UNOFFICIAL COPY 22 RS BR 1419
Page 1 of 12
XXXX Jacketed
AN ACT relating to prescriptive authority. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 314.042 is amended to read as follows: 3
(1) An applicant for licensure to practice as an advanced practice registered nurse shall 4
file with the board a written application for licensure and submit evidence, verified 5
by oath, that the applicant: 6
(a) Has completed an education program that prepares the registered nurse for one 7
(1) of four (4) APRN roles that has been accredited by a national nursing 8
accrediting body recognized by the United States Department of Education; 9
(b) Is certified by a nationally established organization or agency recognized by 10
the board to certify registered nurses for advanced practice registered nursing; 11
(c) Is able to understandably speak and write the English language and to read the 12
English language with comprehension; and 13
(d) Has passed the jurisprudence examination approved by the board as provided 14
in subsection (12) of this section. 15
(2) The board may issue a license to practice advanced practice registered nursing to an 16
applicant who holds a current active registered nurse license issued by the board or 17
holds the privilege to practice as a registered nurse in this state and meets the 18
qualifications of subsection (1) of this section. An advanced practice registered 19
nurse shall be: 20
(a) Designated by the board as a certified registered nurse anesthetist, certified 21
nurse midwife, certified nurse practitioner, or clinical nurse specialist; and 22
(b) Certified in at least one (1) population focus. 23
(3) The applicant for licensure or renewal thereof to practice as an advanced practice 24
registered nurse shall pay a fee to the board as set forth in regulation by the board. 25
(4) An advanced practice registered nurse shall maintain a current active registered 26
nurse license issued by the board or hold the privilege to practice as a registered 27 UNOFFICIAL COPY 22 RS BR 1419
Page 2 of 12
XXXX Jacketed
nurse in this state and maintain current certification by the appropriate national 1
organization or agency recognized by the board. 2
(5) Any person who holds a license to practice as an advanced practice registered nurse 3
in this state shall have the right to use the title "advanced practice registered nurse" 4
and the abbreviation "APRN." No other person shall assume the title or use the 5
abbreviation or any other words, letters, signs, or figures to indicate that the person 6
using the same is an advanced practice registered nurse. No person shall practice as 7
an advanced practice registered nurse unless licensed under this section. 8
(6) Any person heretofore licensed as an advanced practice registered nurse under the 9
provisions of this chapter who has allowed the license to lapse may be reinstated on 10
payment of the current fee and by meeting the provisions of this chapter and 11
regulations promulgated by the board pursuant to the provisions of KRS Chapter 12
13A. 13
(7) The board may authorize a person to practice as an advanced practice registered 14
nurse temporarily and pursuant to applicable regulations promulgated by the board 15
pursuant to the provisions of KRS Chapter 13A if the person is awaiting licensure 16
by endorsement. 17
(8) (a) Except as authorized by subsection (9) of this section, before an advanced 18
practice registered nurse engages in the prescribing or dispensing of 19
nonscheduled legend drugs as authorized by KRS 314.011(8), the advanced 20
practice registered nurse shall enter into a written "Collaborative Agreement 21
for the Advanced Practice Registered Nurse's Prescriptive Authority for 22
Nonscheduled Legend Drugs" (CAPA-NS) with a physician licensed in 23
Kentucky that defines the scope of the prescriptive authority for nonscheduled 24
legend drugs. 25
(b) The advanced practice registered nurse shall notify the Kentucky Board of 26
Nursing of the existence of the CAPA-NS and the name of the collaborating 27 UNOFFICIAL COPY 22 RS BR 1419
Page 3 of 12
XXXX Jacketed
physician and shall, upon request, furnish to the board or its staff a copy of the 1
completed CAPA-NS. The Kentucky Board of Nursing shall notify the 2
Kentucky Board of Medical Licensure that a CAPA-NS exists and furnish the 3
collaborating physician's name. 4
(c) The CAPA-NS shall be in writing and signed by both the advanced practice 5
registered nurse and the collaborating physician. A copy of the completed 6
collaborative agreement shall be available at each site where the advanced 7
practice registered nurse is providing patient care. 8
(d) The CAPA-NS shall describe the arrangement for collaboration and 9
communication between the advanced practice registered nurse and the 10
collaborating physician regarding the prescribing of nonscheduled legend 11
drugs by the advanced practice registered nurse. 12
(e) The advanced practice registered nurse who is prescribing nonscheduled 13
legend drugs and the collaborating physician shall be qualified in the same or 14
a similar specialty. 15
(f) The CAPA-NS is not intended to be a substitute for the exercise of 16
professional judgment by the advanced practice registered nurse or by the 17
collaborating physician. 18
(g) The CAPA-NS shall be reviewed and signed by both the advanced practice 19
registered nurse and the collaborating physician and may be rescinded by 20
either party upon written notice to the other party and the Kentucky Board of 21
Nursing. 22
(9) (a) Before an advanced practice registered nurse may discontinue or be exempt 23
from a CAPA-NS required under subsection (8) of this section, the advanced 24
practice registered nurse shall have completed four (4) years of prescribing as 25
a certified nurse practitioner, clinical nurse specialist, certified nurse midwife, 26
or as a certified registered nurse anesthetist. For certified nurse practitioners 27 UNOFFICIAL COPY 22 RS BR 1419
Page 4 of 12
XXXX Jacketed
and clinical nurse specialists, the four (4) years of prescribing shall be in a 1
population focus as defined in KRS 314.011. 2
(b) After four (4) years of prescribing with a CAPA-NS in collaboration with a 3
physician: 4
1. An advanced practice registered nurse whose license is in good standing 5
at that time with the Kentucky Board of Nursing and who will be 6
prescribing nonscheduled legend drugs without a CAPA-NS shall notify 7
that board that the four (4) year requirement has been met and that he or 8
she will be prescribing nonscheduled legend drugs without a CAPA-NS; 9
2. The advanced practice registered nurse will no longer be required to 10
maintain a CAPA-NS and shall not be compelled to maintain a CAPA-11
NS as a condition to prescribe after the four (4) years have expired, but 12
an advanced practice registered nurse may choose to maintain a CAPA-13
NS indefinitely after the four (4) years have expired; and 14
3. If the advanced practice registered nurse's license is not in good 15
standing, the CAPA-NS requirement shall not be removed until the 16
license is restored to good standing. 17
(c) An advanced practice registered nurse wishing to practice in Kentucky 18
through licensure by endorsement is exempt from the CAPA-NS requirement 19
if the advanced practice registered nurse: 20
1. Has met the prescribing requirements in a state that grants independent 21
prescribing to advanced practice registered nurses; and 22
2. Has been prescribing for at least four (4) years. 23
(d) An advanced practice registered nurse wishing to practice in Kentucky 24
through licensure by endorsement who had a collaborative prescribing 25
agreement with a physician in another state for at least four (4) years is 26
exempt from the CAPA-NS requirement. 27 UNOFFICIAL COPY 22 RS BR 1419
Page 5 of 12
XXXX Jacketed
(10) (a) Except as provided in subsections (13) and (14) of this section, before an 1
advanced practice registered nurse engages in the prescribing of Schedules II 2
through V controlled substances as authorized by KRS 314.011(8), the 3
advanced practice registered nurse shall enter into a written "Collaborative 4
Agreement for the Advanced Practice Registered Nurse's Prescriptive 5
Authority for Controlled Substances" (CAPA-CS) with a physician licensed in 6
Kentucky that defines the scope of the prescriptive authority for controlled 7
substances. 8
(b) The advanced practice registered nurse shall notify the Kentucky Board of 9
Nursing of the existence of the CAPA-CS and the name of the collaborating 10
physician and shall, upon request, furnish to the board or its staff a copy of the 11
completed CAPA-CS. The Kentucky Board of Nursing shall notify the 12
Kentucky Board of Medical Licensure that a CAPA-CS exists and furnish the 13
collaborating physician's name. 14
(c) The CAPA-CS shall be in writing and signed by both the advanced practice 15
registered nurse and the collaborating physician. A copy of the completed 16
collaborative agreement shall be available at each site where the advanced 17
practice registered nurse is providing patient care. 18
(d) The CAPA-CS shall describe the arrangement for collaboration and 19
communication between the advanced practice registered nurse and the 20
collaborating physician regarding the prescribing of controlled substances by 21
the advanced practice registered nurse. 22
(e) The advanced practice registered nurse who is prescribing controlled 23
substances and the collaborating physician shall be qualified in the same or a 24
similar specialty. 25
(f) The CAPA-CS is not intended to be a substitute for the exercise of 26
professional judgment by the advanced practice registered nurse or by the 27 UNOFFICIAL COPY 22 RS BR 1419
Page 6 of 12
XXXX Jacketed
collaborating physician. 1
(g) [Before engaging in the prescribing of controlled substances, the advanced 2
practice registered nurse shall: 3
1. Have been licensed to practice as an advanced practice registered nurse 4
for one (1) year with the Kentucky Board of Nursing; or 5
2. Be nationally certified as an advanced practice registered nurse and be 6
registered, certified, or licensed in good standing as an advanced 7
practice registered nurse in another state for one (1) year prior to 8
applying for licensure by endorsement in Kentucky. 9
(h) ]Prior to prescribing controlled substances, the advanced practice registered 10
nurse shall obtain a Controlled Substance Registration Certificate through the 11
United States[U.S.] Drug Enforcement Administration[Agency]. 12
(h)[(i)] The CAPA-CS shall be reviewed and signed by both the advanced 13
practice registered nurse and the collaborating physician and may be rescinded 14
by either party upon written notice to the other party and the Kentucky Board 15
of Nursing. 16
(i)[(j)] The CAPA-CS shall state the limits on controlled substances which may 17
be prescribed by the advanced practice registered nurse, as agreed to by the 18
advanced practice registered nurse and the collaborating physician. The 19
CAPA-CS may include any limitations on drugs and amounts that may be 20
prescribed, as well as any requirements for the advanced practice registered 21
nurses to communicate with the collaborating physician before prescribing 22
a controlled substance. These agreements may be individualized to 23
accommodate variations in practice. The limits so imposed may be more 24
stringent than either the schedule limits on controlled substances established 25
in KRS 314.011(8) or the limits imposed in regulations promulgated by the 26
Kentucky Board of Nursing thereunder. 27 UNOFFICIAL COPY 22 RS BR 1419
Page 7 of 12
XXXX Jacketed
(j)[(k)] Within thirty (30) days of obtaining a Controlled Substance Registration 1
Certificate from the United States Drug Enforcement Administration, and 2
prior to prescribing controlled substances, the advanced practice registered 3
nurse shall register with the electronic system for monitoring controlled 4
substances established by KRS 218A.202 and shall provide a copy of the 5
registration certificate to the board. 6
(11) Nothing in this chapter shall be construed as requiring an advanced practice 7
registered nurse designated by the board as a certified registered nurse anesthetist to 8
enter into a collaborative agreement with a physician, pursuant to this chapter or any 9
other provision of law, in order to deliver anesthesia care. 10
(12) The jurisprudence examination shall be prescribed by the board and be conducted 11
on the licensing requirements under this chapter and board regulations and 12
requirements applicable to advanced practice registered nursing in this 13
Commonwealth. The board shall promulgate administrative regulations in 14
accordance with KRS Chapter 13A, establishing the provisions to meet this 15
requirement. 16
(13) (a) Except as provided in subsection (14) of this section, before an advanced 17
practice registered nurse who wishes to continue to prescribe controlled 18
substances may discontinue or be exempt from a CAPA-CS required under 19
subsection (10) of this section, the advanced practice registered nurse shall 20
have completed four (4) years of prescribing authority for controlled 21
substances, while maintaining a CAPA-CS, United States Drug 22
Enforcement Administration registration, and a master account with the 23
electronic system for monitoring controlled substances established by KRS 24
218A.202. 25
(b) On or after the effective date of this Act: 26
1. An advanced practice registered nurse who has had four (4) years of 27 UNOFFICIAL COPY 22 RS BR 1419
Page 8 of 12
XXXX Jacketed
prescribing authority with a CAPA-CS and who wishes to prescribe 1
controlled substances without a CAPA-CS shall submit, via the APRN 2
update portal, a request for review from the Kentucky Board of 3
Nursing that the advanced practice registered nurse's license is in 4
good standing; 5
2. The advanced practice registered nurse shall not prescribe controlled 6
substances without a CAPA-CS until the board has completed its 7
review and has notified the advanced practice registered nurse in 8
writing that the advanced practice registered nurse is exempt from the 9
CAPA-CS requirement; and 10
3. The review request shall include the payment of a fee set by the board 11
through the promulgation of an administrative regulation. 12
(c) Upon receipt of a request pursuant to this subsection, the Kentucky Board 13
of Nursing shall perform a review to determine whether the license of the 14
advanced practice registered nurse is in good standing based upon an 15
evaluation of the criteria specified in this subsection and in the 16
administrative regulation promulgated by the board pursuant to this 17
subsection, including but not limited to: 18
1. Verification that a current United States Drug Enforcement 19
Administration registration certificate for the advanced practice 20
registered nurse is on file with the board; 21
2. Verification that a current CAPA-CS notification for the advanced 22
practice registered nurse is on file with the board; 23
3. Verification that the advanced practice registered nurse has an active 24
master account with the electronic system for monitoring controlled 25
substances pursuant to KRS 218A.202; 26
4. Verification through a criminal background check of the absence of 27 UNOFFICIAL COPY 22 RS BR 1419
Page 9 of 12
XXXX Jacketed
any unreported misdemeanor or felony convictions in Kentucky; and 1
5. Verification through a check of the coordinated licensure information 2
system specified in KRS 314.475 of the absence of any unreported 3
disciplinary actions in another state. 4
(d) Based on the findings of these actions, the Kentucky Board of Nursing shall 5
determine whether or not the advanced practice registered nurse's license is 6
in good standing for the purpose of removing the requirement for the 7
advanced practice registered nurse to have a CAPA-CS in order to prescribe 8
controlled substances. 9
(e) If the advanced practice registered nurse's license is found to be in good 10
standing, the advanced practice registered nurse shall be notified by the 11
board in writing that a CAPA-CS is no longer required. The advanced 12
practice registered nurse shall not be required to maintain a CAPA-CS as a 13
condition to prescribe controlled substances unless the board later imposes 14
such a requirement as part of an action instituted under KRS 314.091(1). 15
An advanced practice registered nurse may choose to maintain a CAPA-CS 16
indefinitely after the determination of good standing has been made. 17
(f) If the advanced practice registered nurse's license is found not to be in good 18
standing, the CAPA-CS requirement shall not be removed until the license 19
is restored to good standing, as directed by the board. 20
(g) The Kentucky Board of Nursing may conduct random audits of the 21
prescribing practices of advanced practice registered nurses, including 22
those who are no longer required to have a CAPA-CS in order to prescribe, 23
through a review of data obtained from the electronic system for monitoring 24
controlled substances pursuant to KRS 218A.202 and may take disciplinary 25
action under KRS 314.091(1) if a violation has occurred. 26
(14) (a) An advanced practice registered nurse wishing to practice in Kentucky 27 UNOFFICIAL COPY 22 RS BR 1419
Page 10 of 12
XXXX Jacketed
through licensure by endorsement is exempt from the CAPA-CS 1
requirement if the advanced practice registered nurse: 2
1. Has met the prescribing requirements for controlled substances in a 3
state that grants such prescribing authority to advanced practice 4
registered nurses; 5
2. Has had authority to prescribe controlled substances for at least four 6
(4) years; and 7
3. Has a license in good standing as described in subsection (13) of this 8
section and in the administrative regulation promulgated by the board 9
pursuant to subsection (13) of this section. 10
(b) An advanced practice registered nurse wishing to practice in Kentucky 11
through licensure by endorsement who has had the authority to prescribe 12
controlled substances for less than four (4) years and wishes to continue to 13
prescribe controlled substances shall enter into a CAPA-CS with a 14
physician licensed in Kentucky until the cumulative four (4) year 15
requirement is met, after which the advanced practice registered nurse who 16
wishes to prescribe controlled substances without a CAPA-CS shall follow 17
the process identified in subsection (13) of this section and in the 18
administrative regulation promulgated by the board pursuant to subsection 19
(13) of this section. 20
(15) An advanced practice registered nurse shall not prescribe controlled substances 21
without a CAPA-CS until the board has completed its review and has notified the 22
advanced practice registered nurse in writing that the advanced practice 23
registered nurse is exempt from the CAPA-CS requirement. 24
SECTION 2. A NEW SECTION OF KRS CHAPTER 194A IS CREATED TO 25
READ AS FOLLOWS: 26
(1) There is hereby established within the Office of the Inspector General the 27 UNOFFICIAL COPY 22 RS BR 1419
Page 11 of 12
XXXX Jacketed
Controlled Substance Prescribing Boards Advisory Council. The council shall 1
consist of eight (8) members, including: 2
(a) A representative appointed by each of the following: 3
1. The inspector general of the Cabinet for Health and Family Services; 4
and 5
2. The Kentucky Office of Drug Control Policy; 6
(b) A representative who is currently a licensed prescriber of scheduled drugs, 7
appointed by each of the following licensure boards: 8
1. The Kentucky Board of Dentistry; 9
2. The Kentucky Board of Medical Licensure; 10
3. The Kentucky Board of Nursing; 11
4. The Kentucky Board of Optometric Examiners; and 12
5. The Kentucky Board of Podiatry; and 13
(c) A representative who is a licensed pharmacist, appointed by the Kentucky 14
Board of Pharmacy. 15
(2) The chair of the council shall be the inspector general of the Cabinet for Health 16
and Family Services. 17
(3) The council shall meet at least quarterly to discuss matters relating to the 18
prescribing of controlled substances, including: 19
(a) The most effective means to identify and eliminate prescription drug abuse; 20
(b) Methods to help the professional boards coordinate those efforts; 21
(c) Recommended improvements in data collection and reporting by the 22
electronic system for monitoring controlled substances pursuant to KRS 23
218A.202; 24
(d) Advice, guidance, and recommendations to professional boards on 25
prescribing best practices; and 26
(e) Recommendations to professional boards for a continuing education 27 UNOFFICIAL COPY 22 RS BR 1419
Page 12 of 12
XXXX Jacketed
program on opioid stewardship that may be included as part of the 1
continuing education currently required for all prescribers of controlled 2
substances. 3
(4) The council shall submit an annual report by December 31 of each year to the 4
Governor and to the Legislative Research Commission. The annual report shall: 5
(a) Report the council’s meeting dates and topics for the preceding year; 6
(b) Provide relevant statistical information; 7
(c) Describe the efforts made by the council to share information related to 8
issues with prescribing controlled substances; and 9
(d) Provide any policy recommendations, including recommendations for 10
statutory changes or administrative regulation changes. 11
(5) Members shall not receive any additional compensation for their service on the 12
council but shall be reimbursed for all necessary expenses. 13