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AN ACT relating to prescriptive authority and making an appropriation therefor. 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 HB 354/GA
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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 HB 354/GA
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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 HB 354/GA
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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 HB 354/GA
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(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 HB 354/GA
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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 HB 354/GA
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(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 HB 354/GA
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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 HB 354/GA
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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. An 17
advanced practice registered nurse who chooses to practice without a 18
CAPA-CS shall be held to the same standard of care as all other providers 19
with prescriptive authority. 20
(f) If the advanced practice registered nurse's license is found not to be in good 21
standing, the CAPA-CS requirement shall not be removed until the license 22
is restored to good standing, as directed by the board. 23
(g) The Kentucky Board of Nursing may conduct random audits of the 24
prescribing practices of advanced practice registered nurses, including 25
those who are no longer required to have a CAPA-CS in order to prescribe, 26
through a review of data obtained from the electronic system for monitoring 27 UNOFFICIAL COPY 22 RS HB 354/GA
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controlled substances pursuant to KRS 218A.202 and may take disciplinary 1
action under KRS 314.091(1) if a violation has occurred. 2
(14) (a) An advanced practice registered nurse wishing to practice in Kentucky 3
through licensure by endorsement is exempt from the CAPA-CS 4
requirement if the advanced practice registered nurse: 5
1. Has met the prescribing requirements for controlled substances in a 6
state that grants such prescribing authority to advanced practice 7
registered nurses; 8
2. Has had authority to prescribe controlled substances for at least four 9
(4) years; and 10
3. Has a license in good standing as described in subsection (13) of this 11
section and in the administrative regulation promulgated by the board 12
pursuant to subsection (13) of this section. 13
(b) An advanced practice registered nurse wishing to practice in Kentucky 14
through licensure by endorsement who has had the authority to prescribe 15
controlled substances for less than four (4) years and wishes to continue to 16
prescribe controlled substances shall enter into a CAPA-CS with a 17
physician licensed in Kentucky until the cumulative four (4) year 18
requirement is met, after which the advanced practice registered nurse who 19
wishes to prescribe controlled substances without a CAPA-CS shall follow 20
the process identified in subsection (13) of this section and in the 21
administrative regulation promulgated by the board pursuant to subsection 22
(13) of this section. 23
(15) An advanced practice registered nurse shall not prescribe controlled substances 24
without a CAPA-CS until the board has completed its review and has notified the 25
advanced practice registered nurse in writing that the advanced practice 26
registered nurse is exempt from the CAPA-CS requirement. 27 UNOFFICIAL COPY 22 RS HB 354/GA
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SECTION 2. A NEW SECTION OF KRS CHAPTER 218A IS CREATED TO 1
READ AS FOLLOWS: 2
(1) There is hereby established the Controlled Substance Prescribing Review Panel 3
to provide investigations and referrals for action to the Kentucky Board of 4
Dentistry, the Kentucky Board of Medical Licensure, and the Kentucky Board of 5
Nursing. 6
(2) The panel shall be located within the Office of the Inspector General in the 7
Cabinet for Health and Family Services. 8
(3) The panel shall consist of: 9
(a) The inspector general, who shall act as chair; 10
(b) The executive director of the Kentucky Board of Dentistry; 11
(c) The executive director of the Kentucky Board of Medical Licensure; 12
(d) The executive director of the Kentucky Board of Nursing; and 13
(e) Three (3) licensed prescribers of controlled substances, of which one (1) 14
licensed prescriber shall be licensed by each the boards listed in subsection 15
(1) of this section. Each board shall provide to the Governor the names of 16
three (3) recommended licensees whose licenses are in good standing and 17
who currently prescribe controlled substances. The Governor shall appoint 18
one (1) of these recommended licensees as a representative of each board. 19
(4) Support staff, facilities, and resources for the meetings and work of the panel 20
shall be provided by the inspector general, including three (3) full-time 21
investigators, with one (1) full-time investigator assigned to each of the three (3) 22
boards serving on the panel for the sole purpose of conducting investigations of 23
controlled substance prescribing by licensees governed by the board through 24
which they are licensed, the funding for which shall come from the 2022 opioid 25
settlement fund. 26
(5) The panel shall: 27 UNOFFICIAL COPY 22 RS HB 354/GA
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(a) Review the quarterly reports issued by the Office of the Inspector General 1
pursuant to KRS 218A.202(17) that identify patterns of potential improper, 2
inappropriate, or illegal prescribing or dispensing of a controlled substance 3
and additional data from the electronic surveillance prescription drug 4
monitoring program established by the state; 5
(b) Initiate an investigation of any prescriber whose prescribing patterns are 6
identified as potentially improper, inappropriate, or illegal; 7
(c) Upon the completion of each investigation, forward the name of the 8
prescriber, a detailed description of the improper, inappropriate, or illegal 9
prescribing pattern, and the results of the investigation including any data, 10
expert review, or testimony collected to the board of jurisdiction so the 11
board shall take up the case for disciplinary action against the prescriber; 12
and 13
(d) Require a response from the board in writing within thirty (30) business 14
days from the receipt of the prescriber’s name and investigative findings 15
and then every thirty (30) business days thereafter to the conclusion of the 16
case by the board. These responses shall include a description of the review 17
taken by the board and the disciplinary action taken or the reason for action 18
not being taken. 19
(6) The panel shall meet at regular intervals and no less than quarterly, and at the 20
call of the inspector general. 21
(7) Members of the panel shall be reimbursed for actual expenses incurred in 22
connection with the discharge of their official duties. 23
(8) The panel shall provide an annual report to the Governor and to the Legislative 24
Research Commission by December 1, 2022, and by December 1 of each year 25
thereafter which shall contain the following information for the previous year 26
regarding prescribing and dispensing of controlled substances: 27 UNOFFICIAL COPY 22 RS HB 354/GA
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(a) Number of prescribers referred to each licensure board; 1
(b) Aggregate number, types of violations, and types of disciplinary actions 2
taken by each licensure board; 3
(c) A list from each licensure board that includes the name of the prescriber, 4
the violation or violations, and the disciplinary actions taken; 5
(d) Reasons for not taking disciplinary action by each licensure board; 6
(e) Number of individual prescribers with multiple disciplinary actions taken by 7
their licensure board which included an action in the current year; and 8
(f) Timeliness of reports back to the panel by each licensure board for each 9
referred prescriber. 10
(9) The panel shall sunset on July 15, 2026, unless authorized by the General 11
Assembly to continue its work for a specified period of time. 12