Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB154 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 154
5	5	April 10, 2023 - Introduced by Representatives MAGNAFICI, ARMSTRONG, BEHNKE,
6	6	BODDEN, DITTRICH, DONOVAN, GREEN, GUNDRUM, GUSTAFSON, S. JOHNSON,
7	7	KITCHENS, KRUG, KURTZ, MACCO, MURPHY, NOVAK, RODRIGUEZ, SCHMIDT,
8	8	SCHRAA, SCHUTT, SORTWELL, STEFFEN, TITTL, TUSLER, WICHGERS and NEDWESKI,
9	9	cosponsored by Senators TESTIN, CABRAL-GUEVARA, ROYS, BALLWEG, COWLES,
10	10	FELZKOWSKI, JACQUE, MARKLEIN, NASS, QUINN, STROEBEL and TAYLOR. Referred
11	11	to Committee on Health, Aging and Long-Term Care.
12	12	*AUTHORS SUBJECT TO CHANGE*
13	13	AN ACT to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 8.,
14	14	252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a) 4m., 440.08 (2)
15	15	(a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16, 441.19, 448.035 (1)
16	16	(a), 450.01 (1m) and 655.001 (9); to renumber 655.001 (1); to renumber and
17	17	amend 146.89 (1) (r) 3., 253.13 (1), 255.06 (1) (d), 441.06 (7) and 441.11 (2); to
18	18	amend 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2)
19	19	(cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 29.193 (3) (a), 45.40 (1g) (a), 46.03
20	20	(44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k),
21	21	50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8) (intro.), 77.54 (14) (f) 4., 97.59,
22	22	102.13 (1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4., 102.13 (1) (d) 1., 2., 3. and 4.,
23	23	102.13 (2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and 2., 102.29 (3), 102.42 (2) (a),
24	24	106.30 (1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1) (e), 118.2925 (3), 118.2925 (4)
25	25	(c), 118.2925 (5), 146.615 (1) (a), 146.82 (3) (a), 146.89 (1) (r) 1., 146.89 (6),
26	26	154.01 (1g), 252.07 (8) (a) 2., 252.07 (9) (c), 252.10 (7), 252.11 (2), (4), (5) and (7),
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42	42	ASSEMBLY BILL 154
43	43	252.11 (10), 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3.
44	44	and (7m) (intro.) and (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 253.07 (4)
45	45	(d), 253.115 (4), 253.115 (7) (a) (intro.), 253.15 (2), 255.06 (2) (d), 255.07 (1) (d),
46	46	257.01 (5) (a) and (b), 341.14 (1a), (1e) (a), (1m) and (1q), 343.16 (5) (a), 343.51
47	47	(1), 343.62 (4) (a) 4., 440.077 (1) (a), 440.077 (2) (c), 440.094 (1) (c) 1., 440.094
48	48	(2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01 (4), 441.01
49	49	(7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g) (intro.), (a), (c)
50	50	and (e), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b), 441.18 (3), 448.03 (2) (a),
51	51	448.035 (2) to (4), 448.56 (1) and (1m) (b), 448.62 (2m), 448.67 (2), 448.956 (1m),
52	52	450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1) (e), 450.11 (1g) (b), 450.11 (1i)
53	53	(a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11 (8) (e), 450.13 (5) (b), 450.135 (7)
54	54	(b), 462.04, 655.001 (7t), 655.002 (1) (a), 655.002 (1) (b), 655.002 (1) (c), 655.002
55	55	(1) (d), 655.002 (1) (e), 655.002 (1) (em), 655.002 (2) (a), 655.002 (2) (b), 655.003
56	56	(1), 655.003 (3), 655.005 (2) (a), 655.005 (2) (b), 655.23 (5m), 655.27 (3) (a) 4.,
57	57	655.27 (3) (b) 2m., 655.275 (2), 655.275 (5) (b) 2., 961.01 (19) (a) and 961.395;
58	58	to repeal and recreate 155.01 (1g) (b), 251.01 (1c) and 441.06 (title); and to
59	59	create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03 (13)
60	60	(b) 39m., 440.08 (2) (a) 47r., 441.001 (1c), 441.001 (3c), 441.001 (3g), 441.001
61	61	(3n), 441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.09, 441.092 and
62	62	655.001 (1g) of the statutes; relating to: advanced practice registered nurses,
63	63	extending the time limit for emergency rule procedures, providing an
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87	87	ASSEMBLY BILL 154
88	88	exemption from emergency rule procedures, and granting rule-making
89	89	authority.
90	90	Analysis by the Legislative Reference Bureau
91	91	NURSING PRACTICE AND LICENSURE
92	92	This bill makes various changes to practice, licensure, and certification
93	93	requirements for nurses, which are administered by the Board of Nursing.
94	94	Licensure of advanced practice registered nurses
95	95	Under current law, a person who wishes to practice professional nursing must
96	96	be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
97	97	additional system of licensure for advanced practice registered nurses (APRNs), to
98	98	be administered by the board. Under the bill, in order to apply for an APRN license,
99	99	a person must 1) hold, or concurrently apply for, an RN license; 2) have completed
100	100	an accredited graduate-level or postgraduate-level education program preparing
101	101	the person to practice as an APRN in one of four recognized roles and hold a current
102	102	national certification approved by the board; 3) possess malpractice liability
103	103	insurance as provided in the bill; 4) pay a fee determined by the Department of Safety
104	104	and Professional Services; and 5) satisfy certain other criteria specified in the bill.
105	105	The bill also allows a person who has not completed an accredited education program
106	106	described above to receive an APRN license if the person 1) on January 1, 2024, is
107	107	both licensed as an RN in Wisconsin and practicing in one of the four recognized roles;
108	108	and 2) satisfies additional practice or education criteria established by the board.
109	109	The bill also, however, automatically grants licenses to certain RNs, as further
110	110	described below. The four recognized roles, as defined in the bill, are 1) certified
111	111	nurse-midwife; 2) certified registered nurse anesthetist; 3) clinical nurse specialist;
112	112	and 4) nurse practitioner. The bill requires the board, upon granting a person an
113	113	APRN license, to also grant the person one or more specialty designations
114	114	corresponding to the recognized role or roles for which the person qualifies.
115	115	Under the bill, all APRNs, except APRNs with a certified nurse-midwife
116	116	specialty designation, must practice in collaboration with a physician or dentist.
117	117	However, under the bill, an APRN may practice without being supervised by a
118	118	physician or dentist if the Board of Nursing verifies that the APRN has completed
119	119	3,840 clinical hours of advanced practice registered nursing practice in their
120	120	recognized role while working with a physician or dentist during those 3,840 hours
121	121	of practice. APRNs with a certified nurse-midwife specialty designation are instead
122	122	required, if they offer to deliver babies outside of a hospital setting, to file and keep
123	123	current with the board a proactive plan for involving a hospital or a physician who
124	124	has admitting privileges at a hospital in the treatment of patients with higher acuity
125	125	or emergency care needs, as further described below. Additionally, under the bill, an
126	126	APRN may provide pain management services only while working in a collaborative
127	127	relationship with a physician or, if the APRN has qualified to practice independently,
128	128	in a hospital or clinic associated with a hospital.
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132	132	ASSEMBLY BILL 154
133	133	The holder of an APRN license may append the title “A.P.R.N." to his or her
134	134	name, as well as a title corresponding to whichever specialty designations that the
135	135	person possesses. The bill prohibits any person from using the title “A.P.R.N.," and
136	136	from otherwise indicating that he or she is an APRN, unless the person is licensed
137	137	by the board as an APRN. The bill also prohibits the use of titles and abbreviations
138	138	corresponding to a recognized role unless the person has a specialty designation for
139	139	that role. However, the bill allows an APRN to delegate a task or order to another
140	140	clinically trained health care worker if the task or order is within the scope of the
141	141	APRN's practice, the APRN is competent to perform the task or issue the order, and
142	142	the APRN has reasonable evidence that the health care worker is minimally
143	143	competent to perform the task or issue the order under the circumstances. The bill
144	144	requires an APRN to adhere to professional standards when managing situations
145	145	that are beyond the APRN's expertise.
146	146	Under the bill, when an APRN renews his or her APRN license, the board must
147	147	grant the person the renewal of both the person's RN license and the person's APRN
148	148	license. The bill requires all APRNs to complete continuing education requirements
149	149	each biennium in clinical pharmacology or therapeutics relevant to the APRN's area
150	150	of practice and to satisfy certain other requirements when renewing a license.
151	151	Practice of nurse-midwifery
152	152	This bill repeals licensure and practice requirements specific to
153	153	nurse-midwives and the practice of nurse-midwifery, including specific
154	154	requirements to practice with an obstetrician. Under the bill, “certified
155	155	nurse-midwife" is one of the four recognized roles for APRNs, and a person who is
156	156	licensed as a nurse-midwife under current law is automatically granted an APRN
157	157	license with a certified nurse-midwife specialty designation. The bill otherwise
158	158	allows nurse-midwives to be licensed as APRNs if they satisfy the licensure
159	159	requirements, except that the bill also requires that a person applying for a certified
160	160	nurse-midwife specialty designation be certified by the American Midwifery
161	161	Certification Board. The bill also requires an APRN with a specialty designation as
162	162	a certified nurse-midwife to file with the board, and obtain the board's approval of,
163	163	a plan for ensuring appropriate care or care transitions in treating certain patients
164	164	if the APRN offers to deliver babies outside of a hospital setting.
165	165	Prescribing authority
166	166	Under current law, a person licensed as an RN may apply to the board for a
167	167	certificate to issue prescription orders if the person meets certain requirements
168	168	established by the board. An RN holding a certificate is subject to various practice
169	169	requirements and limitations established by the board and must possess malpractice
170	170	liability insurance in an amount determined by the board.
171	171	The bill eliminates certificates to issue prescription orders and generally
172	172	authorizes APRNs to issue prescription orders. A person who is certified to issue
173	173	prescription orders under current law is automatically granted an APRN license
174	174	with his or her appropriate specialty designation. RNs who are practicing in a
175	175	recognized role on January 1, 2024, but who do not hold a certificate to issue
176	176	prescription orders on that date and who are granted an APRN license under the bill
177	177	may not issue prescription orders. As under current law, an APRN issuing - 5 -2023 - 2024 Legislature
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181	181	prescription orders is subject to various practice requirements and limitations
182	182	established by the board.
183	183	The bill repeals a provision concerning the ability of advanced practice nurses
184	184	who are certified to issue prescription orders and who are required to work in
185	185	collaboration with or under the supervision of a physician to obtain and practice
186	186	under a federal waiver to dispense narcotic drugs to individuals for addiction
187	187	treatment.
188	188	Malpractice liability insurance
189	189	The bill requires all APRNs to maintain malpractice liability insurance in
190	190	coverage amounts specified under current law for physicians and nurse anesthetists
191	191	except for APRNs whose employer has in effect malpractice liability insurance that
192	192	provides the same amount of coverage for the APRN. Additionally, the bill requires
193	193	APRNs who have qualified to practice independently and who practice outside a
194	194	collaborative or employment relationship, but not including those APRNs who only
195	195	practice as a certified nurse-midwife, to participate in the Injured Patients and
196	196	Families Compensation Fund. The Injured Patients and Families Compensation
197	197	Fund provides excess medical malpractice coverage for health care providers who
198	198	participate in the fund and meet all other participation requirements, which
199	199	includes maintaining malpractice liability insurance in coverage amounts specified
200	200	under current law.
201	201	OTHER CHANGES
202	202	The bill makes numerous other changes throughout the statutes relating to
203	203	APRNs, including various terminology changes.
204	204	For further information see the state fiscal estimate, which will be printed as
205	205	an appendix to this bill.
206	206	The people of the state of Wisconsin, represented in senate and assembly, do
207	207	enact as follows:
208	208	SECTION 1. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
209	209	29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
210	210	or both arms or one or both hands and fails to meet the minimum standards of any
211	211	one of the following standard tests, administered under the direction of a licensed
212	212	physician, a licensed physician assistant, a licensed chiropractor, or a certified
213	213	licensed advanced practice registered nurse prescriber:
214	214	SECTION 2. 29.193 (2) (b) 2. of the statutes is amended to read:
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223	223	SECTION 2 ASSEMBLY BILL 154
224	224	29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
225	225	and furnished by the department, which shall include a written statement or report
226	226	prepared and signed by a licensed physician, a licensed physician assistant, a
227	227	licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
228	228	registered nurse prescriber prepared no more than 6 months preceding the
229	229	application and verifying that the applicant is physically disabled.
230	230	SECTION 3. 29.193 (2) (c) 3. of the statutes is amended to read:
231	231	29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
232	232	who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
233	233	subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
234	234	applicant and the recommendation of a licensed physician, a licensed physician
235	235	assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed
236	236	advanced practice registered nurse prescriber selected by the applicant from a list
237	237	of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
238	238	podiatrists, and certified licensed advanced practice nurse prescribers registered
239	239	nurses compiled by the department, the department finds that issuance of a permit
240	240	complies with the intent of this subsection. The use of this review procedure is
241	241	discretionary with the department and all costs of the review procedure shall be paid
242	242	by the applicant.
243	243	SECTION 4. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
244	244	29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
245	245	in one or both arms and fails to meet the minimum standards of the standard upper
246	246	extremity pinch test, the standard grip test, or the standard nine-hole peg test,
247	247	administered under the direction of a licensed physician, a licensed physician
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274	274	SECTION 4
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276	276	assistant, a licensed chiropractor, or a certified licensed advanced practice registered
277	277	nurse prescriber.
278	278	SECTION 5. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
279	279	29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
280	280	one or both shoulders and fails to meet the minimum standards of the standard
281	281	shoulder strength test, administered under the direction of a licensed physician, a
282	282	licensed physician assistant, a licensed chiropractor, or a certified licensed advanced
283	283	practice registered nurse prescriber.
284	284	SECTION 6. 29.193 (2) (e) of the statutes is amended to read:
285	285	29.193 (2) (e) Review of decisions. An applicant denied a permit under this
286	286	subsection, except a permit under par. (c) 3., may obtain a review of that decision by
287	287	a licensed physician, a licensed physician assistant, a licensed chiropractor, a
288	288	licensed podiatrist, or a certified licensed advanced practice registered nurse
289	289	prescriber designated by the department and with an office located in the
290	290	department district in which the applicant resides. The department shall pay for the
291	291	cost of a review under this paragraph unless the denied application on its face fails
292	292	to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
293	293	the only method of review of a decision to deny a permit under this subsection and
294	294	is not subject to further review under ch. 227.
295	295	SECTION 7. 29.193 (3) (a) of the statutes is amended to read:
296	296	29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
297	297	physician assistant, a licensed optometrist, or a certified licensed advanced practice
298	298	registered nurse prescriber stating that his or her sight is impaired to the degree that
299	299	he or she cannot read ordinary newspaper print with or without corrective glasses.
300	300	SECTION 8. 45.40 (1g) (a) of the statutes is amended to read:
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327	327	SECTION 8 ASSEMBLY BILL 154
328	328	45.40 (1g) (a) “Health care provider" means an advanced practice registered
329	329	nurse prescriber certified who may issue prescription orders under s. 441.16 441.09
330	330	(2), an audiologist licensed under ch. 459, a dentist licensed under ch. 447, an
331	331	optometrist licensed under ch. 449, a physician licensed under s. 448.02, or a
332	332	podiatrist licensed under s. 448.63.
333	333	SECTION 9. 46.03 (44) of the statutes is amended to read:
334	334	46.03 (44) SEXUALLY TRANSMITTED DISEASE TREATMENT INFORMATION. Prepare and
335	335	keep current an information sheet to be distributed to a patient by a physician, a
336	336	physician assistant, or certified an advanced practice registered nurse prescriber
337	337	who may issue prescription orders under s. 441.09 (2) providing expedited partner
338	338	therapy to that patient under s. 441.092, 448.035, or 448.9725. The information
339	339	sheet shall include information about sexually transmitted diseases and their
340	340	treatment and about the risk of drug allergies. The information sheet shall also
341	341	include a statement advising a person with questions about the information to
342	342	contact his or her physician, advanced practice registered nurse, pharmacist, or local
343	343	health department, as defined in s. 250.01 (4).
344	344	SECTION 10. 50.01 (1b) of the statutes is repealed.
345	345	SECTION 11. 50.08 (2) of the statutes is amended to read:
346	346	50.08 (2) A physician, an advanced practice registered nurse prescriber
347	347	certified who may issue prescription orders under s. 441.16 441.09 (2), or a physician
348	348	assistant who prescribes a psychotropic medication to a nursing home resident who
349	349	has degenerative brain disorder shall notify the nursing home if the prescribed
350	350	medication has a boxed warning under 21 CFR 201.57.
351	351	SECTION 12. 50.09 (1) (a) (intro.) of the statutes is amended to read:
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378	378	SECTION 12
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380	380	50.09 (1) (a) (intro.) Private and unrestricted communications with the
381	381	resident's family, physician, physician assistant, advanced practice registered nurse
382	382	prescriber, attorney, and any other person, unless medically contraindicated as
383	383	documented by the resident's physician, physician assistant, or advanced practice
384	384	registered nurse prescriber in the resident's medical record, except that
385	385	communications with public officials or with the resident's attorney shall not be
386	386	restricted in any event. The right to private and unrestricted communications shall
387	387	include, but is not limited to, the right to:
388	388	SECTION 13. 50.09 (1) (f) 1. of the statutes is amended to read:
389	389	50.09 (1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
390	390	or both domestic partners under ch. 770 are residents of the same facility, the spouses
391	391	or domestic partners shall be permitted to share a room unless medically
392	392	contraindicated as documented by the resident's physician, physician assistant, or
393	393	advanced practice registered nurse prescriber in the resident's medical record.
394	394	SECTION 14. 50.09 (1) (h) of the statutes is amended to read:
395	395	50.09 (1) (h) Meet with, and participate in activities of social, religious, and
396	396	community groups at the resident's discretion, unless medically contraindicated as
397	397	documented by the resident's physician, physician assistant, or advanced practice
398	398	registered nurse prescriber in the resident's medical record.
399	399	SECTION 15. 50.09 (1) (k) of the statutes is amended to read:
400	400	50.09 (1) (k) Be free from mental and physical abuse, and be free from chemical
401	401	and physical restraints except as authorized in writing by a physician, physician
402	402	assistant, or advanced practice registered nurse prescriber for a specified and
403	403	limited period of time and documented in the resident's medical record. Physical
404	404	restraints may be used in an emergency when necessary to protect the resident from
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431	431	SECTION 15 ASSEMBLY BILL 154
432	432	injury to himself or herself or others or to property. However, authorization for
433	433	continuing use of the physical restraints shall be secured from a physician, physician
434	434	assistant, or advanced practice registered nurse prescriber within 12 hours. Any use
435	435	of physical restraints shall be noted in the resident's medical records. “Physical
436	436	restraints" includes, but is not limited to, any article, device, or garment that
437	437	interferes with the free movement of the resident and that the resident is unable to
438	438	remove easily, and confinement in a locked room.
439	439	SECTION 16. 50.49 (1) (b) (intro.) of the statutes is amended to read:
440	440	50.49 (1) (b) (intro.) “Home health services" means the following items and
441	441	services that are furnished to an individual, who is under the care of a physician,
442	442	physician assistant, or advanced practice registered nurse prescriber, by a home
443	443	health agency, or by others under arrangements made by the home health agency,
444	444	that are under a plan for furnishing those items and services to the individual that
445	445	is established and periodically reviewed by a physician, physician assistant, or
446	446	advanced practice registered nurse prescriber and that are, except as provided in
447	447	subd. 6., provided on a visiting basis in a place of residence used as the individual's
448	448	home:
449	449	SECTION 17. 51.41 (1d) (b) 4. of the statutes is amended to read:
450	450	51.41 (1d) (b) 4. A psychiatric mental health advanced practice registered
451	451	nurse who is suggested by the Milwaukee County board of supervisors. The
452	452	Milwaukee County board of supervisors shall solicit suggestions from organizations
453	453	including the Wisconsin Nurses Association for individuals who specialize in a full
454	454	continuum of behavioral health and medical services including emergency
455	455	detention, inpatient, residential, transitional, partial hospitalization, intensive
456	456	outpatient, and wraparound community-based services. The Milwaukee County
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484	484	SECTION 17
485	485	ASSEMBLY BILL 154
486	486	board of supervisors shall suggest to the Milwaukee County executive 4 psychiatric
487	487	mental health advanced practice registered nurses for this board membership
488	488	position.
489	489	SECTION 18. 70.47 (8) (intro.) of the statutes is amended to read:
490	490	70.47 (8) HEARING. (intro.) The board shall hear upon oath all persons who
491	491	appear before it in relation to the assessment. Instead of appearing in person at the
492	492	hearing, the board may allow the property owner, or the property owner's
493	493	representative, at the request of either person, to appear before the board, under
494	494	oath, by telephone or to submit written statements, under oath, to the board. The
495	495	board shall hear upon oath, by telephone, all ill or disabled persons who present to
496	496	the board a letter from a physician, physician assistant, or advanced practice
497	497	registered nurse prescriber certified under s. 441.16 (2) licensed under ch. 441 that
498	498	confirms their illness or disability. At the request of the property owner or the
499	499	property owner's representative, the board may postpone and reschedule a hearing
500	500	under this subsection, but may not postpone and reschedule a hearing more than
501	501	once during the same session for the same property. The board at such hearing shall
502	502	proceed as follows:
503	503	SECTION 19. 77.54 (14) (f) 3. of the statutes is repealed.
504	504	SECTION 20. 77.54 (14) (f) 4. of the statutes is amended to read:
505	505	77.54 (14) (f) 4. An advanced practice registered nurse who may issue
506	506	prescription orders under s. 441.09 (2).
507	507	SECTION 21. 97.59 of the statutes is amended to read:
508	508	97.59 Handling foods. No person in charge of any public eating place or other
509	509	establishment where food products to be consumed by others are handled may
510	510	knowingly employ any person handling food products who has a disease in a form
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537	537	SECTION 21 ASSEMBLY BILL 154
538	538	that is communicable by food handling. If required by the local health officer or any
539	539	officer of the department for the purposes of an investigation, any person who is
540	540	employed in the handling of foods or is suspected of having a disease in a form that
541	541	is communicable by food handling shall submit to an examination by the officer or
542	542	by a physician, physician assistant, or advanced practice registered nurse prescriber
543	543	designated by the officer. The expense of the examination, if any, shall be paid by the
544	544	person examined. Any person knowingly infected with a disease in a form that is
545	545	communicable by food handling who handles food products to be consumed by others
546	546	and any persons knowingly employing or permitting such a person to handle food
547	547	products to be consumed by others shall be punished as provided by s. 97.72.
548	548	SECTION 22. 102.13 (1) (a) of the statutes is amended to read:
549	549	102.13 (1) (a) Except as provided in sub. (4), whenever compensation is claimed
550	550	by an employee, the employee shall, upon the written request of the employee's
551	551	employer or worker's compensation insurer, submit to reasonable examinations by
552	552	physicians, chiropractors, psychologists, dentists, physician assistants, advanced
553	553	practice nurse prescribers registered nurses, or podiatrists provided and paid for by
554	554	the employer or insurer. No employee who submits to an examination under this
555	555	paragraph is a patient of the examining physician, chiropractor, psychologist,
556	556	dentist, physician assistant, advanced practice registered nurse prescriber, or
557	557	podiatrist for any purpose other than for the purpose of bringing an action under ch.
558	558	655, unless the employee specifically requests treatment from that physician,
559	559	chiropractor, psychologist, dentist, physician assistant, advanced practice registered
560	560	nurse prescriber, or podiatrist.
561	561	SECTION 23. 102.13 (1) (b) (intro.), 1., 3. and 4. of the statutes are amended to
562	562	read:
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590	590	SECTION 23
591	591	ASSEMBLY BILL 154
592	592	102.13 (1) (b) (intro.) An employer or insurer who requests that an employee
593	593	submit to reasonable examination under par. (a) or (am) shall tender to the employee,
594	594	before the examination, all necessary expenses including transportation expenses.
595	595	The employee is entitled to have a physician, chiropractor, psychologist, dentist,
596	596	physician assistant, advanced practice registered nurse prescriber, or podiatrist
597	597	provided by himself or herself present at the examination and to receive a copy of all
598	598	reports of the examination that are prepared by the examining physician,
599	599	chiropractor, psychologist, podiatrist, dentist, physician assistant, advanced
600	600	practice registered nurse prescriber, or vocational expert immediately upon receipt
601	601	of those reports by the employer or worker's compensation insurer. The employee is
602	602	entitled to have one observer provided by himself or herself present at the
603	603	examination. The employee is also entitled to have a translator provided by himself
604	604	or herself present at the examination if the employee has difficulty speaking or
605	605	understanding the English language. The employer's or insurer's written request
606	606	for examination shall notify the employee of all of the following:
607	607	1. The proposed date, time, and place of the examination and the identity and
608	608	area of specialization of the examining physician, chiropractor, psychologist, dentist,
609	609	podiatrist, physician assistant, advanced practice registered nurse prescriber, or
610	610	vocational expert.
611	611	3. The employee's right to have his or her physician, chiropractor, psychologist,
612	612	dentist, physician assistant, advanced practice registered nurse prescriber, or
613	613	podiatrist present at the examination.
614	614	4. The employee's right to receive a copy of all reports of the examination that
615	615	are prepared by the examining physician, chiropractor, psychologist, dentist,
616	616	podiatrist, physician assistant, advanced practice registered nurse prescriber, or
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643	643	SECTION 23 ASSEMBLY BILL 154
644	644	vocational expert immediately upon receipt of these reports by the employer or
645	645	worker's compensation insurer.
646	646	SECTION 24. 102.13 (1) (d) 1., 2., 3. and 4. of the statutes are amended to read:
647	647	102.13 (1) (d) 1. Any physician, chiropractor, psychologist, dentist, podiatrist,
648	648	physician assistant, advanced practice registered nurse prescriber, or vocational
649	649	expert who is present at any examination under par. (a) or (am) may be required to
650	650	testify as to the results of the examination.
651	651	2. Any physician, chiropractor, psychologist, dentist, physician assistant,
652	652	advanced practice registered nurse prescriber, or podiatrist who attended a worker's
653	653	compensation claimant for any condition or complaint reasonably related to the
654	654	condition for which the claimant claims compensation may be required to testify
655	655	before the division when the division so directs.
656	656	3. Notwithstanding any statutory provisions except par. (e), any physician,
657	657	chiropractor, psychologist, dentist, physician assistant, advanced practice registered
658	658	nurse prescriber, or podiatrist attending a worker's compensation claimant for any
659	659	condition or complaint reasonably related to the condition for which the claimant
660	660	claims compensation may furnish to the employee, employer, worker's compensation
661	661	insurer, department, or division information and reports relative to a compensation
662	662	claim.
663	663	4. The testimony of any physician, chiropractor, psychologist, dentist,
664	664	physician assistant, advanced practice registered nurse prescriber, or podiatrist who
665	665	is licensed to practice where he or she resides or practices in any state and the
666	666	testimony of any vocational expert may be received in evidence in compensation
667	667	proceedings.
668	668	SECTION 25. 102.13 (2) (a) of the statutes is amended to read:
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696	696	SECTION 25
697	697	ASSEMBLY BILL 154
698	698	102.13 (2) (a) An employee who reports an injury alleged to be work-related
699	699	or files an application for hearing waives any physician-patient,
700	700	psychologist-patient, or chiropractor-patient privilege with respect to any condition
701	701	or complaint reasonably related to the condition for which the employee claims
702	702	compensation. Notwithstanding ss. 51.30 and 146.82 and any other law, any
703	703	physician, chiropractor, psychologist, dentist, podiatrist, physician assistant,
704	704	advanced practice registered nurse prescriber, hospital, or health care provider
705	705	shall, within a reasonable time after written request by the employee, employer,
706	706	worker's compensation insurer, department, or division, or its representative,
707	707	provide that person with any information or written material reasonably related to
708	708	any injury for which the employee claims compensation. If the request is by a
709	709	representative of a worker's compensation insurer for a billing statement, the
710	710	physician, chiropractor, psychologist, dentist, podiatrist, physician assistant,
711	711	advanced practice registered nurse prescriber, hospital, or health care provider
712	712	shall, within 30 days after receiving the request, provide that person with a complete
713	713	copy of an itemized billing statement or a billing statement in a standard billing
714	714	format recognized by the federal government.
715	715	SECTION 26. 102.13 (2) (b) of the statutes is amended to read:
716	716	102.13 (2) (b) A physician, chiropractor, podiatrist, psychologist, dentist,
717	717	physician assistant, advanced practice registered nurse prescriber, hospital, or
718	718	health service provider shall furnish a legible, certified duplicate of the written
719	719	material requested under par. (a) in paper format upon payment of the actual costs
720	720	of preparing the certified duplicate, not to exceed the greater of 45 cents per page or
721	721	$7.50 per request, plus the actual costs of postage, or shall furnish a legible, certified
722	722	duplicate of that material in electronic format upon payment of $26 per request. Any
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749	749	SECTION 26 ASSEMBLY BILL 154
750	750	person who refuses to provide certified duplicates of written material in the person's
751	751	custody that is requested under par. (a) shall be liable for reasonable and necessary
752	752	costs and, notwithstanding s. 814.04 (1), reasonable attorney fees incurred in
753	753	enforcing the requester's right to the duplicates under par. (a).
754	754	SECTION 27. 102.17 (1) (d) 1. and 2. of the statutes are amended to read:
755	755	102.17 (1) (d) 1. The contents of certified medical and surgical reports by
756	756	physicians, podiatrists, surgeons, dentists, psychologists, physician assistants,
757	757	advanced practice nurse prescribers registered nurses, and chiropractors licensed in
758	758	and practicing in this state, and of certified reports by experts concerning loss of
759	759	earning capacity under s. 102.44 (2) and (3), presented by a party for compensation
760	760	constitute prima facie evidence as to the matter contained in those reports, subject
761	761	to any rules and limitations the division prescribes. Certified reports of physicians,
762	762	podiatrists, surgeons, dentists, psychologists, physician assistants, advanced
763	763	practice nurse prescribers registered nurses, and chiropractors, wherever licensed
764	764	and practicing, who have examined or treated the claimant, and of experts, if the
765	765	practitioner or expert consents to being subjected to cross-examination, also
766	766	constitute prima facie evidence as to the matter contained in those reports. Certified
767	767	reports of physicians, podiatrists, surgeons, psychologists, and chiropractors are
768	768	admissible as evidence of the diagnosis, necessity of the treatment, and cause and
769	769	extent of the disability. Certified reports by doctors of dentistry, physician
770	770	assistants, and advanced practice nurse prescribers registered nurses are
771	771	admissible as evidence of the diagnosis and necessity of treatment but not of the
772	772	cause and extent of disability. Any physician, podiatrist, surgeon, dentist,
773	773	psychologist, chiropractor, physician assistant, advanced practice registered nurse
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800	800	SECTION 27
801	801	ASSEMBLY BILL 154
802	802	prescriber, or expert who knowingly makes a false statement of fact or opinion in a
803	803	certified report may be fined or imprisoned, or both, under s. 943.395.
804	804	2. The record of a hospital or sanatorium in this state that is satisfactory to the
805	805	division, established by certificate, affidavit, or testimony of the supervising officer
806	806	of the hospital or sanatorium, any other person having charge of the record, or a
807	807	physician, podiatrist, surgeon, dentist, psychologist, physician assistant, advanced
808	808	practice registered nurse prescriber, or chiropractor to be the record of the patient
809	809	in question, and made in the regular course of examination or treatment of the
810	810	patient, constitutes prima facie evidence as to the matter contained in the record, to
811	811	the extent that the record is otherwise competent and relevant.
812	812	SECTION 28. 102.29 (3) of the statutes is amended to read:
813	813	102.29 (3) Nothing in this chapter shall prevent an employee from taking the
814	814	compensation that the employee may be entitled to under this chapter and also
815	815	maintaining a civil action against any physician, chiropractor, psychologist, dentist,
816	816	physician assistant, advanced practice registered nurse prescriber, or podiatrist for
817	817	malpractice.
818	818	SECTION 29. 102.42 (2) (a) of the statutes is amended to read:
819	819	102.42 (2) (a) When the employer has notice of an injury and its relationship
820	820	to the employment, the employer shall offer to the injured employee his or her choice
821	821	of any physician, chiropractor, psychologist, dentist, physician assistant, advanced
822	822	practice registered nurse prescriber, or podiatrist licensed to practice and practicing
823	823	in this state for treatment of the injury. By mutual agreement, the employee may
824	824	have the choice of any qualified practitioner not licensed in this state. In case of
825	825	emergency, the employer may arrange for treatment without tendering a choice.
826	826	After the emergency has passed the employee shall be given his or her choice of
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853	853	SECTION 29 ASSEMBLY BILL 154
854	854	attending practitioner at the earliest opportunity. The employee has the right to a
855	855	2nd choice of attending practitioner on notice to the employer or its insurance carrier.
856	856	Any further choice shall be by mutual agreement. Partners and clinics are
857	857	considered to be one practitioner. Treatment by a practitioner on referral from
858	858	another practitioner is considered to be treatment by one practitioner.
859	859	SECTION 30. 106.30 (1) of the statutes is amended to read:
860	860	106.30 (1) DEFINITION. In this section, “nurse" means a registered nurse
861	861	licensed under s. 441.06 or permitted under s. 441.08, a licensed practical nurse
862	862	licensed or permitted under s. 441.10, or an advanced practice registered nurse
863	863	prescriber certified under s. 441.16 (2), or a nurse-midwife licensed under s. 441.15
864	864	441.09.
865	865	SECTION 31. 118.15 (3) (a) of the statutes is amended to read:
866	866	118.15 (3) (a) Any child who is excused by the school board because the child
867	867	is temporarily not in proper physical or mental condition to attend a school program
868	868	but who can be expected to return to a school program upon termination or
869	869	abatement of the illness or condition. The school attendance officer may request the
870	870	parent or guardian of the child to obtain a written statement from a licensed
871	871	physician, naturopathic doctor, dentist, chiropractor, optometrist, psychologist,
872	872	physician assistant, or nurse practitioner, as defined in s. 255.06 (1) (d), or certified
873	873	advanced practice registered nurse prescriber, or registered nurse described under
874	874	s. 255.06 (1) (f) 1. or Christian Science practitioner living and residing in this state,
875	875	who is listed in the Christian Science Journal, as sufficient proof of the physical or
876	876	mental condition of the child. An excuse under this paragraph shall be in writing and
877	877	shall state the time period for which it is valid, not to exceed 30 days.
878	878	SECTION 32. 118.25 (1) (a) of the statutes is amended to read:
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906	906	SECTION 32
907	907	ASSEMBLY BILL 154
908	908	118.25 (1) (a) “Practitioner" means a person licensed as a physician,
909	909	naturopathic doctor, or physician assistant in any state or licensed as an advanced
910	910	practice registered nurse or certified as an advanced practice registered nurse
911	911	prescriber in any state. In this paragraph, “physician” has the meaning given in s.
912	912	448.01 (5).
913	913	SECTION 33. 118.29 (1) (e) of the statutes is amended to read:
914	914	118.29 (1) (e) “Practitioner" means any physician, naturopathic doctor, dentist,
915	915	optometrist, physician assistant, advanced practice registered nurse prescriber with
916	916	prescribing authority, or podiatrist licensed in any state.
917	917	SECTION 34. 118.2925 (1) (b) of the statutes is repealed.
918	918	SECTION 35. 118.2925 (3) of the statutes is amended to read:
919	919	118.2925 (3) PRESCRIPTIONS FOR SCHOOLS. A physician, an advanced practice
920	920	registered nurse prescriber who may issue prescription orders under s. 441.09 (2),
921	921	or a physician assistant may prescribe epinephrine auto-injectors or prefilled
922	922	syringes in the name of a school that has adopted a plan under sub. (2) (a), to be
923	923	maintained by the school for use under sub. (4).
924	924	SECTION 36. 118.2925 (4) (c) of the statutes is amended to read:
925	925	118.2925 (4) (c) Administer an epinephrine auto-injector or prefilled syringe
926	926	to a pupil or other person who the school nurse or designated school personnel in good
927	927	faith believes is experiencing anaphylaxis in accordance with a standing protocol
928	928	from a physician, an advanced practice registered nurse prescriber who may issue
929	929	prescription orders under s. 441.09 (2), or a physician assistant, regardless of
930	930	whether the pupil or other person has a prescription for an epinephrine auto-injector
931	931	or prefilled syringe. If the pupil or other person does not have a prescription for an
932	932	epinephrine auto-injector or prefilled syringe, or the person who administers the
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959	959	SECTION 36 ASSEMBLY BILL 154
960	960	epinephrine auto-injector or prefilled syringe does not know whether the pupil or
961	961	other person has a prescription for an epinephrine auto-injector or prefilled syringe,
962	962	the person who administers the epinephrine auto-injector or prefilled syringe shall,
963	963	as soon as practicable, report the administration by dialing the telephone number
964	964	“911" or, in an area in which the telephone number “911" is not available, the
965	965	telephone number for an emergency medical service provider.
966	966	SECTION 37. 118.2925 (5) of the statutes is amended to read:
967	967	118.2925 (5) IMMUNITY FROM CIVIL LIABILITY; EXEMPTION FROM PRACTICE OF
968	968	MEDICINE. A school and its designated school personnel, and a physician, an advanced
969	969	practice registered nurse prescriber who may issue prescription orders under s.
970	970	441.09 (2), or a physician assistant who provides a prescription or standing protocol
971	971	for school epinephrine auto-injectors or prefilled syringes, are not liable for any
972	972	injury that results from the administration or self-administration of an epinephrine
973	973	auto-injector or prefilled syringe under this section, regardless of whether
974	974	authorization was given by the pupil's parent or guardian or by the pupil's physician,
975	975	physician assistant, or advanced practice registered nurse prescriber, unless the
976	976	injury is the result of an act or omission that constitutes gross negligence or willful
977	977	or wanton misconduct. The immunity from liability provided under this subsection
978	978	is in addition to and not in lieu of that provided under s. 895.48.
979	979	SECTION 38. 146.615 (1) (a) of the statutes is amended to read:
980	980	146.615 (1) (a) “Advanced practice clinician" means a physician assistant or an
981	981	advanced practice registered nurse, including a nurse practitioner, certified
982	982	nurse-midwife, clinical nurse specialist, or certified registered nurse anesthetist
983	983	licensed under s. 441.09.
984	984	SECTION 39. 146.82 (3) (a) of the statutes is amended to read:
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1012	1012	SECTION 39
1013	1013	ASSEMBLY BILL 154
1014	1014	146.82 (3) (a) Notwithstanding sub. (1), a physician, a naturopathic doctor, a
1015	1015	limited-scope naturopathic doctor, a physician assistant, or an advanced practice
1016	1016	registered nurse prescriber certified under s. 441.16 (2) licensed under s. 441.09 who
1017	1017	treats a patient whose physical or mental condition in the physician's, naturopathic
1018	1018	doctor's, limited-scope naturopathic doctor's, physician assistant's, or advanced
1019	1019	practice nurse prescriber's registered nurse's judgment affects the patient's ability
1020	1020	to exercise reasonable and ordinary control over a motor vehicle may report the
1021	1021	patient's name and other information relevant to the condition to the department of
1022	1022	transportation without the informed consent of the patient.
1023	1023	SECTION 40. 146.89 (1) (r) 1. of the statutes is amended to read:
1024	1024	146.89 (1) (r) 1. Licensed as a physician under ch. 448, naturopathic doctor
1025	1025	under ch. 466, a dentist or dental hygienist under ch. 447, a registered nurse,
1026	1026	practical nurse, or nurse-midwife advanced practice registered nurse under ch. 441,
1027	1027	an optometrist under ch. 449, a physician assistant under subch. IX of ch. 448, a
1028	1028	pharmacist under ch. 450, a chiropractor under ch. 446, a podiatrist under subch. IV
1029	1029	of ch. 448, or a physical therapist under subch. III of ch. 448.
1030	1030	SECTION 41. 146.89 (1) (r) 3. of the statutes is renumbered 146.89 (1) (r) 5e. and
1031	1031	amended to read:
1032	1032	146.89 (1) (r) 5e. A registered nurse practitioner, as defined in s. 255.06 (1) (d)
1033	1033	who holds a multistate license, as defined in s. 441.51 (2) (h), issued by a party state,
1034	1034	as defined in s. 441.51 (2) (k), and whose practice of professional nursing under s.
1035	1035	441.001 (4) includes performance of delegated medical services under the
1036	1036	supervision of a physician, dentist, podiatrist, or advanced practice registered nurse.
1037	1037	SECTION 42. 146.89 (1) (r) 8. of the statutes is repealed.
1038	1038	SECTION 43. 146.89 (6) of the statutes is amended to read:
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1065	1065	SECTION 43 ASSEMBLY BILL 154
1066	1066	146.89 (6) (a) While serving as a volunteer health care provider under this
1067	1067	section, an advanced practice registered nurse who has a certificate to issue
1068	1068	prescription orders under s. 441.16 (2) is considered to meet the requirements of s.
1069	1069	655.23, if required to comply with s. 655.23.
1070	1070	(b) While serving as a volunteer health care provider under this section, an
1071	1071	advanced practice registered nurse who has a certificate to issue prescription orders
1072	1072	under s. 441.16 (2) is not required to maintain in effect malpractice insurance.
1073	1073	SECTION 44. 154.01 (1g) of the statutes is amended to read:
1074	1074	154.01 (1g) “Advanced practice registered nurse” means a nurse an individual
1075	1075	licensed under ch. 441 who is currently certified by a national certifying body
1076	1076	approved by the board of nursing as a nurse practitioner, certified nurse-midwife,
1077	1077	certified registered nurse anesthetist, or clinical nurse specialist s. 441.09.
1078	1078	SECTION 45. 155.01 (1g) (b) of the statutes is repealed and recreated to read:
1079	1079	155.01 (1g) (b) An individual who is licensed as an advanced practice registered
1080	1080	nurse and possesses a nurse practitioner specialty designation under s. 441.09.
1081	1081	SECTION 46. 251.01 (1c) of the statutes is repealed and recreated to read:
1082	1082	251.01 (1c) “Advanced practice registered nurse” means an individual licensed
1083	1083	under s. 441.09.
1084	1084	SECTION 47. 252.01 (1c) of the statutes is repealed.
1085	1085	SECTION 48. 252.07 (8) (a) 2. of the statutes is amended to read:
1086	1086	252.07 (8) (a) 2. The department or local health officer provides to the court a
1087	1087	written statement from a physician, physician assistant, or advanced practice
1088	1088	registered nurse prescriber that the individual has infectious tuberculosis or suspect
1089	1089	tuberculosis.
1090	1090	SECTION 49. 252.07 (9) (c) of the statutes is amended to read:
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1118	1118	SECTION 49
1119	1119	ASSEMBLY BILL 154
1120	1120	252.07 (9) (c) If the court orders confinement of an individual under this
1121	1121	subsection, the individual shall remain confined until the department or local health
1122	1122	officer, with the concurrence of a treating physician, physician assistant, or advanced
1123	1123	practice registered nurse prescriber, determines that treatment is complete or that
1124	1124	the individual is no longer a substantial threat to himself or herself or to the public
1125	1125	health. If the individual is to be confined for more than 6 months, the court shall
1126	1126	review the confinement every 6 months.
1127	1127	SECTION 50. 252.10 (7) of the statutes is amended to read:
1128	1128	252.10 (7) Drugs necessary for the treatment of mycobacterium tuberculosis
1129	1129	shall be purchased by the department from the appropriation account under s.
1130	1130	20.435 (1) (e) and dispensed to patients through the public health dispensaries, local
1131	1131	health departments, physicians, or advanced practice nurse prescribers registered
1132	1132	nurses who may issue prescription orders under s. 441.09 (2).
1133	1133	SECTION 51. 252.11 (2), (4), (5) and (7) of the statutes are amended to read:
1134	1134	252.11 (2) An officer of the department or a local health officer having
1135	1135	knowledge of any reported or reasonably suspected case or contact of a sexually
1136	1136	transmitted disease for which no appropriate treatment is being administered, or of
1137	1137	an actual contact of a reported case or potential contact of a reasonably suspected
1138	1138	case, shall investigate or cause the case or contact to be investigated as necessary.
1139	1139	If, following a request of an officer of the department or a local health officer, a person
1140	1140	reasonably suspected of being infected with a sexually transmitted disease refuses
1141	1141	or neglects examination by a physician, physician assistant, or advanced practice
1142	1142	registered nurse prescriber or treatment, an officer of the department or a local
1143	1143	health officer may proceed to have the person committed under sub. (5) to an
1144	1144	institution or system of care for examination, treatment, or observation.
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1171	1171	SECTION 51 ASSEMBLY BILL 154
1172	1172	(4) If a person infected with a sexually transmitted disease ceases or refuses
1173	1173	treatment before reaching what in a physician's, physician assistant's, or advanced
1174	1174	practice nurse prescriber's registered nurse's opinion is the noncommunicable stage,
1175	1175	the physician, physician assistant, or advanced practice registered nurse prescriber
1176	1176	shall notify the department. The department shall without delay take the necessary
1177	1177	steps to have the person committed for treatment or observation under sub. (5), or
1178	1178	shall notify the local health officer to take these steps.
1179	1179	(5) Any court of record may commit a person infected with a sexually
1180	1180	transmitted disease to any institution or may require the person to undergo a system
1181	1181	of care for examination, treatment, or observation if the person ceases or refuses
1182	1182	examination, treatment, or observation under the supervision of a physician,
1183	1183	physician assistant, or advanced practice registered nurse prescriber. The court
1184	1184	shall summon the person to appear on a date at least 48 hours, but not more than
1185	1185	96 hours, after service if an officer of the department or a local health officer petitions
1186	1186	the court and states the facts authorizing commitment. If the person fails to appear
1187	1187	or fails to accept commitment without reasonable cause, the court may cite the
1188	1188	person for contempt. The court may issue a warrant and may direct the sheriff, any
1189	1189	constable, or any police officer of the county immediately to arrest the person and
1190	1190	bring the person to court if the court finds that a summons will be ineffectual. The
1191	1191	court shall hear the matter of commitment summarily. Commitment under this
1192	1192	subsection continues until the disease is no longer communicable or until other
1193	1193	provisions are made for treatment that satisfy the department. The certificate of the
1194	1194	petitioning officer is prima facie evidence that the disease is no longer communicable
1195	1195	or that satisfactory provisions for treatment have been made.
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1222	1222	SECTION 51
1223	1223	ASSEMBLY BILL 154
1224	1224	(7) Reports, examinations and inspections, and all records concerning sexually
1225	1225	transmitted diseases are confidential and not open to public inspection, and may not
1226	1226	be divulged except as may be necessary for the preservation of the public health, in
1227	1227	the course of commitment proceedings under sub. (5), or as provided under s. 938.296
1228	1228	(4) or 968.38 (4). If a physician, physician assistant, or advanced practice registered
1229	1229	nurse prescriber has reported a case of sexually transmitted disease to the
1230	1230	department under sub. (4), information regarding the presence of the disease and
1231	1231	treatment is not privileged when the patient, physician, physician assistant, or
1232	1232	advanced practice registered nurse prescriber is called upon to testify to the facts
1233	1233	before any court of record.
1234	1234	SECTION 52. 252.11 (10) of the statutes is amended to read:
1235	1235	252.11 (10) The state laboratory of hygiene shall examine specimens for the
1236	1236	diagnosis of sexually transmitted diseases for any physician, naturopathic doctor,
1237	1237	physician assistant, advanced practice registered nurse prescriber, or local health
1238	1238	officer in the state, and shall report the positive results of the examinations to the
1239	1239	local health officer and to the department. All laboratories performing tests for
1240	1240	sexually transmitted diseases shall report all positive results to the local health
1241	1241	officer and to the department, with the name of the physician, naturopathic doctor,
1242	1242	physician assistant, or advanced practice registered nurse prescriber to whom
1243	1243	reported.
1244	1244	SECTION 53. 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3.
1245	1245	and (7m) (intro.) and (b) of the statutes are amended to read:
1246	1246	252.15 (3m) (d) 11. b. The coroner, medical examiner, or appointed assistant
1247	1247	is investigating the cause of death of the subject of the HIV test and has contact with
1248	1248	the body fluid of the subject of the HIV test that constitutes a significant exposure,
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1275	1275	SECTION 53 ASSEMBLY BILL 154
1276	1276	if a physician, physician assistant, or advanced practice registered nurse prescriber,
1277	1277	based on information provided to the physician, physician assistant, or advanced
1278	1278	practice registered nurse prescriber, determines and certifies in writing that the
1279	1279	coroner, medical examiner, or appointed assistant has had a contact that constitutes
1280	1280	a significant exposure and if the certification accompanies the request for disclosure.
1281	1281	13. If the subject of the HIV test has a positive HIV test result and is deceased,
1282	1282	by the subject's attending physician, physician assistant, or advanced practice
1283	1283	registered nurse prescriber, to persons, if known to the physician, physician
1284	1284	assistant, or advanced practice registered nurse prescriber, with whom the subject
1285	1285	had sexual contact or shared intravenous drug use paraphernalia.
1286	1286	(5g) (c) A physician, physician assistant, or advanced practice registered nurse
1287	1287	prescriber, based on information provided to the physician, physician assistant, or
1288	1288	advanced practice registered nurse prescriber, determines and certifies in writing
1289	1289	that the person has had contact that constitutes a significant exposure. The
1290	1290	certification shall accompany the request for HIV testing and disclosure. If the
1291	1291	person is a physician, physician assistant, or advanced practice registered nurse
1292	1292	prescriber, he or she may not make this determination or certification. The
1293	1293	information that is provided to a physician, physician assistant, or advanced practice
1294	1294	registered nurse prescriber to document the occurrence of the contact that
1295	1295	constitutes a significant exposure and the physician's, physician assistant's, or
1296	1296	advanced practice nurse prescriber's registered nurse's certification that the person
1297	1297	has had contact that constitutes a significant exposure, shall be provided on a report
1298	1298	form that is developed by the department of safety and professional services under
1299	1299	s. 101.02 (19) (a) or on a report form that the department of safety and professional
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1326	1326	SECTION 53
1327	1327	ASSEMBLY BILL 154
1328	1328	services determines, under s. 101.02 (19) (b), is substantially equivalent to the report
1329	1329	form that is developed under s. 101.02 (19) (a).
1330	1330	(5m) (d) 2. A physician, physician assistant, or advanced practice registered
1331	1331	nurse prescriber, based on information provided to the physician, physician
1332	1332	assistant, or advanced practice registered nurse prescriber, determines and certifies
1333	1333	in writing that the contact under subd. 1. constitutes a significant exposure. A health
1334	1334	care provider who has a contact under subd. 1. c. may not make the certification
1335	1335	under this subdivision for himself or herself.
1336	1336	(e) 2. If the contact occurs as provided under par. (d) 1. b., the attending
1337	1337	physician, physician assistant, or advanced practice registered nurse prescriber of
1338	1338	the funeral director, coroner, medical examiner, or appointed assistant.
1339	1339	3. If the contact occurs as provided under par. (d) 1. c., the physician, physician
1340	1340	assistant, or advanced practice registered nurse prescriber who makes the
1341	1341	certification under par. (d) 2.
1342	1342	(7m) REPORTING OF PERSONS SIGNIFICANTLY EXPOSED. (intro.) If a positive,
1343	1343	validated HIV test result is obtained from a test subject, the test subject's physician,
1344	1344	physician assistant, or advanced practice registered nurse prescriber who maintains
1345	1345	a record of the HIV test result under sub. (4) (c) may report to the state epidemiologist
1346	1346	the name of any person known to the physician, physician assistant, or advanced
1347	1347	practice registered nurse prescriber to have had contact with body fluid of the test
1348	1348	subject that constitutes a significant exposure, only after the physician, physician
1349	1349	assistant, or advanced practice registered nurse prescriber has done all of the
1350	1350	following:
1351	1351	(b) Notified the HIV test subject that the name of any person known to the
1352	1352	physician, physician assistant, or advanced practice registered nurse prescriber to
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1379	1379	SECTION 53 ASSEMBLY BILL 154
1380	1380	have had contact with body fluid of the test subject that constitutes a significant
1381	1381	exposure will be reported to the state epidemiologist.
1382	1382	SECTION 54. 252.16 (3) (c) (intro.) of the statutes is amended to read:
1383	1383	252.16 (3) (c) (intro.) Has submitted to the department a certification from a
1384	1384	physician, as defined in s. 448.01 (5), physician assistant, or advanced practice
1385	1385	registered nurse prescriber of all of the following:
1386	1386	SECTION 55. 252.17 (3) (c) (intro.) of the statutes is amended to read:
1387	1387	252.17 (3) (c) (intro.) Has submitted to the department a certification from a
1388	1388	physician, as defined in s. 448.01 (5), physician assistant, or advanced practice
1389	1389	registered nurse prescriber of all of the following:
1390	1390	SECTION 56. 253.07 (4) (d) of the statutes is amended to read:
1391	1391	253.07 (4) (d) In each fiscal year, $31,500 as grants for employment in
1392	1392	communities of licensed registered nurses, licensed practical nurses, certified
1393	1393	nurse-midwives licensed advanced practice registered nurses, or licensed physician
1394	1394	assistants who are members of a racial minority.
1395	1395	SECTION 57. 253.115 (1) (f) of the statutes is created to read:
1396	1396	253.115 (1) (f) “Nurse-midwife" means an individual who is licensed as an
1397	1397	advanced practice registered nurse and possesses a certified nurse-midwife
1398	1398	specialty designation under s. 441.09.
1399	1399	SECTION 58. 253.115 (4) of the statutes is amended to read:
1400	1400	253.115 (4) SCREENING REQUIRED. Except as provided in sub. (6), the physician,
1401	1401	nurse-midwife licensed under s. 441.15, or certified professional midwife licensed
1402	1402	under s. 440.982 who attended the birth shall ensure that the infant is screened for
1403	1403	hearing loss before being discharged from a hospital, or within 30 days of birth if the
1404	1404	infant was not born in a hospital.
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1433	1433	ASSEMBLY BILL 154
1434	1434	SECTION 59. 253.115 (7) (a) (intro.) of the statutes is amended to read:
1435	1435	253.115 (7) (a) (intro.) The physician, nurse-midwife licensed under s. 441.15,
1436	1436	or certified professional midwife licensed under s. 440.982 who is required to ensure
1437	1437	that the infant is screened for hearing loss under sub. (4) shall do all of the following:
1438	1438	SECTION 60. 253.13 (1) of the statutes is renumbered 253.13 (1) (b) and
1439	1439	amended to read:
1440	1440	253.13 (1) (b) The attending physician or nurse licensed under s. 441.15
1441	1441	nurse-midwife shall cause every infant born in each hospital or maternity home,
1442	1442	prior to its discharge therefrom, to be subjected to tests for congenital and metabolic
1443	1443	disorders, as specified in rules promulgated by the department. If the infant is born
1444	1444	elsewhere than in a hospital or maternity home, the attending physician, nurse
1445	1445	licensed under s. 441.15 nurse-midwife, or birth attendant who attended the birth
1446	1446	shall cause the infant, within one week of birth, to be subjected to these tests.
1447	1447	SECTION 61. 253.13 (1) (a) of the statutes is created to read:
1448	1448	253.13 (1) (a) In this subsection, “nurse-midwife" means an individual who is
1449	1449	licensed as an advanced practice registered nurse and possesses a certified
1450	1450	nurse-midwife specialty designation under s. 441.09.
1451	1451	SECTION 62. 253.15 (1) (em) of the statutes is created to read:
1452	1452	253.15 (1) (em) “Nurse-midwife" means an individual who is licensed as an
1453	1453	advanced practice registered nurse and possesses a certified nurse-midwife
1454	1454	specialty designation under s. 441.09.
1455	1455	SECTION 63. 253.15 (2) of the statutes is amended to read:
1456	1456	253.15 (2) INFORMATIONAL MATERIALS. The board shall purchase or prepare or
1457	1457	arrange with a nonprofit organization to prepare printed and audiovisual materials
1458	1458	relating to shaken baby syndrome and impacted babies. The materials shall include
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1485	1485	SECTION 63 ASSEMBLY BILL 154
1486	1486	information regarding the identification and prevention of shaken baby syndrome
1487	1487	and impacted babies, the grave effects of shaking or throwing on an infant or young
1488	1488	child, appropriate ways to manage crying, fussing, or other causes that can lead a
1489	1489	person to shake or throw an infant or young child, and a discussion of ways to reduce
1490	1490	the risks that can lead a person to shake or throw an infant or young child. The
1491	1491	materials shall be prepared in English, Spanish, and other languages spoken by a
1492	1492	significant number of state residents, as determined by the board. The board shall
1493	1493	make those written and audiovisual materials available to all hospitals, maternity
1494	1494	homes, and nurse-midwives licensed under s. 441.15 that are required to provide or
1495	1495	make available materials to parents under sub. (3) (a) 1., to the department and to
1496	1496	all county departments and nonprofit organizations that are required to provide the
1497	1497	materials to child care providers under sub. (4) (d), and to all school boards and
1498	1498	nonprofit organizations that are permitted to provide the materials to pupils in one
1499	1499	of grades 5 to 8 and in one of grades 10 to 12 under sub. (5). The board shall also make
1500	1500	those written materials available to all county departments and Indian tribes that
1501	1501	are providing home visitation services under s. 48.983 (4) (b) 1. and to all providers
1502	1502	of prenatal, postpartum, and young child care coordination services under s. 49.45
1503	1503	(44). The board may make available the materials required under this subsection
1504	1504	to be made available by making those materials available at no charge on the board's
1505	1505	Internet site.
1506	1506	SECTION 64. 255.06 (1) (d) of the statutes is renumbered 255.06 (1) (f) (intro.)
1507	1507	and amended to read:
1508	1508	255.06 (1) (f) (intro.) “Nurse practitioner" “Women's health nurse clinician"
1509	1509	means a any of the following:
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1536	1536	SECTION 64
1537	1537	ASSEMBLY BILL 154
1538	1538	1. A registered nurse who is licensed under ch. 441 or who holds a multistate
1539	1539	license, as defined in s. 441.51 (2) (h), issued in a party state, as defined in s. 441.51
1540	1540	(2) (k), and whose practice of professional nursing under s. 441.001 (4) includes
1541	1541	performance of delegated medical services under the supervision of a physician,
1542	1542	naturopathic doctor, dentist, or podiatrist, or advanced practice registered nurse.
1543	1543	SECTION 65. 255.06 (1) (f) 2. of the statutes is created to read:
1544	1544	255.06 (1) (f) 2. An advanced practice registered nurse.
1545	1545	SECTION 66. 255.06 (2) (d) of the statutes is amended to read:
1546	1546	255.06 (2) (d) Specialized training for rural colposcopic examinations and
1547	1547	activities. Provide not more than $25,000 in each fiscal year as reimbursement for
1548	1548	the provision of specialized training of nurse practitioners women's health nurse
1549	1549	clinicians to perform, in rural areas, colposcopic examinations and follow-up
1550	1550	activities for the treatment of cervical cancer.
1551	1551	SECTION 67. 255.07 (1) (d) of the statutes is amended to read:
1552	1552	255.07 (1) (d) “Health care practitioner" means a physician, a physician
1553	1553	assistant, or an advanced practice registered nurse who is certified to may issue
1554	1554	prescription orders under s. 441.16 441.09 (2).
1555	1555	SECTION 68. 257.01 (5) (a) and (b) of the statutes are amended to read:
1556	1556	257.01 (5) (a) An individual who is licensed as a physician, a physician
1557	1557	assistant, or a podiatrist under ch. 448, licensed as a naturopathic doctor under ch.
1558	1558	466, licensed as a registered nurse, licensed practical nurse, or nurse-midwife
1559	1559	advanced practice registered nurse under ch. 441, licensed as a dentist under ch. 447,
1560	1560	licensed as a pharmacist under ch. 450, licensed as a veterinarian or certified as a
1561	1561	veterinary technician under ch. 89, or certified as a respiratory care practitioner
1562	1562	under ch. 448.
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1589	1589	SECTION 68 ASSEMBLY BILL 154
1590	1590	(b) An individual who was at any time within the previous 10 years, but is not
1591	1591	currently, licensed as a physician, a physician assistant, or a podiatrist under ch. 448,
1592	1592	licensed as a naturopathic doctor under ch. 466, licensed as a registered nurse,
1593	1593	licensed practical nurse, or nurse-midwife, advanced practice registered nurse
1594	1594	under ch. 441, licensed as a nurse-midwife under ch. 441, 2021 stats., licensed as a
1595	1595	dentist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a
1596	1596	veterinarian or certified as a veterinary technician under ch. 89, or certified as a
1597	1597	respiratory care practitioner under ch. 448, if the individual's license or certification
1598	1598	was never revoked, limited, suspended, or denied renewal.
1599	1599	SECTION 69. 341.14 (1a), (1e) (a), (1m) and (1q) of the statutes are amended to
1600	1600	read:
1601	1601	341.14 (1a) If any resident of this state, who is registering or has registered an
1602	1602	automobile, or a motor truck, dual purpose motor home or dual purpose farm truck
1603	1603	which has a gross weight of not more than 8,000 pounds, a farm truck which has a
1604	1604	gross weight of not more than 12,000 pounds or a motor home, submits a statement
1605	1605	once every 4 years, as determined by the department, from a physician licensed to
1606	1606	practice medicine in any state, from an advanced practice registered nurse licensed
1607	1607	to practice nursing in any state, from a public health nurse certified or licensed to
1608	1608	practice in any state, from a physician assistant licensed or certified to practice in
1609	1609	any state, from a podiatrist licensed to practice in any state, from a chiropractor
1610	1610	licensed to practice chiropractic in any state, or from a Christian Science practitioner
1611	1611	residing in this state and listed in the Christian Science journal certifying to the
1612	1612	department that the resident is a person with a disability that limits or impairs the
1613	1613	ability to walk, the department shall procure, issue and deliver to the disabled
1614	1614	person plates of a special design in lieu of plates which ordinarily would be issued
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1642	1642	SECTION 69
1643	1643	ASSEMBLY BILL 154
1644	1644	for the vehicle, and shall renew the plates. The plates shall be so designed as to
1645	1645	readily apprise law enforcement officers of the fact that the vehicle is owned by a
1646	1646	nonveteran disabled person and is entitled to the parking privileges specified in s.
1647	1647	346.50 (2a). No charge in addition to the registration fee shall be made for the
1648	1648	issuance or renewal of such plates.
1649	1649	(1e) (a) If any resident of this state, who is registering or has registered a
1650	1650	motorcycle, submits a statement once every 4 years, as determined by the
1651	1651	department, from a physician licensed to practice medicine in any state, from an
1652	1652	advanced practice registered nurse licensed to practice nursing in any state, from a
1653	1653	public health nurse certified or licensed to practice in any state, from a physician
1654	1654	assistant licensed or certified to practice in any state, from a podiatrist licensed to
1655	1655	practice in any state, from a chiropractor licensed to practice chiropractic in any
1656	1656	state, from a Christian Science practitioner residing in this state and listed in the
1657	1657	Christian Science journal, or from the U.S. department of veterans affairs certifying
1658	1658	to the department that the resident is a person with a disability that limits or impairs
1659	1659	the ability to walk, the department shall procure, issue and deliver to the disabled
1660	1660	person a plate of a special design in lieu of the plate which ordinarily would be issued
1661	1661	for the motorcycle, and shall renew the plate. The statement shall state whether the
1662	1662	disability is permanent or temporary and, if temporary, the opinion of the physician,
1663	1663	advanced practice registered nurse, public health nurse, physician assistant,
1664	1664	podiatrist, chiropractor, practitioner, or U.S. department of veterans affairs as to the
1665	1665	duration of the disability. The plate shall be so designed as to readily apprise law
1666	1666	enforcement officers of the fact that the motorcycle is owned by a disabled person and
1667	1667	is entitled to the parking privileges specified in s. 346.50 (2a). No charge in addition
1668	1668	to the registration fee may be made for the issuance or renewal of the plate.
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1695	1695	SECTION 69 ASSEMBLY BILL 154
1696	1696	(1m) If any licensed driver submits to the department a statement once every
1697	1697	4 years, as determined by the department, from a physician licensed to practice
1698	1698	medicine in any state, from a public health nurse certified or licensed to practice in
1699	1699	any state, from an advanced practice registered nurse licensed to practice nursing
1700	1700	in any state, from a physician assistant licensed or certified to practice in any state,
1701	1701	from a podiatrist licensed to practice in any state, from a chiropractor licensed to
1702	1702	practice chiropractic in any state, or from a Christian Science practitioner residing
1703	1703	in this state and listed in the Christian Science journal certifying that another
1704	1704	person who is regularly dependent on the licensed driver for transportation is a
1705	1705	person with a disability that limits or impairs the ability to walk, the department
1706	1706	shall issue and deliver to the licensed driver plates of a special design in lieu of the
1707	1707	plates which ordinarily would be issued for the automobile or motor truck, dual
1708	1708	purpose motor home or dual purpose farm truck having a gross weight of not more
1709	1709	than 8,000 pounds, farm truck having a gross weight of not more than 12,000 pounds
1710	1710	or motor home, and shall renew the plates. The plates shall be so designed as to
1711	1711	readily apprise law enforcement officers of the fact that the vehicle is operated by a
1712	1712	licensed driver on whom a disabled person is regularly dependent and is entitled to
1713	1713	the parking privileges specified in s. 346.50 (2a). No charge in addition to the
1714	1714	registration fee may be made for the issuance or renewal of the plates. The plates
1715	1715	shall conform to the plates required in sub. (1a).
1716	1716	(1q) If any employer who provides an automobile, or a motor truck, dual
1717	1717	purpose motor home or dual purpose farm truck which has a gross weight of not more
1718	1718	than 8,000 pounds, a farm truck which has a gross weight of not more than 12,000
1719	1719	pounds or a motor home, for an employee's use submits to the department a
1720	1720	statement once every 4 years, as determined by the department, from a physician
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1748	1748	SECTION 69
1749	1749	ASSEMBLY BILL 154
1750	1750	licensed to practice medicine in any state, from an advanced practice registered
1751	1751	nurse licensed to practice nursing in any state, from a public health nurse certified
1752	1752	or licensed to practice in any state, from a physician assistant licensed or certified
1753	1753	to practice in any state, from a podiatrist licensed to practice in any state, from a
1754	1754	chiropractor licensed to practice chiropractic in any state, or from a Christian
1755	1755	Science practitioner residing in this state and listed in the Christian Science journal
1756	1756	certifying that the employee is a person with a disability that limits or impairs the
1757	1757	ability to walk, the department shall issue and deliver to such employer plates of a
1758	1758	special design in lieu of the plates which ordinarily would be issued for the vehicle,
1759	1759	and shall renew the plates. The plates shall be so designed as to readily apprise law
1760	1760	enforcement officers of the fact that the vehicle is operated by a disabled person and
1761	1761	is entitled to the parking privileges specified in s. 346.50 (2a). No charge in addition
1762	1762	to the registration fee may be made for the issuance or renewal of the plates. The
1763	1763	plates shall conform to the plates required in sub. (1a).
1764	1764	SECTION 70. 343.16 (5) (a) of the statutes is amended to read:
1765	1765	343.16 (5) (a) The secretary may require any applicant for a license or any
1766	1766	licensed operator to submit to a special examination by such persons or agencies as
1767	1767	the secretary may direct to determine incompetency, physical or mental disability,
1768	1768	disease, or any other condition that might prevent such applicant or licensed person
1769	1769	from exercising reasonable and ordinary control over a motor vehicle. If the
1770	1770	department requires the applicant to submit to an examination, the applicant shall
1771	1771	pay for the examination. If the department receives an application for a renewal or
1772	1772	duplicate license after voluntary surrender under s. 343.265 or receives a report from
1773	1773	a physician, physician assistant, advanced practice registered nurse prescriber
1774	1774	certified under s. 441.16 (2) licensed under s. 441.09, or optometrist under s. 146.82
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1801	1801	SECTION 70 ASSEMBLY BILL 154
1802	1802	(3), or if the department has a report of 2 or more arrests within a one-year period
1803	1803	for any combination of violations of s. 346.63 (1) or (5) or a local ordinance in
1804	1804	conformity with s. 346.63 (1) or (5) or a law of a federally recognized American Indian
1805	1805	tribe or band in this state in conformity with s. 346.63 (1) or (5), or s. 346.63 (1m),
1806	1806	1985 stats., or s. 346.63 (2) or (6) or 940.25, or s. 940.09 where the offense involved
1807	1807	the use of a vehicle, the department shall determine, by interview or otherwise,
1808	1808	whether the operator should submit to an examination under this section. The
1809	1809	examination may consist of an assessment. If the examination indicates that
1810	1810	education or treatment for a disability, disease or condition concerning the use of
1811	1811	alcohol, a controlled substance or a controlled substance analog is appropriate, the
1812	1812	department may order a driver safety plan in accordance with s. 343.30 (1q). If there
1813	1813	is noncompliance with assessment or the driver safety plan, the department shall
1814	1814	revoke the person's operating privilege in the manner specified in s. 343.30 (1q) (d).
1815	1815	SECTION 71. 343.51 (1) of the statutes is amended to read:
1816	1816	343.51 (1) Any person who qualifies for registration plates of a special design
1817	1817	under s. 341.14 (1), (1a), (1m), or (1q) or any other person with a disability that limits
1818	1818	or impairs the ability to walk may request from the department a special
1819	1819	identification card that will entitle any motor vehicle parked by, or under the
1820	1820	direction of, the person, or a motor vehicle operated by or on behalf of the
1821	1821	organization when used to transport such a person, to parking privileges under s.
1822	1822	346.50 (2), (2a), and (3). The department shall issue the card at a fee to be determined
1823	1823	by the department, upon submission by the applicant, if the applicant is an
1824	1824	individual rather than an organization, of a statement from a physician licensed to
1825	1825	practice medicine in any state, from an advanced practice registered nurse licensed
1826	1826	to practice nursing in any state, from a public health nurse certified or licensed to
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1854	1854	SECTION 71
1855	1855	ASSEMBLY BILL 154
1856	1856	practice in any state, from a physician assistant licensed or certified to practice in
1857	1857	any state, from a podiatrist licensed to practice in any state, from a chiropractor
1858	1858	licensed to practice chiropractic in any state, or from a Christian Science practitioner
1859	1859	residing in this state and listed in the Christian Science journal that the person is
1860	1860	a person with a disability that limits or impairs the ability to walk. The statement
1861	1861	shall state whether the disability is permanent or temporary and, if temporary, the
1862	1862	opinion of the physician, advanced practice registered nurse, public health nurse,
1863	1863	physician assistant, podiatrist, chiropractor, or practitioner as to the duration of the
1864	1864	disability. The department shall issue the card upon application by an organization
1865	1865	on a form prescribed by the department if the department believes that the
1866	1866	organization meets the requirements under this subsection.
1867	1867	SECTION 72. 343.62 (4) (a) 4. of the statutes is amended to read:
1868	1868	343.62 (4) (a) 4. The applicant submits with the application a statement
1869	1869	completed within the immediately preceding 24 months, except as provided by rule,
1870	1870	by a physician licensed to practice medicine in any state, from an advanced practice
1871	1871	registered nurse licensed to practice nursing in any state, from a physician assistant
1872	1872	licensed or certified to practice in any state, from a podiatrist licensed to practice in
1873	1873	any state, from a chiropractor licensed to practice chiropractic in any state, or from
1874	1874	a Christian Science practitioner residing in this state, and listed in the Christian
1875	1875	Science journal certifying that, in the medical care provider's judgment, the
1876	1876	applicant is physically fit to teach driving.
1877	1877	SECTION 73. 440.03 (13) (b) 3. of the statutes is repealed.
1878	1878	SECTION 74. 440.03 (13) (b) 39m. of the statutes is created to read:
1879	1879	440.03 (13) (b) 39m. Nurse, advanced practice registered.
1880	1880	SECTION 75. 440.03 (13) (b) 42. of the statutes is repealed.
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1907	1907	SECTION 76 ASSEMBLY BILL 154
1908	1908	SECTION 76. 440.077 (1) (a) of the statutes is amended to read:
1909	1909	440.077 (1) (a) “Advanced practice registered nurse prescriber” means an
1910	1910	advanced practice registered nurse prescriber certified licensed under s. 441.16 (2)
1911	1911	441.09.
1912	1912	SECTION 77. 440.077 (2) (c) of the statutes is amended to read:
1913	1913	440.077 (2) (c) Under the program under par. (a), a participating military
1914	1914	medical personnel shall be supervised by a physician, physician assistant,
1915	1915	podiatrist, registered professional nurse, or advanced practice registered nurse
1916	1916	prescriber. The supervising physician, physician assistant, podiatrist, registered
1917	1917	professional nurse, or advanced practice registered nurse prescriber shall retain
1918	1918	responsibility for the care of the patient.
1919	1919	SECTION 78. 440.08 (2) (a) 4m. of the statutes is repealed.
1920	1920	SECTION 79. 440.08 (2) (a) 47r. of the statutes is created to read:
1921	1921	440.08 (2) (a) 47r. Nurse, advanced practice registered: March 1 of each
1922	1922	even-numbered year.
1923	1923	SECTION 80. 440.08 (2) (a) 50. of the statutes is repealed.
1924	1924	SECTION 81. 440.094 (1) (c) 1. of the statutes is amended to read:
1925	1925	440.094 (1) (c) 1. A registered nurse, licensed practical nurse, or nurse midwife
1926	1926	licensed under ch. 441, or an advanced practice registered nurse prescriber certified
1927	1927	licensed under ch. 441.
1928	1928	SECTION 82. 440.094 (2) (a) (intro.) of the statutes is amended to read:
1929	1929	440.094 (2) (a) (intro.) Notwithstanding ss. 441.06 (4), 441.15 (2), 441.16,
1930	1930	441.09 (3) (b), 446.02 (1), 447.03 (1) and (2), 448.03 (1) (a), (b), and (c) and (1m), 448.51
1931	1931	(1), 448.61, 448.76, 448.961 (1) and (2), 449.02 (1), 450.03 (1), 451.04 (1), 455.02 (1m),
1932	1932	457.04 (4), (5), (6), and (7), 459.02 (1), 459.24 (1), and 460.02, a health care provider
1933	1933	1
1934	1934	2
1935	1935	3
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1952	1952	20
1953	1953	21
1954	1954	22
1955	1955	23
1956	1956	24
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1958	1958	LRB-2341/1
1959	1959	JPC&MED:amn
1960	1960	SECTION 82
1961	1961	ASSEMBLY BILL 154
1962	1962	may provide services within the scope of the credential that the health care provider
1963	1963	holds and the department shall grant the health care provider a temporary
1964	1964	credential to practice under this section if all of the following apply:
1965	1965	SECTION 83. 440.981 (1) of the statutes is amended to read:
1966	1966	440.981 (1) No person may use the title “licensed midwife," describe or imply
1967	1967	that he or she is a licensed midwife, or represent himself or herself as a licensed
1968	1968	midwife unless the person is granted a license under this subchapter or is licensed
1969	1969	as a nurse-midwife under s. 441.15 an advanced practice registered nurse and
1970	1970	possesses a certified nurse-midwife specialty designation under s. 441.09.
1971	1971	SECTION 84. 440.982 (1) of the statutes is amended to read:
1972	1972	440.982 (1) No person may engage in the practice of midwifery unless the
1973	1973	person is granted a license under this subchapter, is granted a temporary permit
1974	1974	pursuant to a rule promulgated under s. 440.984 (2m), or is licensed as a
1975	1975	nurse-midwife under s. 441.15 an advanced practice registered nurse and possesses
1976	1976	a certified nurse-midwife specialty designation under s. 441.09.
1977	1977	SECTION 85. 440.987 (2) of the statutes is amended to read:
1978	1978	440.987 (2) One member who is licensed as a nurse-midwife under s. 441.15
1979	1979	an advanced practice registered nurse and possesses a certified nurse-midwife
1980	1980	specialty designation under s. 441.09 and who practices in an out-of-hospital
1981	1981	setting.
1982	1982	SECTION 86. 441.001 (1c) of the statutes is created to read:
1983	1983	441.001 (1c) ADVANCED PRACTICE REGISTERED NURSING. “Advanced practice
1984	1984	registered nursing” means the practice of a certified nurse-midwife, the practice of
1985	1985	a certified registered nurse anesthetist, the practice of a clinical nurse specialist, and
1986	1986	the practice of a nurse practitioner.
1987	1987	1
1988	1988	2
1989	1989	3
1990	1990	4
1991	1991	5
1992	1992	6
1993	1993	7
1994	1994	8
1995	1995	9
1996	1996	10
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2000	2000	14
2001	2001	15
2002	2002	16
2003	2003	17
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2005	2005	19
2006	2006	20
2007	2007	21
2008	2008	22
2009	2009	23
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2012	2012	JPC&MED:amn
2013	2013	SECTION 87 ASSEMBLY BILL 154
2014	2014	SECTION 87. 441.001 (3c) of the statutes is created to read:
2015	2015	441.001 (3c) PRACTICE OF A CERTIFIED NURSE-MIDWIFE. “Practice of a certified
2016	2016	nurse-midwife” means practice in the management of women' s health care,
2017	2017	pregnancy, childbirth, postpartum care for newborns, family planning, and
2018	2018	gynecological services consistent with the standards of practice of the American
2019	2019	College of Nurse-Midwives or its successor.
2020	2020	SECTION 88. 441.001 (3g) of the statutes is created to read:
2021	2021	441.001 (3g) PRACTICE OF A CERTIFIED REGISTERED NURSE ANESTHETIST. “Practice
2022	2022	of a certified registered nurse anesthetist” means providing anesthesia care, pain
2023	2023	management care, and care related to anesthesia and pain management for persons
2024	2024	across their lifespan, whose health status may range from healthy through all levels
2025	2025	of acuity, including persons with immediate, severe, or life-threatening illness or
2026	2026	injury, in diverse settings, including hospitals, ambulatory surgery centers,
2027	2027	outpatient clinics, medical offices, and home health care settings.
2028	2028	SECTION 89. 441.001 (3n) of the statutes is created to read:
2029	2029	441.001 (3n) PRACTICE OF A CLINICAL NURSE SPECIALIST. “Practice of a clinical
2030	2030	nurse specialist” means providing advanced nursing care, primarily in health care
2031	2031	facilities, including the diagnosis and treatment of illness for identified specific
2032	2032	populations based on a specialty.
2033	2033	SECTION 90. 441.001 (3r) of the statutes is created to read:
2034	2034	441.001 (3r) PRACTICE OF A NURSE PRACTITIONER. “Practice of a nurse
2035	2035	practitioner” means practice in ambulatory, acute, long-term, or other health care
2036	2036	settings as a primary or specialty care provider who provides health services,
2037	2037	including assessing, diagnosing, treating, or managing acute, episodic, and chronic
2038	2038	illnesses.
2039	2039	1
2040	2040	2
2041	2041	3
2042	2042	4
2043	2043	5
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2065	2065	JPC&MED:amn
2066	2066	SECTION 91
2067	2067	ASSEMBLY BILL 154
2068	2068	SECTION 91. 441.001 (3w) of the statutes is created to read:
2069	2069	441.001 (3w) PRESCRIPTION ORDER. “Prescription order” has the meaning given
2070	2070	in s. 450.01 (21).
2071	2071	SECTION 92. 441.001 (5) of the statutes is created to read:
2072	2072	441.001 (5) RECOGNIZED ROLE. “Recognized role” means one of the following
2073	2073	roles:
2074	2074	(a) Certified nurse-midwife.
2075	2075	(b) Certified registered nurse anesthetist.
2076	2076	(c) Clinical nurse specialist.
2077	2077	(d) Nurse practitioner.
2078	2078	SECTION 93. 441.01 (3) of the statutes is amended to read:
2079	2079	441.01 (3) The board may promulgate rules to establish minimum standards
2080	2080	for schools for professional nurses and, schools for licensed practical nurses, and
2081	2081	schools for advanced practice registered nurses, including all related clinical units
2082	2082	and facilities, and make and provide periodic surveys and consultations to such
2083	2083	schools. It The board may also establish promulgate rules to prevent unauthorized
2084	2084	persons from practicing professional nursing. It shall approve all rules for the
2085	2085	administration of this chapter in accordance with ch. 227.
2086	2086	SECTION 94. 441.01 (4) of the statutes is amended to read:
2087	2087	441.01 (4) The board shall direct that those schools that qualify be placed on
2088	2088	a list of schools the board has approved for professional nurses or, of schools the board
2089	2089	has approved for licensed practical nurses, or of schools the board has approved for
2090	2090	advanced practice registered nurses on application and proof of qualifications;, and
2091	2091	the board shall make a study of nursing education and initiate promulgate rules and
2092	2092	policies to improve it.
2093	2093	1
2094	2094	2
2095	2095	3
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2118	2118	JPC&MED:amn
2119	2119	SECTION 95 ASSEMBLY BILL 154
2120	2120	SECTION 95. 441.01 (7) (a) (intro.) of the statutes is amended to read:
2121	2121	441.01 (7) (a) (intro.) The board shall require each applicant for the renewal
2122	2122	of a registered nurse or, licensed practical nurse, or advanced practice registered
2123	2123	nurse license issued under this chapter to do all of the following as a condition for
2124	2124	renewing the license:
2125	2125	SECTION 96. 441.01 (7) (b) of the statutes is amended to read:
2126	2126	441.01 (7) (b) The board may not renew a registered nurse or, licensed practical
2127	2127	nurse, or advanced practice registered nurse license under this chapter unless the
2128	2128	renewal applicant has completed the nursing workforce survey to the satisfaction of
2129	2129	the board. The board shall establish standards to determine whether the survey has
2130	2130	been completed. The board shall, by no later than June 30 of each odd-numbered
2131	2131	year, submit all completed nursing workforce survey forms to the department of
2132	2132	workforce development.
2133	2133	SECTION 97. 441.01 (7) (c) of the statutes is created to read:
2134	2134	441.01 (7) (c) An applicant who is renewing both a registered nurse and
2135	2135	advanced practice registered nurse license under s. 441.09 (1) (c) is only required to
2136	2136	pay a single fee under par. (a) 2.
2137	2137	SECTION 98. 441.06 (title) of the statutes is repealed and recreated to read:
2138	2138	441.06 (title) Registered nurses; civil liability exemption.
2139	2139	SECTION 99. 441.06 (3) of the statutes is amended to read:
2140	2140	441.06 (3) A Except as provided in s. 441.09 (1) (c), a registered nurse
2141	2141	practicing for compensation shall, on or before the applicable renewal date specified
2142	2142	under s. 440.08 (2) (a), submit to the board on furnished forms a statement giving
2143	2143	name, residence, and other facts that the board requires, with the nursing workforce
2144	2144	1
2145	2145	2
2146	2146	3
2147	2147	4
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2164	2164	21
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2168	2168	LRB-2341/1
2169	2169	JPC&MED:amn
2170	2170	SECTION 99
2171	2171	ASSEMBLY BILL 154
2172	2172	survey and fee required under s. 441.01 (7) and the applicable renewal fee
2173	2173	determined by the department under s. 440.03 (9) (a).
2174	2174	SECTION 100. 441.06 (4) of the statutes is amended to read:
2175	2175	441.06 (4) Except as provided in ss. 257.03 and 440.077, no person may practice
2176	2176	or attempt to practice professional nursing, nor use the title, letters, or anything else
2177	2177	to indicate that he or she is a registered or professional nurse unless he or she is
2178	2178	licensed under this section. Except as provided in ss. 257.03 and 440.077, no person
2179	2179	not so licensed may use in connection with his or her nursing employment or vocation
2180	2180	any title or anything else to indicate that he or she is a trained, certified or graduate
2181	2181	nurse. This subsection does not apply to any registered nurse who holds a multistate
2182	2182	license, as defined in s. 441.51 (2) (h), issued by a jurisdiction, other than this state,
2183	2183	that has adopted the nurse licensure compact under s. 441.51.
2184	2184	SECTION 101. 441.06 (7) of the statutes is renumbered 441.09 (7) and amended
2185	2185	to read:
2186	2186	441.09 (7) CIVIL LIABILITY. No person certified licensed as an advanced practice
2187	2187	registered nurse prescriber under s. 441.16 (2) this section is liable for civil damages
2188	2188	for any of the following:
2189	2189	(a) Reporting in good faith to the department of transportation under s. 146.82
2190	2190	(3) a patient's name and other information relevant to a physical or mental condition
2191	2191	of the patient that in the advanced practice nurse prescriber's registered nurse's
2192	2192	judgment impairs the patient's ability to exercise reasonable and ordinary control
2193	2193	over a motor vehicle.
2194	2194	(b) In good faith, not reporting to the department of transportation under s.
2195	2195	146.82 (3) a patient's name and other information relevant to a physical or mental
2196	2196	condition of the patient that in the advanced practice nurse prescriber's registered
2197	2197	1
2198	2198	2
2199	2199	3
2200	2200	4
2201	2201	5
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2214	2214	18
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2217	2217	21
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2222	2222	JPC&MED:amn
2223	2223	SECTION 101 ASSEMBLY BILL 154
2224	2224	nurse's judgment does not impair the patient's ability to exercise reasonable and
2225	2225	ordinary control over a motor vehicle.
2226	2226	SECTION 102. 441.07 (1g) (intro.), (a), (c) and (e) of the statutes are amended
2227	2227	to read:
2228	2228	441.07 (1g) (intro.) Subject to the rules promulgated under s. 440.03 (1), the
2229	2229	board may deny an initial license or revoke, limit, suspend, or deny the renewal of
2230	2230	a license of a registered nurse, nurse-midwife advanced practice registered nurse,
2231	2231	or licensed practical nurse; deny an initial certificate or revoke, limit, suspend, or
2232	2232	deny the renewal of a certificate to prescribe drugs or devices granted under s.
2233	2233	441.16; or reprimand a registered nurse, nurse-midwife advanced practice
2234	2234	registered nurse, or licensed practical nurse, if the board finds that the applicant or
2235	2235	licensee committed any of the following:
2236	2236	(a) Fraud in the procuring or renewal of the certificate or license.
2237	2237	(c) Acts which that show the registered nurse, nurse-midwife advanced
2238	2238	practice registered nurse, or licensed practical nurse to be unfit or incompetent by
2239	2239	reason of negligence, abuse of alcohol or other drugs, or mental incompetency.
2240	2240	(e) A violation of any state or federal law that regulates prescribing or
2241	2241	dispensing drugs or devices, if the person has a certificate to prescribe drugs or
2242	2242	devices under s. 441.16 may issue prescription orders under s. 441.09 (2).
2243	2243	SECTION 103. 441.09 of the statutes is created to read:
2244	2244	441.09 Advanced practice registered nurses; civil liability exemption.
2245	2245	(1) LICENSE. (a) An applicant who satisfies all of the following requirements may
2246	2246	apply to the board for initial licensure by the board as an advanced practice
2247	2247	registered nurse:
2248	2248	1. The applicant satisfies one of the following criteria:
2249	2249	1
2250	2250	2
2251	2251	3
2252	2252	4
2253	2253	5
2254	2254	6
2255	2255	7
2256	2256	8
2257	2257	9
2258	2258	10
2259	2259	11
2260	2260	12
2261	2261	13
2262	2262	14
2263	2263	15
2264	2264	16
2265	2265	17
2266	2266	18
2267	2267	19
2268	2268	20
2269	2269	21
2270	2270	22
2271	2271	23
2272	2272	24
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2274	2274	LRB-2341/1
2275	2275	JPC&MED:amn
2276	2276	SECTION 103
2277	2277	ASSEMBLY BILL 154
2278	2278	a. The applicant holds a valid license to practice as a registered nurse issued
2279	2279	under s. 441.06 (1), (1c), or (1m).
2280	2280	b. The applicant applies concurrently for a license under s. 441.06 (1), (1c), or
2281	2281	(1m) with the application for a license under this paragraph.
2282	2282	c. The applicant is a registered nurse who holds a multistate license, as defined
2283	2283	in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has adopted
2284	2284	the nurse licensure compact.
2285	2285	2. The applicant provides evidence satisfactory to the board that he or she
2286	2286	satisfies one of the following criteria:
2287	2287	a. The applicant has completed a graduate-level or postgraduate-level
2288	2288	education program that is approved by the board and that prepares the applicant for
2289	2289	the practice of advanced practice registered nursing in one of the 4 recognized roles,
2290	2290	and the applicant holds a current certification by a national certifying body approved
2291	2291	by the board.
2292	2292	b. On January 1, 2024, the applicant was licensed as a registered nurse in this
2293	2293	state and was practicing in a recognized role, and the applicant satisfies additional
2294	2294	criteria established by the board by rule under sub. (6) (a) 3. relating to practice,
2295	2295	education, or certification.
2296	2296	3. The applicant pays the fee specified under s. 440.05 (1).
2297	2297	4. The applicant provides to the board evidence of any malpractice liability
2298	2298	insurance coverage required under sub. (5).
2299	2299	5. If the applicant is applying to receive a certified nurse-midwife specialty
2300	2300	designation under par. (b) 1., the applicant does all of the following:
2301	2301	a. Provides evidence satisfactory to the board that the applicant is currently
2302	2302	certified by the American Midwifery Certification Board or its successor.
2303	2303	1
2304	2304	2
2305	2305	3
2306	2306	4
2307	2307	5
2308	2308	6
2309	2309	7
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2329	2329	SECTION 103 ASSEMBLY BILL 154
2330	2330	b. Files with the board any plan required under sub. (3m) (f).
2331	2331	6. The applicant does not have an arrest or conviction record, subject to ss.
2332	2332	111.321, 111.322, and 111.335.
2333	2333	7. The applicant meets any other criteria established by the board by rule under
2334	2334	sub. (6) (a) 3. relating to the education, training, or experience required for each
2335	2335	recognized role.
2336	2336	(b) 1. a. Subject to subd. 3. and s. 441.07 (1g), the board shall grant an advanced
2337	2337	practice registered nurse license to an applicant the board determines meets the
2338	2338	requirements under par. (a). The board shall also grant a person who is granted a
2339	2339	license under this subd. 1. a. one or more specialty designations corresponding to the
2340	2340	recognized roles for which the board determines that the person qualifies based on
2341	2341	the person's qualifications under par. (a).
2342	2342	b. The board shall grant an advanced practice registered nurse license to each
2343	2343	individual who, on the day before the effective date of this subd. 1. b. .... [LRB inserts
2344	2344	date], was certified to issue prescription orders under s. 441.16, 2021 stats. The
2345	2345	board shall also grant a person who is granted a license under this subd. 1. b. one or
2346	2346	more specialty designations corresponding to the recognized roles for which the
2347	2347	board determines that the person qualifies based on the person's qualifications.
2348	2348	c. The board shall grant an advanced practice registered nurse license to each
2349	2349	individual who, on the day before the effective date of this subd. 1. c. .... [LRB inserts
2350	2350	date], was licensed as a nurse-midwife under s. 441.15, 2021 stats. The board shall
2351	2351	also grant a person who is granted a license under this subd. 1. c. a nurse-midwife
2352	2352	specialty designation.
2353	2353	2. Each specialty designation granted under subd. 1. shall appear on the
2354	2354	person's advanced practice registered nurse license.
2355	2355	1
2356	2356	2
2357	2357	3
2358	2358	4
2359	2359	5
2360	2360	6
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2380	2380	LRB-2341/1
2381	2381	JPC&MED:amn
2382	2382	SECTION 103
2383	2383	ASSEMBLY BILL 154
2384	2384	3. The board may not grant an advanced practice registered nurse license to
2385	2385	a person applying concurrently for a license under s. 441.06 (1), (1c), or (1m), unless
2386	2386	the board also grants the person the license under s. 441.06 (1), (1c), or (1m).
2387	2387	4. The board may place specific limitations on a person licensed as an advanced
2388	2388	practice registered nurse as a condition of licensure.
2389	2389	5. If all of the following apply to a person, a notation indicating that the person
2390	2390	may not issue prescription orders shall appear on the person's advanced practice
2391	2391	registered nurse license:
2392	2392	a. The person is granted an advanced practice registered nurse license under
2393	2393	subd. 1. a. and satisfies only par. (a) 2. b. but not par. (a) 2. a., or the person is granted
2394	2394	an advanced practice registered nurse license under subd. 1. c.
2395	2395	b. On January 1, 2024, the person did not hold a certificate under s. 441.16 (2),
2396	2396	2021 stats.
2397	2397	(c) On or before the applicable renewal date specified under s. 440.08 (2) (a),
2398	2398	an advanced practice registered nurse shall submit to the board on a form furnished
2399	2399	by the board a statement giving his or her name and residence, the nursing workforce
2400	2400	survey and fee required under s. 441.01 (7), evidence of having satisfied the
2401	2401	continuing education requirements under sub. (4), evidence of any malpractice
2402	2402	liability insurance coverage required under sub. (5), any plan required under sub.
2403	2403	(3m) (f), current evidence that the person satisfies each of the requirements under
2404	2404	par. (a) 1., 2., 5. a., and 7. that apply with respect to the person, and any other
2405	2405	information that the board requires by rule, with the applicable renewal fee
2406	2406	determined by the department under s. 440.03 (9) (a). The board shall grant to a
2407	2407	person who satisfies the requirements under this paragraph the renewal of his or her
2408	2408	advanced practice registered nurse license and specialty designations granted under
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2435	2435	SECTION 103 ASSEMBLY BILL 154
2436	2436	par. (b) 1. and shall, if the person holds a license under s. 441.06 (1), (1c), or (1m), also
2437	2437	grant the renewal of that license.
2438	2438	(2) PRESCRIBING AUTHORITY. (a) Except as provided in par. (b), an advanced
2439	2439	practice registered nurse may issue prescription orders, subject to the rules
2440	2440	promulgated under sub. (6) (a) 1. and 4., and may provide expedited partner therapy
2441	2441	in the manner described in s. 441.092.
2442	2442	(b) An advanced practice registered nurse may not issue prescription orders if
2443	2443	a notation under sub. (1) (b) 5. indicating that the advanced practice registered nurse
2444	2444	may not issue prescription orders appears on the advanced practice registered
2445	2445	nurse's license.
2446	2446	(3) LICENSE REQUIRED; USE OF TITLES. (a) 1. The holder of a license issued under
2447	2447	this section is an “advanced practice registered nurse," may append to his or her
2448	2448	name the title “A.P.R.N.," and is authorized to practice advanced practice registered
2449	2449	nursing.
2450	2450	2. The holder of a specialty designation for a recognized role granted under sub.
2451	2451	(1) (b) 1. may append to his or her name the title and an abbreviation corresponding
2452	2452	to that recognized role.
2453	2453	(b) 1. Except as provided in sub. (3m) (e) and s. 257.03, no person may practice
2454	2454	or attempt to practice advanced practice registered nursing, nor use the title
2455	2455	“advanced practice registered nurse," the title “A.P.R.N.," or anything else to indicate
2456	2456	that he or she is an advanced practice registered nurse unless he or she is licensed
2457	2457	under this section.
2458	2458	2. Except as provided in s. 257.03, no person may do any of the following:
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2484	2484	SECTION 103
2485	2485	ASSEMBLY BILL 154
2486	2486	a. Use the title “certified nurse-midwife,” the title “C.N.M.,” or anything else
2487	2487	to indicate that he or she is a certified nurse-midwife unless he or she has been
2488	2488	granted a certified nurse-midwife specialty designation under sub. (1) (b) 1.
2489	2489	b. Use the title “certified registered nurse anesthetist,” the title “C.R.N.A.,” or
2490	2490	anything else to indicate that he or she is a certified registered nurse anesthetist
2491	2491	unless he or she has been granted a certified registered nurse anesthetist specialty
2492	2492	designation under sub. (1) (b) 1.
2493	2493	c. Use the title “clinical nurse specialist,” the title “C.N.S.,” or anything else to
2494	2494	indicate that he or she is a clinical nurse specialist unless he or she has been granted
2495	2495	a clinical nurse specialist specialty designation under sub. (1) (b) 1.
2496	2496	d. Use the title “nurse practitioner,” the title “N.P.,” or anything else to indicate
2497	2497	that he or she is a nurse practitioner unless he or she has been granted a nurse
2498	2498	practitioner specialty designation under sub. (1) (b) 1.
2499	2499	(3m) PRACTICE REQUIREMENTS AND LIMITATIONS. (a) 1. An advanced practice
2500	2500	registered nurse licensed under this section may, except as provided in subd. 2. and
2501	2501	par. (b), practice advanced practice registered nursing only in collaboration with a
2502	2502	physician or dentist.
2503	2503	2. Subdivision 1. does not apply to an advanced practice registered nurse with
2504	2504	a certified nurse-midwife specialty designation.
2505	2505	(b) 1. An advanced practice registered nurse to whom par. (a) 1. applies may,
2506	2506	except as provided in pars. (bg) 1. and (c), practice advanced practice registered
2507	2507	nursing in a recognized role without being supervised by or collaborating with, and
2508	2508	independent of, a physician or dentist if the board verifies, upon application of the
2509	2509	advanced practice registered nurse, that the advanced practice registered nurse has
2510	2510	completed 3,840 clinical hours of advanced practice registered nursing practice in
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2537	2537	SECTION 103 ASSEMBLY BILL 154
2538	2538	that recognized role while working with a physician or dentist during those 3,840
2539	2539	hours of practice. For purposes of this subdivision, during the completion of these
2540	2540	hours, the advanced practice registered nurse must have continuously satisfied all
2541	2541	of the following requirements:
2542	2542	a. Maintained a mutual, professional relationship with at least one physician
2543	2543	or dentist.
2544	2544	b. Maintained, and provided to the board upon request, documentation
2545	2545	indicating the relationships the advanced practice registered nurse had with one or
2546	2546	more physicians or dentists to deal with issues outside of his or her licensed scope
2547	2547	of practice.
2548	2548	c. Maintained evidence that he or she was subject to a quality assurance
2549	2549	program, peer review process, or other similar program or process that was
2550	2550	implemented for and designed to ensure the provision of competent and quality
2551	2551	patient care and that also included participation by a physician or dentist. Such a
2552	2552	program or process may include a program or process administered through the
2553	2553	advanced practice registered nurse's employer, hospital, ambulatory surgery center,
2554	2554	clinic, or other outpatient facility.
2555	2555	2. For purposes of subd. 1., hours of advanced practice registered nursing
2556	2556	practice may include the lawful practice of advanced practice registered nursing
2557	2557	outside this state or the lawful practice of advanced practice registered nursing in
2558	2558	this state prior to the effective date of this subdivision .... [LRB inserts date].
2559	2559	(bg) 1. An advanced practice registered nurse may provide pain management
2560	2560	services only while working in a collaborative relationship with a physician. Except
2561	2561	as provided in subd. 2., this subdivision applies regardless of whether the advanced
2562	2562	practice registered nurse has qualified for independent practice under par. (b).
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2590	2590	SECTION 103
2591	2591	ASSEMBLY BILL 154
2592	2592	2. Except as provided in par. (c), subd. 1. does not apply to an advanced practice
2593	2593	registered nurse who is providing pain management services in a hospital, as defined
2594	2594	in s. 50.33 (2), or a clinic associated with a hospital, and who has qualified for
2595	2595	independent practice under par. (b).
2596	2596	(bm) For purposes of pars. (a) 1. and (bg) 1., a collaborative relationship is a
2597	2597	process in which an advanced practice registered nurse is working with a physician
2598	2598	or dentist, in each other's presence when necessary, to deliver health care services
2599	2599	within the scope of the advanced practice registered nurse's training, education, and
2600	2600	experience. The advanced practice registered nurse shall document such a
2601	2601	collaborative relationship.
2602	2602	(c) Nothing in this section prohibits an entity employing or with a relationship
2603	2603	with an advanced practice registered nurse from establishing additional
2604	2604	requirements for an advanced practice registered nurse as a condition of
2605	2605	employment or relationship.
2606	2606	(d) An advanced practice registered nurse shall adhere to professional
2607	2607	standards when managing situations that are beyond the advanced practice
2608	2608	registered nurse's expertise. If a particular patient's needs are beyond the advanced
2609	2609	practice registered nurse's expertise, the advanced practice registered nurse shall,
2610	2610	as warranted by the patient's needs, consult or collaborate with or refer the patient
2611	2611	to at least one of the following:
2612	2612	1. A physician licensed under ch. 448.
2613	2613	2. Another health care provider for whom the advanced practice registered
2614	2614	nurse has reasonable evidence of having a scope of practice that includes the
2615	2615	authorization to address the patient's needs.
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2641	2641	SECTION 103 ASSEMBLY BILL 154
2642	2642	(e) An advanced practice registered nurse licensed under this section may
2643	2643	delegate a task or order to another clinically trained health care worker if the task
2644	2644	or order is within the scope of the advanced practice registered nurse's practice, the
2645	2645	advanced practice registered nurse is competent to perform the task or issue the
2646	2646	order, and the advanced practice registered nurse has reasonable evidence that the
2647	2647	health care worker is minimally competent to perform the task or issue the order
2648	2648	under the circumstances.
2649	2649	(f) An advanced practice registered nurse with a certified nurse-midwife
2650	2650	specialty designation may not offer to deliver babies outside of a hospital setting
2651	2651	unless the advanced practice registered nurse files with the board, and the board
2652	2652	approves, a proactive plan for ensuring appropriate care or care transitions
2653	2653	conforming with professional standards for patients with higher acuity or emergency
2654	2654	care needs that exceed the advanced practice registered nurse's scope of practice. An
2655	2655	advanced practice registered nurse who offers to deliver babies outside of a hospital
2656	2656	setting shall file a plan under this paragraph when applying for an initial license
2657	2657	under this section or a renewal of a license under this section, shall keep the plan
2658	2658	current with the board, and shall follow the plan.
2659	2659	(4) CONTINUING EDUCATION. Every advanced practice registered nurse shall
2660	2660	submit to the board evidence of having completed at least 16 contact hours per
2661	2661	biennium in clinical pharmacology or therapeutics relevant to the advanced practice
2662	2662	registered nurse's area of practice. The board may promulgate rules regarding the
2663	2663	continuing education requirements under this subsection.
2664	2664	(5) MALPRACTICE LIABILITY INSURANCE. Except for a person whose employer has
2665	2665	in effect malpractice liability insurance that provides coverage for the person in the
2666	2666	amounts specified under s. 655.23 (4), no person may practice advanced practice
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2694	2694	SECTION 103
2695	2695	ASSEMBLY BILL 154
2696	2696	registered nursing unless he or she at all times has in effect malpractice liability
2697	2697	insurance coverage in the minimum amounts required by the rules of the board. An
2698	2698	advanced practice registered nurse shall submit evidence of that coverage to the
2699	2699	board when applying for an initial license under this section or a renewal of a license
2700	2700	under this section. An advanced practice registered nurse shall also submit such
2701	2701	evidence to the board upon request of the board.
2702	2702	(6) RULES. (a) The board shall promulgate rules necessary to administer this
2703	2703	section, including rules for all of the following:
2704	2704	1. Further defining the scope of practice of an advanced practice registered
2705	2705	nurse, practice of a certified nurse-midwife, practice of a certified registered nurse
2706	2706	anesthetist, practice of a nurse practitioner, and practice of a clinical nurse specialist
2707	2707	and defining the scope of practice within which an advanced practice registered
2708	2708	nurse may issue prescription orders under sub. (2).
2709	2709	2. Determining acceptable national certification for purposes of sub. (1) (a) 2.
2710	2710	a.
2711	2711	3. Establishing the appropriate education, training, or experience
2712	2712	requirements that a registered nurse must satisfy in order to be an advanced practice
2713	2713	registered nurse and to obtain each specialty designation corresponding to the
2714	2714	recognized roles.
2715	2715	4. Specifying the classes of drugs, individual drugs, or devices that may not be
2716	2716	prescribed by an advanced practice registered nurse under sub. (2).
2717	2717	5. Specifying the conditions to be met for registered nurses to do the following:
2718	2718	a. Administer a drug prescribed by an advanced practice registered nurse.
2719	2719	b. Administer a drug at the direction of an advanced practice registered nurse.
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2745	2745	SECTION 103 ASSEMBLY BILL 154
2746	2746	6. Establishing the minimum amount of malpractice liability insurance
2747	2747	coverage that an advanced practice registered nurse must at all times have in effect
2748	2748	for purposes of sub. (5). The board shall promulgate rules under this subdivision in
2749	2749	consultation with the commissioner of insurance.
2750	2750	7. Establishing standards of professional conduct for advanced practice
2751	2751	registered nurses generally and for practicing in each recognized role.
2752	2752	(am) The board may promulgate rules to implement sub. (3m) (b).
2753	2753	(b) The board may not promulgate rules that expand the scope of practice of an
2754	2754	advanced practice registered nurse beyond the practices within advanced practice
2755	2755	registered nursing.
2756	2756	SECTION 104. 441.092 of the statutes is created to read:
2757	2757	441.092 Expedited partner therapy. (1) In this section:
2758	2758	(b) “Antimicrobial drug" has the meaning given in s. 448.035 (1) (b).
2759	2759	(c) “Expedited partner therapy" has the meaning given in s. 448.035 (1) (c).
2760	2760	(2) Notwithstanding the requirements of s. 448.9785, an advanced practice
2761	2761	registered nurse who may issue prescription orders under s. 441.09 (2) may provide
2762	2762	expedited partner therapy if a patient is diagnosed as infected with a chlamydial
2763	2763	infection, gonorrhea, or trichomoniasis and the patient has had sexual contact with
2764	2764	a sexual partner during which the chlamydial infection, gonorrhea, or
2765	2765	trichomoniasis may have been transmitted to or from the sexual partner. The
2766	2766	advanced practice registered nurse shall attempt to obtain the name of the patient's
2767	2767	sexual partner. A prescription order for an antimicrobial drug prepared under this
2768	2768	subsection shall include the name and address of the patient's sexual partner, if
2769	2769	known. If the advanced practice registered nurse is unable to obtain the name of the
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2796	2796	SECTION 104
2797	2797	ASSEMBLY BILL 154
2798	2798	patient's sexual partner, the prescription order shall include, in ordinary, bold-faced
2799	2799	capital letters, the words, “expedited partner therapy" or the letters “EPT."
2800	2800	(3) The advanced practice registered nurse shall provide the patient with a
2801	2801	copy of the information sheet prepared by the department of health services under
2802	2802	s. 46.03 (44) and shall request that the patient give the information sheet to the
2803	2803	person with whom the patient had sexual contact.
2804	2804	(4) (a) Except as provided in par. (b), an advanced practice registered nurse is
2805	2805	immune from civil liability for injury to or the death of a person who takes any
2806	2806	antimicrobial drug if the antimicrobial drug is prescribed, dispensed, or furnished
2807	2807	under this section and if expedited partner therapy is provided as specified under
2808	2808	this section.
2809	2809	(b) The immunity under par. (a) does not extend to the donation, distribution,
2810	2810	furnishing, or dispensing of an antimicrobial drug by an advanced practice
2811	2811	registered nurse whose act or omission involves reckless, wanton, or intentional
2812	2812	misconduct.
2813	2813	SECTION 105. 441.10 (7) of the statutes is amended to read:
2814	2814	441.10 (7) No license is required for practical nursing, but, except as provided
2815	2815	in s. 257.03, no person without a license may hold himself or herself out as a licensed
2816	2816	practical nurse or licensed attendant, use the title or letters “Trained Practical
2817	2817	Nurse" or “T.P.N.", “Licensed Practical Nurse" or “L.P.N.", “Licensed Attendant" or
2818	2818	“L.A.", “Trained Attendant" or “T.A.", or otherwise seek to indicate that he or she is
2819	2819	a licensed practical nurse or licensed attendant. No licensed practical nurse or
2820	2820	licensed attendant may use the title, or otherwise seek to act as a registered, licensed,
2821	2821	graduate or professional nurse. Anyone violating this subsection shall be subject to
2822	2822	the penalties prescribed by s. 441.13. The board shall grant without examination a
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2849	2849	SECTION 105 ASSEMBLY BILL 154
2850	2850	license as a licensed practical nurse to any person who was on July 1, 1949, a licensed
2851	2851	attendant. This subsection does not apply to any licensed practical nurse who holds
2852	2852	a multistate license, as defined in s. 441.51 (2) (h), issued by a jurisdiction, other than
2853	2853	this state, that has adopted the nurse licensure compact under s. 441.51.
2854	2854	SECTION 106. 441.11 (title) of the statutes is repealed.
2855	2855	SECTION 107. 441.11 (1) of the statutes is repealed.
2856	2856	SECTION 108. 441.11 (2) of the statutes is renumbered 441.09 (5m) and
2857	2857	amended to read:
2858	2858	441.09 (5m) LICENSURE EXEMPTION. The provisions of s. 448.04 (1) (g) 448.03
2859	2859	(1) (d) do not apply to a an advanced practice registered nurse licensed under this
2860	2860	section who possesses a certified registered nurse anesthetist specialty designation
2861	2861	under sub. (1) (b) 1. or to a person who engages in the practice of a nurse anesthetist
2862	2862	while performing official duties for the armed services or federal health services of
2863	2863	the United States.
2864	2864	SECTION 109. 441.11 (3) of the statutes is repealed.
2865	2865	SECTION 110. 441.15 of the statutes is repealed.
2866	2866	SECTION 111. 441.16 of the statutes is repealed.
2867	2867	SECTION 112. 441.18 (2) (a) (intro.) of the statutes is amended to read:
2868	2868	441.18 (2) (a) (intro.) An advanced practice registered nurse certified to who
2869	2869	may issue prescription orders under s. 441.16 441.09 (2) may do any of the following:
2870	2870	SECTION 113. 441.18 (2) (b) of the statutes is amended to read:
2871	2871	441.18 (2) (b) An advanced practice registered nurse who prescribes or delivers
2872	2872	an opioid antagonist under par. (a) 1. shall ensure that the person to whom the opioid
2873	2873	antagonist is prescribed has or has the capacity to provide the knowledge and
2874	2874	training necessary to safely administer the opioid antagonist to an individual
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2902	2902	SECTION 113
2903	2903	ASSEMBLY BILL 154
2904	2904	undergoing an opioid-related overdose and that the person demonstrates the
2905	2905	capacity to ensure that any individual to whom the person further delivers the opioid
2906	2906	antagonist has or receives that knowledge and training.
2907	2907	SECTION 114. 441.18 (3) of the statutes is amended to read:
2908	2908	441.18 (3) An advanced practice registered nurse who, acting in good faith,
2909	2909	prescribes or delivers an opioid antagonist in accordance with sub. (2), or who, acting
2910	2910	in good faith, otherwise lawfully prescribes or dispenses an opioid antagonist, shall
2911	2911	be immune from criminal or civil liability and may not be subject to professional
2912	2912	discipline under s. 441.07 for any outcomes resulting from prescribing, delivering,
2913	2913	or dispensing the opioid antagonist.
2914	2914	SECTION 115. 441.19 of the statutes is repealed.
2915	2915	SECTION 116. 448.03 (2) (a) of the statutes is amended to read:
2916	2916	448.03 (2) (a) Any person lawfully practicing within the scope of a license,
2917	2917	permit, registration, certificate, or certification granted to practice midwifery under
2918	2918	subch. XIII of ch. 440, to practice professional or, practical, or advanced practice
2919	2919	registered nursing or nurse-midwifery under ch. 441, to practice chiropractic under
2920	2920	ch. 446, to practice dentistry or dental hygiene or as an expanded function dental
2921	2921	auxiliary under ch. 447, to practice optometry under ch. 449, to practice as a
2922	2922	physician assistant under subch. IX, to practice acupuncture under ch. 451 or under
2923	2923	any other statutory provision, to practice naturopathic medicine under ch. 466, or as
2924	2924	otherwise provided by statute.
2925	2925	SECTION 117. 448.035 (1) (a) of the statutes is repealed.
2926	2926	SECTION 118. 448.035 (2) to (4) of the statutes are amended to read:
2927	2927	448.035 (2) Notwithstanding the requirements of s. 448.30, a physician or
2928	2928	certified advanced practice nurse prescriber may provide expedited partner therapy
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2955	2955	SECTION 118 ASSEMBLY BILL 154
2956	2956	if the patient is diagnosed as infected with a chlamydial infection, gonorrhea, or
2957	2957	trichomoniasis and the patient has had sexual contact with a sexual partner during
2958	2958	which the chlamydial infection, gonorrhea, or trichomoniasis may have been
2959	2959	transmitted to or from the sexual partner. The physician or certified advanced
2960	2960	practice nurse prescriber shall attempt to obtain the name of the patient's sexual
2961	2961	partner. A prescription order for an antimicrobial drug prepared under this
2962	2962	subsection shall include the name and address of the patient's sexual partner, if
2963	2963	known. If the physician or certified advanced practice nurse prescriber is unable to
2964	2964	obtain the name of the patient's sexual partner, the prescription order shall include,
2965	2965	in ordinary bold-faced capital letters, the words, “expedited partner therapy" or the
2966	2966	letters “EPT."
2967	2967	(3) The physician or certified advanced practice nurse prescriber shall provide
2968	2968	the patient with a copy of the information sheet prepared by the department of health
2969	2969	services under s. 46.03 (44) and shall request that the patient give the information
2970	2970	sheet to the person with whom the patient had sexual contact.
2971	2971	(4) (a) Except as provided in par. (b), a physician or certified advanced practice
2972	2972	nurse prescriber is immune from civil liability for injury to or the death of a person
2973	2973	who takes any antimicrobial drug if the antimicrobial drug is prescribed, dispensed,
2974	2974	or furnished under this section and if expedited partner therapy is provided as
2975	2975	specified under this section.
2976	2976	(b) The immunity under par. (a) does not extend to the donation, distribution,
2977	2977	furnishing, or dispensing of an antimicrobial drug by a physician or certified
2978	2978	advanced practice nurse prescriber whose act or omission involves reckless, wanton,
2979	2979	or intentional misconduct.
2980	2980	SECTION 119. 448.56 (1) and (1m) (b) of the statutes are amended to read:
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3008	3008	SECTION 119
3009	3009	ASSEMBLY BILL 154
3010	3010	448.56 (1) WRITTEN REFERRAL. Except as provided in this subsection and s.
3011	3011	448.52, a person may practice physical therapy only upon the written referral of a
3012	3012	physician, naturopathic doctor, physician assistant, chiropractor, dentist, podiatrist,
3013	3013	or advanced practice registered nurse prescriber certified under s. 441.16 (2).
3014	3014	Written referral is not required if a physical therapist provides services in schools to
3015	3015	children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated
3016	3016	by the department of public instruction; provides services as part of a home health
3017	3017	care agency; provides services to a patient in a nursing home pursuant to the
3018	3018	patient's plan of care; provides services related to athletic activities, conditioning, or
3019	3019	injury prevention; or provides services to an individual for a previously diagnosed
3020	3020	medical condition after informing the individual's physician, naturopathic doctor,
3021	3021	physician assistant, chiropractor, dentist, podiatrist, or advanced practice registered
3022	3022	nurse prescriber certified under s. 441.16 (2) who made the diagnosis. The
3023	3023	examining board may promulgate rules establishing additional services that are
3024	3024	excepted from the written referral requirements of this subsection.
3025	3025	(1m) (b) The examining board shall promulgate rules establishing the
3026	3026	requirements that a physical therapist must satisfy if a physician, naturopathic
3027	3027	doctor, physician assistant, chiropractor, dentist, podiatrist, or advanced practice
3028	3028	registered nurse prescriber makes a written referral under sub. (1). The purpose of
3029	3029	the rules shall be to ensure continuity of care between the physical therapist and the
3030	3030	health care practitioner.
3031	3031	SECTION 120. 448.62 (2m) of the statutes is amended to read:
3032	3032	448.62 (2m) An advanced practice registered nurse who is certified to issue
3033	3033	prescription orders under s. 441.16 and who is providing nonsurgical patient services
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3059	3059	SECTION 120 ASSEMBLY BILL 154
3060	3060	as directed, supervised, and inspected by a podiatrist who has the power to direct,
3061	3061	decide, and oversee the implementation of the patient services rendered.
3062	3062	SECTION 121. 448.67 (2) of the statutes is amended to read:
3063	3063	448.67 (2) SEPARATE BILLING REQUIRED. Except as provided in sub. (4), a licensee
3064	3064	who renders any podiatric service or assistance, or gives any podiatric advice or any
3065	3065	similar advice or assistance, to any patient, podiatrist, physician, physician
3066	3066	assistant, advanced practice registered nurse prescriber certified under s. 441.16 (2),
3067	3067	partnership, or corporation, or to any other institution or organization, including a
3068	3068	hospital, for which a charge is made to a patient, shall, except as authorized by
3069	3069	Title 18 or Title 19 of the federal Social Security Act, render an individual statement
3070	3070	or account of the charge directly to the patient, distinct and separate from any
3071	3071	statement or account by any other podiatrist, physician, physician assistant,
3072	3072	advanced practice registered nurse prescriber, or other person.
3073	3073	SECTION 122. 448.956 (1m) of the statutes, as affected by 2021 Wisconsin Act
3074	3074	251, is amended to read:
3075	3075	448.956 (1m) Subject to sub. (1) (a), a licensee may provide athletic training
3076	3076	to an individual without a referral, except that a licensee may not provide athletic
3077	3077	training as described under s. 448.95 (5) (d) or (e) in an outpatient rehabilitation
3078	3078	setting unless the licensee has obtained a written referral for the individual from a
3079	3079	practitioner licensed or certified under subch. II, III, IV, V, or VII of this chapter;
3080	3080	under ch. 446; or under s. 441.16 (2) 441.09 or from a practitioner who holds a
3081	3081	compact privilege under subch. XI or XII of ch. 448.
3082	3082	SECTION 123. 450.01 (1m) of the statutes is repealed.
3083	3083	SECTION 124. 450.01 (16) (h) 2. of the statutes is amended to read:
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3110	3110	SECTION 124
3111	3111	ASSEMBLY BILL 154
3112	3112	450.01 (16) (h) 2. The patient's advanced practice registered nurse prescriber,
3113	3113	if the advanced practice registered nurse prescriber has entered into a written
3114	3114	agreement to collaborate with a physician may issue prescription orders under s.
3115	3115	441.09 (2).
3116	3116	SECTION 125. 450.01 (16) (hr) 2. of the statutes is amended to read:
3117	3117	450.01 (16) (hr) 2. An advanced practice registered nurse prescriber who may
3118	3118	issue prescription orders under s. 441.09 (2).
3119	3119	SECTION 126. 450.03 (1) (e) of the statutes is amended to read:
3120	3120	450.03 (1) (e) Any person lawfully practicing within the scope of a license,
3121	3121	permit, registration, certificate, or certification granted to practice as a pharmacy
3122	3122	technician under s. 450.068, to provide home medical oxygen under s. 450.076, to
3123	3123	practice professional or, practical, or advanced practice registered nursing or
3124	3124	nurse-midwifery under ch. 441, to practice dentistry or dental hygiene or as an
3125	3125	expanded function dental auxiliary under ch. 447, to practice medicine and surgery
3126	3126	under ch. 448, to practice optometry under ch. 449, to practice naturopathic medicine
3127	3127	under ch. 466, or to practice veterinary medicine under ch. 89, or as otherwise
3128	3128	provided by statute.
3129	3129	SECTION 127. 450.11 (1g) (b) of the statutes is amended to read:
3130	3130	450.11 (1g) (b) A pharmacist may, upon the prescription order of a practitioner
3131	3131	providing expedited partner therapy, as specified in s. 441.092, 448.035, or 448.9725,
3132	3132	that complies with the requirements of sub. (1), dispense an antimicrobial drug as
3133	3133	a course of therapy for treatment of chlamydial infections, gonorrhea, or
3134	3134	trichomoniasis to the practitioner's patient or a person with whom the patient has
3135	3135	had sexual contact for use by the person with whom the patient has had sexual
3136	3136	contact. The pharmacist shall provide a consultation in accordance with rules
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3163	3163	SECTION 127 ASSEMBLY BILL 154
3164	3164	promulgated by the board for the dispensing of a prescription to the person to whom
3165	3165	the antimicrobial drug is dispensed. A pharmacist providing a consultation under
3166	3166	this paragraph shall ask whether the person for whom the antimicrobial drug has
3167	3167	been prescribed is allergic to the antimicrobial drug and advise that the person for
3168	3168	whom the antimicrobial drug has been prescribed must discontinue use of the
3169	3169	antimicrobial drug if the person is allergic to or develops signs of an allergic reaction
3170	3170	to the antimicrobial drug.
3171	3171	SECTION 128. 450.11 (1i) (a) 1. of the statutes is amended to read:
3172	3172	450.11 (1i) (a) 1. A pharmacist may, upon and in accordance with the
3173	3173	prescription order of an advanced practice registered nurse prescriber under s.
3174	3174	441.18 (2) (a) 1., of a physician under s. 448.037 (2) (a) 1., or of a physician assistant
3175	3175	under s. 448.9727 (2) (a) 1. that complies with the requirements of sub. (1), deliver
3176	3176	an opioid antagonist to a person specified in the prescription order and may, upon
3177	3177	and in accordance with the standing order of an advanced practice registered nurse
3178	3178	prescriber under s. 441.18 (2) (a) 2., of a physician under s. 448.037 (2) (a) 2., or of
3179	3179	a physician assistant under s. 448.9727 (2) (a) 2. that complies with the requirements
3180	3180	of sub. (1), deliver an opioid antagonist to an individual in accordance with the order.
3181	3181	The pharmacist shall provide a consultation in accordance with rules promulgated
3182	3182	by the board for the delivery of a prescription to the person to whom the opioid
3183	3183	antagonist is delivered.
3184	3184	SECTION 129. 450.11 (1i) (b) 2. b. of the statutes is amended to read:
3185	3185	450.11 (1i) (b) 2. b. An advanced practice registered nurse prescriber may only
3186	3186	deliver or dispense an opioid antagonist in accordance with s. 441.18 (2) or in
3187	3187	accordance with his or her other legal authority to dispense prescription drugs.
3188	3188	SECTION 130. 450.11 (7) (b) of the statutes is amended to read:
3189	3189	1
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3216	3216	SECTION 130
3217	3217	ASSEMBLY BILL 154
3218	3218	450.11 (7) (b) Information communicated to a physician, physician assistant,
3219	3219	or advanced practice registered nurse prescriber in an effort to procure unlawfully
3220	3220	a prescription drug or the administration of a prescription drug is not a privileged
3221	3221	communication.
3222	3222	SECTION 131. 450.11 (8) (e) of the statutes is amended to read:
3223	3223	450.11 (8) (e) The board of nursing, insofar as this section applies to advanced
3224	3224	practice nurse prescribers registered nurses.
3225	3225	SECTION 132. 450.13 (5) (b) of the statutes is amended to read:
3226	3226	450.13 (5) (b) The patient's advanced practice registered nurse prescriber, if the
3227	3227	advanced practice registered nurse prescriber has entered into a written agreement
3228	3228	to collaborate with a physician may issue prescription orders under s. 441.09 (2).
3229	3229	SECTION 133. 450.135 (7) (b) of the statutes is amended to read:
3230	3230	450.135 (7) (b) The patient's advanced practice registered nurse prescriber, if
3231	3231	the advanced practice registered nurse prescriber has entered into a written
3232	3232	agreement to collaborate with a physician may issue prescription orders under s.
3233	3233	441.09 (2).
3234	3234	SECTION 134. 462.04 of the statutes, as affected by 2021 Wisconsin Act 251, is
3235	3235	amended to read:
3236	3236	462.04 Prescription or order required. A person who holds a license or
3237	3237	limited X-ray machine operator permit under this chapter may not use diagnostic
3238	3238	X-ray equipment on humans for diagnostic purposes unless authorized to do so by
3239	3239	prescription or order of a physician licensed under s. 448.04 (1) (a), a naturopathic
3240	3240	doctor licensed under s. 466.04 (1), a dentist licensed under s. 447.04 (1), a podiatrist
3241	3241	licensed under s. 448.63, a chiropractor licensed under s. 446.02, an advanced
3242	3242	practice registered nurse certified licensed under s. 441.16 (2) 441.09, a physician
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3269	3269	SECTION 134 ASSEMBLY BILL 154
3270	3270	assistant licensed under s. 448.974, or, subject to s. 448.56 (7) (a), a physical therapist
3271	3271	who is licensed under s. 448.53 or who holds a compact privilege under subch. XI of
3272	3272	ch. 448.
3273	3273	SECTION 135. 655.001 (1) of the statutes is renumbered 655.001 (1r).
3274	3274	SECTION 136. 655.001 (1g) of the statutes is created to read:
3275	3275	655.001 (1g) “Advanced practice registered nurse” means an individual who
3276	3276	is licensed under s. 441.09, who has qualified to practice independently in his or her
3277	3277	recognized role under s. 441.09 (3m) (b), and who practices advanced practice
3278	3278	registered nursing, as defined under s. 441.001 (1c), outside of a collaborative
3279	3279	relationship with a physician or dentist, as described under s. 441.09 (3m) (a) 1., or
3280	3280	other employment relationship. “Advanced practice registered nurse” does not
3281	3281	include an individual who only engages in the practice of a certified nurse-midwife,
3282	3282	as defined under s. 441.001 (3c).
3283	3283	SECTION 137. 655.001 (7t) of the statutes is amended to read:
3284	3284	655.001 (7t) “Health care practitioner" means a health care professional, as
3285	3285	defined in s. 180.1901 (1m), who is an employee of a health care provider described
3286	3286	in s. 655.002 (1) (d), (e), (em), or (f) and who has the authority to provide health care
3287	3287	services that are not in collaboration with a physician under s. 441.15 (2) (b) or under
3288	3288	the direction and supervision of a physician or nurse anesthetist advanced practice
3289	3289	registered nurse.
3290	3290	SECTION 138. 655.001 (9) of the statutes is repealed.
3291	3291	SECTION 139. 655.002 (1) (a) of the statutes is amended to read:
3292	3292	655.002 (1) (a) A physician or a nurse anesthetist an advanced practice
3293	3293	registered nurse for whom this state is a principal place of practice and who practices
3294	3294	his or her profession in this state more than 240 hours in a fiscal year.
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3322	3322	SECTION 140
3323	3323	ASSEMBLY BILL 154
3324	3324	SECTION 140. 655.002 (1) (b) of the statutes is amended to read:
3325	3325	655.002 (1) (b) A physician or a nurse anesthetist an advanced practice
3326	3326	registered nurse for whom Michigan is a principal place of practice, if all of the
3327	3327	following apply:
3328	3328	1. The physician or nurse anesthetist advanced practice registered nurse is a
3329	3329	resident of this state.
3330	3330	2. The physician or nurse anesthetist advanced practice registered nurse
3331	3331	practices his or her profession in this state or in Michigan or a combination of both
3332	3332	more than 240 hours in a fiscal year.
3333	3333	3. The physician or nurse anesthetist advanced practice registered nurse
3334	3334	performs more procedures in a Michigan hospital than in any other hospital. In this
3335	3335	subdivision, “Michigan hospital" means a hospital located in Michigan that is an
3336	3336	affiliate of a corporation organized under the laws of this state that maintains its
3337	3337	principal office and a hospital in this state.
3338	3338	SECTION 141. 655.002 (1) (c) of the statutes is amended to read:
3339	3339	655.002 (1) (c) A physician or nurse anesthetist an advanced practice
3340	3340	registered nurse who is exempt under s. 655.003 (1) or (3), but who practices his or
3341	3341	her profession outside the scope of the exemption and who fulfills the requirements
3342	3342	under par. (a) in relation to that practice outside the scope of the exemption. For a
3343	3343	physician or a nurse anesthetist an advanced practice registered nurse who is
3344	3344	subject to this chapter under this paragraph, this chapter applies only to claims
3345	3345	arising out of practice that is outside the scope of the exemption under s. 655.003 (1)
3346	3346	or (3).
3347	3347	SECTION 142. 655.002 (1) (d) of the statutes is amended to read:
3348	3348	1
3349	3349	2
3350	3350	3
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3373	3373	SECTION 142 ASSEMBLY BILL 154
3374	3374	655.002 (1) (d) A partnership comprised of physicians or nurse anesthetists
3375	3375	advanced practice registered nurses and organized and operated in this state for the
3376	3376	primary purpose of providing the medical services of physicians or nurse
3377	3377	anesthetists advanced practice registered nurses.
3378	3378	SECTION 143. 655.002 (1) (e) of the statutes is amended to read:
3379	3379	655.002 (1) (e) A corporation organized and operated in this state for the
3380	3380	primary purpose of providing the medical services of physicians or nurse
3381	3381	anesthetists advanced practice registered nurses.
3382	3382	SECTION 144. 655.002 (1) (em) of the statutes is amended to read:
3383	3383	655.002 (1) (em) Any organization or enterprise not specified under par. (d) or
3384	3384	(e) that is organized and operated in this state for the primary purpose of providing
3385	3385	the medical services of physicians or nurse anesthetists advanced practice registered
3386	3386	nurses.
3387	3387	SECTION 145. 655.002 (2) (a) of the statutes is amended to read:
3388	3388	655.002 (2) (a) A physician or nurse anesthetist advanced practice registered
3389	3389	nurse for whom this state is a principal place of practice but who practices his or her
3390	3390	profession fewer than 241 hours in a fiscal year, for a fiscal year, or a portion of a fiscal
3391	3391	year, during which he or she practices his or her profession.
3392	3392	SECTION 146. 655.002 (2) (b) of the statutes is amended to read:
3393	3393	655.002 (2) (b) Except as provided in sub. (1) (b), a physician or nurse
3394	3394	anesthetist advanced practice registered nurse for whom this state is not a principal
3395	3395	place of practice, for a fiscal year, or a portion of a fiscal year, during which he or she
3396	3396	practices his or her profession in this state. For a health care provider who elects to
3397	3397	be subject to this chapter under this paragraph, this chapter applies only to claims
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3424	3424	SECTION 146
3425	3425	ASSEMBLY BILL 154
3426	3426	arising out of practice that is in this state and that is outside the scope of an
3427	3427	exemption under s. 655.003 (1) or (3).
3428	3428	SECTION 147. 655.003 (1) of the statutes is amended to read:
3429	3429	655.003 (1) A physician or a nurse anesthetist an advanced practice registered
3430	3430	nurse who is a state, county or municipal employee, or federal employee or contractor
3431	3431	covered under the federal tort claims act, as amended, and who is acting within the
3432	3432	scope of his or her employment or contractual duties.
3433	3433	SECTION 148. 655.003 (3) of the statutes is amended to read:
3434	3434	655.003 (3) Except for a physician or nurse anesthetist advanced practice
3435	3435	registered nurse who meets the criteria under s. 146.89 (5) (a), a physician or a nurse
3436	3436	anesthetist an advanced practice registered nurse who provides professional
3437	3437	services under the conditions described in s. 146.89, with respect to those
3438	3438	professional services provided by the physician or nurse anesthetist advanced
3439	3439	practice registered nurse for which he or she is covered by s. 165.25 and considered
3440	3440	an agent of the department, as provided in s. 165.25 (6) (b).
3441	3441	SECTION 149. 655.005 (2) (a) of the statutes is amended to read:
3442	3442	655.005 (2) (a) An employee of a health care provider if the employee is a
3443	3443	physician or a nurse anesthetist an advanced practice registered nurse or is a health
3444	3444	care practitioner who is providing health care services that are not in collaboration
3445	3445	with a physician under s. 441.15 (2) (b) or under the direction and supervision of a
3446	3446	physician or nurse anesthetist advanced practice registered nurse.
3447	3447	SECTION 150. 655.005 (2) (b) of the statutes is amended to read:
3448	3448	655.005 (2) (b) A service corporation organized under s. 180.1903 by health care
3449	3449	professionals, as defined under s. 180.1901 (1m), if the board of governors determines
3450	3450	that it is not the primary purpose of the service corporation to provide the medical
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3477	3477	SECTION 150 ASSEMBLY BILL 154
3478	3478	services of physicians or nurse anesthetists advanced practice registered nurses.
3479	3479	The board of governors may not determine under this paragraph that it is not the
3480	3480	primary purpose of a service corporation to provide the medical services of physicians
3481	3481	or nurse anesthetists advanced practice registered nurses unless more than 50
3482	3482	percent of the shareholders of the service corporation are neither physicians nor
3483	3483	nurse anesthetists advanced practice registered nurses.
3484	3484	SECTION 151. 655.23 (5m) of the statutes is amended to read:
3485	3485	655.23 (5m) The limits set forth in sub. (4) shall apply to any joint liability of
3486	3486	a physician or nurse anesthetist advanced practice registered nurse and his or her
3487	3487	corporation, partnership, or other organization or enterprise under s. 655.002 (1) (d),
3488	3488	(e), or (em).
3489	3489	SECTION 152. 655.27 (3) (a) 4. of the statutes is amended to read:
3490	3490	655.27 (3) (a) 4. For a health care provider described in s. 655.002 (1) (d), (e),
3491	3491	(em), or (f), risk factors and past and prospective loss and expense experience
3492	3492	attributable to employees of that health care provider other than employees licensed
3493	3493	as a physician or nurse anesthetist advanced practice registered nurse.
3494	3494	SECTION 153. 655.27 (3) (b) 2m. of the statutes is amended to read:
3495	3495	655.27 (3) (b) 2m. In addition to the fees and payment classifications described
3496	3496	under subds. 1. and 2., the commissioner, after approval by the board of governors,
3497	3497	may establish a separate payment classification for physicians satisfying s. 655.002
3498	3498	(1) (b) and a separate fee for nurse anesthetists advanced practice registered nurses
3499	3499	satisfying s. 655.002 (1) (b) which take into account the loss experience of health care
3500	3500	providers for whom Michigan is a principal place of practice.
3501	3501	SECTION 154. 655.275 (2) of the statutes is amended to read:
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3528	3528	SECTION 154
3529	3529	ASSEMBLY BILL 154
3530	3530	655.275 (2) APPOINTMENT. The board of governors shall appoint the members
3531	3531	of the council. Section 15.09, except s. 15.09 (4) and (8), does not apply to the council.
3532	3532	The board of governors shall designate the chairperson, who shall be a physician, the
3533	3533	vice chairperson, and the secretary of the council and the terms to be served by
3534	3534	council members. The council shall consist of 5 or 7 persons, not more than 3 of whom
3535	3535	are physicians who are licensed and in good standing to practice medicine in this
3536	3536	state and one of whom is a nurse anesthetist an advanced practice registered nurse
3537	3537	who is licensed and in good standing to practice nursing in this state. The
3538	3538	chairperson or another peer review council member designated by the chairperson
3539	3539	shall serve as an ex officio nonvoting member of the medical examining board and
3540	3540	may attend meetings of the medical examining board, as appropriate.
3541	3541	SECTION 155. 655.275 (5) (b) 2. of the statutes is amended to read:
3542	3542	655.275 (5) (b) 2. If a claim was paid for damages arising out of the rendering
3543	3543	of care by a nurse anesthetist an advanced practice registered nurse, with at least
3544	3544	one nurse anesthetist advanced practice registered nurse.
3545	3545	SECTION 156. 961.01 (19) (a) of the statutes is amended to read:
3546	3546	961.01 (19) (a) A physician, advanced practice registered nurse, dentist,
3547	3547	veterinarian, podiatrist, optometrist, scientific investigator or, subject to s. 448.975
3548	3548	(1) (b), a physician assistant, or other person licensed, registered, certified or
3549	3549	otherwise permitted to distribute, dispense, conduct research with respect to,
3550	3550	administer or use in teaching or chemical analysis a controlled substance in the
3551	3551	course of professional practice or research in this state.
3552	3552	SECTION 157. 961.395 of the statutes is amended to read:
3553	3553	961.395 Limitation on advanced practice registered nurses. (1) An
3554	3554	advanced practice registered nurse who is certified may issue prescription orders
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3581	3581	SECTION 157 ASSEMBLY BILL 154
3582	3582	under s. 441.16 441.09 (2) may prescribe controlled substances only as permitted by
3583	3583	the rules promulgated under s. 441.16 (3) 441.09 (6) (a) 4.
3584	3584	(2) An advanced practice registered nurse certified under s. 441.16 who may
3585	3585	issue prescription orders under s. 441.09 (2) shall include with each prescription
3586	3586	order the advanced practice nurse prescriber certification license number issued to
3587	3587	him or her by the board of nursing.
3588	3588	(3) An advanced practice registered nurse certified under s. 441.16 who may
3589	3589	issue prescription orders under s. 441.09 (2) may dispense a controlled substance
3590	3590	only by prescribing or administering the controlled substance or as otherwise
3591	3591	permitted by the rules promulgated under s. 441.16 (3) 441.09 (6) (a) 4.
3592	3592	SECTION 158.0Nonstatutory provisions.
3593	3593	(1) Using the procedure under s. 227.24, the board of nursing may promulgate
3594	3594	rules under ch. 441 that are necessary to implement the changes in this act.
3595	3595	Notwithstanding s. 227.24 (1) (a) and (3), the board is not required to provide
3596	3596	evidence that promulgating a rule under this subsection as an emergency rule is
3597	3597	necessary for the preservation of the public peace, health, safety, or welfare and is
3598	3598	not required to provide a finding of emergency for a rule promulgated under this
3599	3599	subsection. A rule under this subsection may take effect no later than the date
3600	3600	specified in SECTION 159 (intro.) of this act. Notwithstanding s. 227.24 (1) (c) and (2),
3601	3601	a rule promulgated under this subsection is effective for 2 years after its
3602	3602	promulgation, or until permanent rules take effect, whichever is sooner, and the
3603	3603	effective period of a rule promulgated under this subsection may not be further
3604	3604	extended under s. 227.24 (2).
3605	3605	(2) (a) In this subsection, the definitions under s. 441.001 apply.
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3632	3632	SECTION 158
3633	3633	ASSEMBLY BILL 154
3634	3634	(b) Notwithstanding s. 441.09 (3), an individual who, on January 1, 2024, is
3635	3635	licensed as a registered nurse in this state and is practicing in a recognized role may
3636	3636	continue to practice advanced practice registered nursing and the corresponding
3637	3637	recognized role in which he or she is practicing and may continue to use the titles
3638	3638	corresponding to the recognized roles in which he or she is practicing during the
3639	3639	period before which the board takes final action on the person's application under s.
3640	3640	441.09. This paragraph does not apply after the first day of the 13th month
3641	3641	beginning after the effective date of this paragraph.
3642	3642	SECTION 159.0Effective dates. This act takes effect on the first day of the 13th
3643	3643	month beginning after publication, except as follows:
3644	3644	(1) SECTION 158 (1) of this act takes effect on the day after publication.
3645	3645	(END)
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