Introduced Version
SENATE BILL No. 213
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-15-5-14; IC 16-41-6-1; IC 25-1-9-6.8;
IC 25-23-1; IC 34-30-2.1-374; IC 35-48-3-11.
Synopsis: Advanced practice registered nurses. Removes the
requirements that an advanced practice registered nurse (APRN) have
a practice agreement with a collaborating physician. Removes a
provision requiring an APRN to operate under a collaborative practice
agreement or the privileges granted by a hospital governing board.
Repeals law concerning the audit of practice agreements. Allows an
APRN with prescriptive authority to prescribe a schedule II controlled
substance for weight reduction or to control obesity. Makes conforming
changes.
Effective: July 1, 2023.
Breaux
January 10, 2023, read first time and referred to Committee on Health and Provider
Services.
2023 IN 213—LS 6417/DI 77 Introduced
First Regular Session of the 123rd General Assembly (2023)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2022 Regular Session of the General Assembly.
SENATE BILL No. 213
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-15-5-14, AS AMENDED BY P.L.129-2018,
2 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2023]: Sec. 14. (a) As used in this section, "advanced practice
4 registered nurse" means:
5 (1) a nurse practitioner; or
6 (2) a clinical nurse specialist;
7 who is a registered nurse licensed under IC 25-23 and qualified to
8 practice nursing in a specialty role based upon the additional
9 knowledge and skill gained through a formal organized program of
10 study and clinical experience, or the equivalent as determined by the
11 Indiana state board of nursing.
12 (b) As used in this section, "office" includes the following:
13 (1) The office of the secretary of family and social services.
14 (2) A managed care organization that has contracted with the
15 office of Medicaid policy and planning under this article.
16 (3) A person that has contracted with a managed care organization
17 described in subdivision (2).
2023 IN 213—LS 6417/DI 77 2
1 (c) The office shall reimburse eligible Medicaid claims for the
2 following services provided by an advanced practice registered nurse
3 employed by a community mental health center if the services are part
4 of the advanced practice registered nurse's scope of practice:
5 (1) Mental health services.
6 (2) Behavioral health services.
7 (3) Substance abuse treatment.
8 (4) Primary care services.
9 (5) Evaluation and management services for inpatient or
10 outpatient psychiatric treatment.
11 (6) Prescription drugs.
12 (d) The office shall include an advanced practice registered nurse
13 as an eligible provider for the supervision of a plan of treatment for a
14 patient's outpatient mental health or substance abuse treatment
15 services, if the supervision is in the advanced practice registered
16 nurse's scope of practice, education, and training.
17 (e) This section
18 (1) may not be construed to expand an advanced practice
19 registered nurse's scope of practice. and
20 (2) is subject to IC 25-23-1-19.4(c) and applies only if the service
21 is included in the advanced practice registered nurse's practice
22 agreement with a collaborating physician.
23 SECTION 2. IC 16-41-6-1, AS AMENDED BY P.L.112-2020,
24 SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
25 JULY 1, 2023]: Sec. 1. (a) As used in this section, "physician's
26 authorized representative" means:
27 (1) an advanced practice registered nurse (as defined by
28 IC 25-23-1-1(b)); who is operating in collaboration with a
29 licensed physician; or
30 (2) an individual acting under the supervision of a licensed
31 physician and within the individual's scope of employment.
32 (b) A physician or the physician's authorized representative shall not
33 order an HIV test on an individual under the care of a physician unless
34 the physician or the physician's authorized representative does the
35 following:
36 (1) Informs the patient of the test, orally or in writing.
37 (2) Provides the patient with an explanation of the test orally, in
38 writing, by video, or by a combination of these methods.
39 (3) Informs the patient of the patient's right to ask questions and
40 to refuse the test.
41 Subject to subsection (e), if the patient refuses the test, the physician
42 or the physician's authorized representative may not perform the test
2023 IN 213—LS 6417/DI 77 3
1 and shall document the patient's refusal in the patient's medical record.
2 (c) Unless it is clearly not feasible, the information delivered to the
3 patient who is to be tested under subsection (b) must be provided in the
4 native language or other communication used by the patient. If the
5 patient is unable to read written materials, the materials must be
6 translated or read to the patient in a language the patient understands.
7 (d) After ordering an HIV test for a patient, the physician or the
8 physician's authorized representative shall notify the patient of the test
9 results and the availability of HIV and other bloodborne disease
10 prevention counseling. If a test conducted under this section indicates
11 that a patient is HIV positive, in addition to the requirements set forth
12 in IC 16-41-2, the physician or the physician's authorized
13 representative shall inform the patient of the availability of counseling
14 and of the treatment and referral options available to the patient.
15 (e) A physician or a physician's authorized representative may order
16 an HIV test to be performed without informing the patient or the
17 patient's representative (as defined in IC 16-36-1-2) of the test or
18 regardless of the patient's or the patient's representative's refusal of the
19 HIV test if any of the following conditions apply:
20 (1) If ordered by a physician, consent can be implied due to
21 emergency circumstances and the test is medically necessary to
22 diagnose or treat the patient's emergent condition.
23 (2) Under a court order based on clear and convincing evidence
24 of a serious and present health threat to others posed by an
25 individual. A patient shall be notified of the patient's right to:
26 (A) a hearing; and
27 (B) counsel;
28 before a hearing is held under this subdivision. Any hearing
29 conducted under this subdivision shall be held in camera at the
30 request of the individual.
31 (3) If the test is done on blood collected or tested anonymously as
32 part of an epidemiologic survey under IC 16-41-2-3 or
33 IC 16-41-17-10(a)(5).
34 (4) The test is ordered under section 4 of this chapter.
35 (5) The test is required or authorized under IC 11-10-3-2.5.
36 (6) The individual upon whom the test will be performed is
37 described in IC 16-41-8-6 or IC 16-41-10-2.5.
38 (7) A court has ordered the individual to undergo testing for HIV
39 under IC 35-38-1-10.5(a) or IC 35-38-2-2.3(a)(17).
40 (f) The state department shall make HIV testing and treatment
41 information from the federal Centers for Disease Control and
42 Prevention available to health care providers.
2023 IN 213—LS 6417/DI 77 4
1 (g) The state department may adopt rules under IC 4-22-2 necessary
2 to implement this section.
3 SECTION 3. IC 25-1-9-6.8, AS AMENDED BY P.L.129-2018,
4 SECTION 23, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
5 JULY 1, 2023]: Sec. 6.8. (a) This section applies to a practitioner who
6 is:
7 (1) licensed to practice medicine or osteopathic medicine under
8 IC 25-22.5; or
9 (2) an advanced practice registered nurse granted prescriptive
10 authority under IC 25-23. and whose practice agreement with a
11 collaborating physician reflects the conditions specified in
12 subsection (b).
13 (b) Before prescribing a stimulant medication for a child for the
14 treatment of attention deficit disorder or attention deficit hyperactivity
15 disorder, a practitioner described in subsection (a) shall follow the most
16 recent guidelines adopted by the American Academy of Pediatrics or
17 the American Academy of Child and Adolescent Psychiatry for the
18 diagnosis and evaluation of a child with attention deficit disorder or
19 attention deficit hyperactivity disorder.
20 SECTION 4. IC 25-23-1-1, AS AMENDED BY P.L.129-2018,
21 SECTION 28, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
22 JULY 1, 2023]: Sec. 1. As used in this chapter:
23 (a) "Board" means the Indiana state board of nursing.
24 (b) "Advanced practice registered nurse" means:
25 (1) a nurse practitioner;
26 (2) a certified nurse midwife;
27 (3) a clinical nurse specialist; or
28 (4) a certified registered nurse anesthetist;
29 who is a registered nurse qualified to practice nursing in a specialty
30 role based upon the additional knowledge and skill gained through a
31 formal organized program of study and clinical experience, or the
32 equivalent as determined by the board, which does not limit but
33 extends or expands the function of the nurse which may be initiated by
34 the client or provider. in settings that shall include hospital outpatient
35 clinics and health maintenance organizations. Notwithstanding any
36 other law, this subsection does not add to the powers and duties or
37 scope of practice of certified registered nurse anesthetists as described
38 in section 30 of this chapter.
39 (c) "Human response" means those signs, symptoms, behaviors, and
40 processes that denote the individual's interaction with the environment.
41 SECTION 5. IC 25-23-1-7, AS AMENDED BY P.L.69-2022,
42 SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
2023 IN 213—LS 6417/DI 77 5
1 JULY 1, 2023]: Sec. 7. (a) The board shall do the following:
2 (1) Adopt under IC 4-22-2 rules necessary to enable it to carry
3 into effect this chapter.
4 (2) Prescribe standards and approve curricula for nursing
5 education programs preparing persons for licensure under this
6 chapter.
7 (3) Provide for surveys of such programs at such times as it
8 considers necessary.
9 (4) Accredit such programs as meet the requirements of this
10 chapter and of the board.
11 (5) Deny or withdraw accreditation from nursing education
12 programs for failure to meet prescribed curricula or other
13 standards.
14 (6) Examine, license, and renew the license of qualified
15 applicants.
16 (7) Issue subpoenas, compel the attendance of witnesses, and
17 administer oaths to persons giving testimony at hearings.
18 (8) Cause the prosecution of all persons violating this chapter and
19 have power to incur necessary expenses for these prosecutions.
20 (9) Adopt rules under IC 4-22-2 that do the following:
21 (A) Prescribe standards for the competent practice of
22 registered, practical, and advanced practice registered nursing.
23 (B) Establish with the approval of the medical licensing board
24 created by IC 25-22.5-2-1 requirements that advanced practice
25 registered nurses must meet to be granted authority to
26 prescribe legend drugs and to retain that authority.
27 (C) Establish, with the approval of the medical licensing board
28 created by IC 25-22.5-2-1, requirements for the renewal of a
29 practice agreement under section 19.4 of this chapter, which
30 shall expire on October 31 in each odd-numbered year.
31 (10) Keep a record of all its proceedings.
32 (11) Collect and distribute annually demographic information on
33 the number and type of registered nurses and licensed practical
34 nurses employed in Indiana.
35 (12) Adopt rules and administer the interstate nurse licensure
36 compact under IC 25-42.
37 (13) Adopt or amend rules to implement the nursing licensure by
38 endorsement available for foreign nursing school graduates under
39 sections 11 and 12 of this chapter.
40 (b) The board may do the following:
41 (1) Create ad hoc subcommittees representing the various nursing
42 specialties and interests of the profession of nursing. Persons
2023 IN 213—LS 6417/DI 77 6
1 appointed to a subcommittee serve for terms as determined by the
2 board.
3 (2) Utilize the appropriate subcommittees so as to assist the board
4 with its responsibilities. The assistance provided by the
5 subcommittees may include the following:
6 (A) Recommendation of rules necessary to carry out the duties
7 of the board.
8 (B) Recommendations concerning educational programs and
9 requirements.
10 (C) Recommendations regarding examinations and licensure
11 of applicants.
12 (3) Appoint nurses to serve on each of the ad hoc subcommittees.
13 (c) Nurses appointed under subsection (b) must:
14 (1) be committed to advancing and safeguarding the nursing
15 profession as a whole; and
16 (2) represent nurses who practice in the field directly affected by
17 a subcommittee's actions.
18 SECTION 6. IC 25-23-1-19.4, AS AMENDED BY P.L.127-2020,
19 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
20 JULY 1, 2023]: Sec. 19.4. (a) This section does not apply to certified
21 registered nurse anesthetists.
22 (b) As used in this section, "practitioner" has the meaning set forth
23 in IC 16-42-19-5. However, the term does not include the following:
24 (1) A veterinarian.
25 (2) An advanced practice registered nurse.
26 (3) A physician assistant.
27 (c) An advanced practice registered nurse shall operate:
28 (1) in collaboration with a licensed practitioner as evidenced by
29 a practice agreement;
30 (2) by privileges granted by the governing board of a hospital
31 licensed under IC 16-21 with the advice of the medical staff of the
32 hospital that sets forth the manner in which an advanced practice
33 registered nurse and a licensed practitioner will cooperate,
34 coordinate, and consult with each other in the provision of health
35 care to their patients; or
36 (3) by privileges granted by the governing body of a hospital
37 operated under IC 12-24-1 that sets forth the manner in which an
38 advanced practice registered nurse and a licensed practitioner will
39 cooperate, coordinate, and consult with each other in the
40 provision of health care to their patients.
41 (d) (b) This subsection applies for purposes of the Medicaid
42 program to an advanced practice registered nurse who:
2023 IN 213—LS 6417/DI 77 7
1 (1) is licensed pursuant to IC 25-23-1-19.5; and
2 (2) has been educated and trained to work with patients with
3 addiction and mental health needs.
4 An advanced practice registered nurse who meets the requirements of
5 this subsection has all of the supervisory rights and responsibilities,
6 including prior authorization, that are available to a licensed physician
7 or a health service provider in psychology (HSPP) operating in a
8 community mental health center certified under IC 12-21-2-3(5)(C).
9 (e) (c) Before January 1, 2021, the office of the secretary shall apply
10 to the United States Department of Health and Human Services for any
11 state plan amendment necessary to implement subsection (d). (b).
12 SECTION 7. IC 25-23-1-19.6, AS AMENDED BY P.L.28-2019,
13 SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
14 JULY 1, 2023]: Sec. 19.6. (a) When the board grants authority to an
15 advanced practice registered nurse to prescribe legend drugs under this
16 chapter, the board shall assign an identification number to the
17 advanced practice registered nurse.
18 (b) An advanced practice registered nurse who is granted authority
19 by the board to prescribe legend drugs must do the following:
20 (1) Enter on each prescription form that the advanced practice
21 registered nurse uses to prescribe a legend drug:
22 (A) the signature of the advanced practice registered nurse;
23 (B) initials indicating the credentials awarded to the advanced
24 practice registered nurse under this chapter; and
25 (C) the identification number assigned to the advanced
26 practice registered nurse under subsection (a).
27 (2) Transmit the prescription in an electronic format for an
28 electronically transmitted prescription.
29 (3) Comply with all applicable state and federal laws concerning
30 prescriptions for legend drugs, including the requirement to issue
31 electronically transmitted prescriptions under IC 25-1-9.3.
32 (c) An advanced practice registered nurse may be granted authority
33 to prescribe legend drugs under this chapter only within the scope of
34 practice of the advanced practice registered nurse. and the scope of the
35 licensed collaborating health practitioner.
36 SECTION 8. IC 25-23-1-19.8 IS REPEALED [EFFECTIVE JULY
37 1, 2023]. Sec. 19.8. (a) Before December 31 of an even-numbered year,
38 the Indiana professional licensing agency or the agency's designee shall
39 randomly audit at least one percent (1%) but not more than ten percent
40 (10%) of the practice agreements of advanced practice registered
41 nurses with authority to prescribe legend drugs under section 19.5 of
42 this chapter to determine whether the practice agreement meets the
2023 IN 213—LS 6417/DI 77 8
1 requirements of this chapter or rules adopted by the board.
2 (b) The Indiana professional licensing agency shall establish an
3 audit procedure, which may include the following:
4 (1) Requiring the advanced practice registered nurse to provide
5 the agency with a copy of verification of attendance at or
6 completion of a continuing education course or program the
7 advanced practice registered nurse attended during the previous
8 two (2) years.
9 (2) Requiring the advanced practice registered nurse and the
10 licensed practitioner who have entered into a practice agreement
11 to submit information on a form prescribed by the agency that
12 must include a sworn statement signed by the advanced practice
13 registered nurse and the licensed practitioner that the parties are
14 operating within the terms of the practice agreement and the
15 requirements under this chapter or rules adopted by the board.
16 (3) Reviewing patient health records and other patient information
17 at the practice location or by requiring the submission of accurate
18 copies to determine if the parties are operating within the terms
19 of the practice agreement and the requirements under this chapter
20 or rules adopted by the board.
21 (4) After a reasonable determination that the advanced practice
22 registered nurse and the licensed practitioner who have entered
23 into a practice agreement are not operating within the terms of the
24 practice agreement, requiring the parties to appear before the
25 agency or the agency's designee to provide evidence of
26 compliance with the practice agreement.
27 (c) Not more than sixty (60) days after the completion of the audit
28 required in subsection (a), the Indiana professional licensing agency
29 shall provide the board with the following:
30 (1) A summary of the information obtained in the audit.
31 (2) A statement regarding whether an advanced practice
32 registered nurse and a licensed practitioner who have entered into
33 a practice agreement that is audited under subsection (a) are
34 operating within the terms of the practice agreement.
35 The agency shall also provide a copy of the information described in
36 this subsection to the board that regulates the licensed practitioner.
37 (d) The Indiana professional licensing agency may cause to be
38 served upon the advanced practice registered nurse an order to show
39 cause to the board as to why the board should not impose disciplinary
40 sanctions under IC 25-1-9-9 on the advanced practice registered nurse
41 for the advanced practice registered nurse's failure to comply with:
42 (1) an audit conducted under this section; or
2023 IN 213—LS 6417/DI 77 9
1 (2) the requirements of a practice agreement under this chapter.
2 (e) Except for a violation concerning continuing education
3 requirements under IC 25-1-4, the board shall hold a hearing in
4 accordance with IC 4-21.5 and state the date, time, and location of the
5 hearing in the order served under subsection (d).
6 (f) The board that regulates the licensed practitioner may cause to
7 be served upon the licensed practitioner an order to show cause to the
8 board as to why the board should not impose disciplinary sanctions
9 under IC 25-1-9-9 on the licensed practitioner for the licensed
10 practitioner's failure to comply with:
11 (1) an audit conducted under this section; or
12 (2) the requirements of a practice agreement under this chapter.
13 (g) The board that regulates the licensed practitioner shall hold a
14 hearing in accordance with IC 4-21.5 and state the date, time, and
15 location of the hearing in the order served under subsection (f).
16 (h) An order to show cause issued under this section must comply
17 with the notice requirements of IC 4-21.5.
18 (i) The licensed practitioner may divulge health records and other
19 patient information to the Indiana professional licensing agency or the
20 agency's designee. The licensed practitioner is immune from civil
21 liability for any action based upon release of the patient information
22 under this section.
23 SECTION 9. IC 34-30-2.1-374 IS REPEALED [EFFECTIVE JULY
24 1, 2023]. Sec. 374. IC 25-23-1-19.8(i) (Concerning licensed
25 practitioners who release health records and patient information to the
26 Indiana professional licensing agency).
27 SECTION 10. IC 35-48-3-11, AS AMENDED BY P.L.129-2018,
28 SECTION 45, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
29 JULY 1, 2023]: Sec. 11. (a) Only a physician licensed under
30 IC 25-22.5, a physician assistant licensed under IC 25-27.5, or an
31 advanced practice registered nurse licensed under IC 25-23 with
32 prescriptive authority may treat a patient with a Schedule III or
33 Schedule IV controlled substance for the purpose of weight reduction
34 or to control obesity.
35 (b) A physician licensed under IC 25-22.5, a physician assistant
36 licensed under IC 25-27.5, or an advanced practice registered nurse
37 licensed under IC 25-23 with prescriptive authority may not prescribe,
38 dispense, administer, supply, sell, or give any amphetamine,
39 sympathomimetic amine drug, or compound designated as a Schedule
40 III or Schedule IV controlled substance under IC 35-48-2-8 and
41 IC 35-48-2-10 for a patient for purposes of weight reduction or to
42 control obesity, unless the physician, physician assistant, or advanced
2023 IN 213—LS 6417/DI 77 10
1 practice registered nurse does the following:
2 (1) Determines:
3 (A) through review of:
4 (i) the physician's records of prior treatment of the patient;
5 or
6 (ii) the records of prior treatment of the patient provided by
7 a previous treating physician or weight loss program;
8 that the physician's patient has made a reasonable effort to lose
9 weight in a treatment program using a regimen of weight
10 reduction based on caloric restriction, nutritional counseling,
11 behavior modification, and exercise without using controlled
12 substances; and
13 (B) that the treatment described in clause (A) has been
14 ineffective for the physician's patient.
15 (2) Obtains a thorough history and performs a thorough physical
16 examination of the physician's patient before initiating a treatment
17 plan using a Schedule III or Schedule IV controlled substance for
18 purposes of weight reduction or to control obesity.
19 (c) A physician licensed under IC 25-22.5, a physician assistant
20 licensed under IC 25-27.5, or an advanced practice registered nurse
21 licensed under IC 25-23 with prescriptive authority may not begin and
22 shall discontinue using a Schedule III or Schedule IV controlled
23 substance for purposes of weight reduction or to control obesity after
24 the physician, physician assistant, or advanced practice registered nurse
25 determines in the physician's, physician assistant's, or advanced
26 practice registered nurse's professional judgment that:
27 (1) the physician's patient has failed to lose weight using a
28 treatment plan involving the controlled substance;
29 (2) the controlled substance has provided a decreasing
30 contribution toward further weight loss for the patient unless
31 continuing to take the controlled substance is medically necessary
32 or appropriate for maintenance therapy;
33 (3) the physician's patient:
34 (A) has a history of; or
35 (B) shows a propensity for;
36 alcohol or drug abuse; or
37 (4) the physician's patient has consumed or disposed of a
38 controlled substance in a manner that does not strictly comply
39 with a treating physician's, physician assistant's, or advanced
40 practice registered nurse's direction.
41 (d) A physician assistant licensed under IC 25-27.5 or an advanced
42 practice registered nurse licensed under IC 25-23 with prescriptive
2023 IN 213—LS 6417/DI 77 11
1 authority may not prescribe a schedule II controlled substance for the
2 purpose of weight reduction or to control obesity.
2023 IN 213—LS 6417/DI 77