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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1419 By: Rosino
AS INTRODUCED
An Act relating to Advanced Unlicensed Assistants;
defining term; directing the Oklahoma Health Care
Authority to establish certain prog ram subject to
certain conditions; stating qualification criteria;
limiting skilled tasks performed by certain Advanced
Unlicensed Assistant s; requiring Registered Nurse or
Licensed Practical Nurse to conduct certain home
visits; directing certain reimbursement of Advanced
Unlicensed Assistant services; requiring certain
agencies to coordinate for implementation; directing
promulgation of rules; requiring application for
certain federal approval; amending 59 O.S. 2021,
Section 567.3a, which relates to defin itions used in
the Oklahoma Nursing Practice Act ; broadening certain
definition; amending 59 O.S. 2021, Section 567.6a,
which relates to Advanced Unlicensed Assistant s;
requiring the Oklahoma Board of Nursing to count
certain training toward completion of prescribed
curricula; providing for codification; providi ng an
effective date; and declaring an emergency .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5013.2 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section, “family member” means a child,
parent, parent-in-law, sibling, grandparent, grandchild, spouse, or
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any other individual related by blood, and any other individual with
a close association that is the equivalent of a family relationship.
B. No later than one year after the effective date of this act
and subject to receipt of federal approval for the program, the
Oklahoma Health Care Authority shall establish a program under which
a family member of a Medicaid enrollee may be certified as an
Advanced Unlicensed Assistant by the Oklahoma Board of Nursing and,
after receiving such certification may, under the direction and
supervision of a Registered Nurse or Licensed Practical Nurse ,
provide Advanced Unlicensed Assistant services to the enrollee
through a licensed home care agency under the reimbursement rates
established under subsection E of this section, provided that the
enrollee qualifies for such services under the state Medicaid
program.
C. The program established under this section shall require the
family member to complete all the training, testing, and other
qualification criteria required under state and federal law for
certification as an Advanced Unlicensed Assistant in a home setting
including, but not limit ed to, qualification criteria established
under the Oklahoma Nursing Practice Act .
D. 1. The skilled tasks performed by an Advanced Unlicensed
Assistant in a home setting under this section shall be subject to
the scope of practice established by the Oklahoma Board of Nursing
for Advanced Unlicensed Assi stants in a home setting.
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2. A Registered Nurse or Licensed Practical Nurse shall conduct
all home visits required by the Oklahoma Health Care Authority at
the enrollee’s home.
E. Advanced Unlicensed Assistant services provided by a family
member of a Medicaid enrollee who becomes cer tified as an Advanced
Unlicensed Assistant under the program established under this
section shall be reimbursed to a home care agency at a rate
established by the Oklahoma Health Care Authority.
F. 1. The Authority and the Oklahoma Board of Nursing shall
coordinate and share information as necessary to implement this
section.
2. The Oklahoma Health Care Authority Board and the Oklahoma
Board of Nursing shall promulgate rules as necessary to implement
this section.
3. The Administrator of the Authority shall apply for such
state plan amendments or waivers as may be necessary to implement
this section and secure federal financial participation for state
Medicaid expenditures under the federal Medi caid program.
SECTION 2. AMENDATORY 59 O.S. 2021, Section 567.3a, is
amended to read as follows:
Section 567.3a. As used in the Oklahoma Nursing Practice Act:
1. “Board” means the Oklahoma Board of Nursing;
2. “The practice of nursing ” means the performance of services
provided for purposes of nursing diagnosis and treatment of human
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responses to actual or potential health problems consistent with
educational preparation. Knowledge and skill are the basis for
assessment, analysis, planning, intervention, a nd evaluation used in
the promotion and maintenance of health and nursing management of
illness, injury, infirmity, restoration or optimal function, or
death with dignity. Practice is based on understanding the human
condition across the human lifespan and understanding the
relationship of the individual within the environment. This
practice includes execution of the medical regime including the
administration of medications and treatments prescribed by any
person authorized by state law to so prescribe;
3. “Registered nursing” means the practice of the full scope of
nursing which includes, but is not limited to:
a. assessing the health status of individual s, families
and groups,
b. analyzing assessment data to determine nursing care
needs,
c. establishing goals to meet identified heal th care
needs,
d. planning a strategy of care,
e. establishing priorities of nursing intervention to
implement the strategy of care,
f. implementing the strategy of care,
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g. delegating such tasks as may safely be performed by
others, consistent with educational preparation and
that do not conflict with the p rovisions of the
Oklahoma Nursing Practice Act,
h. providing safe and ef fective nursing care rendered
directly or indirectly,
i. evaluating responses to interventions,
j. teaching the principles and prac tice of nursing,
k. managing and supervising the practice of n ursing,
l. collaborating with other health professionals in the
management of health care,
m. performing additional nursing functions in accordance
with knowledge and skills acquired beyo nd basic
nursing preparation, and
n. delegating those nursin g tasks as defined in the rules
of the Board that may be performed by an advanced
unlicensed assistive person;
4. “Licensed practical nursing ” means the practice of nursing
under the supervision or dire ction of a registered nurse, licensed
physician or dentist. T his directed scope of nursing practice
includes, but is not limited to:
a. contributing to the assessment of the health status of
individuals and groups,
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b. participating in the development and modification of
the plan of care,
c. implementing the appropriate aspects of the plan of
care,
d. delegating such tasks as ma y safely be performed by
others, consistent with educational preparatio n and
that do not conflict with the Oklahoma Nursing
Practice Act,
e. providing safe and effective nursing care rendered
directly or indirectly,
f. participating in the evaluation of responses to
interventions,
g. teaching basic nursing skills and related principles,
h. performing additional nursing procedures in accordance
with knowledge and skills acquired through education
beyond nursing preparation, and
i. delegating those nursing ta sks as defined in the rules
of the Board that may be performed by an ad vanced
unlicensed assistive person;
5. “Advanced Practice Registered Nurse” means a licensed
Registered Nurse:
a. who has completed an advanced practice registered
nursing education program in preparation for one of
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four recognized advanced practice regis tered nurse
roles,
b. who has passed a national certification examination
recognized by the Board that measures t he advanced
practice registered nurse role and specialty
competencies and who maintains recertification in the
role and specialty through a national certification
program,
c. who has acquired advanced cl inical knowledge and
skills in preparation for providing both direct and
indirect care to patients; however, the defining
factor for all Advanced Practice Registered Nurses is
that a significant c omponent of the education and
practice focuses on direct care of individuals,
d. whose practice builds on the com petencies of
Registered Nurses by demonstrating a greater depth and
breadth of knowledge, a greater synthesis of data, and
increased complexity of skills and interventions, and
e. who has obtained a lice nse as an Advanced Practice
Registered Nurse in one of the fol lowing roles:
Certified Registered Nurse Anesthetist, Certified
Nurse-Midwife, Clinical Nurse Specialist, or Certified
Nurse Practitioner.
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Only those persons who hold a license to practice advanced
practice registered nursing in this state shall have the right to
use the title “Advanced Practice Registered Nurse ” and to use the
abbreviation “APRN”. Only those persons who have obtained a license
in the following disciplines shall have the right to fulfill the
roles and use the applicable titles: Certified Registered Nurse
Anesthetist and the abbreviation “CRNA”, Certified Nurse-Midwife and
the abbreviation “CNM”, Clinical Nurse Speciali st and the
abbreviation “CNS”, and Certified Nurse Practitioner and the
abbreviation “CNP”.
It shall be unlawful for any person to assume the role or use
the title Advanced Practice Reg istered Nurse or use the abbreviation
“APRN” or use the respective specialty role titles and abbreviations
or to use any other titl es or abbreviations that would reasonably
lead a person to bel ieve the user is an Advanced Practice Registered
Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any
individual doing so shall be guilty of a misdem eanor, which shall be
punishable, upon conviction, by imprisonment in the county jai l for
not more than one (1) year or by a fine of not less than One Hundr ed
Dollars ($100.00) nor more than One Thous and Dollars ($1,000.00), or
by both such imprisonment and fine for each offense;
6. “Certified Nurse Practitioner ” is an Advanced Practice
Registered Nurse who performs in an expanded role in the delivery of
health care:
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a. consistent with advanced educational preparation as a
Certified Nurse Practitioner in a n area of specialty,
b. functions within the Certified Nurse Practitioner
scope of practice for the selected area of
specialization, and
c. is in accord with the standards for Certified Nurse
Practitioners as identified by the certifying body and
approved by the Board.
A Certified Nurse Practitioner shall be eligi ble, in accordance
with the scope of practice of the Certified Nurse Practitioner, to
obtain recognition as authorized by the Board to prescribe, as
defined by the rules promulgated by the Board pu rsuant to this
section and subject to the medical direction of a supervising
physician. This authorization shall not include dispensing drugs,
but shall not preclude, subject to federal regulations, the receipt
of, the signing for, or the dispensing of professional samples to
patients.
The Certified Nurse Practit ioner accepts responsibility,
accountability, and obligation to practice in accordance with usual
and customary advanced practice registered nursing standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse Practitioner;
7. a. “Clinical Nurse Specialist” is an Advanced Practice
Registered Nurse who holds:
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(1) a master’s degree or higher in nursing with
clinical specialization preparation to function
in an expanded role,
(2) specialty certification from a national
certifying organization r ecognized by the Board,
(3) an Advanced Practice Registered Nurse license
from the Board, and
(4) any nurse holding a specialty certif ication as a
Clinical Nurse Specialist valid on January 1,
1994, granted by a national certifying
organization recognized by the Board, shall be
deemed to be a Clinical Nurse Specialist under
the provisions of the Oklahoma Nursing Practice
Act.
b. In the expanded role, the Clinical Nurse Specialist
performs at an advanced practice level which shall
include, but not be limited to:
(1) practicing as an expert clinician in the
provision of direct nursing care to a selected
population of patients or clients in any setting,
including private practice,
(2) managing the care of patients or clients with
complex nursing proble ms,
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(3) enhancing patient or client care by integrating
the competencies of clinical practice, education,
consultation, and research, and
(4) referring patients or clients to other services.
c. A Clinical Nurse Specialist in accordance with the
scope of practice of such Clinical Nurse Specialist
shall be eligible to obtain recognition as authorized
by the Board to prescribe, as defined by the rul es
promulgated by the Board p ursuant to this section, and
subject to the medical direction of a supervising
physician. This authorization shall not include
dispensing drugs, but shall not preclude, subject to
federal regulations, the receipt of, the signing for,
or the dispensing of professional samples to patient s.
d. The Clinical Nurse Specialist accepts responsibility,
accountability, and obligation to practice in
accordance with usual and customary advanced practice
nursing standards and functions as d efined by the
scope of practice/role definition statements for the
Clinical Nurse Specialist;
8. “Nurse-Midwife” is a nurse who has received an Advanced
Practice Registered Nurse licen se from the Oklahoma Board of Nursing
who possesses evidence of certification according to the
requirements of the American College of Nurse-Midwives.
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A Certified Nurse-Midwife in accordance wi th the scope of
practice of such Certified Nurse -Midwife shall be eligible to obtain
recognition as authorized by the Board to prescri be, as defined by
the rules promulgated by the Board pursuant to this section and
subject to the medical directio n of a supervising physician. This
authorization shall not include the dispensing of drugs, but shall
not preclude, subject to federal regulations, the receipt of, the
signing for, or the dispensing of professional samples to patients.
The Certified Nurse-Midwife accepts responsibility,
accountability, and obligation to practice in accordance with usual
and customary advanced practice registered nursing standards and
functions as defined by the scope of practice/role definition
statements for the Certified Nurse-Midwife;
9. “Nurse-midwifery practice” means providing managemen t of
care of normal newborns and women, antepartally, intrapartally,
postpartally and gynecologically, occurring within a health ca re
system which provides for medical consultation, medical man agement
or referral, and is in accord with the standards for nurse -midwifery
practice as defined by the American College of Nurse -Midwives;
10. a. “Certified Registered Nurse Anesthetist ” is an
Advanced Practice Registered Nurse who:
(1) is certified by the National Board of
Certification and Recertification for Nurse
Anesthetists as a Certified Registered Nurse
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Anesthetist within one (1) year following
completion of an approved certified registe red
nurse anesthetist education program, and
continues to maintain such recertification by the
National Board of Certification and
Recertification for Nurse Anesthetists, and
(2) administers anesthesia in collaboration with a
medical doctor, an oste opathic physician, a
podiatric physician or a dentist licens ed in this
state and under conditions in which timely onsite
consultation by such doctor, osteopath, podiatric
physician or dentist is available.
b. A Certified Registered Nurse Anesthetist, in
collaboration with a medical doctor, osteopathic
physician, podiatric p hysician or dentist licensed in
this state, and under conditions in which timely, on -
site consultation by such medical doctor, osteopa thic
physician, podiatric phy sician or dentist is
available, shall be authorized, pursuant to rules
adopted by the Oklahoma Board of Nursing, to order,
select, obtain and administer leg end drugs, Schedules
II through V controlled substances, devices, and
medical gases only when engaged in the preanesthetic
preparation and evaluation; anesthesia induction,
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maintenance and emer gence; and postanesthesia care. A
Certified Registered Nurse Anesthetist may order,
select, obtain and administer drugs only during t he
perioperative or periobste trical period.
c. A Certified Registered Nurse Anesthetist who applies
for authorization to order, select, obtain and
administer drugs shall:
(1) be currently recognized as a Certified Registered
Nurse Anesthetist in this state,
(2) provide evidence of completion, within the two -
year period immediately preceding the date of
application, of a minim um of fifteen (15) units
of continuing education in advanced pharmacology
related to the administration of anesthesia as
recognized by the National Board of Certif ication
and Recertification for Nurse Anesthetists, and
(3) complete and submit a no tarized application, on a
form prescribed by the Board, accompanied by t he
application fee established pursuant to this
section.
d. The authority to order, select, obtain and administer
drugs shall be terminated if a Certified Registered
Nurse Anesthetist has:
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(1) ordered, selected, obtained or administered drugs
outside of the Certified Registered Nurse
Anesthetist scope of practice or ordered,
selected, obtained or adminis tered drugs for
other than therapeutic purposes, or
(2) violated any provision of st ate laws or rules or
federal laws or regulations pertaining to the
practice of nursing or the authority to order,
select, obtain and administer drugs.
e. The Oklahoma Board of Nursing shall notify the Bo ard
of Pharmacy after termination of or a change in the
authority to order, select, obtain and administer
drugs for a Certified Registered Nurse Anesthetist.
f. The Board shall provide by rule for biennial
application renewal and reauthorization of authority
to order, select, obtain and administer drugs for
Certified Registered Nurse Anesthetists. At the time
of application renewal, a Certified Registered Nurse
Anesthetist shall submit documentation of a minimum of
eight (8) units of continuing education, completed
during the previous two (2) years, in advanced
pharmacology relating to the administration of
anesthesia, as recognized by the Council on
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Recertification of Nurse Anesthetists or the Cou ncil
on Certification of Nurs e Anesthetists.
g. This paragraph shall not prohibit the administration
of local or topical anesthetics as now permitted by
law. Provided further, nothing in this paragraph
shall limit the authority of the Board of Dentistry to
establish the qualifications for dentists who direct
the administration of anesthesia.
h. As used in this paragraph, “collaboration” means an
agreement between a medical doctor, osteopathic
physician, podiatric physician or dentist performing
the procedure or directly involved with the procedure
and the Certified Registered Nurse Anesthetist working
jointly toward a common goal providing services for
the same patient. This collaborati on involves the
joint formulation, discussion and agreement of the
anesthesia plan by both parties, and the collaborating
medical doctor, osteopathic physician, podiatric
physician or dentist p erforming the procedure or
directly involved with the procedure and that
collaborating physician shall remain available for
timely onsite consultation during the d elivery of
anesthesia for diagnosis, consultation, and treatment
of medical conditions;
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11. “Supervising physician” means an individual holding a
current license to practice as a physician from the State Board of
Medical Licensure and Supervision or the State Board of Osteopathic
Examiners, who supervises a Certified Nurse Practitioner, a Clinica l
Nurse Specialist, or a Certified Nurse -Midwife, and who is not in
training as an intern, resident, or fellow. To be eligible to
supervise such Advanced Practice Registered Nurse, such physician
shall remain in compliance with the rules promulga ted by the State
Board of Medical Licensure and Supervision or the State Board of
Osteopathic Examiners;
12. “Supervision of an Advanced Practice Registered Nurse with
prescriptive authority ” means overseeing and accepting
responsibility for the ordering and trans mission by a Certified
Nurse Practitioner, a Clinical Nurse Specialist, or a Certified
Nurse-Midwife of written, telephonic, electroni c or oral
prescriptions for drugs and other medical supplies, subject to a
defined formulary; and
13. “Advanced Unlicensed Assistant” means any person who has
successfully completed a certified traini ng program approved by the
Board that trains the Advanced Unlicensed Assistant to perform
specified technical skill s identified by the Board in acute care
settings or home settings under the direction and supervision of the
Registered Nurse or Licensed Practical Nurse.
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SECTION 3. AMENDATORY 59 O.S. 2021, Section 567.6a, is
amended to read as follows:
Section 567.6a. A. All applicants for a certificate to
practice as an Advanced Unlicensed Assistant shall be subject to
Section 567.8 of this title.
B. An applicant for a certificate to practice as an Advanced
Unlicensed Assistant shall submit t o the Oklahoma Board of Nursing
certified evidence that the ap plicant:
1. Has successfully completed the prescribed curricula in a
state-approved education program for Advanced Unlicensed Assista nts
and holds or is entitled to hold a diploma or certificate theref rom,
or equivalent courses in a formal program of inst ruction;
2. Has never been convicted of a felony crime that
substantially relates to the occupation of nursing and poses a
reasonable threat to public safety;
3. Has submitted a criminal histo ry records search that is
compliant with Section 567.18 of thi s title;
4. Is a minimum of eighteen (18) years of age; and
5. Has met such other reasonable preliminary qualification
requirements as the Board may prescribe.
C. The applicant for a certificate to p ractice as an Advanced
Unlicensed Assistant shall be r equired to pass an examination in
such subjects as the Board may require. Upon the applicant
successfully passing such examination, the Board may issue to the
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applicant a certificate to practic e as an Advanced Unlicensed
Assistant. An applicant who fails such examination shall be subject
to reexamination according to the rules of the Board. The passing
criteria shall be established by Board rules.
D. Any person who holds a certificate to practice as an
Advanced Unlicensed Assistant in this state shall h ave the right to
use both the title “Advanced Unlicensed Assistant ” and the
abbreviation “A.U.A.”. No other person shall assume such title or
use such abbreviation or any other words, letters, signs, or figures
to indicate that the person using the same i s an Advanced Unlicensed
Assistant. Any individual doing so shall be guilty of a
misdemeanor, which shall be punishable, upon convict ion, by
imprisonment in the c ounty jail for not more than one (1) year or by
a fine of not less than One Hundred Dollars ( $100.00) nor more than
One Thousand Dollars ($1,000.00), or by both such impris onment and
fine for each offense.
E. As part of the prescribed curricula in a state -approved
education program as described in subsection B of this section, the
Board shall allow a portion, as determined by the Board, of the
prescribed curricula for applicants seeking certification to provide
Advanced Unlicensed Assistant services in home settings to be
completed through training pro vided by home care agencies or other
appropriate entities approved by the Board.
F. As used in this section:
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1. “Substantially relates” means the nature of criminal conduct
for which the person was convicted has a direct bearing on the
fitness or ability to perform one or more of the duties or
responsibilities necessarily related to the occupation; and
2. “Poses a reasonable threat ” means the nature of criminal
conduct for which the person was convicted invo lved an act or threat
of harm against another and has a bearing on the fitness or ability
to serve the public or work with others in the occupation.
SECTION 4. This act shall become effe ctive July 1, 2024.
SECTION 5. It being immediately necessary for t he preservation
of the public peace, health or safety, an emer gency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and ap proval.
59-2-2723 DC 12/15/2023 3:50:51 PM