CHAPTER 73
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CHAPTER 73
( SB 94 )
AN ACT relating to prescriptive authority.
Be it enacted by the General Assembly of the Commonwealth of Kentucky:
Section 1. KRS 314.042 is amended to read as follows:
(1) An applicant for licensure to practice as an advanced practice registered nurse shall file with the board a
written application for licensure and submit evidence, verified by oath, that the applicant:
(a) Has completed an education program that prepares the registered nurse for one (1) of four (4) APRN
roles that has been accredited by a national nursing accrediting body recognized by the United States
Department of Education;
(b) Is certified by a nationally established organization or agency recognized by the board to certify
registered nurses for advanced practice registered nursing;
(c) Is able to understandably speak and write the English language and to read the English language with
comprehension; and
(d) Has passed the jurisprudence examination approved by the board as provided in subsection (13)[(12)]
of this section.
(2) The board may issue a license to practice advanced practice registered nursing to an applicant who holds a
current active registered nurse license issued by the board or holds the privilege to practice as a registered
nurse in this state and meets the qualifications of subsection (1) of this section. An advanced practice
registered nurse shall be:
(a) Designated by the board as a certified registered nurse anesthetist, certified nurse midwife, certified
nurse practitioner, or clinical nurse specialist; and
(b) Certified in at least one (1) population focus.
(3) The applicant for licensure or renewal thereof to practice as an advanced practice registered nurse shall pay a
fee to the board as set forth in regulation by the board.
(4) An advanced practice registered nurse shall maintain a current active registered nurse license issued by the
board or hold the privilege to practice as a registered nurse in this state and maintain current certification by
the appropriate national organization or agency recognized by the board.
(5) Any person who holds a license to practice as an advanced practice registered nurse in this state shall have the
right to use the title "advanced practice registered nurse" and the abbreviation "APRN." No other person shall
assume the title or use the abbreviation or any other words, letters, signs, or figures to indicate that the person
using the same is an advanced practice registered nurse. No person shall practice as an advanced practice
registered nurse unless licensed under this section.
(6) Any person heretofore licensed as an advanced practice registered nurse under the provisions of this chapter
who has allowed the license to lapse may be reinstated on payment of the current fee and by meeting the
provisions of this chapter and regulations promulgated by the board pursuant to the provisions of KRS Chapter
13A.
(7) The board may authorize a person to practice as an advanced practice registered nurse temporarily and
pursuant to applicable regulations promulgated by the board pursuant to the provisions of KRS Chapter 13A if
the person is awaiting licensure by endorsement.
(8) (a) Except as authorized by subsection (9) of this section, before an advanced practice registered nurse
engages in the prescribing or dispensing of nonscheduled legend drugs as authorized by KRS
314.011(8), the advanced practice registered nurse shall enter into a written "Collaborative Agreement
for the Advanced Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend Drugs"
(CAPA-NS) with a physician licensed in Kentucky that defines the scope of the prescriptive authority
for nonscheduled legend drugs. ACTS OF THE GENERAL ASSEMBLY 2
(b) The advanced practice registered nurse shall notify the Kentucky Board of Nursing of the existence of
the CAPA-NS and the name of the collaborating physician and shall, upon request, furnish to the board
or its staff a copy of the completed CAPA-NS. The Kentucky Board of Nursing shall notify the
Kentucky Board of Medical Licensure that a CAPA-NS exists and furnish the collaborating physician's
name.
(c) The CAPA-NS shall be in writing and signed by both the advanced practice registered nurse and the
collaborating physician. A copy of the completed collaborative agreement shall be available at each site
where the advanced practice registered nurse is providing patient care.
(d) The CAPA-NS shall describe the arrangement for collaboration and communication between the
advanced practice registered nurse and the collaborating physician regarding the prescribing of
nonscheduled legend drugs by the advanced practice registered nurse.
(e) The advanced practice registered nurse who is prescribing nonscheduled legend drugs and the
collaborating physician shall be qualified in the same or a similar specialty.
(f) The CAPA-NS is not intended to be a substitute for the exercise of professional judgment by the
advanced practice registered nurse or by the collaborating physician.
(g) The CAPA-NS shall be reviewed and signed by both the advanced practice registered nurse and the
collaborating physician and may be rescinded by either party upon written notice to the other party and
the Kentucky Board of Nursing.
(9) (a) Before an advanced practice registered nurse may discontinue or be exempt from a CAPA-NS required
under subsection (8) of this section, the advanced practice registered nurse shall have completed four
(4) years of prescribing as a certified nurse practitioner, clinical nurse specialist, certified nurse
midwife, or as a certified registered nurse anesthetist. For nurse practitioners and clinical nurse
specialists, the four (4) years of prescribing shall be in a population focus as defined in KRS 314.011.
(b) After four (4) years of prescribing with a CAPA-NS in collaboration with a physician:
1. An advanced practice registered nurse whose license is in good standing at that time with the
Kentucky Board of Nursing and who will be prescribing nonscheduled legend drugs without a
CAPA-NS shall notify that board that the four (4) year requirement has been met and that he or
she will be prescribing nonscheduled legend drugs without a CAPA-NS;
2. The advanced practice registered nurse will no longer be required to maintain a CAPA-NS and
shall not be compelled to maintain a CAPA-NS as a condition to prescribe after the four (4) years
have expired, but an advanced practice registered nurse may choose to maintain a CAPA-NS
indefinitely after the four (4) years have expired; and
3. If the advanced practice registered nurse's license is not in good standing, the CAPA-NS
requirement shall not be removed until the license is restored to good standing.
(c) An advanced practice registered nurse wishing to practice in Kentucky through licensure by
endorsement is exempt from the CAPA-NS requirement if the advanced practice registered nurse:
1. Has met the prescribing requirements in a state that grants independent prescribing to advanced
practice registered nurses; and
2. Has been prescribing for at least four (4) years.
(d) An advanced practice registered nurse wishing to practice in Kentucky through licensure by
endorsement who had a collaborative prescribing agreement with a physician in another state for at least
four (4) years is exempt from the CAPA-NS requirement.
(10) (a) There is hereby established the "Collaborative Agreement for the Advanced Practice Registered
Nurse's Prescriptive Authority for Controlled Substances" (CAPA-CS) Committee. The committee
shall be composed of four (4) members selected as follows:
1. Two (2) members shall be advanced practice registered nurses who currently prescribe or have
prescribed scheduled drugs, each appointed by the Kentucky Board of Nursing from a list of
names submitted for each position by the Kentucky Association of Nurse Practitioners and
Nurse-Midwives; and CHAPTER 73
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2. Two (2) members shall be physicians who have currently or had previously a signed CAPA-CS
with an advanced practice registered nurse who prescribes scheduled drugs, each appointed by
the Kentucky Board of Medical Licensure from a list of names submitted for each position by
the Kentucky Medical Association.
(b) Within sixty (60) days of the effective date of this Act, the committee shall develop a standardized
CAPA-CS form to be used in accordance with the provisions of subsection (11) of this section. The
standardized CAPA-CS form shall be used by all advanced practice registered nurses and all
physicians in Kentucky who enter into a CAPA-CS.
(c) The committee may be reconvened at the request of the Kentucky Board of Nursing or the Kentucky
Board of Medical Licensure if it becomes necessary to update the standardized CAPA-CS form.
(d) The Kentucky Board of Nursing and the Kentucky Board of Medical Licensure shall each be
responsible for and have exclusive authority over their respective members appointed to the
committee.
(e) The committee shall be attached to the Kentucky Board of Nursing for administrative purposes. The
Kentucky Board of Nursing shall be responsible for the expenses of its members. The Kentucky
Board of Medical Licensure shall be responsible for the expenses of its members.
(f) The Kentucky Board of Nursing shall promulgate an administrative regulation pursuant to KRS
Chapter 13A within ninety (90) days of the effective date of this Act to establish and implement the
standardized CAPA-CS form developed by the committee.
(11) (a) Except as provided in subsections (14) and (15) of this section, before an advanced practice registered
nurse engages in the prescribing of Schedules II through V controlled substances as authorized by KRS
314.011(8), the advanced practice registered nurse shall enter into a written "Collaborative Agreement
for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances"
(CAPA-CS) on a standardized CAPA-CS form with a physician licensed in Kentucky that defines the
scope of the prescriptive authority for controlled substances.
(b) The advanced practice registered nurse shall notify the Kentucky Board of Nursing of the existence of
the CAPA-CS and the name of the collaborating physician and shall, upon request, furnish to the board
or its staff a copy of the completed standardized CAPA-CS form. The Kentucky Board of Nursing shall
notify the Kentucky Board of Medical Licensure that a CAPA-CS exists and furnish an executed copy
of the Kentucky Board of Nursing notification of a CAPA-CS completed by the advanced practice
registered nurse to the Kentucky Board of Medical Licensure[the collaborating physician's name].
(c) The CAPA-CS shall be in writing and signed by both the advanced practice registered nurse and the
collaborating physician. A copy of the completed standardized CAPA-CS form[collaborative
agreement] shall be available at each site where the advanced practice registered nurse is providing
patient care.
(d) The CAPA-CS shall describe the arrangement for collaboration and communication between the
advanced practice registered nurse and the collaborating physician regarding the prescribing of
controlled substances by the advanced practice registered nurse.
(e) The advanced practice registered nurse who is prescribing controlled substances and the collaborating
physician shall be qualified in the same or a similar specialty.
(f) The CAPA-CS is not intended to be a substitute for the appropriate exercise of professional judgment
by the advanced practice registered nurse or by the collaborating physician.
(g) The relevant statutes and regulations pertaining to the prescribing authority of advanced practice
registered nurses for controlled substances shall be reviewed by the advanced practice registered
nurse and the collaborating physician at the outset of the CAPA-CS[Before engaging in the
prescribing of controlled substances, the advanced practice registered nurse shall:
1. Have been licensed to practice as an advanced practice registered nurse for one (1) year with the
Kentucky Board of Nursing; or
2. Be nationally certified as an advanced practice registered nurse and be registered, certified, or
licensed in good standing as an advanced practice registered nurse in another state for one (1)
year prior to applying for licensure by endorsement in Kentucky]. ACTS OF THE GENERAL ASSEMBLY 4
(h) Prior to prescribing controlled substances, the advanced practice registered nurse shall obtain a
Controlled Substance Registration Certificate through the United States[U.S.] Drug Enforcement
Administration[Agency].
(i) The CAPA-CS shall be reviewed and signed by both the advanced practice registered nurse and the
collaborating physician and may be rescinded by either party upon thirty (30) days written notice to the
other party. The advanced practice registered nurse shall notify the Kentucky Board of Nursing that
the CAPA-CS has been rescinded. The Kentucky Board of Nursing shall notify the Kentucky Board
of Medical Licensure that the CAPA-CS has been rescinded and shall furnish an executed copy of
the Kentucky Board of Nursing recission of a CAPA-CS completed by the advanced practice
registered nurse or by the collaborating physician to the Kentucky Board of Medical Licensure[ and
the Kentucky Board of Nursing].
(j) The CAPA-CS shall state any[the] limits on controlled substances which may be prescribed by the
advanced practice registered nurse, as agreed to by the advanced practice registered nurse and the
collaborating physician. The limits so imposed may be more stringent than either the schedule limits on
controlled substances established in KRS 314.011(8) or the limits imposed in regulations promulgated
by the Kentucky Board of Nursing thereunder. The CAPA-CS shall also include any requirements, as
agreed to by both the advanced practice registered nurse and the collaborating physician, for
communication between the advanced practice registered nurse and the collaborating physician.
(k) Within thirty (30) days of obtaining a Controlled Substance Registration Certificate from the United
States Drug Enforcement Administration, and prior to prescribing controlled substances, the advanced
practice registered nurse shall register with the electronic system for monitoring controlled substances
established by KRS 218A.202 and shall provide a copy of the registration certificate to the board.
(l) After the effective date of this Act, for advanced practice registered nurses who have not had a
CAPA-CS:
1. An advanced practice registered nurse wishing to have a CAPA-CS in his or her first year of
licensure must be employed by a health care entity or provider. If the employing provider is an
advanced practice registered nurse, he or she must have completed four (4) years of
prescribing with a CAPA-CS and no longer be required to maintain a CAPA-CS;
2. In the first year of the CAPA-CS, the advanced practice registered nurse and the physician
shall meet at least quarterly, either in person or via video conferencing, to review the advanced
practice registered nurse's reverse KASPER report or that of the prescription drug monitoring
program (PDMP) currently in use in Kentucky pursuant to KRS 218A.202. The advanced
practice registered nurse and the collaborating physician may meet via telephonic
communication when an in-person meeting or videoconferencing session is not logistically or
technologically feasible. The review of specific prescriptions identified in the reverse KASPER
report or that of the PDMP currently in use in Kentucky pursuant to KRS 218A.202 by the
advanced practice registered nurse and the collaborating physician may include information
from the patient's medical record that relates to the condition or conditions being treated with
controlled substances by the advanced practice registered nurse to facilitate meaningful
discussion. A record of the meeting date, summary of discussions, and any recommendations
made shall be made in writing and a copy retained by both parties to the agreement for a
period of one (1) year past the expiration of the CAPA-CS. The meeting records shall be
subject to audit by the Kentucky Board of Nursing for the advanced practice registered nurse
and by the Kentucky Board of Medical Licensure for the physician. The sole purpose of the
audit shall be to document that the collaboration meetings have taken place as required by this
section and that other provisions of this section have been met; and
3. In the ensuing three (3) years of the CAPA-CS, the advanced practice registered nurse and the
physician shall meet at least biannually in person or via video conferencing to review the
advanced practice registered nurse's reverse KASPER report or that of the PDMP currently in
use in Kentucky pursuant to KRS 218A.202. The advanced practice registered nurse and the
collaborating physician may meet via telephonic communication when an in-person meeting
or videoconferencing session is not logistically or technologically feasible. The review of
specific prescriptions identified in the reverse KASPER report or that of the PDMP currently
in use in Kentucky pursuant to KRS 218A.202 by the advanced practice registered nurse and
the collaborating physician may include information from the patient's medical record that
relates to the condition or conditions being treated with controlled substances by the advanced CHAPTER 73
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practice registered nurse to facilitate meaningful discussion. A record of the meeting date,
summary of discussions, and any recommendations made shall be noted in writing and a copy
retained by both parties to the agreement for a period of one (1) year past the expiration of the
CAPA-CS. The meeting records shall be subject to audit by the Kentucky Board of Nursing for
the advanced practice registered nurse and by the Kentucky Board of Medical Licensure for
the physician. The sole purpose of the audit shall be to document that the collaboration
meetings have taken place as required by this section and that other provisions of this section
have been met.
(12)[(11)] Nothing in this chapter shall be construed as requiring an advanced practice registered nurse designated
by the board as a certified registered nurse anesthetist to enter into a collaborative agreement with a physician,
pursuant to this chapter or any other provision of law, in order to deliver anesthesia care.
(13)[(12)] The jurisprudence examination shall be prescribed by the board and be conducted on the licensing
requirements under this chapter and board regulations and requirements applicable to advanced practice
registered nursing in this Commonwealth. The board shall promulgate administrative regulations in
accordance with KRS Chapter 13A, establishing the provisions to meet this requirement.
(14) (a) Except as provided in subsection (15) of this section, an advanced practice registered nurse who
wishes to continue to prescribe controlled substances may be exempt from a CAPA-CS required
under subsection (11) of this section if the advanced practice registered nurse has:
1. Completed four (4) years of prescribing authority for controlled substances with a CAPA-CS;
2. Maintained a United States Drug Enforcement Administration registration; and
3. Maintained a master account with KASPER or the PDMP currently in use in Kentucky
pursuant to KRS 218A.202.
(b) On or after the effective date of this Act:
1. An advanced practice registered nurse who has had four (4) years of prescribing authority
with a CAPA-CS and who wishes to prescribe controlled substances without a CAPA-CS shall
submit, via the APRN update portal, a request for review from the Kentucky Board of Nursing
that the advanced practice registered nurse's license is in good standing;
2. An advanced practice registered nurse who has fewer than four (4) years of prescribing
authority with a CAPA-CS and who wishes to prescribe controlled substances without a
CAPA-CS shall complete the required number of years under the then-current CAPA-CS to
reach four (4) years and shall submit, via the APRN update portal, a request for review from
the Kentucky Board of Nursing that the advanced practice registered nurse's license is in good
standing. However, if the then current CAPA-CS expires or is rescinded prior to the end of the
four (4) year term, a new CAPA-CS shall be required and subject to the provisions of this
section;
3. The advanced practice registered nurse shall not prescribe controlled substances without a
CAPA-CS until the board has completed its review and has notified the advanced practice
registered nurse in writing that the advanced practice registered nurse is exempt from the
CAPA-CS requirement; and
4. The review request shall include the payment of a fee set by the board through the
promulgation of an administrative regulation.
(c) Upon receipt of a request pursuant to this subsection, the Kentucky Board of Nursing shall perform a
review to determine whether the license of the advanced practice registered nurse is in good standing
based upon an evaluation of the criteria specified in this subsection and in the administrative
regulation promulgated by the board pursuant to this subsection, including but not limited to
verification:
1. That a current United States Drug Enforcement Administration registration certificate for the
advanced practice registered nurse is on file with the board;
2. That a current CAPA-CS notification for the advanced practice registered nurse is on file with
the board; ACTS OF THE GENERAL ASSEMBLY 6
3. That the advanced practice registered nurse has an active master account with the electronic
system for monitoring controlled substances pursuant to KRS 218A.202;
4. Through a criminal background check of the absence of any unreported misdemeanor or
felony convictions in Kentucky; and
5. Through a check of the coordinated licensure information system specified in KRS 314.475 of
the absence of any unreported disciplinary actions in another state.
(d) Based on the findings of these actions, the Kentucky Board of Nursing shall determine if the
advanced practice registered nurse's license is in good standing for the purpose of removing the
requirement for the advanced practice registered nurse to have a CAPA-CS in order to prescribe
controlled substances.
(e) If the advanced practice registered nurse's license is found to be in good standing, the advanced
practice registered nurse shall be notified by the board in writing that a CAPA-CS is no longer
required. The advanced practice registered nurse shall not be required to maintain a CAPA-CS as a
condition to prescribe controlled substances unless the board later imposes such a requirement as
part of an action instituted under KRS 314.091(1). An advanced practice registered nurse may
choose to maintain a CAPA-CS indefinitely after the determination of good standing has been made.
An advanced practice registered nurse who chooses to prescribe without a CAPA-CS shall be held to
the same standard of care as all other providers with prescriptive authority.
(f) If the advanced practice registered nurse's license is found not to be in good standing, the CAPA-CS
requirement shall not be removed until the license is restored to good standing, as directed by the
board.
(g) The Kentucky Board of Nursing shall conduct random audits of the prescribing practices of
advanced practice registered nurses, including those who are no longer required to have a CAPA-CS
in order to prescribe, through a review of data obtained from the KASPER report or that of the
PDMP currently in use in Kentucky pursuant to KRS 218A.202 and shall take disciplinary action
under KRS 314.091(1) if a violation has occurred.
(15) (a) An advanced practice registered nurse wishing to practice in Kentucky through licensure by
endorsement is exempt from the CAPA-CS requirement if the advanced practice registered nurse:
1. Has met the prescribing requirements for controlled substances in a state that grants such
prescribing authority to advanced practice registered nurses;
2. Has had authority to prescribe controlled substances for at least four (4) years; and
3. Has a license in good standing as described in subsection (14) of this section and in the
administrative regulation promulgated by the board pursuant to subsection (14) of this section.
(b) An advanced practice registered nurse wishing to practice in Kentucky through licensure by
endorsement who has had the authority to prescribe controlled substances for less than four (4) years
and wishes to continue to prescribe controlled substances shall enter into a CAPA-CS with a
physician licensed in Kentucky and comply with the provisions of this section until the cumulative
four (4) year requirement is met, after which the advanced practice registered nurse who wishes to
prescribe controlled substances without a CAPA-CS shall follow the process identified in subsection
(14) of this section and in the administrative regulation promulgated by the board pursuant to
subsection (14) of this section.
(16) An advanced practice registered nurse shall not prescribe controlled substances without a CAPA-CS until
the board has completed its review and has notified the advanced practice registered nurse in writing that
the advanced practice registered nurse is exempt from the CAPA-CS requirement.
SECTION 2. A NEW SECTION OF KRS CHAPTER 218A IS CREATED TO READ AS FOLLOWS:
(1) The Controlled Substances Prescribing Council is hereby established under the Office of the Inspector
General. The council shall consist of the following fifteen (15) members:
(a) The Inspector General of the Cabinet for Health and Family Services, who shall serve as chair of the
council;
(b) The executive director of the Office of Drug Control Policy; CHAPTER 73
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(c) Two (2) currently licensed prescribers of scheduled drugs selected by the Kentucky Board of
Dentistry, one (1) of whom shall be a dentist and one (1) of who shall be an oral surgeon;
(d) Four (4) licensed physicians who currently prescribe scheduled drugs selected by the Kentucky
Board of Medical Licensure, one (1) of whom shall have a specialty in primary care, one (1) of whom
shall have a specialty in emergency medicine, one (1) of whom shall have a specialty in psychiatry or
addiction medicine, and one (1) of whom shall have a specialty in pain management;
(e) Four (4) licensed advanced practice registered nurses who currently prescribe scheduled drugs
selected by the Kentucky Board of Nursing, one (1) of whom shall have a specialty in primary care,
one (1) whom shall have a specialty in acute care, one (1) of whom shall have a specialty in
psychiatric mental health or addiction, and one (1) of whom shall have a specialty in pain
management;
(f) One (1) licensed prescriber of scheduled drugs selected by the Kentucky Board of Optometric
Examiners;
(g) One (1) licensed prescriber of scheduled drugs selected by the Kentucky Board of Podiatry; and
(h) One (1) licensed pharmacist selected by the Kentucky Board of Pharmacy.
(2) The council shall meet at least quarterly to discuss matters relating to the safe and appropriate prescribing
and dispensing of controlled substances, including:
(a) The review of quarterly reports issued by the Office of the Inspector General pursuant to KRS
218A.202(17) to identify potential improper, inappropriate, or illegal prescribing or dispensing of
controlled substances by examining aggregate patterns of prescribing by profession of the prescriber
and county where the medication was prescribed and dispensed;
(b) Recommendations for improvements in data collection and reporting by the electronic system for
monitoring controlled substances pursuant to KRS 218A.202;
(c) Recommendations for best prescribing practices based on up-to-date research;
(d) Recommendations to the professional licensing boards for actions to aid in enforcing current law,
reviewing prescribing and dispensing data, and correcting improper, inappropriate, or illegal
prescribing or dispensing of a controlled substance; and
(e) Development and communication of any recommendations, based on review of data or research, to
each licensure board. The licensure boards shall respond in writing to the panel within ninety (90)
days of receiving the recommendations with an explanation of their response to the
recommendations.
(3) The council may request information from the licensure boards regarding their procedures for conducting
investigations and taking actions regarding the possible improper, inappropriate, or illegal prescribing or
dispensing of controlled substances.
(4) On or before December 31, 2024, and each December 31 thereafter, the council shall submit an annual
report to the Governor and the Legislative Research Commission. The annual report shall:
(a) List the council’s meeting dates and topics for the preceding year;
(b) Provide relevant statistical information, including a summary of the aggregate patterns by profession
of prescriber and by county, of potential improper, inappropriate, or illegal prescribing or dispensing
of a controlled substance;
(c) Describe the efforts made by the council to share information among the licensure boards related to
improving the safe and appropriate prescribing and dispensing of controlled substances;
(d) Summarize responses received from the licensure boards to the panel’s recommendations; and
(e) Provide any policy recommendations, including recommendations for statutory or administrative
regulation changes intended to improve prescribing and dispensing practices and prevent improper,
inappropriate, or illegal prescribing or dispensing of controlled substances.
(5) The council shall not make any recommendations related to the scope of practice of any prescribing or
dispensing professionals. ACTS OF THE GENERAL ASSEMBLY 8
(6) The council shall be attached to the Office of the Inspector General for administrative purposes.
(7) Members shall not receive any additional compensation for their service on the council but shall be
reimbursed for all necessary expenses.
Signed by Governor March 23, 2023.