to nursing
OR MIDWIFERY, nursing OR MIDWIFERY
education, nursing OR MIDWIFERY research and science, and other nursing
OR MIDWIFERY charitable purposes.
(4) Notwithstanding sections 12-255-119 and 24-4-104, the board
may immediately suspend the license of any licensee who is referred to a
peer health assistance program or nurse
alternative to discipline program by
the board and who fails to attend or to complete the program. If the licensee
objects to the suspension, he or she
THE LICENSEE may submit a written
request to the board for a formal hearing on the suspension within ten days
after receiving notice of the suspension, and the board shall grant the
request. In the hearing, the licensee shall bear the burden of proving that his
or her THE INDIVIDUAL'S license should not be suspended.
(6) Nothing in this section shall be construed to create any liability
of the board, members of the board, or the state of Colorado for the actions
PAGE 29-SENATE BILL 23-167 of the board in making awards to peer health assistance organizations or
nurse alternative to discipline programs or in designating licensees to
participate in the programs of such organizations. No civil action may be
brought or maintained against the board, its members, or the state for an
injury alleged to have been the result of an act or omission of a licensee
participating in or referred to a program provided by a peer health assistance
organization or to a nurse
AN alternative to discipline program. However,
the state shall remain REMAINS liable under the provisions of the "Colorado
Governmental Immunity Act", article 10 of title 24, if an injury alleged to
have been the result of an act or omission of a licensee participating in or
referred to a peer health assistance program or nurse
alternative to discipline
program occurred while such licensee was performing duties as an
employee of the state.
SECTION 20. In Colorado Revised Statutes, amend 12-255-131
as follows:
12-255-131. Delegation of nursing or midwifery tasks - rules.
(1) Any licensed practical nurse, registered nurse, or
advanced practice
registered nurse,
OR CERTIFIED MIDWIFE may delegate any task included in
the nurse's
OR CERTIFIED MIDWIFE'S licensed scope of practice, subject to the
requirements of this section. A licensed practical nurse, registered nurse, or
advanced practice registered nurse, OR CERTIFIED MIDWIFE may delegate
nursing
OR CERTIFIED MIDWIFE tasks to licensed, certified, registered, or
unlicensed or unregulated assistive personnel. In no event may a registered
nurse
OR CERTIFIED MIDWIFE delegate to another person the authority to
select medications if the person is not, independent of the delegation,
authorized by law to select medications.
(2) Delegated tasks shall
MUST be within the area of responsibility
of the delegating nurse
OR CERTIFIED MIDWIFE and shall
MUST not require
any delegatee to exercise the judgment required of a nurse
OR CERTIFIED
MIDWIFE
.
(3) No delegation shall be made without the delegating nurse
OR
CERTIFIED MIDWIFE
making a determination that, in his or her
THE
LICENSEE
'S professional judgment, the delegated task can be properly and
safely performed by the delegatee and that the delegation is commensurate
with the patient's safety and welfare.
PAGE 30-SENATE BILL 23-167 (4) The delegating nurse shall be OR CERTIFIED MIDWIFE IS solely
responsible for determining the required degree of supervision the delegatee
will need, after an evaluation of the appropriate factors, which shall
include
but
ARE not be
limited to the following:
(a) The stability of the condition of the patient;
(b) The training and ability of the delegatee;
(c) The nature of the nursing
OR CERTIFIED MIDWIFE task being
delegated; and
(d) Whether the delegated task has a predictable outcome.
(5) An employer of a nurse
OR CERTIFIED MIDWIFE may establish
policies, procedures, protocols, or standards of care that limit or prohibit
delegations by nurses
OR CERTIFIED MIDWIVES in specified circumstances.
(6) The board may promulgate rules pursuant to this section,
including but not limited to standards on the assessment of the proficiency
of the delegatee to perform delegated tasks, and standards for accountability
of any nurse
OR CERTIFIED MIDWIFE who delegates nursing OF CERTIFIED
MIDWIFE
tasks. The rules shall be consistent with the provisions of part 3 of
article 1.5 of title 25, section 25.5-10-204 (2)(j), and section 27-10.5-103
(2)(i).
SECTION 21. In Colorado Revised Statutes, 12-255-135, amend
(2) as follows:
12-255-135. Confidential agreement to limit practice. (2) This
section and section 12-30-108 do not apply to a nurse
OR CERTIFIED
MIDWIFE
subject to discipline under section 12-255-120 (1)(i).
SECTION 22. In Colorado Revised Statutes, 12-20-404, amend
(1)(d)(II)(J.5) and (3)(a)(II)(J) as follows:
12-20-404. Disciplinary actions - regulator powers - disposition
of fines - mistreatment of at-risk adult. (1) General disciplinary
authority. If a regulator determines that an applicant, licensee, certificate
holder, or registrant has committed an act or engaged in conduct that
PAGE 31-SENATE BILL 23-167 constitutes grounds for discipline or unprofessional conduct under a part or
article of this title 12 governing the particular profession or occupation, the
regulator may:
(d) (II) A regulator is not authorized under this subsection (1)(d) to
refuse to renew the license, certification, or registration of a licensee,
certificate holder, or registrant regulated under the following:
(J.5) Article 255 of this title 12 concerning nurses
AND CERTIFIED
MIDWIVES
;
(3) Waiting period after revocation or surrender. (a) (II) In
addition, the waiting period specified in subsection (3)(a)(I) of this section
applies when a person regulated under any of the following articles
surrenders a license, certification, or registration to avoid discipline:
(J) Article 255 of this title 12 concerning nurses,
CERTIFIED
MIDWIVES
, and nurse aides;
SECTION 23. In Colorado Revised Statutes, 12-20-406, amend
(2)(b)(IX) as follows:
12-20-406. Injunctive relief. (2) (b) Subsection (2)(a) of this
section does not apply to the following:
(IX) Article 255 of this title 12 concerning nurses,
CERTIFIED
MIDWIVES
, and nurse aides;
SECTION 24. In Colorado Revised Statutes, 12-20-407, amend
(1)(a)(V)(O), (1)(e) introductory portion, and (1)(e)(VII) as follows:
12-20-407. Unauthorized practice of profession or occupation -
penalties - exclusions. (1) (a) A person commits a class 2 misdemeanor
and shall be punished as provided in section 18-1.3-501 if the person:
(V) Practices or offers or attempts to practice any of the following
professions or occupations without an active license, certification, or
registration issued under the part or article of this title 12 governing the
particular profession or occupation:
PAGE 32-SENATE BILL 23-167 (O) Practical or professional nursing OR PRACTICE AS A CERTIFIED
MIDWIFE
, as regulated under article 255 of this title 12;
(e) A person commits a class 6 felony and shall be punished as
provided in section 18-1.3-401 if the person practices or offers or attempts
to practice any of the following professions or occupations and intentionally
and fraudulently represents oneself as a licensed, certified, or registered
professional or practitioner issued
pursuant to a part or article of this title
12 governing the particular profession or occupation:
(VII) Professional nursing
OR PRACTICE AS A CERTIFIED MIDWIFE, as
regulated pursuant to article 255 of this title 12;
SECTION 25. In Colorado Revised Statutes, 12-30-102, amend
(3)(a)(XI) as follows:
12-30-102. Medical transparency act of 2010 - disclosure of
information about health-care providers - fines - rules - short title -
legislative declaration - review of functions - repeal. (3) (a) As used in
this section, "applicant" means a person applying for a new, active license,
certification, or registration or to renew, reinstate, or reactivate an active
license, certification, or registration to practice:
(XI) Practical nursing, professional nursing, or
advanced practice
registered nursing,
OR AS A CERTIFIED MIDWIFE pursuant to article 255 of
this title 12;
SECTION 26. In Colorado Revised Statutes, 12-30-105, amend (1)
introductory portion, (1)(b), (4), (5)(i), and (5)(j) as follows:
12-30-105. Nurse-physician advisory task force for Colorado
health care - creation - duties - definition - repeal. (1) There is hereby
created, within the division, the nurse-physician advisory task force for
Colorado health care, referred to in this section as "NPATCH". The purpose
of the NPATCH is to promote public safety and improve health care in
Colorado by supporting collaboration and communication between the
practices
PRACTICE of nursing, THE PRACTICE AS A CERTIFIED MIDWIFE, and
THE PRACTICE OF medicine. The NPATCH shall:
(b) Address issues of mutual concern at the interface of the practices
PAGE 33-SENATE BILL 23-167 PRACTICE of nursing, THE PRACTICE AS A CERTIFIED MIDWIFE , and THE
PRACTICE OF
medicine;
(4) The division shall staff the NPATCH. The division's costs for
administering and staffing the NPATCH shall be funded by an increase in
fees for professional and advanced practice registered nursing,
CERTIFIED
MIDWIFE
, and medical license renewal fees, as authorized in sections
12-240-130 and 12-255-107 (1)(b)(I), with fifty percent of the funding
derived from the physician license renewal fees and fifty percent derived
from the professional and advanced practice registered nursing
AND
CERTIFIED MIDWIFE LICENSE RENEWAL
fees.
(5) The NPATCH shall prioritize consideration of and make
recommendations on the following topics:
(i) Physician standards, process
PROCESSES, and metrics to ensure
appropriate consultation, collaboration, and referral regarding advanced
practice registered nurse
AND CERTIFIED MIDWIFE prescriptive authority;
(j) Prescribing issues regarding providers other than physicians, and
advanced practice registered nurses, AND CERTIFIED MIDWIVES;
SECTION 27. In Colorado Revised Statutes, 12-30-106, amend (1)
as follows:
12-30-106. Health-care work force data collection. (1) The
director of the division shall implement a system to collect health-care work
force data from health-care professionals who are eligible for the Colorado
health service corps pursuant to part 5 of article 1.5 of title 25, from
practical and professional nurses
AND CERTIFIED MIDWIVES licensed
pursuant to part 1 of article 255 of this title 12, and from pharmacists
licensed pursuant to article 280 of this title 12, collectively referred to in
this section as "health-care professionals". Each health-care professional
shall submit the data as part of the initial licensure process and upon the
renewal of the health-care professional's license. Neither an executive
department nor a board in an executive department is responsible for
verifying the data or disciplining a health-care professional for
noncompliance with this section.
SECTION 28. In Colorado Revised Statutes, 12-30-109, amend
PAGE 34-SENATE BILL 23-167 (4)(c) as follows:
12-30-109. Prescriptions - limitations - definition - rules. (4) As
used in this section, "prescriber" means:
(c) An advanced practice registered nurse
OR CERTIFIED MIDWIFE
with prescriptive authority pursuant to section 12-255-112;
SECTION 29. In Colorado Revised Statutes, 12-30-110, amend
(7)(h)(II) as follows:
12-30-110. Prescribing or dispensing opiate antagonists -
authorized recipients - definitions. (7) As used in this section:
(h) "Prescriber" means:
(II) An advanced practice registered nurse, as defined in section
12-255-104 (1),
OR A CERTIFIED MIDWIFE , AS DEFINED IN SECTION
12-255-104 (3.2), with prescriptive authority pursuant to section
12-255-112; or
SECTION 30. In Colorado Revised Statutes, 12-30-111, amend
(4)(a)(III) as follows:
12-30-111. Electronic prescribing of controlled substances -
exceptions - rules - definitions. (4) As used in this section:
(a) "Prescriber" means:
(III) An advanced practice registered nurse
OR CERTIFIED MIDWIFE
with prescriptive authority pursuant to section 12-255-112;
SECTION 31. In Colorado Revised Statutes, 12-30-114, amend (2)
as follows:
12-30-114. Demonstrated competency - opiate prescribers - rules
- definition. (2) For the purposes of this section, "licensed health-care
provider" includes
ANY OF THE FOLLOWING PROVIDERS WHO ARE LICENSED
PURSUANT TO THIS TITLE
12:
PAGE 35-SENATE BILL 23-167 (a) A physician;
(b) A physician assistant;
(c) A podiatrist;
(d) A dentist;
(e) A
N advanced practice registered nurse OR CERTIFIED MIDWIFE
with prescriptive authority;
(f) A
N optometrist; and
(g) A veterinarian. licensed pursuant to this title 12.
SECTION 32. In Colorado Revised Statutes, 12-30-201, amend (1)
introductory portion, (2)(b), and (3) as follows:
12-30-201. Legislative declaration. (1) The general assembly
hereby finds, determines, and declares that the Colorado medical board
created in article 240 of this title 12 and the state board of nursing created
in article 255 of this title 12 act for the state in their sovereign capacity to
govern licensure, discipline, and professional review of persons licensed to
practice medicine, persons licensed as physician assistants, and
advanced
practice registered nurses,
AND CERTIFIED MIDWIVES, respectively, in this
state. The general assembly further finds, determines, and declares that:
(2) The general assembly recognizes that:
(b) Many patients lack the knowledge, experience, or education to
properly evaluate the quality of medical, or
nursing, OR CERTIFIED MIDWIFE
practice or the professional conduct of persons licensed to practice medicine, persons licensed as physician assistants, and
advanced practice
registered nurses,
AND CERTIFIED MIDWIVES; and
(3) The general assembly recognizes that, in the proper exercise of
their authority and responsibilities under this part 2, the Colorado medical
board and the state board of nursing must, to some extent, replace
competition with regulation, and that the replacement of competition by
regulation, particularly with regard to persons licensed under article 240 of
PAGE 36-SENATE BILL 23-167 this title 12, or to advanced practice registered nurses, OR TO CERTIFIED
MIDWIVES
, is related to a legitimate state interest in the protection of the
health, safety, and welfare of the people of this state.
SECTION 33. In Colorado Revised Statutes, 12-30-202, amend
(7); and add (2.5) as follows:
12-30-202. Definitions. As used in this part 2, unless the context
otherwise requires:
(2.5) "C
ERTIFIED MIDWIFE" HAS THE SAME MEANING AS SET FORTH
IN SECTION
12-255-104 (3.2).
(7) "Professional review committee" means any committee
authorized under this part 2 to review and evaluate the competence of,
professional conduct of, or the quality and appropriateness of patient care
provided by any person licensed under article 240 of this title 12, or
an
advanced practice registered nurse,
OR A CERTIFIED MIDWIFE. "Professional
review committee" includes a governing board, a hearing panel appointed
by a governing board to conduct a hearing under section 12-30-204 (8)(a),
and an independent third party designated by a governing board under
section 12-30-204 (9)(b).
SECTION 34. In Colorado Revised Statutes, 12-30-203, amend
(1)(a) and (2) as follows:
12-30-203. Use of professional review committees. (1) (a) The
general assembly recognizes that:
(I) The medical board and the nursing board, while assuming and
retaining ultimate authority for licensure and discipline in accordance with
article 240 of this title 12 and part 1 of article 255 of this title 12,
respectively, and in accordance with this part 2, cannot practically and
economically assume responsibility over every single allegation or instance
of purported deviation from the standards of quality for the practice of
medicine, or
THE PRACTICE OF nursing, OR THE PRACTICE AS A CERTIFIED
MIDWIFE
; from the standards of professional conduct; or from the standards
of appropriate care; and
(II) An attempt to exercise this oversight would result in
PAGE 37-SENATE BILL 23-167 extraordinary delays in the determination of the legitimacy of the allegations
and would result in the inappropriate and unequal exercise of their authority
to license and discipline persons licensed under article 240 of this title 12,
or
advanced practice registered nurses, OR CERTIFIED MIDWIVES.
(2) Persons licensed under article 240 of this title 12, and advanced
practice registered nurses,
AND CERTIFIED MIDWIVES are encouraged to
serve upon professional review committees when called to do so and to
study and review in an objectively reasonable manner the professional
conduct of persons licensed under article 240 of this title 12, or
advanced
practice registered nurses,
OR CERTIFIED MIDWIVES , including the
competence of, professional conduct of, or the quality and appropriateness
of patient care provided by those persons.
SECTION 35. In Colorado Revised Statutes, 12-30-204, amend
(1), (3), (5)(d), (5)(f), (5)(g), (5)(h), (5)(k), (5)(l), (5)(n), (7)(a), (8)
introductory portion, (8)(a)(I), (9)(a), (11)(b)(II), and (11)(b)(VII); and add
(5)(d.5) as follows:
12-30-204. Establishment of professional review committees -
function - rules. (1) A professional review committee may be established
pursuant to this section to review and evaluate the competence of, the
quality and appropriateness of patient care provided by, or the professional
conduct of any person licensed under article 240 of this title 12, or
any
advanced practice registered nurse,
OR ANY CERTIFIED MIDWIFE.
(3) (a) A professional review committee that is reviewing the
competence of, the quality and appropriateness of patient care provided by,
or the professional conduct of an advanced practice registered nurse must
either:
(a)
(I) Have, as a voting member, at least one advanced practice
registered nurse with a scope of practice similar to that of the person who
is the subject of the review; or
(b)
(II) Engage, to perform an independent review as appropriate,
an independent person who is an advanced practice registered nurse with a
scope of practice similar to that of the person who is the subject of the
review. The person conducting the independent review must be a person
who was not previously involved in the review.
PAGE 38-SENATE BILL 23-167 (b) A PROFESSIONAL REVIEW COMMITTEE THAT IS REVIEWING THE
COMPETENCE OF
, THE QUALITY AND APPROPRIATENESS OF PATIENT CARE
PROVIDED BY
, OR THE PROFESSIONAL CONDUCT OF A CERTIFIED MIDWIFE
MUST EITHER
:
(I) H
AVE, AS A VOTING MEMBER, AT LEAST ONE CERTIFIED MIDWIFE
OR ADVANCED PRACTICE REGISTERED NURSE WITH A SCOPE OF PRACTICE
SIMILAR TO THAT OF THE PERSON WHO IS THE SUBJECT OF THE REVIEW
; OR
(II) ENGAGE, TO PERFORM AN INDEPENDENT REVIEW AS
APPROPRIATE
, AN INDEPENDENT PERSON WHO IS A CERTIFIED MIDWIFE WITH
A SCOPE OF PRACTICE SIMILAR TO THAT OF THE PERSON WHO IS THE SUBJECT
OF THE REVIEW
. THE PERSON CONDUCTING THE INDEPENDENT REVIEW MUST
BE A PERSON WHO WAS NOT PREVIOUSLY INVOLVED IN THE REVIEW
.
(5) A professional review committee established by any of the
following authorized entities is an approved professional review committee
under this part 2 if it operates in compliance with written bylaws, policies,
or procedures that are in compliance with this part 2 and that have been
approved by the authorized entity's governing board and if it is registered
with the division in accordance with section 12-30-206:
(d) A society or association of advanced practice registered nurses
who
WHOSE MEMBERS reside in this state, if the advanced practice registered
nurse whose services are the subject of the review is a member of the
society or association;
(d.5) A
SOCIETY OR ASSOCIATION OF CERTIFIED MIDWIVES WHOSE
MEMBERS RESIDE IN THIS STATE
, IF THE CERTIFIED MIDWIFE WHOSE SERVICES
ARE THE SUBJECT OF THE REVIEW IS A MEMBER OF THE SOCIETY OR
ASSOCIATION
;
(f) A society or association of advanced practice registered nurses
who
OR CERTIFIED MIDWIVES WHOSE MEMBERS practice in a specified
nursing
OR MIDWIFERY role and population focus, as defined by the nursing
board, which society or association has been designated by the nursing
board as the specific nursing
OR MIDWIFERY society or association
representative of those advanced practice registered nurses
OR CERTIFIED
MIDWIVES
practicing in that nursing OR MIDWIFERY role and population
focus, if the advanced practice registered nurse
OR CERTIFIED MIDWIFE
PAGE 39-SENATE BILL 23-167 whose services are the subject of the review is a member of the designated
nursing
OR MIDWIFERY society or association;
(g) An individual practice association or a preferred provider
organization consisting of persons licensed under article 240 of this title 12,
or
of advanced practice registered nurses, OR OF CERTIFIED MIDWIVES or a
medical group that predominantly serves members of a health maintenance
organization licensed pursuant to parts 1 and 4 of article 16 of title 10. A
professional review committee established pursuant to this subsection (5)(g)
has jurisdiction to review persons licensed under article 240 of this title 12,
or
advanced practice registered nurses, OR CERTIFIED MIDWIVES only if the
persons licensed under said article, or the advanced practice registered
nurses,
OR THE CERTIFIED MIDWIVES are members of the association or
organization creating and authorizing that committee; except that the
professional review committee may review the care provided to a particular
patient referred by a member of the association or organization to another
person who is not a member of the association or organization and is
licensed under article 240 of this title 12, or
is an advanced practice
registered nurse,
OR IS A CERTIFIED MIDWIFE.
(h) A corporation authorized pursuant to article 3 of title 10 to insure
persons licensed under article 240 of this title 12, or
advanced practice
registered nurses,
OR CERTIFIED MIDWIVES or any other organization
authorized to insure such persons in this state when designated by the
medical board or nursing board under subsection (6) of this section;
(k) (I) A nonprofit corporation or association consisting of
representatives from a statewide professional society and a statewide
hospital association. The association must consist of persons licensed under
article 240 of this title 12, or
advanced practice registered nurses, OR
CERTIFIED MIDWIVES
, AS APPLICABLE, AND hospital administrators and
hospital trustees, with a majority of the representatives being personslicensed under article 240 of this title 12 SUBJECT TO THE FOLLOWING
REQUIREMENTS
:
(A) When the subject of the investigation is a person licensed under
article 240 of this title 12, and
A MAJORITY OF THE REPRESENTATIVES MUST
BE PERSONS LICENSED UNDER ARTICLE
240 OF THIS TITLE 12;
(B) W
HEN THE SUBJECT OF THE INVESTIGATION IS AN ADVANCED
PAGE 40-SENATE BILL 23-167 PRACTICE REGISTERED NURSE, at least one of the representatives being MUST
BE
an advanced practice registered nurse; when the subject of theinvestigation is an advanced practice registered nurse. AND
(C) WHEN THE SUBJECT OF THE INVESTIGATION IS A CERTIFIED
MIDWIFE
, AT LEAST ONE OF THE REPRESENTATIVES MUST BE A CERTIFIED
MIDWIFE
.
(II) The association may establish, or contract for, one or more
professional review committees to review the care by hospital staff
personnel who are licensed under article 240 of this title 12, or are advanced
practice registered nurses,
OR ARE CERTIFIED MIDWIVES, with priority given
to small rural hospital staffs. These professional review services must be
available statewide on a fee-for-service basis to licensed or certified
hospitals at the joint request of the governing board and the medical, or
nursing, OR CERTIFIED MIDWIFE staff of the hospital or at the sole request of
the governing board of the hospital. If a member being reviewed specializes
in a generally recognized specialty of medicine, or
nursing, OR MIDWIFERY,
at least one of the health-care providers on the professional review
committee must be a person who is licensed under article 240 of this title
12, or
is an advanced practice registered nurse, OR IS A CERTIFIED MIDWIFE
and who practices such specialty.
(II) (III) For purposes of the introductory portion to this subsection
(5) and this subsection (5)(k), the bylaws, policies, or procedures must be
in compliance with this part 2 and approved by the nonprofit corporation or
association.
(l) The medical, or
nursing, OR CERTIFIED MIDWIFE staff of an
ambulatory surgical center licensed pursuant to part 1 of article 3 of title 25;
(n) A provider network that is organized pursuant to part 3 of article
18 of title 6 and includes persons licensed under article 240 of this title 12,
or
advanced practice registered nurses, OR CERTIFIED MIDWIVES;
(7) (a) A professional review committee acting pursuant to this part
2 may investigate or cause to be investigated:
(I) The qualifications and competence of any person licensed under
article 240 of this title 12, or any advanced practice registered nurse, OR
PAGE 41-SENATE BILL 23-167 ANY CERTIFIED MIDWIFE who seeks to subject himself or herself
THEMSELVES to the authority of any authorized entity; or
(II) The quality or appropriateness of patient care rendered by, or the
professional conduct of, any person licensed under article 240 of this title
12, or
any advanced practice registered nurse, OR ANY CERTIFIED MIDWIFE
who is subject to the authority of the authorized entity.
(8) The written bylaws, policies, or procedures of any professional
review committee for persons licensed under article 240 of this title 12, or
advanced practice registered nurses, OR CERTIFIED MIDWIVES must provide
for at least the following:
(a) (I) Except as provided in subsection (8)(a)(II) of this section, if
the findings of any investigation indicate that a person licensed under article
240 of this title 12, or
an advanced practice registered nurse, OR A CERTIFIED
MIDWIFE
who is the subject of the investigation is lacking in qualifications
or competency, has provided substandard or inappropriate patient care, or
has exhibited inappropriate professional conduct and the professional
review committee takes or recommends an action to adversely affect the
person's membership, affiliation, or privileges with the authorized entity, the
professional review committee shall hold a hearing to consider the findings
and recommendations unless the person waives, in writing, the right to a
hearing or is given notice of a hearing and fails to appear.
(9) (a) All governing boards shall adopt written bylaws, policies, or
procedures under which a person who is licensed under article 240 of this
title 12, or
is an advanced practice registered nurse, OR IS A CERTIFIED
MIDWIFE
and who is the subject of an adverse recommendation by a
professional review committee may appeal to the governing board
following a hearing in accordance with subsection (8) of this section. The
bylaws, policies, or procedures must provide that the person be given
reasonable notice of his or her
THE PERSON'S right to appeal and, unless
waived by the person, has the right to appear before the governing board,
to be represented by legal counsel, and to offer the argument on the record
that the person deems appropriate.
(11) (b) Subject to subsection (14) of this section, the records are
subject to subpoena and available for use:
PAGE 42-SENATE BILL 23-167 (II) By a person licensed under article 240 of this title 12, or an
advanced practice registered nurse,
OR A CERTIFIED MIDWIFE in a suit
seeking judicial review of an action by the governing board;
(VII) By the nursing board within the scope of its authority over
advanced practice registered nurses
AND CERTIFIED MIDWIVES.
SECTION 36. In Colorado Revised Statutes, 12-30-205, amend (1)
as follows:
12-30-205. Hospital professional review committees. (1) The
quality and appropriateness of patient care rendered by persons licensed
under article 240 of this title 12, advanced practice registered nurses,
CERTIFIED MIDWIVES, and other licensed health-care professionals so
influence the total quality of patient care that a review of care provided in
a hospital is ineffective without concomitantly reviewing the overall
competence of, professional conduct of, or the quality and appropriateness
of care rendered by these persons.
SECTION 37. In Colorado Revised Statutes, 12-30-206, amend
(1), (2) introductory portion, (2)(b)(II) introductory portion, and (3)(a) as
follows:
12-30-206. Governing boards to register with division - annual
reports - aggregation and publication of data - definition - rules. (1) As
used in this section, "adversely affecting" has the same meaning as set forth
in 45 CFR 60.3; except that it does not include a precautionary suspension
or any professional review action affecting, for a period of thirty or fewer
days, a person licensed under article 240 of this title 12, or
an advanced
practice registered nurse,
OR A CERTIFIED MIDWIFE.
(2) Each governing board that establishes or uses one or more
professional review committees to review the practice of persons licensed
under article 240 of this title 12, or
of advanced practice registered nurses,
OR OF CERTIFIED MIDWIVES shall:
(b) In addition to any other state or federal reporting requirements:
(II) Report annually to the nursing board, in a form satisfactory to
the nursing board, the number of final professional review actions in each
PAGE 43-SENATE BILL 23-167 of the following categories relating to advanced practice registered nurses
AND CERTIFIED MIDWIVES:
(3) (a) The division shall publish the data provided pursuant to
subsections (2)(b) and (2)(c) of this section in aggregate form and without
individually identifiable information concerning the governing board, the
authorized entity, or any person who was subject to review and is licensed
under article 240 of this title 12, or
is an advanced practice registered nurse,
OR IS A CERTIFIED MIDWIFE.
SECTION 38. In Colorado Revised Statutes, 12-30-207, amend
(1), (2) introductory portion, and (2)(d) as follows:
12-30-207. Immunity from liability. (1) A member of a
professional review committee, a governing board, or any committee or
third party designated by the governing board under section 12-30-204
(9)(b); and
any person serving on the staff of that committee, board, panel,
or third party; a witness or consultant before a professional review
committee; and any person who files a complaint or otherwise participates
in the professional review process is immune from suit and liability for
damages in any civil or criminal action, including antitrust actions, brought
by a person licensed under article 240 of this title 12, or
an advanced
practice registered nurse,
OR A CERTIFIED MIDWIFE who is the subject of the
review by the professional review committee unless, in connection with the
professional review process, the person provided false information and
knew that the information was false.
(2) The governing board and the authorized entity that has
established a professional review committee pursuant to section 12-30-204
is immune from suit and liability for damages in any civil or criminal action,
including antitrust actions, brought by a person licensed under article 240
of this title 12, or
an advanced practice registered nurse, OR A CERTIFIED
MIDWIFE
who is the subject of the review by such professional review
committee if the professional review action was taken within the scope of
the professional review process and was taken:
(d) In accordance with procedures that, under the circumstances,
were fair to the person licensed under article 240 of this title 12, or
the
advanced practice registered nurse,
OR THE CERTIFIED MIDWIFE.
PAGE 44-SENATE BILL 23-167 SECTION 39. In Colorado Revised Statutes, 12-30-208, amend
(3)(b)(I), (3)(c) introductory portion, and (3)(c)(V) as follows:
12-30-208. Conformance with federal law and regulation -
legislative declaration - rules - limitations on liability - definition.
(3) (b) (I) Notwithstanding subsection (3)(a) of this section, nothing in this
section relieves an authorized entity that is a health-care facility licensed or
certified pursuant to part 1 of article 3 of title 25 or certified pursuant to
section 25-1.5-103 (1)(a)(II) of liability to an injured person or wrongful
death claimant for the facility's independent negligence in the credentialing
or privileging process for a person licensed under article 240 of this title 12,
or
an advanced practice registered nurse, OR A CERTIFIED MIDWIFE who
provided health-care services for the injured or deceased person at the
facility. For purposes of this subsection (3), the facility's participation in the
credentialing process or the privileging process does not constitute the
corporate practice of medicine.
(c) For the purposes of
AS USED IN this subsection (3), unless the
context otherwise requires, "professional review action" means an action or
recommendation of a professional review committee that is taken or made
in the conduct of professional review activity and that is based on the
quality and appropriateness of patient care provided by, or the competence
or professional conduct of, an individual person licensed under article 240
of this title 12, or
an advanced practice registered nurse, OR A CERTIFIED
MIDWIFE
, which action affects or may affect adversely the person's clinical
privileges of or membership in an authorized entity. "Professional review
action" includes a formal decision by the professional review committee not
to take an action or make a recommendation as provided in this subsection
(3)(c) and also includes professional review activities relating to a
professional review action. An action is not based upon the competence or
professional conduct of a person if the action is primarily based on:
(V) Any other matter that does not relate to the quality and
appropriateness of patient care provided by, or the competence or
professional conduct of, a person licensed under article 240 of this title 12,
or
an advanced practice registered nurse, OR A CERTIFIED MIDWIFE.
SECTION 40. In Colorado Revised Statutes, 12-225-101, amend
(1)(b)(I), (1)(b)(II), and (2)(c) as follows:
PAGE 45-SENATE BILL 23-167 12-225-101. Scope of article - exemptions - legislative
declaration. (1) (b) (I) A person who is a certified nurse-midwife
authorized pursuant to section 12-255-111,
A CERTIFIED MIDWIFE
AUTHORIZED PURSUANT TO SECTION
12-255-111.5, or a physician as
provided in article 240 of this title 12 shall not simultaneously be so
licensed and also be registered under this article 225. A physician, orcertified nurse-midwife, OR CERTIFIED MIDWIFE who holds a license in good
standing may relinquish the license and subsequently be registered under
this article 225.
(II) A direct-entry midwife shall not represent himself or herself
ONESELF as a nurse-midwife, or certified nurse-midwife, OR CERTIFIED
MIDWIFE
.
(2) Nothing in this article 225 shall be construed to prohibit, or to
require registration under this article 225, with regard to:
(c) The rendering of services by certified nurse-midwives
OR
CERTIFIED MIDWIVES
properly licensed and practicing in accordance with
the provisions of
part 1 of article 255 of this title 12; or
SECTION 41. In Colorado Revised Statutes, 12-225-106, amend
(5)(a)(III)(C) and (5)(a)(III)(F) as follows:
12-225-106. Prohibited acts - practice standards - informed
consent - emergency plan - risk assessment - referral - rules. (5) (a) A
direct-entry midwife shall keep appropriate records of midwifery-related
activity, including but not limited to the following:
(III) Before accepting a client for care, the direct-entry midwife
shall obtain the client's informed consent, which shall be evidenced by a
written statement in a form prescribed by the director and signed by both the
direct-entry midwife and the client. The form shall certify that full
disclosure has been made and acknowledged by the client as to each of the
following items, with the client's acknowledgment evidenced by a separate
signature or initials adjacent to each item in addition to the client's signature
at the end of the form:
(C) A description of the available alternatives to direct-entry
midwifery care, including a statement that the client understands she
THE
PAGE 46-SENATE BILL 23-167 CLIENT is not retaining a certified nurse midwife, or a nurse midwife, OR A
CERTIFIED MIDWIFE
;
(F) A statement informing the client that, if subsequent care is
required resulting from the acts or omissions of the direct-entry midwife,
any physician, nurse,
CERTIFIED MIDWIFE, prehospital emergency personnel,
and health-care institution rendering subsequent care shall
WILL be held
only to a standard of gross negligence or willful and wanton conduct;
SECTION 42. In Colorado Revised Statutes, 12-225-112, amend
(1) as follows:
12-225-112. Assumption of risk - no vicarious liability -
professional liability insurance required. (1) It is the policy of this state
that registrants shall be ARE liable for their acts or omissions in the
performance of the services that they provide, and that no licensed
physician, nurse,
CERTIFIED MIDWIFE, prehospital emergency medical
personnel, or health-care institution shall be IS liable for any act or omission
resulting from the administration of services by any registrant. This
subsection (1) does not relieve any physician, nurse,
CERTIFIED MIDWIFE,
prehospital emergency personnel, or health-care institution from liability for
any willful and wanton act or omission or any act or omission constituting
gross negligence, or under circumstances where a registrant has a business
or supervised relationship with the physician, nurse,
CERTIFIED MIDWIFE,
prehospital emergency personnel, or health-care institution. A physician,
nurse,
CERTIFIED MIDWIFE, prehospital emergency personnel, or health-care
institution may provide consultation or education to the registrant without
establishing a business or supervisory relationship, and is encouraged to
accept referrals from registrants pursuant to this article 225.
SECTION 43. In Colorado Revised Statutes, 12-240-107, amend
(1) introductory portion, (1)(f)(I), (3)(j), and (3)(s) as follows:
12-240-107. Practice of medicine defined - exemptions from
licensing requirements - unauthorized practice by physician assistants
and anesthesiologist assistants - penalties - definitions - rules - repeal.
(1) For the purpose of
AS USED IN this article 240, "practice of medicine"
means:
(f) The practice of midwifery, except:
PAGE 47-SENATE BILL 23-167 (I) Services rendered by certified nurse-midwives OR CERTIFIED
MIDWIVES
properly licensed and practicing in accordance with theprovisions of part 1 of article 255 of this title 12; or
(3) A person may engage in, and shall not be required to obtain a
license or a physician training license under this article 240 with respect to,
any of the following acts:
(j) The rendering of nursing
OR MIDWIFERY services and delegated
medical functions by registered or other nurses
OR CERTIFIED MIDWIVES in
the lawful discharge of their duties;
(s) (I) The rendering of prescriptions by an advanced practice
registered nurse
OR CERTIFIED MIDWIFE pursuant to section 12-255-112.
(II) On or after July 1, 2010, a physician who serves as a preceptor
or mentor to an advanced practice registered nurse
OR CERTIFIED MIDWIFE
pursuant to sections 12-240-108 and 12-255-112 (4) shall have a license in
good standing without disciplinary sanctions to practice medicine in
Colorado and an unrestricted registration by the federal drug enforcement
administration for the same schedules as the collaborating advanced
practice registered nurse
OR CERTIFIED MIDWIFE.
(III) It is unlawful and a violation of this article 240 for any person,
corporation, or other entity to require payment or employment as a
condition of entering into a mentorship relationship with the
AN advanced
practice registered nurse
OR A CERTIFIED MIDWIFE pursuant to sections
12-240-108 and 12-255-112 (4), but the mentor may request reimbursement
of reasonable expenses and time spent as a result of the mentorship
relationship.
SECTION 44. In Colorado Revised Statutes, 12-240-108, amend
(1) as follows:
12-240-108. Collaboration with advanced practice registered
nurses and certified midwives with prescriptive authority -
mentorships. (1) (a) A physician licensed pursuant to this article 240 may,
and is encouraged to, serve as a mentor to an advanced practice registered
nurse
OR A CERTIFIED MIDWIFE who is applying for prescriptive authority
pursuant to section 12-255-112 (4). A physician who serves as a mentor to
PAGE 48-SENATE BILL 23-167 an advanced practice registered nurse OR A CERTIFIED MIDWIFE seeking
prescriptive authority shall:
(I) Be practicing in Colorado and shall have education, training,
experience, and active practice that corresponds with the role and
population focus of the advanced practice registered nurse
OR CERTIFIED
MIDWIFE
; and
(II) Have a license in good standing without disciplinary sanctions
to practice medicine in Colorado and an unrestricted registration by the
federal drug enforcement administration for the same schedules as the
advanced practice registered nurse
OR CERTIFIED MIDWIFE.
(b) A physician serving as a mentor to an advanced practice
registered nurse
OR A CERTIFIED MIDWIFE pursuant to section 12-255-112 (4)
shall not require payment or employment as a condition of entering into the
mentorship relationship, but the physician may request reimbursement of
reasonable expenses and time spent as a result of the mentorship
relationship.
(c) Upon successful completion of a mentorship as described in
section 12-255-112 (4)(b)(I), the physician shall verify by his or her
THE
PHYSICIAN
'S signature that the advanced practice registered nurse OR
CERTIFIED MIDWIFE
has successfully completed the mentorship within the
required period.
SECTION 45. In Colorado Revised Statutes, 12-240-121, amend
(1)(bb) as follows:
12-240-121. Unprofessional conduct - definitions.
(1) "Unprofessional conduct" as used in this article 240 means:
(bb) Entering into or continuing in a mentorship relationship with
an advanced practice registered nurse
OR A CERTIFIED MIDWIFE pursuant to
sections 12-240-108 and 12-255-112 (4) that fails to meet generally
acceptable standards of medical practice;
SECTION 46. In Colorado Revised Statutes, 12-240-139, amend
(1)(b)(I) introductory portion, (1)(b)(I)(B), (1)(b)(I)(C), (1)(b)(II)(B),
(1)(b)(III), and (1)(b)(V) introductory portion as follows:
PAGE 49-SENATE BILL 23-167 12-240-139. Injuries to be reported - penalty for failure to report
- immunity from liability - definitions. (1) (b) (I) When a licensee, or
nurse, OR CERTIFIED MIDWIFE performs a medical forensic examination that
includes the collection of evidence at the request of a victim of sexual
assault, the licensee's, or
nurse's, OR CERTIFIED MIDWIFE'S employing
medical facility shall, with the consent of the victim of the sexual assault,
make one of the following reports to law enforcement:
(B) A medical report if a victim wishes to obtain a medical forensic
examination with evidence collection but at the time of the medical forensic
examination chooses not to participate in the criminal justice system. The
licensee, or
nurse, OR CERTIFIED MIDWIFE shall collect the evidence and
victim-identifying information, and the employing medical facility shall
release the evidence and information to law enforcement for testing in
accordance with section 24-33.5-113 (1)(b)(III) and storage in accordance
with section 18-3-407.5 (3)(c).
(C) An anonymous report if a victim wishes to obtain a medical
forensic examination with evidence collection but at the time of the medical
forensic examination chooses not to have personal identifying information
provided to law enforcement or to participate in the criminal justice system.
The licensee, or
nurse, OR CERTIFIED MIDWIFE shall collect the evidence, and
the employing medical facility shall release it to law enforcement for
storage in accordance with section 18-3-407.5 (3)(c). Law enforcement
shall receive no identifying information for the victim. Law enforcement
shall assign a unique identifying number to the evidence, and the licensee,
or
nurse, OR CERTIFIED MIDWIFE shall record the identifying number in the
medical record and notify the victim that the identifying number is
recorded. Additionally, the licensee, or
nurse, OR CERTIFIED MIDWIFE shall
provide the identifying number to the victim.
(II) Nothing in this section:
(B) Requires a licensee, nurse,
CERTIFIED MIDWIFE, or medical
facility to make a report to law enforcement concerning an alleged sexual
assault if medical forensic evidence is not collected.
(III) If the licensee's,
NURSE'S, OR CERTIFIED MIDWIFE'S employing
medical facility knows where the alleged sexual assault occurred, the
facility shall make the report with the law enforcement agency in whose
PAGE 50-SENATE BILL 23-167 jurisdiction the crime occurred regarding preservation of the evidence. If the
medical facility does not know where the alleged sexual assault occurred,
the facility shall make the report with its local law enforcement agency
regarding preservation of the evidence.
(V) A licensee, or
nurse, OR CERTIFIED MIDWIFE who performs a
medical forensic examination as described in subsection (1)(b)(I) of this
section shall inform the victim:
SECTION 47. In Colorado Revised Statutes, 12-245-220, amend
(2)(b) as follows:
12-245-220. Disclosure of confidential communications -
definitions. (2) Subsection (1) of this section does not apply and a person
may disclose confidential information when:
(b) A licensee, registrant, or certificate holder was in consultation
with a physician, registered professional nurse,
CERTIFIED MIDWIFE,
licensee, registrant, or certificate holder against whom a suit or complaint
was filed based on the case out of which the suit or complaint arises;
SECTION 48. In Colorado Revised Statutes, 12-250-106, amend
(7) as follows:
12-250-106. Practice of naturopathic medicine by naturopathic
doctors - exclusions - protected activities - definition - rules. (7) As used
in this section, "licensed pediatric health-care provider" means a licensed
physician, or
AN advanced practice registered nurse, OR A CERTIFIED
MIDWIFE
who treats children.
SECTION 49. In Colorado Revised Statutes, 12-280-123, amend
(1)(b) as follows:
12-280-123. Prescription required - exception - dispensing opiate
antagonists - selling nonprescription syringes and needles. (1) (b) A
pharmacist who receives an order for a controlled substance that is included
in schedule II, III, or IV from a podiatrist, dentist, physician, physician
assistant, advanced practice registered nurse,
CERTIFIED MIDWIFE, or
optometrist, which order is not transmitted electronically to the pharmacist,
is not required to verify the applicability of an exception to electronic
PAGE 51-SENATE BILL 23-167 prescribing of controlled substances under section 12-30-111 and may
dispense the controlled substance pursuant to a written, oral, or
facsimile-transmitted order that is otherwise valid and consistent with the
requirements of current law.
SECTION 50. In Colorado Revised Statutes, 12-280-125.7, amend
(1)(f)(II) as follows:
12-280-125.7. Pharmacists' authority to prescribe and dispense
HIV infection prevention drugs - definitions - rules. (1) As used in this
section:
(f) "Prescriber" means:
(II) An advanced practice registered nurse, as defined in section
12-255-104 (1),
OR A CERTIFIED MIDWIFE , AS DEFINED IN SECTION
12-255-104 (3.2), with prescriptive authority pursuant to section
12-255-112.
SECTION 51. In Colorado Revised Statutes, 12-300-104, amend
(3)(c), (3)(d)(II), and (3)(e) as follows:
12-300-104. Definitions. As used in this article 300, unless the
context otherwise requires:
(3) "Respiratory therapy" means providing therapy, management,
rehabilitation, support services for diagnostic evaluation, and care of
patients with deficiencies and abnormalities that affect the pulmonary
system under the overall direction of a medical director. Respiratory therapy
includes the following:
(c) Direct and indirect respiratory care services, including but notlimited to the administration of pharmacological, diagnostic, and therapeutic
agents related to respiratory care procedures necessary to implement a
treatment, disease prevention, and pulmonary rehabilitative or diagnostic
regimen prescribed by a physician, or
AN advanced practice registered
nurse,
OR A CERTIFIED MIDWIFE;
(d) Observation and monitoring of signs, symptoms, reactions,
general behavior, and general physical response to respiratory care
PAGE 52-SENATE BILL 23-167 treatment and diagnostic testing for:
(II) The implementation based on observed abnormalities of
appropriate reporting, referral, or respiratory care protocols or changes in
treatment regimen pursuant to a prescription by a physician, or
AN advanced
practice registered nurse,
OR A CERTIFIED MIDWIFE or the initiation of
emergency procedures;
(e) The diagnostic and therapeutic use of the following in
accordance with the prescription of a physician, or
AN advanced practice
registered nurse,
OR A CERTIFIED MIDWIFE: Administration of medical gases,
exclusive of general anesthesia; aerosols; humidification; environmental
control systems and biomedical therapy; pharmacologic agents related to
respiratory care procedures; mechanical or physiological ventilatory
support; bronchopulmonary hygiene; respiratory protocol and evaluation;
cardiopulmonary resuscitation; maintenance of the natural airways;
insertion and maintenance of artificial airways; diagnostic and testing
techniques required for implementation of respiratory care protocols;
collection of specimens from the respiratory tract; or analysis of blood gases
and respiratory secretions and participation in cardiopulmonary research;
and
SECTION 52. In Colorado Revised Statutes, 10-16-139, amend (1)
as follows:
10-16-139. Access to care - rules - definitions. (1) Access to
obstetricians and gynecologists. A health benefit plan that is delivered,
issued, renewed, or reinstated in this state on or after January 1, 2014, that
provides coverage for reproductive health or gynecological care shall not
be delivered, issued, renewed, or reinstated unless the plan provides a
woman covered by the plan direct access to an obstetrician, a gynecologist,
a physician assistant authorized under section 12-240-107 (6), or
an
advanced practice registered nurse who is a certified nurse midwife
pursuant to section 12-255-111,
OR A CERTIFIED MIDWIFE LICENSED
PURSUANT TO SECTION
12-255-111.5, participating and available under the
plan for her reproductive health care or gynecological care.
SECTION 53. In Colorado Revised Statutes, 13-21-108.7, amend
(2)(b)(I)(A) as follows:
PAGE 53-SENATE BILL 23-167 13-21-108.7. Persons rendering emergency assistance through
the administration of an opiate antagonist - limited immunity -
legislative declaration - definitions. (2) Definitions. As used in this
section, unless the context otherwise requires:
(b) (I) "Health-care provider" means:
(A) A licensed physician,
AN advanced practice registered nurse, OR
A CERTIFIED MIDWIFE
who has prescriptive authority pursuant to section
12-255-112;
A physician assistant; or A pharmacist; or
SECTION 54. In Colorado Revised Statutes, 13-21-115.5, add
(3)(c)(II)(E.5) as follows:
13-21-115.5. Volunteer service act - immunity - exception for
operation of motor vehicles - short title - legislative declaration -
definitions. (3) As used in this section, unless the context otherwise
requires:
(c) (II) "Volunteer" includes:
(E.5) A
CERTIFIED MIDWIFE GOVERNED BY THE "NURSE AND NURSE
AIDE PRACTICE ACT", ARTICLE 255 OF TITLE 12, PERFORMING CERTIFIED
MIDWIFE TASKS WITHIN THE SCOPE OF THE PERSON
'S CERTIFIED MIDWIFE
LICENSE AND PERFORMING PRACTICE AS A CERTIFIED MIDWIFE UNDER
AUTHORITY GRANTED BY THE STATE BOARD OF NURSING PURSUANT TO
SECTIONS
12-255-111.5 AND 12-255-112 AS A VOLUNTEER FOR A NONPROFIT
ORGANIZATION
, A NONPROFIT CORPORATION, A GOVERNMENTAL ENTITY, OR
A HOSPITAL
;
SECTION 55. In Colorado Revised Statutes, 25-1-802, amend
(1)(a) and (1)(b)(II) as follows:
25-1-802. Patient records in custody of individual health-care
providers. (1) (a) Every patient record in the custody of a podiatrist,
chiropractor, dentist, doctor of medicine, doctor of osteopathy, nurse,
CERTIFIED MIDWIFE, optometrist, occupational therapist, audiologist,
acupuncturist, direct-entry midwife, or physical therapist required to be
licensed under title 12; a naturopathic doctor required to be registered
pursuant to article 250 of title 12; or a person practicing psychotherapy
PAGE 54-SENATE BILL 23-167 under article 245 of title 12, except records withheld in accordance with 45
CFR 164.524 (a), must be available to the patient or the patient's personal
representative upon submission of a valid authorization for inspection of
records, dated and signed by the patient, at reasonable times and upon
reasonable notice. A summary of records pertaining to a patient's mental
health problems may, upon written request accompanied by a signed and
dated authorization, be made available to the patient or the patient's
personal representative following termination of the treatment program.
(b) (II) If a licensed health-care professional determines that a copy
of a radiographic study, including an X ray, mammogram, CT scan, MRI,
or other film, is not sufficient for diagnostic or other treatment purposes, the
podiatrist, chiropractor, dentist, doctor of medicine, doctor of osteopathy,
nurse,
CERTIFIED MIDWIFE, optometrist, audiologist, acupuncturist,
direct-entry midwife, or physical therapist required to be licensed under title
12, or, subject to the provisions of section 25-1-801 (1)(a) and subsection
(1)(a) of this section, the person practicing psychotherapy under article 245
of title 12, shall make the original of any radiographic study available to the
patient, the patient's personal representative, a person authorized by the
patient, or another health-care professional or facility as specifically
directed by the patient, personal representative, authorized person, or
health-care professional or facility pursuant to a HIPAA-compliant
authorization and upon the payment of the reasonable fees for the
radiographic study. If a practitioner releases an original radiographic study
pursuant to this subsection (1)(b)(II), the practitioner is not responsible for
any loss, damage, or other consequences as a result of the release. Any
original radiographic study made available pursuant to this subsection
(1)(b)(II) must be returned upon request to the lending practitioner within
thirty days.
SECTION 56. In Colorado Revised Statutes, 25-1-1202, amend
(1)(n) and (1)(q) as follows:
25-1-1202. Index of statutory sections regarding medical record
confidentiality and health information. (1) Statutory provisions
concerning policies, procedures, and references to the release, sharing, and
use of medical records and health information include the following:
(n) Section 12-30-204, concerning professional review committees
for physicians
HEALTH-CARE PROVIDERS SPECIFIED IN PART 2 OF ARTICLE 30
PAGE 55-SENATE BILL 23-167 OF TITLE 12;
(q) Section 12-255-119, concerning disciplinary proceedings against
a practical nurse, a professional nurse,
A CERTIFIED MIDWIFE, or a
psychiatric technician;
SECTION 57. In Colorado Revised Statutes, 25-3.5-207, amend
(1)(e) as follows:
25-3.5-207. Ability of certified or licensed emergency medical
service providers to work in clinical settings - restrictions - definitions
- rules. (1) As used in this section, unless the context otherwise requires:
(e) "Medical supervisor" means a Colorado-licensed physician,
physician assistant, advanced practice registered nurse, or
registered nurse,
OR CERTIFIED MIDWIFE.
SECTION 58. In Colorado Revised Statutes, 25-4-1709, amend (5)
as follows:
25-4-1709. Limitations on liability. (5) A practitioner licensed to
practice medicine pursuant to article 240 of title 12 or
LICENSED TO
PRACTICE
nursing OR AS A CERTIFIED MIDWIFE pursuant to part 1 of article
255 of title 12 or the health-care clinic, hospital, office of a private
practitioner, or county public health clinic at which the immunization was
administered that relies on the health history and other information given by
a person who has been delegated the authority to consent to the
immunization of a minor pursuant to section 25-4-1704 (2.5) is not liable
for damages related to an immunization resulting from factual errors in the
health history or information given to the practitioner or the health-care
clinic, hospital, office of a private practitioner, or county public health
clinic at which the immunization was administered by the person when such
practitioner or health-care clinic, hospital, office of a private practitioner,
or county public health clinic reasonably relies upon the health history
information given and exercises reasonable and prudent care in
administering the immunization.
SECTION 59. In Colorado Revised Statutes, 25-4-2403, amend (8)
as follows:
PAGE 56-SENATE BILL 23-167 25-4-2403. Department of public health and environment -
powers and duties - immunization tracking system - rules - definitions.
(8) A person licensed to practice medicine pursuant to article 240 of title
12; a person licensed to practice nursing
OR AS A CERTIFIED MIDWIFE
pursuant to part 1 of article 255 of title 12; any other licensed health-care
practitioner as defined in section 25-4-1703; providers of county nursing
services; staff members of health-care clinics, hospitals, and offices of
private practitioners; county, district, and municipal public health agencies;
and all persons and entities listed in subsection (2) of this section are
authorized to report to the immunization tracking system and to use the
reminder and recall process established by the immunization tracking
system.
SECTION 60. In Colorado Revised Statutes, amend 25-6-203 as
follows:
25-6-203. Extent of services. Family planning and birth control
services shall include: Interview with trained personnel; distribution of
literature; referral to a licensed physician, or
AN advanced practice
registered nurse,
OR A CERTIFIED MIDWIFE for consultation, examination,
tests, medical treatment, and prescription; and, to the extent so prescribed,
the distribution of rhythm charts, drugs, medical preparations, contraceptive
devices, and similar products.
SECTION 61. In Colorado Revised Statutes, 25-37-102, amend the
introductory portion and (7) as follows:
25-37-102. Definitions. As used in this article
ARTICLE 37, unless
the context otherwise requires:
(7) "Health-care provider" means a person licensed or certified in
this state to practice medicine, pharmacy, chiropractic, nursing, physical
therapy, podiatry, dentistry, optometry, occupational therapy;
TO PRACTICE
AS A CERTIFIED MIDWIFE
; or TO PRACTICE other healing arts. "Health-care
provider" also means an ambulatory surgical center, a licensed pharmacy or
provider of pharmacy services, and a professional corporation or other
corporate entity consisting of licensed health-care providers as permitted by
the laws of this state.
SECTION 62. In Colorado Revised Statutes, 25.5-4-412, amend
PAGE 57-SENATE BILL 23-167 (5) as follows:
25.5-4-412. Family planning services - family-planning-related
services - rules - definitions. (5) Any recipient may obtain family planning
services or family-planning-related services from any licensed health-care
provider, including but not limited to
a doctor of medicine, doctor of
osteopathy, physician assistant, or advanced practice registered nurse, OR
CERTIFIED MIDWIFE
who provides such services. The enrollment of a
recipient in a managed care organization, or a similar entity, does not
restrict a recipient's choice of the licensed provider from whom the recipient
may receive those services.
SECTION 63. In Colorado Revised Statutes, 25.5-10-204, amend
(2)(j)(III) and (2)(j)(IV) as follows:
25.5-10-204. Duties of the executive director - state board rules
- definitions - repeal. (2) The state board shall adopt such rules, in
accordance with section 24-4-103, as are necessary to carry out the
provisions and purposes of this article 10, including but not limited to the
following subjects:
(j) (III) A person who is not otherwise authorized by law to
administer nutrition and fluids through gastrostomy tubes is allowed to
perform the duties only under the supervision of a licensed nurse,
A
LICENSED CERTIFIED MIDWIFE
, or A LICENSED physician. A person who
administers nutrition and fluids in compliance with the provisions of
this
subsection (2)(j) is exempt from the licensing requirements of the
"Colorado Medical Practice Act", article 240 of title 12, and the "Nurse and
Nurse Aide Practice Act", article 255 of title 12. Nothing in this subsection
(2)(j) shall be deemed to authorize the administration of medications
through gastrostomy tubes. A person administering medications through
gastrostomy tubes is subject to the requirements of part 3 of article 1.5 of
title 25.
(IV) For purposes of this paragraph (j),
AS USED IN THIS SUBSECTION
(2)(j):
(A) "Administration" means assisting a person in the ingestion of
nutrition or fluids according to the direction and supervision of a licensed
nurse,
A LICENSED CERTIFIED MIDWIFE, or A LICENSED physician.
PAGE 58-SENATE BILL 23-167 (B) "CERTIFIED MIDWIFE" HAS THE SAME MEANING AS SET FORTH IN
SECTION
12-255-104 (3.2).
SECTION 64. In Colorado Revised Statutes, 27-10.5-103, amend
(2)(i)(III) and (2)(i)(IV) as follows:
27-10.5-103. Duties of the executive director - rules - definitions.
(2) In accordance with section 24-4-103, and in coordination with the
requirements of article 10 of title 25.5, the department shall adopt such rules
as are necessary to carry out the provisions and purposes of this article 10.5,
including but not limited to the following:
(i) (III) A person who is not otherwise authorized by law to
administer nutrition and fluids through gastrostomy tubes is allowed to
perform the duties only under the supervision of a licensed nurse,
A
LICENSED CERTIFIED MIDWIFE
, or A LICENSED physician. A person who
administers nutrition and fluids in compliance with the provisions of
this
subsection (2)(i) is exempt from the licensing requirements of the
"Colorado Medical Practice Act", article 240 of title 12, and the "Nurse and
Nurse Aide Practice Act", article 255 of title 12. Nothing in this subsection
(2)(i) shall be deemed to authorize the administration of medications
through gastrostomy tubes. A person administering medications through
gastrostomy tubes is subject to the requirements of part 3 of article 1.5 of
title 25.
(IV) For purposes of this paragraph (i),
AS USED IN THIS SUBSECTION
(2)(i):
(A) "Administration" means assisting a person in the ingestion of
nutrition or fluids according to the direction and supervision of a licensed
nurse,
A LICENSED CERTIFIED MIDWIFE, or A LICENSED physician.
(B) "C
ERTIFIED MIDWIFE" HAS THE SAME MEANING AS SET FORTH IN
SECTION
12-255-104 (3.2).
SECTION 65. In Colorado Revised Statutes, 27-81-118, amend
(2)(a)(I)(C) as follows:
27-81-118. Opioid crisis recovery funds advisory committee -
creation - membership - purpose. (2) (a) The committee consists of
PAGE 59-SENATE BILL 23-167 members appointed as follows:
(I) Thirteen members appointed by the governor, including:
(C) One member licensed to practice as a nurse
OR AS A CERTIFIED
MIDWIFE
pursuant to part 1 of article 255 of title 12;
SECTION 66. In Colorado Revised Statutes, 27-82-202, amend (2)
as follows:
27-82-202. Definitions. As used in this part 2, unless the context
otherwise requires:
(2) "Licensed health-care provider" means a physician or physician
assistant licensed pursuant to article 240 of title 12 or a nurse
OR CERTIFIED
MIDWIFE
licensed pursuant to part 1 of article 255 of title 12.
SECTION 67. In Colorado Revised Statutes, 38-12-401, amend (4)
as follows:
38-12-401. Definitions. As used in this part 4, unless the context
otherwise requires:
(4) "Medical professional" means a person licensed to practice
medicine pursuant to article 240 of title 12 or
TO PRACTICE NURSING OR AS
A CERTIFIED MIDWIFE PURSUANT TO
part 1 of article 255 of title 12.
SECTION 68. Appropriation. For the 2023-24 state fiscal year,
$15,393 is appropriated to the department of public health and environment
for use by the health facilities and emergency medical services division.
This appropriation is from the general fund and is based on an assumption
that the division will require an additional 0.2 FTE. To implement this act,
the division may use this appropriation for administration and operations
related to operations management.
SECTION 69. Effective date. This act takes effect upon passage;
except that section 12-255-105, Colorado Revised Statues, as amended in
section 3 of this act, takes effect July 1, 2024.
SECTION 70. Safety clause. The general assembly hereby finds,
PAGE 60-SENATE BILL 23-167 determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety.
____________________________ ____________________________
Steve Fenberg
Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 61-SENATE BILL 23-167