Introduced Version
SENATE BILL No. 371
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-15-5-14; IC 25-23-1.
Synopsis: Advanced practice registered nurses. Amends the hospital
governing board requirements for the manner in which a psychiatric
mental health advanced practice registered nurse will interact with
other practitioners. Requires the Indiana state board of nursing to
provide a report to the general assembly concerning psychiatric mental
health advanced practice registered nurses who practice without a
practice agreement. Makes conforming changes.
Effective: Upon passage; July 1, 2023.
Ford Jon
January 19, 2023, read first time and referred to Committee on Health and Provider
Services.
2023 IN 371—LS 7205/DI 148 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. 371
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
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 371—LS 7205/DI 148 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 25-23-1-19.4, AS AMENDED BY P.L.127-2020,
24 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
25 JULY 1, 2023]: Sec. 19.4. (a) This section does not apply to certified
26 registered nurse anesthetists.
27 (b) As used in this section, "practitioner" has the meaning set forth
28 in IC 16-42-19-5. However, the term does not include the following:
29 (1) A veterinarian.
30 (2) An advanced practice registered nurse.
31 (3) A physician assistant.
32 (c) Except as provided in subsection (f), an advanced practice
33 registered nurse shall operate:
34 (1) in collaboration with a licensed practitioner as evidenced by
35 a practice agreement;
36 (2) by privileges granted by the governing board of a hospital
37 licensed under IC 16-21 with the advice of the medical staff of the
38 hospital that sets forth the manner in which an advanced practice
39 registered nurse and a licensed practitioner will cooperate,
40 coordinate, and consult with each other in the provision of health
41 care to their patients; or
42 (3) by privileges granted by the governing body of a hospital
2023 IN 371—LS 7205/DI 148 3
1 operated under IC 12-24-1 that sets forth the manner in which an
2 advanced practice registered nurse and a licensed practitioner will
3 cooperate, coordinate, and consult with each other in the
4 provision of health care to their patients.
5 (d) This subsection applies for purposes of the Medicaid program
6 to an advanced practice registered nurse who:
7 (1) is licensed pursuant to IC 25-23-1-19.5; and
8 (2) has been educated and trained to work with patients with
9 addiction and mental health needs.
10 An advanced practice registered nurse who meets the requirements of
11 this subsection has all of the supervisory rights and responsibilities,
12 including prior authorization, that are available to a licensed physician
13 or a health service provider in psychology (HSPP) operating in a
14 community mental health center certified under IC 12-21-2-3(5)(C).
15 (e) Before January 1, 2021, the office of the secretary shall apply to
16 the United States Department of Health and Human Services for any
17 state plan amendment necessary to implement subsection (d).
18 (f) A psychiatric mental health advanced practice registered
19 nurse with prescriptive authority may practice without a practice
20 agreement if the following conditions are met:
21 (1) The psychiatric mental health advanced practice
22 registered nurse has practiced under a practice agreement
23 with a practitioner for the full-time equivalent of at least one
24 (1) year.
25 (2) The practitioner described in subdivision (1) has been
26 licensed in Indiana for a minimum of five (5) years with the
27 practitioner's respective governing board.
28 (3) The practitioner has reviewed at least five percent (5%) of
29 the psychiatric mental health advanced practice registered
30 nurse's prescriptive charts during the practice agreement
31 period.
32 (4) The psychiatric mental health advanced practice
33 registered nurse has submitted an attestation to the board to
34 the completion of the required one (1) year practice
35 agreement.
36 (5) The psychiatric mental health advanced practice
37 registered nurse practices in the same practice area in which
38 the psychiatric mental health advanced practice registered
39 nurse practiced with the practitioner under a practice
40 agreement.
41 (6) The psychiatric mental health advanced practice
42 registered nurse establishes a referral plan to other
2023 IN 371—LS 7205/DI 148 4
1 appropriate practitioners for complex medical cases, medical
2 emergencies, and cases that are beyond the psychiatric mental
3 health advanced practice registered nurse's scope of practice.
4 The board shall designate on the psychiatric mental health
5 advanced practice registered nurse's prescriptive authority license,
6 in a manner determined by the board, that the psychiatric mental
7 health advanced practice registered nurse has completed the
8 requirements of this subsection.
9 (g) If a psychiatric mental health advanced practice registered
10 nurse practices independently without a practice agreement, the
11 psychiatric mental health advanced practice registered nurse shall
12 notify patients, through posting in a prominent and conspicuous
13 place, that the psychiatric mental health advanced practice
14 registered nurse is practicing independently.
15 SECTION 3. IC 25-23-1-19.6, AS AMENDED BY P.L.28-2019,
16 SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17 JULY 1, 2023]: Sec. 19.6. (a) When the board grants authority to an
18 advanced practice registered nurse to prescribe legend drugs under this
19 chapter, the board shall assign an identification number to the
20 advanced practice registered nurse.
21 (b) An advanced practice registered nurse who is granted authority
22 by the board to prescribe legend drugs must do the following:
23 (1) Enter on each prescription form that the advanced practice
24 registered nurse uses to prescribe a legend drug:
25 (A) the signature of the advanced practice registered nurse;
26 (B) initials indicating the credentials awarded to the advanced
27 practice registered nurse under this chapter; and
28 (C) the identification number assigned to the advanced
29 practice registered nurse under subsection (a).
30 (2) Transmit the prescription in an electronic format for an
31 electronically transmitted prescription.
32 (3) Comply with all applicable state and federal laws concerning
33 prescriptions for legend drugs, including the requirement to issue
34 electronically transmitted prescriptions under IC 25-1-9.3.
35 (c) An advanced practice registered nurse may be granted authority
36 to prescribe legend drugs under this chapter only within the scope of
37 practice of the advanced practice registered nurse and, if applicable,
38 the scope of the licensed collaborating health practitioner.
39 SECTION 4. [EFFECTIVE UPON PASSAGE] (a) Before July 1,
40 2026, the Indiana state board of nursing shall report to the general
41 assembly in an electronic format under IC 5-14-6 the following
42 information concerning psychiatric mental health advanced
2023 IN 371—LS 7205/DI 148 5
1 practice registered nurses who practice without a practice
2 agreement:
3 (1) The number who have been authorized to practice without
4 a practice agreement.
5 (2) The geographic practice areas.
6 (3) The medical population practice areas.
7 (4) A summary of disciplinary actions taken.
8 (b) This SECTION expires December 31, 2026.
9 SECTION 5. An emergency is declared for this act.
2023 IN 371—LS 7205/DI 148