Wisconsin 2025-2026 Regular Session

Wisconsin Senate Bill SB258 Compare Versions

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

Old	New	Differences
1	1	2025 - 2026 LEGISLATURE
2	2	LRB-1565/1
3	3	JPC:emw&wlj
4	4	2025 SENATE BILL 258
5	5	May 16, 2025 - Introduced by Senators TESTIN, CABRAL-GUEVARA, ROYS, DASSLER-
6	6	ALFHEIM, HABUSH SINYKIN, HESSELBEIN, KEYESKI, LEMAHIEU, MARKLEIN,
7	7	QUINN, RATCLIFF, SMITH, SPREITZER, DRAKE and JACQUE, cosponsored by
8	8	Representatives KURTZ, SUBECK, RODRIGUEZ, ANDRACA, BEHNKE, BROWN,
9	9	CRUZ, DESMIDT, EMERSON, GUNDRUM, JOERS, KREIBICH, MAXEY, MURPHY,
10	10	O'CONNOR, ORTIZ-VELEZ, PRADO, SPIROS, TUSLER, UDELL, WICHGERS,
11	11	DONOVAN, PALMERI, MIRESSE, GOEBEN, KNODL and VINING. Referred to
12	12	Committee on Health.
13	13
14	14	*AUTHORS SUBJECT TO CHANGE*
15	15	AN ACT to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 118.294 (1) (a),
16	16	146.89 (1) (r) 8., 252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a)
17	17	4m., 440.08 (2) (a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16,
18	18	441.19, 448.035 (1) (a), 450.01 (1m) and 655.001 (9); to renumber 655.001 (1);
19	19	to renumber and amend 146.89 (1) (r) 3., 253.13 (1), 255.06 (1) (d), 441.06
20	20	(7) and 441.11 (2); to amend 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193
21	21	(2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 29.193 (3) (a),
22	22	45.40 (1g) (a), 46.03 (44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09
23	23	(1) (h), 50.09 (1) (k), 50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8) (intro.),
24	24	77.54 (14) (f) 4., 97.59, 106.30 (1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1) (e),
25	25	118.2915 (2) (a), 118.2915 (3) (a), 118.2915 (4) (c), 118.2915 (6) (a) (intro.),
26	26	118.2915 (6) (a) 2., 118.2915 (6) (a) 3., 118.2925 (3), 118.2925 (4) (c), 118.2925
27	27	(5), 118.294 (1) (am), 118.294 (2), 118.294 (4) (a), 146.615 (1) (a), 146.82 (3) (a),
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40	40	13 2025 - 2026 Legislature
41	41	SENATE BILL 258
42	42	- 2 - LRB-1565/1
43	43	JPC:emw&wlj
44	44	146.89 (1) (r) 1., 146.89 (6), 154.01 (1g), 252.07 (8) (a) 2., 252.07 (9) (c), 252.10
45	45	(7), 252.11 (2), 252.11 (4), 252.11 (5), 252.11 (7), 252.11 (10), 252.15 (3m) (d)
46	46	11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m) (intro.) and (b),
47	47	252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d), 253.115 (4), 253.115
48	48	(7) (a) (intro.), 253.15 (2), 255.06 (2) (d), 255.07 (1) (d), 257.01 (5) (a), 257.01 (5)
49	49	(b), 341.14 (1a), 341.14 (1e) (a), 341.14 (1m), 341.14 (1q), 343.16 (5) (a), 343.51
50	50	(1), 343.62 (4) (a) 4., 440.077 (1) (a), 440.077 (2) (c), 440.094 (1) (c) 1., 440.094
51	51	(2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01 (4),
52	52	441.01 (7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g) (intro.),
53	53	(a), (c) and (e), 441.07 (2), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b),
54	54	441.18 (3), 448.03 (2) (a), 448.035 (2) to (4), 448.56 (1) and (1m) (b), 448.62
55	55	(2m), 448.67 (2), 448.956 (1m), 450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1)
56	56	(e), 450.11 (1g) (b), 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11
57	57	(8) (e), 450.13 (5) (b), 450.135 (7) (b), 462.04, 655.001 (7t), 655.002 (1) (a),
58	58	655.002 (1) (b), 655.002 (1) (c), 655.002 (1) (d), 655.002 (1) (e), 655.002 (1) (em),
59	59	655.002 (2) (a), 655.002 (2) (b), 655.003 (1), 655.003 (3), 655.005 (2) (a),
60	60	655.005 (2) (b), 655.23 (5m), 655.27 (3) (a) 4., 655.27 (3) (b) 2m., 655.275 (2),
61	61	655.275 (5) (b) 2., 895.478 (3m), 961.01 (19) (a) and 961.395; to repeal and
62	62	recreate 118.2915 (1) (a), 155.01 (1g) (b), 251.01 (1c) and 441.06 (title); to
63	63	create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03
64	64	(13) (b) 39m., 440.08 (2) (a) 47r., 441.001 (1c), 441.001 (3c), 441.001 (3g),
65	65	441.001 (3n), 441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.065,
66	66	441.07 (1r), 441.09, 441.092 and 655.001 (1g) of the statutes; relating to:
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89	89	23 2025 - 2026 Legislature
90	90	SENATE BILL 258
91	91	- 3 - LRB-1565/1
92	92	JPC:emw&wlj
93	93	advanced practice registered nurses, extending the time limit for emergency
94	94	rule procedures, providing an exemption from emergency rule procedures, and
95	95	granting rule-making authority.
96	96	Analysis by the Legislative Reference Bureau
97	97	NURSING PRACTICE AND LICENSURE
98	98	This bill makes various changes to practice, licensure, and certification
99	99	requirements for nurses, which are administered by the Board of Nursing.
100	100	Licensure of advanced practice registered nurses
101	101	Under current law, a person who wishes to practice professional nursing must
102	102	be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
103	103	additional system of licensure for advanced practice registered nurses (APRNs), to
104	104	be administered by the board. Under the bill, in order to apply for an APRN license,
105	105	a person must 1) hold, or concurrently apply for, an RN license; 2) have completed
106	106	an accredited graduate-level or postgraduate-level education program preparing
107	107	the person to practice as an APRN in one of four recognized roles and hold a current
108	108	national certification approved by the board; 3) possess malpractice liability
109	109	insurance as provided in the bill; 4) pay a fee determined by the Department of
110	110	Safety and Professional Services; and 5) satisfy certain other criteria specified in
111	111	the bill. The bill also allows a person who has not completed an accredited
112	112	education program described above to receive an APRN license if the person 1) on
113	113	January 1, 2026, is both licensed as an RN in Wisconsin and practicing in one of the
114	114	four recognized roles and 2) satisfies additional practice or education criteria
115	115	established by the board. The bill also, however, automatically grants licenses to
116	116	certain RNs, as further described below. The four recognized roles, as defined in
117	117	the bill, are 1) certified nurse-midwife; 2) certified registered nurse anesthetist; 3)
118	118	clinical nurse specialist; and 4) nurse practitioner. The bill requires the board,
119	119	upon granting a person an APRN license, to also grant the person one or more
120	120	specialty designations corresponding to the recognized role or roles for which the
121	121	person qualifies.
122	122	Under the bill, all APRNs, except APRNs with a certified nurse-midwife
123	123	specialty designation, must practice in collaboration with a physician or dentist.
124	124	However, under the bill, an APRN may practice without being supervised by a
125	125	physician or dentist if the board verifies that the APRN has completed 3,840 hours
126	126	of professional nursing in a clinical setting and has completed 3,840 clinical hours of
127	127	advanced practice registered nursing practice in their recognized role while
128	128	working with a physician or dentist during those 3,840 hours of practice. APRNs
129	129	may count additional hours practiced as an APRN in collaboration with a physician
130	130	or dentist towards the 3,840 required hours of professional nursing. APRNs with a
131	131	1
132	132	2
133	133	3 2025 - 2026 Legislature
134	134	SENATE BILL 258
135	135	- 4 - LRB-1565/1
136	136	JPC:emw&wlj
137	137	certified nurse-midwife specialty designation are instead required, if they offer to
138	138	deliver babies outside of a hospital setting, to file and keep current with the board a
139	139	proactive plan for involving a hospital or a physician who has admitting privileges
140	140	at a hospital in the treatment of patients with higher acuity or emergency care
141	141	needs, as further described below. Regardless of whether an APRN has qualified to
142	142	practice independently, the bill provides that an APRN may provide treatment of
143	143	pain syndromes through the use of invasive techniques only while working in a
144	144	collaborative relationship with any physician who, through education, training, and
145	145	experience, specializes in pain management. Alternatively, if an APRN has
146	146	qualified to practice independently, the APRN may provide treatment of pain
147	147	syndromes through the use of invasive techniques in a hospital or clinic associated
148	148	with a hospital. Further, an APRN may provide treatment of pain syndromes
149	149	through the use of invasive techniques if the APRN has qualified to practice
150	150	independently and has privileges in a hospital to provide treatment of pain
151	151	syndromes through the use of invasive techniques without a collaborative
152	152	relationship with a physician.
153	153	The holder of an APRN license may append the title XA.P.R.N.Y to his or her
154	154	name, as well as a title corresponding to whichever specialty designations that the
155	155	person possesses. The bill prohibits any person from using the title XA.P.R.N.,Y and
156	156	from otherwise indicating that he or she is an APRN, unless the person is licensed
157	157	by the board as an APRN. The bill also prohibits the use of titles and abbreviations
158	158	corresponding to a recognized role unless the person has a specialty designation for
159	159	that role. The bill further prohibits any person licensed by the board from using,
160	160	assuming, or appending to his or her name any title that is not granted under the
161	161	nursing statutes unless the person holds another credential that entitles the person
162	162	to use, assume, or append to his or her name the title or the person is permitted to
163	163	use, assume, or append to his or her name the title under any other law of the state.
164	164	However, the bill provides that a person who is licensed by the board and holds a
165	165	doctorate degree is not prohibited from using, assuming, or appending to his or her
166	166	name the title XdoctorY or any other words, letters, or abbreviations that represent
167	167	that the person holds that doctorate degree or the field in which the degree was
168	168	received. If a person who is licensed by the board uses, assumes, or appends to his
169	169	or her name the title Xdoctor,Y the bill requires that person to also use, assume, or
170	170	append to his or her name words, letters, or abbreviations that represent the field
171	171	in which the person received the doctorate degree. Further, the bill provides that a
172	172	person who holds a bachelor[s degree or master[s degree is not prohibited from
173	173	using, assuming, or appending to his or her name any words, letters, or
174	174	abbreviations that represent that the person holds that degree or the field in which
175	175	the degree was received.
176	176	The bill allows an APRN to delegate a task or order to another clinically
177	177	trained health care worker if the task or order is within the scope of the APRN[s
178	178	practice, the APRN is competent to perform the task or issue the order, and the
179	179	APRN has reasonable evidence that the health care worker is minimally competent 2025 - 2026 Legislature
180	180	SENATE BILL 258
181	181	- 5 - LRB-1565/1
182	182	JPC:emw&wlj
183	183	to perform the task or issue the order under the circumstances. The bill requires an
184	184	APRN to adhere to professional standards when managing situations that are
185	185	beyond the APRN[s expertise.
186	186	Under the bill, when an APRN renews his or her APRN license, the board
187	187	must grant the person the renewal of both the person[s RN license and the person[s
188	188	APRN license. The bill requires all APRNs to complete continuing education
189	189	requirements each biennium in clinical pharmacology or therapeutics relevant to
190	190	the APRN[s area of practice and to satisfy certain other requirements when
191	191	renewing a license.
192	192	Practice of nurse-midwifery
193	193	This bill repeals licensure and practice requirements specific to nurse-
194	194	midwives and the practice of nurse-midwifery, including specific requirements to
195	195	practice with an obstetrician. Under the bill, Xcertified nurse-midwifeY is one of the
196	196	four recognized roles for APRNs, and a person who is licensed as a nurse-midwife
197	197	under current law is automatically granted an APRN license with a certified nurse-
198	198	midwife specialty designation. The bill otherwise allows nurse-midwives to be
199	199	licensed as APRNs if they satisfy the licensure requirements, except that the bill
200	200	also requires that a person applying for a certified nurse-midwife specialty
201	201	designation be certified by the American Midwifery Certification Board. The bill
202	202	also requires an APRN with a specialty designation as a certified nurse-midwife to
203	203	file with the Board of Nursing, and obtain the board[s approval of, a plan for
204	204	ensuring appropriate care or care transitions in treating certain patients if the
205	205	APRN offers to deliver babies outside of a hospital setting.
206	206	Prescribing authority
207	207	Under current law, a person licensed as an RN may apply to the Board of
208	208	Nursing for a certificate to issue prescription orders if the person meets certain
209	209	requirements established by the board. An RN holding a certificate is subject to
210	210	various practice requirements and limitations established by the board and must
211	211	possess malpractice liability insurance in an amount determined by the board.
212	212	The bill eliminates certificates to issue prescription orders and generally
213	213	authorizes APRNs to issue prescription orders. A person who is certified to issue
214	214	prescription orders under current law is automatically granted an APRN license
215	215	with his or her appropriate specialty designation. RNs who are practicing in a
216	216	recognized role on January 1, 2026, but who do not hold a certificate to issue
217	217	prescription orders on that date and who are granted an APRN license under the
218	218	bill may not issue prescription orders. As under current law, an APRN issuing
219	219	prescription orders is subject to various practice requirements and limitations
220	220	established by the board.
221	221	The bill repeals a provision concerning the ability of advanced practice nurses
222	222	who are certified to issue prescription orders and who are required to work in
223	223	collaboration with or under the supervision of a physician to obtain and practice 2025 - 2026 Legislature
224	224	SENATE BILL 258
225	225	- 6 - LRB-1565/1
226	226	JPC:emw&wlj
227	227	SECTION 1
228	228	under a federal waiver to dispense narcotic drugs to individuals for addiction
229	229	treatment.
230	230	Malpractice liability insurance
231	231	The bill requires all APRNs to maintain malpractice liability insurance
232	232	coverage evidenced by personal liability coverage in the amounts specified under
233	233	current law for physicians and nurse anesthetists or coverage under a group
234	234	liability policy providing individual coverage for the APRN in the amounts specified
235	235	under current law for physicians and nurse anesthetists. Additionally, the bill
236	236	requires APRNs who have qualified to practice independently and who practice
237	237	outside a collaborative or employment relationship to participate in the Injured
238	238	Patients and Families Compensation Fund. The Injured Patients and Families
239	239	Compensation Fund provides excess medical malpractice coverage for health care
240	240	providers who participate in the fund and meet all other participation
241	241	requirements, which includes maintaining malpractice liability insurance in
242	242	coverage amounts specified under current law.
243	243	OTHER CHANGES
244	244	The bill makes numerous other changes throughout the statutes relating to
245	245	APRNs, including various terminology changes.
246	246	For further information see the state fiscal estimate, which will be printed as
247	247	an appendix to this bill.
248	248	The people of the state of Wisconsin, represented in senate and assembly, do
249	249	enact as follows:
250	250	SECTION 1. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
251	251	29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
252	252	or both arms or one or both hands and fails to meet the minimum standards of any
253	253	one of the following standard tests, administered under the direction of a licensed
254	254	physician, a licensed physician assistant, a licensed chiropractor, or a certified
255	255	licensed advanced practice registered nurse prescriber:
256	256	SECTION 2. 29.193 (2) (b) 2. of the statutes is amended to read:
257	257	29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
258	258	and furnished by the department, which shall include a written statement or report
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267	267	9 2025 - 2026 Legislature
268	268	SENATE BILL 258
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270	270	JPC:emw&wlj
271	271	SECTION 2
272	272	prepared and signed by a licensed physician, a licensed physician assistant, a
273	273	licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
274	274	registered nurse prescriber prepared no more than 6 months preceding the
275	275	application and verifying that the applicant is physically disabled.
276	276	SECTION 3. 29.193 (2) (c) 3. of the statutes is amended to read:
277	277	29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
278	278	who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit
279	279	under subd. 1., 2. or 2m. if, upon review and after considering the physical condition
280	280	of the applicant and the recommendation of a licensed physician, a licensed
281	281	physician assistant, a licensed chiropractor, a licensed podiatrist, or a certified
282	282	licensed advanced practice registered nurse prescriber selected by the applicant
283	283	from a list of licensed physicians, licensed physician assistants, licensed
284	284	chiropractors, licensed podiatrists, and certified licensed advanced practice nurse
285	285	prescribers registered nurses compiled by the department, the department finds
286	286	that issuance of a permit complies with the intent of this subsection. The use of this
287	287	review procedure is discretionary with the department and all costs of the review
288	288	procedure shall be paid by the applicant.
289	289	SECTION 4. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
290	290	29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
291	291	in one or both arms and fails to meet the minimum standards of the standard upper
292	292	extremity pinch test, the standard grip test, or the standard nine-hole peg test,
293	293	administered under the direction of a licensed physician, a licensed physician
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315	315	22 2025 - 2026 Legislature
316	316	SENATE BILL 258
317	317	- 8 - LRB-1565/1
318	318	JPC:emw&wlj
319	319	SECTION 4
320	320	assistant, a licensed chiropractor, or a certified licensed advanced practice
321	321	registered nurse prescriber.
322	322	SECTION 5. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
323	323	29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
324	324	one or both shoulders and fails to meet the minimum standards of the standard
325	325	shoulder strength test, administered under the direction of a licensed physician, a
326	326	licensed physician assistant, a licensed chiropractor, or a certified licensed
327	327	advanced practice registered nurse prescriber.
328	328	SECTION 6. 29.193 (2) (e) of the statutes is amended to read:
329	329	29.193 (2) (e) Review of decisions. An applicant denied a permit under this
330	330	subsection, except a permit under par. (c) 3., may obtain a review of that decision by
331	331	a licensed physician, a licensed physician assistant, a licensed chiropractor, a
332	332	licensed podiatrist, or a certified licensed advanced practice registered nurse
333	333	prescriber designated by the department and with an office located in the
334	334	department district in which the applicant resides. The department shall pay for
335	335	the cost of a review under this paragraph unless the denied application on its face
336	336	fails to meet the standards set forth in par. (c) 1. or 2. A review under this
337	337	paragraph is the only method of review of a decision to deny a permit under this
338	338	subsection and is not subject to further review under ch. 227.
339	339	SECTION 7. 29.193 (3) (a) of the statutes is amended to read:
340	340	29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
341	341	physician assistant, a licensed optometrist, or a certified licensed advanced practice
342	342	registered nurse prescriber stating that his or her sight is impaired to the degree
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365	365	23 2025 - 2026 Legislature
366	366	SENATE BILL 258
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368	368	JPC:emw&wlj
369	369	SECTION 7
370	370	that he or she cannot read ordinary newspaper print with or without corrective
371	371	glasses.
372	372	SECTION 8. 45.40 (1g) (a) of the statutes is amended to read:
373	373	45.40 (1g) (a) XHealth care providerY means an advanced practice registered
374	374	nurse prescriber who is certified who may issue prescription orders under s. 441.16
375	375	441.09 (2), an audiologist who is licensed under subch. II of ch. 459 or who holds a
376	376	compact privilege under subch. III of ch. 459, a dentist who is licensed under subch.
377	377	I of ch. 447 or who holds a compact privilege under subch. II of ch. 447, an
378	378	optometrist who is licensed under ch. 449, a physician who is licensed under s.
379	379	448.02, or a podiatrist who is licensed under s. 448.63.
380	380	SECTION 9. 46.03 (44) of the statutes is amended to read:
381	381	46.03 (44) SEXUALLY TRANSMITTED DISEASE TREATMENT INFORMATION.
382	382	Prepare and keep current an information sheet to be distributed to a patient by a
383	383	physician, a physician assistant, or certified an advanced practice registered nurse
384	384	prescriber who may issue prescription orders under s. 441.09 (2) providing
385	385	expedited partner therapy to that patient under s. 441.092, 448.035, or 448.9725.
386	386	The information sheet shall include information about sexually transmitted
387	387	diseases and their treatment and about the risk of drug allergies. The information
388	388	sheet shall also include a statement advising a person with questions about the
389	389	information to contact his or her physician, advanced practice registered nurse,
390	390	pharmacist, or local health department, as defined in s. 250.01 (4).
391	391	SECTION 10. 50.01 (1b) of the statutes is repealed.
392	392	SECTION 11. 50.08 (2) of the statutes is amended to read:
393	393	50.08 (2) A physician, an advanced practice registered nurse prescriber
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417	417	24 2025 - 2026 Legislature
418	418	SENATE BILL 258
419	419	- 10 - LRB-1565/1
420	420	JPC:emw&wlj
421	421	SECTION 11
422	422	certified who may issue prescription orders under s. 441.16 441.09 (2), or a
423	423	physician assistant who prescribes a psychotropic medication to a nursing home
424	424	resident who has degenerative brain disorder shall notify the nursing home if the
425	425	prescribed medication has a boxed warning under 21 CFR 201.57.
426	426	SECTION 12. 50.09 (1) (a) (intro.) of the statutes is amended to read:
427	427	50.09 (1) (a) (intro.) Private and unrestricted communications with the
428	428	resident[s family, physician, physician assistant, advanced practice registered
429	429	nurse prescriber, attorney, and any other person, unless medically contraindicated
430	430	as documented by the resident[s physician, physician assistant, or advanced
431	431	practice registered nurse prescriber in the resident[s medical record, except that
432	432	communications with public officials or with the resident[s attorney shall not be
433	433	restricted in any event. The right to private and unrestricted communications shall
434	434	include, but is not limited to, the right to:
435	435	SECTION 13. 50.09 (1) (f) 1. of the statutes is amended to read:
436	436	50.09 (1) (f) 1. Privacy for visits by spouse or domestic partner. If both
437	437	spouses or both domestic partners under ch. 770 are residents of the same facility,
438	438	the spouses or domestic partners shall be permitted to share a room unless
439	439	medically contraindicated as documented by the resident[s physician, physician
440	440	assistant, or advanced practice registered nurse prescriber in the resident[s
441	441	medical record.
442	442	SECTION 14. 50.09 (1) (h) of the statutes is amended to read:
443	443	50.09 (1) (h) Meet with, and participate in activities of social, religious, and
444	444	community groups at the resident[s discretion, unless medically contraindicated as
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468	468	SENATE BILL 258
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470	470	JPC:emw&wlj
471	471	SECTION 14
472	472	documented by the resident[s physician, physician assistant, or advanced practice
473	473	registered nurse prescriber in the resident[s medical record.
474	474	SECTION 15. 50.09 (1) (k) of the statutes is amended to read:
475	475	50.09 (1) (k) Be free from mental and physical abuse, and be free from
476	476	chemical and physical restraints except as authorized in writing by a physician,
477	477	physician assistant, or advanced practice registered nurse prescriber for a specified
478	478	and limited period of time and documented in the resident[s medical record.
479	479	Physical restraints may be used in an emergency when necessary to protect the
480	480	resident from injury to himself or herself or others or to property. However,
481	481	authorization for continuing use of the physical restraints shall be secured from a
482	482	physician, physician assistant, or advanced practice registered nurse prescriber
483	483	within 12 hours. Any use of physical restraints shall be noted in the resident[s
484	484	medical records. XPhysical restraintsY includes, but is not limited to, any article,
485	485	device, or garment that interferes with the free movement of the resident and that
486	486	the resident is unable to remove easily, and confinement in a locked room.
487	487	SECTION 16. 50.49 (1) (b) (intro.) of the statutes is amended to read:
488	488	50.49 (1) (b) (intro.) XHome health servicesY means the following items and
489	489	services that are furnished to an individual, who is under the care of a physician,
490	490	physician assistant, or advanced practice registered nurse prescriber, by a home
491	491	health agency, or by others under arrangements made by the home health agency,
492	492	that are under a plan for furnishing those items and services to the individual that
493	493	is established and periodically reviewed by a physician, physician assistant, or
494	494	advanced practice registered nurse prescriber and that are, except as provided in
495	495	1
496	496	2
497	497	3
498	498	4
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518	518	SENATE BILL 258
519	519	- 12 - LRB-1565/1
520	520	JPC:emw&wlj
521	521	SECTION 16
522	522	subd. 6., provided on a visiting basis in a place of residence used as the individual[s
523	523	home:
524	524	SECTION 17. 51.41 (1d) (b) 4. of the statutes is amended to read:
525	525	51.41 (1d) (b) 4. A psychiatric mental health advanced practice registered
526	526	nurse who is suggested by the Milwaukee County board of supervisors. The
527	527	Milwaukee County board of supervisors shall solicit suggestions from organizations
528	528	including the Wisconsin Nurses Association for individuals who specialize in a full
529	529	continuum of behavioral health and medical services including emergency
530	530	detention, inpatient, residential, transitional, partial hospitalization, intensive
531	531	outpatient, and wraparound community-based services. The Milwaukee County
532	532	board of supervisors shall suggest to the Milwaukee County executive 4 psychiatric
533	533	mental health advanced practice registered nurses for this board membership
534	534	position.
535	535	SECTION 18. 70.47 (8) (intro.) of the statutes is amended to read:
536	536	70.47 (8) HEARING. (intro.) The board shall hear upon oath all persons who
537	537	appear before it in relation to the assessment. Instead of appearing in person at the
538	538	hearing, the board may allow the property owner, or the property owner [s
539	539	representative, at the request of either person, to appear before the board, under
540	540	oath, by telephone or to submit written statements, under oath, to the board. The
541	541	board shall hear upon oath, by telephone, all ill or disabled persons who present to
542	542	the board a letter from a physician, physician assistant, or advanced practice
543	543	registered nurse prescriber certified under s. 441.16 (2) licensed under ch. 441 that
544	544	confirms their illness or disability. At the request of the property owner or the
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568	568	SENATE BILL 258
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570	570	JPC:emw&wlj
571	571	SECTION 18
572	572	property owner[s representative, the board may postpone and reschedule a hearing
573	573	under this subsection, but may not postpone and reschedule a hearing more than
574	574	once during the same session for the same property. The board at such hearing
575	575	shall proceed as follows:
576	576	SECTION 19. 77.54 (14) (f) 3. of the statutes is repealed.
577	577	SECTION 20. 77.54 (14) (f) 4. of the statutes is amended to read:
578	578	77.54 (14) (f) 4. An advanced practice registered nurse who may issue
579	579	prescription orders under s. 441.09 (2).
580	580	SECTION 21. 97.59 of the statutes is amended to read:
581	581	97.59 Handling foods. No person in charge of any public eating place or
582	582	other establishment where food products to be consumed by others are handled may
583	583	knowingly employ any person handling food products who has a disease in a form
584	584	that is communicable by food handling. If required by the local health officer or any
585	585	officer of the department for the purposes of an investigation, any person who is
586	586	employed in the handling of foods or is suspected of having a disease in a form that
587	587	is communicable by food handling shall submit to an examination by the officer or
588	588	by a physician, physician assistant, or advanced practice registered nurse
589	589	prescriber designated by the officer. The expense of the examination, if any, shall
590	590	be paid by the person examined. Any person knowingly infected with a disease in a
591	591	form that is communicable by food handling who handles food products to be
592	592	consumed by others and any persons knowingly employing or permitting such a
593	593	person to handle food products to be consumed by others shall be punished as
594	594	provided by s. 97.72.
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618	618	SENATE BILL 258
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620	620	JPC:emw&wlj
621	621	SECTION 22
622	622	SECTION 22. 106.30 (1) of the statutes is amended to read:
623	623	106.30 (1) DEFINITION. In this section, XnurseY means a registered nurse
624	624	licensed under s. 441.06 or permitted under s. 441.08, a licensed practical nurse
625	625	licensed or permitted under s. 441.10, or an advanced practice registered nurse
626	626	prescriber certified under s. 441.16 (2), or a nurse-midwife licensed under s. 441.15
627	627	441.09.
628	628	SECTION 23. 118.15 (3) (a) of the statutes is amended to read:
629	629	118.15 (3) (a) Any child who is excused by the school board because the child
630	630	is temporarily not in proper physical or mental condition to attend a school program
631	631	but who can be expected to return to a school program upon termination or
632	632	abatement of the illness or condition. The school attendance officer may request
633	633	the parent or guardian of the child to obtain a written statement from a licensed
634	634	physician, naturopathic doctor, dentist, chiropractor, optometrist, psychologist,
635	635	physician assistant, or nurse practitioner, as defined in s. 255.06 (1) (d), or certified
636	636	advanced practice registered nurse prescriber, or registered nurse described under
637	637	s. 255.06 (1) (f) 1. or Christian Science practitioner living and residing in this state,
638	638	who is listed in the Christian Science Journal, as sufficient proof of the physical or
639	639	mental condition of the child. An excuse under this paragraph shall be in writing
640	640	and shall state the time period for which it is valid, not to exceed 30 days.
641	641	SECTION 24. 118.25 (1) (a) of the statutes is amended to read:
642	642	118.25 (1) (a) XPractitionerY means a person licensed as a physician,
643	643	naturopathic doctor, or physician assistant in any state or licensed as an advanced
644	644	practice registered nurse or certified as an advanced practice registered nurse
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668	668	SENATE BILL 258
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670	670	JPC:emw&wlj
671	671	SECTION 24
672	672	prescriber in any state. In this paragraph, XphysicianY has the meaning given in s.
673	673	448.01 (5).
674	674	SECTION 25. 118.29 (1) (e) of the statutes is amended to read:
675	675	118.29 (1) (e) XPractitionerY means any physician, naturopathic doctor,
676	676	dentist, optometrist, physician assistant, advanced practice registered nurse
677	677	prescriber with prescribing authority, or podiatrist licensed in any state.
678	678	SECTION 26. 118.2915 (1) (a) of the statutes is repealed and recreated to read:
679	679	118.2915 (1) (a) XAdvanced practice registered nurseY means an individual
680	680	licensed under s. 441.09 who may issue prescription orders under s. 441.09 (2).
681	681	SECTION 27. 118.2915 (2) (a) of the statutes is amended to read:
682	682	118.2915 (2) (a) The governing body of a school may adopt a plan for the
683	683	management of pupils attending the school who have asthma. If the governing body
684	684	of a school adopts a plan under this paragraph, it shall specify in the plan the
685	685	training necessary to perform the activities under sub. (4). The governing body of a
686	686	school may not adopt a plan under this paragraph unless the plan has been
687	687	approved by a physician, an advanced practice registered nurse prescriber, or a
688	688	physician assistant.
689	689	SECTION 28. 118.2915 (3) (a) of the statutes is amended to read:
690	690	118.2915 (3) (a) A physician, an advanced practice registered nurse
691	691	prescriber, or a physician assistant may provide a prescription or standing order for
692	692	a short-acting bronchodilator or components in the name of a school that has
693	693	adopted a plan under sub. (2) (a) to be maintained by the school for use under sub.
694	694	(4).
695	695	SECTION 29. 118.2915 (4) (c) of the statutes is amended to read:
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722	722	JPC:emw&wlj
723	723	SECTION 29
724	724	118.2915 (4) (c) In accordance with a prescription or standing order from a
725	725	physician, an advanced practice registered nurse prescriber, or a physician
726	726	assistant, administer a short-acting bronchodilator to a pupil or other person who
727	727	the school nurse or designated school personnel believes in good faith is
728	728	experiencing respiratory distress, regardless of whether the pupil or other person
729	729	has a prescription for a short-acting bronchodilator.
730	730	SECTION 30. 118.2915 (6) (a) (intro.) of the statutes is amended to read:
731	731	118.2915 (6) (a) (intro.) None of the following are liable for any injury that
732	732	results from the administration or self-administration of a short-acting
733	733	bronchodilator under this section, regardless of whether authorization was given by
734	734	the pupil[s parent or guardian or by the pupil[s physician, physician assistant, or
735	735	advanced practice registered nurse prescriber, unless the injury is the result of an
736	736	act or omission that constitutes gross negligence or willful or wanton misconduct:
737	737	SECTION 31. 118.2915 (6) (a) 2. of the statutes is amended to read:
738	738	118.2915 (6) (a) 2. A physician, advanced practice registered nurse prescriber,
739	739	or physician assistant who provides a prescription or standing order for a short-
740	740	acting bronchodilator or components to a school under sub. (3) (a).
741	741	SECTION 32. 118.2915 (6) (a) 3. of the statutes is amended to read:
742	742	118.2915 (6) (a) 3. A physician, advanced practice registered nurse prescriber,
743	743	physician assistant, or pharmacist who dispenses a short-acting bronchodilator or
744	744	components to a school in accordance with a prescription or standing order under
745	745	sub. (3) (a).
746	746	SECTION 33. 118.2925 (1) (b) of the statutes is repealed.
747	747	SECTION 34. 118.2925 (3) of the statutes is amended to read:
748	748	1
749	749	2
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772	772	SENATE BILL 258
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774	774	JPC:emw&wlj
775	775	SECTION 34
776	776	118.2925 (3) PRESCRIPTIONS FOR SCHOOLS. A physician, an advanced practice
777	777	registered nurse prescriber who may issue prescription orders under s. 441.09 (2),
778	778	or a physician assistant may prescribe epinephrine delivery systems in the name of
779	779	a school that has adopted a plan under sub. (2) (a), to be maintained by the school
780	780	for use under sub. (4).
781	781	SECTION 35. 118.2925 (4) (c) of the statutes is amended to read:
782	782	118.2925 (4) (c) Administer an epinephrine delivery system to a pupil or other
783	783	person who the school nurse or designated school personnel in good faith believes is
784	784	experiencing anaphylaxis in accordance with a standing protocol from a physician,
785	785	an advanced practice registered nurse prescriber who may issue prescription orders
786	786	under s. 441.09 (2), or a physician assistant, regardless of whether the pupil or
787	787	other person has a prescription for an epinephrine delivery system. If the pupil or
788	788	other person does not have a prescription for an epinephrine delivery system, or the
789	789	person who administers the epinephrine delivery system does not know whether
790	790	the pupil or other person has a prescription for an epinephrine delivery system, the
791	791	person who administers the epinephrine delivery system shall, as soon as
792	792	practicable, report the administration by dialing the telephone number X911Y or, in
793	793	an area in which the telephone number X911Y is not available, the telephone
794	794	number for an emergency medical service provider.
795	795	SECTION 36. 118.2925 (5) of the statutes is amended to read:
796	796	118.2925 (5) IMMUNITY FROM CIVIL LIABILITY; EXEMPTION FROM PRACTICE OF
797	797	MEDICINE. A school and its designated school personnel, and a physician, an
798	798	advanced practice registered nurse prescriber who may issue prescription orders
799	799	under s. 441.09 (2), or a physician assistant who provides a prescription or standing
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824	824	SENATE BILL 258
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826	826	JPC:emw&wlj
827	827	SECTION 36
828	828	protocol for school epinephrine delivery systems, are not liable for any injury that
829	829	results from the administration or self-administration of an epinephrine delivery
830	830	system under this section, regardless of whether authorization was given by the
831	831	pupil[s parent or guardian or by the pupil[s physician, physician assistant, or
832	832	advanced practice registered nurse prescriber, unless the injury is the result of an
833	833	act or omission that constitutes gross negligence or willful or wanton misconduct.
834	834	The immunity from liability provided under this subsection is in addition to and not
835	835	in lieu of that provided under s. 895.48.
836	836	SECTION 37. 118.294 (1) (a) of the statutes is repealed.
837	837	SECTION 38. 118.294 (1) (am) of the statutes is amended to read:
838	838	118.294 (1) (am) XAdvanced practice registered nurseY has the meaning given
839	839	in s. 154.01 (1g) means an individual licensed under s. 441.09 who may issue
840	840	prescription orders under s. 441.09 (2).
841	841	SECTION 39. 118.294 (2) of the statutes is amended to read:
842	842	118.294 (2) PRESCRIPTIONS FOR SCHOOLS. A physician, an advanced practice
843	843	registered nurse prescriber, or a physician assistant may prescribe undesignated
844	844	glucagon in the name of a school to be maintained by the school for use under sub.
845	845	(3).
846	846	SECTION 40. 118.294 (4) (a) of the statutes is amended to read:
847	847	118.294 (4) (a) A school and its school personnel, and a physician, an
848	848	advanced practice registered nurse prescriber, or a physician assistant who
849	849	provides a prescription or standing order for undesignated glucagon are not liable
850	850	for any injury that results from the administration of undesignated glucagon under
851	851	this section, regardless of whether authorization was given by the pupil[s parent or
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878	878	JPC:emw&wlj
879	879	SECTION 40
880	880	guardian or by the pupil[s diabetes provider, unless the injury is the result of an act
881	881	or omission that constitutes gross negligence or willful or wanton misconduct. The
882	882	immunity from liability provided under this paragraph is in addition to and not in
883	883	lieu of that provided under s. 895.48.
884	884	SECTION 41. 146.615 (1) (a) of the statutes is amended to read:
885	885	146.615 (1) (a) XAdvanced practice clinicianY means a physician assistant or
886	886	an advanced practice registered nurse, including a nurse practitioner, certified
887	887	nurse-midwife, clinical nurse specialist, or certified registered nurse anesthetist
888	888	licensed under s. 441.09.
889	889	SECTION 42. 146.82 (3) (a) of the statutes is amended to read:
890	890	146.82 (3) (a) Notwithstanding sub. (1), a physician, a naturopathic doctor, a
891	891	limited-scope naturopathic doctor, a physician assistant, or an advanced practice
892	892	registered nurse prescriber certified under s. 441.16 (2) licensed under s. 441.09
893	893	who treats a patient whose physical or mental condition in the physician[s,
894	894	naturopathic doctor[s, limited-scope naturopathic doctor[s, physician assistant[s, or
895	895	advanced practice nurse prescriber[s registered nurse[s judgment affects the
896	896	patient[s ability to exercise reasonable and ordinary control over a motor vehicle
897	897	may report the patient[s name and other information relevant to the condition to
898	898	the department of transportation without the informed consent of the patient.
899	899	SECTION 43. 146.89 (1) (r) 1. of the statutes is amended to read:
900	900	146.89 (1) (r) 1. Licensed as a physician under ch. 448, naturopathic doctor
901	901	under ch. 466, a dentist, dental therapist, or dental hygienist under ch. 447, a
902	902	registered nurse, practical nurse, or nurse-midwife advanced practice registered
903	903	nurse under ch. 441, an optometrist under ch. 449, a physician assistant under
904	904	1
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930	930	JPC:emw&wlj
931	931	SECTION 43
932	932	subch. IX of ch. 448, a pharmacist under ch. 450, a chiropractor under ch. 446, a
933	933	podiatrist under subch. IV of ch. 448, or a physical therapist under subch. III of ch.
934	934	448.
935	935	SECTION 44. 146.89 (1) (r) 3. of the statutes is renumbered 146.89 (1) (r) 5e.
936	936	and amended to read:
937	937	146.89 (1) (r) 5e. A registered nurse practitioner, as defined in s. 255.06 (1) (d)
938	938	who holds a multistate license, as defined in s. 441.51 (2) (h), issued by a party
939	939	state, as defined in s. 441.51 (2) (k), and whose practice of professional nursing
940	940	under s. 441.001 (4) includes performance of delegated medical services under the
941	941	supervision of a physician, dentist, podiatrist, or advanced practice registered
942	942	nurse.
943	943	SECTION 45. 146.89 (1) (r) 8. of the statutes is repealed.
944	944	SECTION 46. 146.89 (6) of the statutes is amended to read:
945	945	146.89 (6) (a) While serving as a volunteer health care provider under this
946	946	section, an advanced practice registered nurse who has a certificate to issue
947	947	prescription orders under s. 441.16 (2) is considered to meet the requirements of s.
948	948	655.23, if required to comply with s. 655.23.
949	949	(b) While serving as a volunteer health care provider under this section, an
950	950	advanced practice registered nurse who has a certificate to issue prescription
951	951	orders under s. 441.16 (2) is not required to maintain in effect malpractice
952	952	insurance.
953	953	SECTION 47. 154.01 (1g) of the statutes is amended to read:
954	954	154.01 (1g) XAdvanced practice registered nurseY means a nurse an
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978	978	SENATE BILL 258
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980	980	JPC:emw&wlj
981	981	SECTION 47
982	982	individual licensed under ch. 441 who is currently certified by a national certifying
983	983	body approved by the board of nursing as a nurse practitioner, certified nurse-
984	984	midwife, certified registered nurse anesthetist, or clinical nurse specialist s. 441.09.
985	985	SECTION 48. 155.01 (1g) (b) of the statutes is repealed and recreated to read:
986	986	155.01 (1g) (b) An individual who is licensed as an advanced practice
987	987	registered nurse and possesses a nurse practitioner specialty designation under s.
988	988	441.09.
989	989	SECTION 49. 251.01 (1c) of the statutes is repealed and recreated to read:
990	990	251.01 (1c) XAdvanced practice registered nurseY means an individual
991	991	licensed under s. 441.09.
992	992	SECTION 50. 252.01 (1c) of the statutes is repealed.
993	993	SECTION 51. 252.07 (8) (a) 2. of the statutes is amended to read:
994	994	252.07 (8) (a) 2. The department or local health officer provides to the court a
995	995	written statement from a physician, physician assistant, or advanced practice
996	996	registered nurse prescriber that the individual has infectious tuberculosis or
997	997	suspect tuberculosis.
998	998	SECTION 52. 252.07 (9) (c) of the statutes is amended to read:
999	999	252.07 (9) (c) If the court orders confinement of an individual under this
1000	1000	subsection, the individual shall remain confined until the department or local
1001	1001	health officer, with the concurrence of a treating physician, physician assistant, or
1002	1002	advanced practice registered nurse prescriber, determines that treatment is
1003	1003	complete or that the individual is no longer a substantial threat to himself or herself
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1026	1026	SENATE BILL 258
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1028	1028	JPC:emw&wlj
1029	1029	SECTION 52
1030	1030	or to the public health. If the individual is to be confined for more than 6 months,
1031	1031	the court shall review the confinement every 6 months.
1032	1032	SECTION 53. 252.10 (7) of the statutes is amended to read:
1033	1033	252.10 (7) Drugs necessary for the treatment of mycobacterium tuberculosis
1034	1034	shall be purchased by the department from the appropriation account under s.
1035	1035	20.435 (1) (e) and dispensed to patients through the public health dispensaries,
1036	1036	local health departments, physicians, or advanced practice nurse prescribers
1037	1037	registered nurses who may issue prescription orders under s. 441.09 (2).
1038	1038	SECTION 54. 252.11 (2) of the statutes is amended to read:
1039	1039	252.11 (2) An officer of the department or a local health officer having
1040	1040	knowledge of any reported or reasonably suspected case or contact of a sexually
1041	1041	transmitted disease for which no appropriate treatment is being administered, or of
1042	1042	an actual contact of a reported case or potential contact of a reasonably suspected
1043	1043	case, shall investigate or cause the case or contact to be investigated as necessary.
1044	1044	If, following a request of an officer of the department or a local health officer, a
1045	1045	person reasonably suspected of being infected with a sexually transmitted disease
1046	1046	refuses or neglects examination by a physician, physician assistant, or advanced
1047	1047	practice registered nurse prescriber or treatment, an officer of the department or a
1048	1048	local health officer may proceed to have the person committed under sub. (5) to an
1049	1049	institution or system of care for examination, treatment, or observation.
1050	1050	SECTION 55. 252.11 (4) of the statutes is amended to read:
1051	1051	252.11 (4) If a person infected with a sexually transmitted disease ceases or
1052	1052	refuses treatment before reaching what in a physician[s, physician assistant[s, or
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1076	1076	SENATE BILL 258
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1078	1078	JPC:emw&wlj
1079	1079	SECTION 55
1080	1080	advanced practice nurse prescriber[s registered nurse[s opinion is the
1081	1081	noncommunicable stage, the physician, physician assistant, or advanced practice
1082	1082	registered nurse prescriber shall notify the department. The department shall
1083	1083	without delay take the necessary steps to have the person committed for treatment
1084	1084	or observation under sub. (5), or shall notify the local health officer to take these
1085	1085	steps.
1086	1086	SECTION 56. 252.11 (5) of the statutes is amended to read:
1087	1087	252.11 (5) Any court of record may commit a person infected with a sexually
1088	1088	transmitted disease to any institution or may require the person to undergo a
1089	1089	system of care for examination, treatment, or observation if the person ceases or
1090	1090	refuses examination, treatment, or observation under the supervision of a
1091	1091	physician, physician assistant, or advanced practice registered nurse prescriber.
1092	1092	The court shall summon the person to appear on a date at least 48 hours, but not
1093	1093	more than 96 hours, after service if an officer of the department or a local health
1094	1094	officer petitions the court and states the facts authorizing commitment. If the
1095	1095	person fails to appear or fails to accept commitment without reasonable cause, the
1096	1096	court may cite the person for contempt. The court may issue a warrant and may
1097	1097	direct the sheriff, any constable, or any police officer of the county immediately to
1098	1098	arrest the person and bring the person to court if the court finds that a summons
1099	1099	will be ineffectual. The court shall hear the matter of commitment summarily.
1100	1100	Commitment under this subsection continues until the disease is no longer
1101	1101	communicable or until other provisions are made for treatment that satisfy the
1102	1102	department. The certificate of the petitioning officer is prima facie evidence that
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1126	1126	SENATE BILL 258
1127	1127	- 24 - LRB-1565/1
1128	1128	JPC:emw&wlj
1129	1129	SECTION 56
1130	1130	the disease is no longer communicable or that satisfactory provisions for treatment
1131	1131	have been made.
1132	1132	SECTION 57. 252.11 (7) of the statutes is amended to read:
1133	1133	252.11 (7) Reports, examinations and inspections, and all records concerning
1134	1134	sexually transmitted diseases are confidential and not open to public inspection,
1135	1135	and may not be divulged except as may be necessary for the preservation of the
1136	1136	public health, in the course of commitment proceedings under sub. (5), or as
1137	1137	provided under s. 938.296 (4) or 968.38 (4). If a physician, physician assistant, or
1138	1138	advanced practice registered nurse prescriber has reported a case of sexually
1139	1139	transmitted disease to the department under sub. (4), information regarding the
1140	1140	presence of the disease and treatment is not privileged when the patient, physician,
1141	1141	physician assistant, or advanced practice registered nurse prescriber is called upon
1142	1142	to testify to the facts before any court of record.
1143	1143	SECTION 58. 252.11 (10) of the statutes is amended to read:
1144	1144	252.11 (10) The state laboratory of hygiene shall examine specimens for the
1145	1145	diagnosis of sexually transmitted diseases for any physician, naturopathic doctor,
1146	1146	physician assistant, advanced practice registered nurse prescriber, or local health
1147	1147	officer in the state, and shall report the positive results of the examinations to the
1148	1148	local health officer and to the department. All laboratories performing tests for
1149	1149	sexually transmitted diseases shall report all positive results to the local health
1150	1150	officer and to the department, with the name of the physician, naturopathic doctor,
1151	1151	physician assistant, or advanced practice registered nurse prescriber to whom
1152	1152	reported.
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1176	1176	SENATE BILL 258
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1178	1178	JPC:emw&wlj
1179	1179	SECTION 59
1180	1180	SECTION 59. 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and
1181	1181	3. and (7m) (intro.) and (b) of the statutes are amended to read:
1182	1182	252.15 (3m) (d) 11. b. The coroner, medical examiner, or appointed assistant
1183	1183	is investigating the cause of death of the subject of the HIV test and has contact
1184	1184	with the body fluid of the subject of the HIV test that constitutes a significant
1185	1185	exposure, if a physician, physician assistant, or advanced practice registered nurse
1186	1186	prescriber, based on information provided to the physician, physician assistant, or
1187	1187	advanced practice registered nurse prescriber, determines and certifies in writing
1188	1188	that the coroner, medical examiner, or appointed assistant has had a contact that
1189	1189	constitutes a significant exposure and if the certification accompanies the request
1190	1190	for disclosure.
1191	1191	13. If the subject of the HIV test has a positive HIV test result and is
1192	1192	deceased, by the subject[s attending physician, physician assistant, or advanced
1193	1193	practice registered nurse prescriber, to persons, if known to the physician,
1194	1194	physician assistant, or advanced practice registered nurse prescriber, with whom
1195	1195	the subject had sexual contact or shared intravenous drug use paraphernalia.
1196	1196	(5g) (c) A physician, physician assistant, or advanced practice registered
1197	1197	nurse prescriber, based on information provided to the physician, physician
1198	1198	assistant, or advanced practice registered nurse prescriber, determines and
1199	1199	certifies in writing that the person has had contact that constitutes a significant
1200	1200	exposure. The certification shall accompany the request for HIV testing and
1201	1201	disclosure. If the person is a physician, physician assistant, or advanced practice
1202	1202	registered nurse prescriber, he or she may not make this determination or
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1226	1226	SENATE BILL 258
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1228	1228	JPC:emw&wlj
1229	1229	SECTION 59
1230	1230	certification. The information that is provided to a physician, physician assistant,
1231	1231	or advanced practice registered nurse prescriber to document the occurrence of the
1232	1232	contact that constitutes a significant exposure and the physician[s, physician
1233	1233	assistant[s, or advanced practice nurse prescriber[s registered nurse[s certification
1234	1234	that the person has had contact that constitutes a significant exposure, shall be
1235	1235	provided on a report form that is developed by the department of safety and
1236	1236	professional services under s. 101.02 (19) (a) or on a report form that the
1237	1237	department of safety and professional services determines, under s. 101.02 (19) (b),
1238	1238	is substantially equivalent to the report form that is developed under s. 101.02 (19)
1239	1239	(a).
1240	1240	(5m) (d) 2. A physician, physician assistant, or advanced practice registered
1241	1241	nurse prescriber, based on information provided to the physician, physician
1242	1242	assistant, or advanced practice registered nurse prescriber, determines and
1243	1243	certifies in writing that the contact under subd. 1. constitutes a significant
1244	1244	exposure. A health care provider who has a contact under subd. 1. c. may not make
1245	1245	the certification under this subdivision for himself or herself.
1246	1246	(e) 2. If the contact occurs as provided under par. (d) 1. b., the attending
1247	1247	physician, physician assistant, or advanced practice registered nurse prescriber of
1248	1248	the funeral director, coroner, medical examiner, or appointed assistant.
1249	1249	3. If the contact occurs as provided under par. (d) 1. c., the physician,
1250	1250	physician assistant, or advanced practice registered nurse prescriber who makes
1251	1251	the certification under par. (d) 2.
1252	1252	(7m) REPORTING OF PERSONS SIGNIFICANTLY EXPOSED. (intro.) If a positive,
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1276	1276	SENATE BILL 258
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1278	1278	JPC:emw&wlj
1279	1279	SECTION 59
1280	1280	validated HIV test result is obtained from a test subject, the test subject[s
1281	1281	physician, physician assistant, or advanced practice registered nurse prescriber
1282	1282	who maintains a record of the HIV test result under sub. (4) (c) may report to the
1283	1283	state epidemiologist the name of any person known to the physician, physician
1284	1284	assistant, or advanced practice registered nurse prescriber to have had contact with
1285	1285	body fluid of the test subject that constitutes a significant exposure, only after the
1286	1286	physician, physician assistant, or advanced practice registered nurse prescriber has
1287	1287	done all of the following:
1288	1288	(b) Notified the HIV test subject that the name of any person known to the
1289	1289	physician, physician assistant, or advanced practice registered nurse prescriber to
1290	1290	have had contact with body fluid of the test subject that constitutes a significant
1291	1291	exposure will be reported to the state epidemiologist.
1292	1292	SECTION 60. 252.16 (3) (c) (intro.) of the statutes is amended to read:
1293	1293	252.16 (3) (c) (intro.) Has submitted to the department a certification from a
1294	1294	physician, as defined in s. 448.01 (5), physician assistant, or advanced practice
1295	1295	registered nurse prescriber of all of the following:
1296	1296	SECTION 61. 252.17 (3) (c) (intro.) of the statutes is amended to read:
1297	1297	252.17 (3) (c) (intro.) Has submitted to the department a certification from a
1298	1298	physician, as defined in s. 448.01 (5), physician assistant, or advanced practice
1299	1299	registered nurse prescriber of all of the following:
1300	1300	SECTION 62. 253.07 (4) (d) of the statutes is amended to read:
1301	1301	253.07 (4) (d) In each fiscal year, $31,500 as grants for employment in
1302	1302	communities of licensed registered nurses, licensed practical nurses, certified
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1325	1325	23 2025 - 2026 Legislature
1326	1326	SENATE BILL 258
1327	1327	- 28 - LRB-1565/1
1328	1328	JPC:emw&wlj
1329	1329	SECTION 62
1330	1330	nurse-midwives licensed advanced practice registered nurses, or licensed physician
1331	1331	assistants who are members of a racial minority.
1332	1332	SECTION 63. 253.115 (1) (f) of the statutes is created to read:
1333	1333	253.115 (1) (f) XNurse-midwifeY means an individual who is licensed as an
1334	1334	advanced practice registered nurse and possesses a certified nurse-midwife
1335	1335	specialty designation under s. 441.09.
1336	1336	SECTION 64. 253.115 (4) of the statutes is amended to read:
1337	1337	253.115 (4) SCREENING REQUIRED. Except as provided in sub. (6), the
1338	1338	physician, nurse-midwife licensed under s. 441.15, or certified professional midwife
1339	1339	licensed under s. 440.982 who attended the birth shall ensure that the infant is
1340	1340	screened for hearing loss before being discharged from a hospital, or within 30 days
1341	1341	of birth if the infant was not born in a hospital.
1342	1342	SECTION 65. 253.115 (7) (a) (intro.) of the statutes is amended to read:
1343	1343	253.115 (7) (a) (intro.) The physician, nurse-midwife licensed under s. 441.15,
1344	1344	or certified professional midwife licensed under s. 440.982 who is required to ensure
1345	1345	that the infant is screened for hearing loss under sub. (4) shall do all of the
1346	1346	following:
1347	1347	SECTION 66. 253.13 (1) of the statutes is renumbered 253.13 (1) (b) and
1348	1348	amended to read:
1349	1349	253.13 (1) (b) The attending physician or nurse licensed under s. 441.15
1350	1350	nurse-midwife shall cause every infant born in each hospital or maternity home,
1351	1351	prior to its discharge therefrom, to be subjected to tests for congenital and metabolic
1352	1352	disorders, as specified in rules promulgated by the department. If the infant is born
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1378	1378	JPC:emw&wlj
1379	1379	SECTION 66
1380	1380	elsewhere than in a hospital or maternity home, the attending physician, nurse
1381	1381	licensed under s. 441.15 nurse-midwife, or birth attendant who attended the birth
1382	1382	shall cause the infant, within one week of birth, to be subjected to these tests.
1383	1383	SECTION 67. 253.13 (1) (a) of the statutes is created to read:
1384	1384	253.13 (1) (a) In this subsection, Xnurse-midwifeY means an individual who is
1385	1385	licensed as an advanced practice registered nurse and possesses a certified nurse-
1386	1386	midwife specialty designation under s. 441.09.
1387	1387	SECTION 68. 253.15 (1) (em) of the statutes is created to read:
1388	1388	253.15 (1) (em) XNurse-midwifeY means an individual who is licensed as an
1389	1389	advanced practice registered nurse and possesses a certified nurse-midwife
1390	1390	specialty designation under s. 441.09.
1391	1391	SECTION 69. 253.15 (2) of the statutes is amended to read:
1392	1392	253.15 (2) INFORMATIONAL MATERIALS. The board shall purchase or prepare
1393	1393	or arrange with a nonprofit organization to prepare printed and audiovisual
1394	1394	materials relating to shaken baby syndrome and impacted babies. The materials
1395	1395	shall include information regarding the identification and prevention of shaken
1396	1396	baby syndrome and impacted babies, the grave effects of shaking or throwing on an
1397	1397	infant or young child, appropriate ways to manage crying, fussing, or other causes
1398	1398	that can lead a person to shake or throw an infant or young child, and a discussion
1399	1399	of ways to reduce the risks that can lead a person to shake or throw an infant or
1400	1400	young child. The materials shall be prepared in English, Spanish, and other
1401	1401	languages spoken by a significant number of state residents, as determined by the
1402	1402	board. The board shall make those written and audiovisual materials available to
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1426	1426	SENATE BILL 258
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1428	1428	JPC:emw&wlj
1429	1429	SECTION 69
1430	1430	all hospitals, maternity homes, and nurse-midwives licensed under s. 441.15 that
1431	1431	are required to provide or make available materials to parents under sub. (3) (a) 1.,
1432	1432	to the department and to all county departments and nonprofit organizations that
1433	1433	are required to provide the materials to child care providers under sub. (4) (d), and
1434	1434	to all school boards and nonprofit organizations that are permitted to provide the
1435	1435	materials to pupils in one of grades 5 to 8 and in one of grades 10 to 12 under sub.
1436	1436	(5). The board shall also make those written materials available to all county
1437	1437	departments and Indian tribes that are providing home visitation services under s.
1438	1438	48.983 (4) (b) 1. and to all providers of prenatal, postpartum, and young child care
1439	1439	coordination services under s. 49.45 (44). The board may make available the
1440	1440	materials required under this subsection to be made available by making those
1441	1441	materials available at no charge on the board[s Internet site.
1442	1442	SECTION 70. 255.06 (1) (d) of the statutes is renumbered 255.06 (1) (f) (intro.)
1443	1443	and amended to read:
1444	1444	255.06 (1) (f) (intro.) XNurse practitionerY XWomen[s health nurse clinicianY
1445	1445	means a any of the following:
1446	1446	1. A registered nurse who is licensed under ch. 441 or who holds a multistate
1447	1447	license, as defined in s. 441.51 (2) (h), issued in a party state, as defined in s. 441.51
1448	1448	(2) (k), and whose practice of professional nursing under s. 441.001 (4) includes
1449	1449	performance of delegated medical services under the supervision of a physician,
1450	1450	naturopathic doctor, dentist, or podiatrist, or advanced practice registered nurse.
1451	1451	SECTION 71. 255.06 (1) (f) 2. of the statutes is created to read:
1452	1452	255.06 (1) (f) 2. An advanced practice registered nurse.
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1476	1476	SENATE BILL 258
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1478	1478	JPC:emw&wlj
1479	1479	SECTION 72
1480	1480	SECTION 72. 255.06 (2) (d) of the statutes is amended to read:
1481	1481	255.06 (2) (d) Specialized training for rural colposcopic examinations and
1482	1482	activities. Provide not more than $25,000 in each fiscal year as reimbursement for
1483	1483	the provision of specialized training of nurse practitioners women[s health nurse
1484	1484	clinicians to perform, in rural areas, colposcopic examinations and follow-up
1485	1485	activities for the treatment of cervical cancer.
1486	1486	SECTION 73. 255.07 (1) (d) of the statutes is amended to read:
1487	1487	255.07 (1) (d) XHealth care practitionerY means a physician, a physician
1488	1488	assistant, or an advanced practice registered nurse who is certified to may issue
1489	1489	prescription orders under s. 441.16 441.09 (2).
1490	1490	SECTION 74. 257.01 (5) (a) of the statutes is amended to read:
1491	1491	257.01 (5) (a) An individual who is licensed as a physician, a physician
1492	1492	assistant, or a podiatrist under ch. 448, licensed as a naturopathic doctor under ch.
1493	1493	466, licensed as a registered nurse, licensed practical nurse, or nurse-midwife
1494	1494	advanced practice registered nurse under ch. 441, licensed as a dentist or dental
1495	1495	therapist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a
1496	1496	veterinarian or certified as a veterinary technician under ch. 89, or certified as a
1497	1497	respiratory care practitioner under ch. 448.
1498	1498	SECTION 75. 257.01 (5) (b) of the statutes is amended to read:
1499	1499	257.01 (5) (b) An individual who was at any time within the previous 10 years,
1500	1500	but is not currently, licensed as a physician, a physician assistant, or a podiatrist
1501	1501	under ch. 448, licensed as a naturopathic doctor under ch. 466, licensed as a
1502	1502	registered nurse, licensed practical nurse, or nurse-midwife, advanced practice
1503	1503	registered nurse under ch. 441, licensed as a nurse-midwife under ch. 441, 2023
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1528	1528	SENATE BILL 258
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1530	1530	JPC:emw&wlj
1531	1531	SECTION 75
1532	1532	stats., licensed as a dentist or dental therapist under ch. 447, licensed as a
1533	1533	pharmacist under ch. 450, licensed as a veterinarian or certified as a veterinary
1534	1534	technician under ch. 89, or certified as a respiratory care practitioner under ch. 448,
1535	1535	if the individual[s license or certification was never revoked, limited, suspended, or
1536	1536	denied renewal.
1537	1537	SECTION 76. 341.14 (1a) of the statutes is amended to read:
1538	1538	341.14 (1a) If any resident of this state, who is registering or has registered
1539	1539	an automobile, or a motor truck, dual purpose motor home or dual purpose farm
1540	1540	truck which has a gross weight of not more than 8,000 pounds, a farm truck which
1541	1541	has a gross weight of not more than 12,000 pounds or a motor home, submits a
1542	1542	statement once every 4 years, as determined by the department, from a physician
1543	1543	licensed to practice medicine in any state, from an advanced practice registered
1544	1544	nurse licensed to practice nursing in any state, from a public health nurse certified
1545	1545	or licensed to practice in any state, from a physician assistant licensed or certified
1546	1546	to practice in any state, from a podiatrist licensed to practice in any state, from a
1547	1547	chiropractor licensed to practice chiropractic in any state, from a physical therapist
1548	1548	licensed to practice in any state, or from a Christian Science practitioner residing in
1549	1549	this state and listed in the Christian Science journal certifying to the department
1550	1550	that the resident is a person with a disability that limits or impairs the ability to
1551	1551	walk, the department shall procure, issue and deliver to the disabled person plates
1552	1552	of a special design in lieu of plates which ordinarily would be issued for the vehicle,
1553	1553	and shall renew the plates. The plates shall be so designed as to readily apprise law
1554	1554	enforcement officers of the fact that the vehicle is owned by a nonveteran disabled
1555	1555	person and is entitled to the parking privileges specified in s. 346.50 (2a). No
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1580	1580	SENATE BILL 258
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1582	1582	JPC:emw&wlj
1583	1583	SECTION 76
1584	1584	charge in addition to the registration fee shall be made for the issuance or renewal
1585	1585	of such plates.
1586	1586	SECTION 77. 341.14 (1e) (a) of the statutes is amended to read:
1587	1587	341.14 (1e) (a) If any resident of this state, who is registering or has
1588	1588	registered a motorcycle, submits a statement once every 4 years, as determined by
1589	1589	the department, from a physician licensed to practice medicine in any state, from an
1590	1590	advanced practice registered nurse licensed to practice nursing in any state, from a
1591	1591	public health nurse certified or licensed to practice in any state, from a physician
1592	1592	assistant licensed or certified to practice in any state, from a podiatrist licensed to
1593	1593	practice in any state, from a chiropractor licensed to practice chiropractic in any
1594	1594	state, from a physical therapist licensed to practice in any state, from a Christian
1595	1595	Science practitioner residing in this state and listed in the Christian Science
1596	1596	journal, or from the U.S. department of veterans affairs certifying to the
1597	1597	department that the resident is a person with a disability that limits or impairs the
1598	1598	ability to walk, the department shall procure, issue and deliver to the disabled
1599	1599	person a plate of a special design in lieu of the plate which ordinarily would be
1600	1600	issued for the motorcycle, and shall renew the plate. The statement shall state
1601	1601	whether the disability is permanent or temporary and, if temporary, the opinion of
1602	1602	the physician, advanced practice registered nurse, public health nurse, physician
1603	1603	assistant, podiatrist, chiropractor, physical therapist, practitioner, or U.S.
1604	1604	department of veterans affairs as to the duration of the disability. The plate shall
1605	1605	be so designed as to readily apprise law enforcement officers of the fact that the
1606	1606	motorcycle is owned by a disabled person and is entitled to the parking privileges
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1630	1630	SENATE BILL 258
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1632	1632	JPC:emw&wlj
1633	1633	SECTION 77
1634	1634	specified in s. 346.50 (2a). No charge in addition to the registration fee may be
1635	1635	made for the issuance or renewal of the plate.
1636	1636	SECTION 78. 341.14 (1m) of the statutes is amended to read:
1637	1637	341.14 (1m) If any licensed driver submits to the department a statement
1638	1638	once every 4 years, as determined by the department, from a physician licensed to
1639	1639	practice medicine in any state, from a public health nurse certified or licensed to
1640	1640	practice in any state, from an advanced practice registered nurse licensed to
1641	1641	practice nursing in any state, from a physician assistant licensed or certified to
1642	1642	practice in any state, from a podiatrist licensed to practice in any state, from a
1643	1643	chiropractor licensed to practice chiropractic in any state, from a physical therapist
1644	1644	licensed to practice in any state, or from a Christian Science practitioner residing in
1645	1645	this state and listed in the Christian Science journal certifying that another person
1646	1646	who is regularly dependent on the licensed driver for transportation is a person
1647	1647	with a disability that limits or impairs the ability to walk, the department shall
1648	1648	issue and deliver to the licensed driver plates of a special design in lieu of the plates
1649	1649	which ordinarily would be issued for the automobile or motor truck, dual purpose
1650	1650	motor home or dual purpose farm truck having a gross weight of not more than
1651	1651	8,000 pounds, farm truck having a gross weight of not more than 12,000 pounds or
1652	1652	motor home, and shall renew the plates. The plates shall be so designed as to
1653	1653	readily apprise law enforcement officers of the fact that the vehicle is operated by a
1654	1654	licensed driver on whom a disabled person is regularly dependent and is entitled to
1655	1655	the parking privileges specified in s. 346.50 (2a). No charge in addition to the
1656	1656	registration fee may be made for the issuance or renewal of the plates. The plates
1657	1657	shall conform to the plates required in sub. (1a).
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1682	1682	SENATE BILL 258
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1684	1684	JPC:emw&wlj
1685	1685	SECTION 79
1686	1686	SECTION 79. 341.14 (1q) of the statutes is amended to read:
1687	1687	341.14 (1q) If any employer who provides an automobile, or a motor truck,
1688	1688	dual purpose motor home or dual purpose farm truck which has a gross weight of
1689	1689	not more than 8,000 pounds, a farm truck which has a gross weight of not more
1690	1690	than 12,000 pounds or a motor home, for an employee[s use submits to the
1691	1691	department a statement once every 4 years, as determined by the department, from
1692	1692	a physician licensed to practice medicine in any state, from an advanced practice
1693	1693	registered nurse licensed to practice nursing in any state, from a public health
1694	1694	nurse certified or licensed to practice in any state, from a physician assistant
1695	1695	licensed or certified to practice in any state, from a podiatrist licensed to practice in
1696	1696	any state, from a physical therapist licensed to practice in any state, from a
1697	1697	chiropractor licensed to practice chiropractic in any state, or from a Christian
1698	1698	Science practitioner residing in this state and listed in the Christian Science
1699	1699	journal certifying that the employee is a person with a disability that limits or
1700	1700	impairs the ability to walk, the department shall issue and deliver to such employer
1701	1701	plates of a special design in lieu of the plates which ordinarily would be issued for
1702	1702	the vehicle, and shall renew the plates. The plates shall be so designed as to readily
1703	1703	apprise law enforcement officers of the fact that the vehicle is operated by a
1704	1704	disabled person and is entitled to the parking privileges specified in s. 346.50 (2a).
1705	1705	No charge in addition to the registration fee may be made for the issuance or
1706	1706	renewal of the plates. The plates shall conform to the plates required in sub. (1a).
1707	1707	SECTION 80. 343.16 (5) (a) of the statutes is amended to read:
1708	1708	343.16 (5) (a) The secretary may require any applicant for a license or any
1709	1709	licensed operator to submit to a special examination by such persons or agencies as
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1734	1734	SENATE BILL 258
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1736	1736	JPC:emw&wlj
1737	1737	SECTION 80
1738	1738	the secretary may direct to determine incompetency, physical or mental disability,
1739	1739	disease, or any other condition that might prevent such applicant or licensed person
1740	1740	from exercising reasonable and ordinary control over a motor vehicle. If the
1741	1741	department requires the applicant to submit to an examination, the applicant shall
1742	1742	pay for the examination. If the department receives an application for a renewal or
1743	1743	duplicate license after voluntary surrender under s. 343.265 or receives a report
1744	1744	from a physician, physician assistant, advanced practice registered nurse
1745	1745	prescriber certified under s. 441.16 (2) licensed under s. 441.09, or optometrist
1746	1746	under s. 146.82 (3), or if the department has a report of 2 or more arrests within a
1747	1747	one-year period for any combination of violations of s. 346.63 (1) or (5) or a local
1748	1748	ordinance in conformity with s. 346.63 (1) or (5) or a law of a federally recognized
1749	1749	American Indian tribe or band in this state in conformity with s. 346.63 (1) or (5), or
1750	1750	s. 346.63 (1m), 1985 stats., or s. 346.63 (2) or (6) or 940.25, or s. 940.09 where the
1751	1751	offense involved the use of a vehicle, the department shall determine, by interview
1752	1752	or otherwise, whether the operator should submit to an examination under this
1753	1753	section. The examination may consist of an assessment. If the examination
1754	1754	indicates that education or treatment for a disability, disease or condition
1755	1755	concerning the use of alcohol, a controlled substance or a controlled substance
1756	1756	analog is appropriate, the department may order a driver safety plan in accordance
1757	1757	with s. 343.30 (1q). If there is noncompliance with assessment or the driver safety
1758	1758	plan, the department shall revoke the person[s operating privilege in the manner
1759	1759	specified in s. 343.30 (1q) (d).
1760	1760	SECTION 81. 343.51 (1) of the statutes is amended to read:
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1784	1784	SENATE BILL 258
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1786	1786	JPC:emw&wlj
1787	1787	SECTION 81
1788	1788	343.51 (1) Any person who qualifies for registration plates of a special design
1789	1789	under s. 341.14 (1), (1a), (1m), or (1q) or any other person with a disability that
1790	1790	limits or impairs the ability to walk may request from the department a special
1791	1791	identification card that will entitle any motor vehicle parked by, or under the
1792	1792	direction of, the person, or a motor vehicle operated by or on behalf of the
1793	1793	organization when used to transport such a person, to parking privileges under s.
1794	1794	346.50 (2), (2a), and (3). The department shall issue the card at a fee to be
1795	1795	determined by the department, upon submission by the applicant, if the applicant
1796	1796	is an individual rather than an organization, of a statement from a physician
1797	1797	licensed to practice medicine in any state, from an advanced practice registered
1798	1798	nurse licensed to practice nursing in any state, from a public health nurse certified
1799	1799	or licensed to practice in any state, from a physician assistant licensed or certified
1800	1800	to practice in any state, from a podiatrist licensed to practice in any state, from a
1801	1801	chiropractor licensed to practice chiropractic in any state, from a physical therapist
1802	1802	licensed to practice in any state, or from a Christian Science practitioner residing in
1803	1803	this state and listed in the Christian Science journal that the person is a person
1804	1804	with a disability that limits or impairs the ability to walk. The statement shall
1805	1805	state whether the disability is permanent or temporary and, if temporary, the
1806	1806	opinion of the physician, advanced practice registered nurse, public health nurse,
1807	1807	physician assistant, podiatrist, chiropractor, physical therapist, or practitioner as to
1808	1808	the duration of the disability. The department shall issue the card upon application
1809	1809	by an organization on a form prescribed by the department if the department
1810	1810	believes that the organization meets the requirements under this subsection.
1811	1811	SECTION 82. 343.62 (4) (a) 4. of the statutes is amended to read:
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1836	1836	SENATE BILL 258
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1838	1838	JPC:emw&wlj
1839	1839	SECTION 82
1840	1840	343.62 (4) (a) 4. The applicant submits with the application a statement
1841	1841	completed within the immediately preceding 24 months, except as provided by rule,
1842	1842	by a physician licensed to practice medicine in any state, from an advanced practice
1843	1843	registered nurse licensed to practice nursing in any state, from a physician
1844	1844	assistant licensed or certified to practice in any state, from a podiatrist licensed to
1845	1845	practice in any state, from a chiropractor licensed to practice chiropractic in any
1846	1846	state, from a physical therapist licensed to practice in any state, or from a Christian
1847	1847	Science practitioner residing in this state, and listed in the Christian Science
1848	1848	journal certifying that, in the medical care provider[s judgment, the applicant is
1849	1849	physically fit to teach driving.
1850	1850	SECTION 83. 440.03 (13) (b) 3. of the statutes is repealed.
1851	1851	SECTION 84. 440.03 (13) (b) 39m. of the statutes is created to read:
1852	1852	440.03 (13) (b) 39m. Nurse, advanced practice registered.
1853	1853	SECTION 85. 440.03 (13) (b) 42. of the statutes is repealed.
1854	1854	SECTION 86. 440.077 (1) (a) of the statutes is amended to read:
1855	1855	440.077 (1) (a) XAdvanced practice registered nurse prescriberY means an
1856	1856	advanced practice registered nurse prescriber certified licensed under s. 441.16 (2)
1857	1857	441.09.
1858	1858	SECTION 87. 440.077 (2) (c) of the statutes is amended to read:
1859	1859	440.077 (2) (c) Under the program under par. (a), a participating military
1860	1860	medical personnel shall be supervised by a physician, physician assistant,
1861	1861	podiatrist, registered professional nurse, or advanced practice registered nurse
1862	1862	prescriber. The supervising physician, physician assistant, podiatrist, registered
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1889	1889	SECTION 87
1890	1890	professional nurse, or advanced practice registered nurse prescriber shall retain
1891	1891	responsibility for the care of the patient.
1892	1892	SECTION 88. 440.08 (2) (a) 4m. of the statutes is repealed.
1893	1893	SECTION 89. 440.08 (2) (a) 47r. of the statutes is created to read:
1894	1894	440.08 (2) (a) 47r. Nurse, advanced practice registered: March 1 of each even-
1895	1895	numbered year.
1896	1896	SECTION 90. 440.08 (2) (a) 50. of the statutes is repealed.
1897	1897	SECTION 91. 440.094 (1) (c) 1. of the statutes is amended to read:
1898	1898	440.094 (1) (c) 1. A registered nurse, licensed practical nurse, or nurse
1899	1899	midwife licensed under ch. 441, or an advanced practice registered nurse prescriber
1900	1900	certified licensed under ch. 441.
1901	1901	SECTION 92. 440.094 (2) (a) (intro.) of the statutes is amended to read:
1902	1902	440.094 (2) (a) (intro.) Notwithstanding ss. 441.06 (4), 441.15 (2), 441.16,
1903	1903	441.09 (3) (b), 446.02 (1), 447.03 (1) and (2), 448.03 (1) (a), (b), and (c) and (1m),
1904	1904	448.51 (1), 448.61, 448.76, 448.961 (1) and (2), 449.02 (1), 450.03 (1), 451.04 (1),
1905	1905	455.02 (1m), 457.04 (4), (5), (6), and (7), 459.02 (1), 459.24 (1), and 460.02, a health
1906	1906	care provider may provide services within the scope of the credential that the
1907	1907	health care provider holds and the department shall grant the health care provider
1908	1908	a temporary credential to practice under this section if all of the following apply:
1909	1909	SECTION 93. 440.981 (1) of the statutes is amended to read:
1910	1910	440.981 (1) No person may use the title Xlicensed midwife,Y describe or imply
1911	1911	that he or she is a licensed midwife, or represent himself or herself as a licensed
1912	1912	midwife unless the person is granted a license under this subchapter or is licensed
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1932	1932	20
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1934	1934	22
1935	1935	23 2025 - 2026 Legislature
1936	1936	SENATE BILL 258
1937	1937	- 40 - LRB-1565/1
1938	1938	JPC:emw&wlj
1939	1939	SECTION 93
1940	1940	as a nurse-midwife under s. 441.15 an advanced practice registered nurse and
1941	1941	possesses a certified nurse-midwife specialty designation under s. 441.09.
1942	1942	SECTION 94. 440.982 (1) of the statutes is amended to read:
1943	1943	440.982 (1) No person may engage in the practice of midwifery unless the
1944	1944	person is granted a license under this subchapter, is granted a temporary permit
1945	1945	pursuant to a rule promulgated under s. 440.984 (2m), or is licensed as a nurse-
1946	1946	midwife under s. 441.15 an advanced practice registered nurse and possesses a
1947	1947	certified nurse-midwife specialty designation under s. 441.09.
1948	1948	SECTION 95. 440.987 (2) of the statutes is amended to read:
1949	1949	440.987 (2) One member who is licensed as a nurse-midwife under s. 441.15
1950	1950	an advanced practice registered nurse and possesses a certified nurse-midwife
1951	1951	specialty designation under s. 441.09 and who practices in an out-of-hospital
1952	1952	setting.
1953	1953	SECTION 96. 441.001 (1c) of the statutes is created to read:
1954	1954	441.001 (1c) ADVANCED PRACTICE REGISTERED NURSING. XAdvanced practice
1955	1955	registered nursingY means the practice of a certified nurse-midwife, the practice of
1956	1956	a certified registered nurse anesthetist, the practice of a clinical nurse specialist,
1957	1957	and the practice of a nurse practitioner.
1958	1958	SECTION 97. 441.001 (3c) of the statutes is created to read:
1959	1959	441.001 (3c) PRACTICE OF A CERTIFIED NURSE-MIDWIFE. XPractice of a
1960	1960	certified nurse-midwifeY means practice in the management of women[s health
1961	1961	care, pregnancy, childbirth, postpartum care for newborns, family planning, and
1962	1962	1
1963	1963	2
1964	1964	3
1965	1965	4
1966	1966	5
1967	1967	6
1968	1968	7
1969	1969	8
1970	1970	9
1971	1971	10
1972	1972	11
1973	1973	12
1974	1974	13
1975	1975	14
1976	1976	15
1977	1977	16
1978	1978	17
1979	1979	18
1980	1980	19
1981	1981	20
1982	1982	21
1983	1983	22 2025 - 2026 Legislature
1984	1984	SENATE BILL 258
1985	1985	- 41 - LRB-1565/1
1986	1986	JPC:emw&wlj
1987	1987	SECTION 97
1988	1988	gynecological services consistent with the standards of practice of the American
1989	1989	College of Nurse-Midwives or its successor.
1990	1990	SECTION 98. 441.001 (3g) of the statutes is created to read:
1991	1991	441.001 (3g) PRACTICE OF A CERTIFIED REGISTERED NURSE ANESTHETIST.
1992	1992	XPractice of a certified registered nurse anesthetistY means providing anesthesia
1993	1993	care, pain management care, and care related to anesthesia and pain management
1994	1994	for persons across their lifespan, whose health status may range from healthy
1995	1995	through all levels of acuity, including persons with immediate, severe, or life-
1996	1996	threatening illness or injury, in diverse settings, including hospitals, ambulatory
1997	1997	surgery centers, outpatient clinics, medical offices, and home health care settings.
1998	1998	SECTION 99. 441.001 (3n) of the statutes is created to read:
1999	1999	441.001 (3n) PRACTICE OF A CLINICAL NURSE SPECIALIST. XPractice of a
2000	2000	clinical nurse specialistY means providing advanced nursing care, primarily in
2001	2001	health care facilities, including the diagnosis and treatment of illness for identified
2002	2002	specific populations based on a specialty.
2003	2003	SECTION 100. 441.001 (3r) of the statutes is created to read:
2004	2004	441.001 (3r) PRACTICE OF A NURSE PRACTITIONER. XPractice of a nurse
2005	2005	practitionerY means practice in ambulatory, acute, long-term, or other health care
2006	2006	settings as a primary or specialty care provider who provides health services,
2007	2007	including assessing, diagnosing, treating, or managing acute, episodic, and chronic
2008	2008	illnesses.
2009	2009	SECTION 101. 441.001 (3w) of the statutes is created to read:
2010	2010	1
2011	2011	2
2012	2012	3
2013	2013	4
2014	2014	5
2015	2015	6
2016	2016	7
2017	2017	8
2018	2018	9
2019	2019	10
2020	2020	11
2021	2021	12
2022	2022	13
2023	2023	14
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2025	2025	16
2026	2026	17
2027	2027	18
2028	2028	19
2029	2029	20
2030	2030	21
2031	2031	22 2025 - 2026 Legislature
2032	2032	SENATE BILL 258
2033	2033	- 42 - LRB-1565/1
2034	2034	JPC:emw&wlj
2035	2035	SECTION 101
2036	2036	441.001 (3w) PRESCRIPTION ORDER. XPrescription orderY has the meaning
2037	2037	given in s. 450.01 (21).
2038	2038	SECTION 102. 441.001 (5) of the statutes is created to read:
2039	2039	441.001 (5) RECOGNIZED ROLE. XRecognized roleY means one of the following
2040	2040	roles:
2041	2041	(a) Certified nurse-midwife.
2042	2042	(b) Certified registered nurse anesthetist.
2043	2043	(c) Clinical nurse specialist.
2044	2044	(d) Nurse practitioner.
2045	2045	SECTION 103. 441.01 (3) of the statutes is amended to read:
2046	2046	441.01 (3) The board may promulgate rules to establish minimum standards
2047	2047	for schools for professional nurses and, schools for licensed practical nurses, and
2048	2048	schools for advanced practice registered nurses, including all related clinical units
2049	2049	and facilities, and make and provide periodic surveys and consultations to such
2050	2050	schools. It The board may also establish promulgate rules to prevent unauthorized
2051	2051	persons from practicing professional nursing. It shall approve all rules for the
2052	2052	administration of this chapter in accordance with ch. 227.
2053	2053	SECTION 104. 441.01 (4) of the statutes is amended to read:
2054	2054	441.01 (4) The board shall direct that those schools that qualify be placed on
2055	2055	a list of schools the board has approved for professional nurses or, of schools the
2056	2056	board has approved for licensed practical nurses, or of schools the board has
2057	2057	approved for advanced practice registered nurses on application and proof of
2058	2058	1
2059	2059	2
2060	2060	3
2061	2061	4
2062	2062	5
2063	2063	6
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2075	2075	18
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2077	2077	20
2078	2078	21
2079	2079	22 2025 - 2026 Legislature
2080	2080	SENATE BILL 258
2081	2081	- 43 - LRB-1565/1
2082	2082	JPC:emw&wlj
2083	2083	SECTION 104
2084	2084	qualifications;, and the board shall make a study of nursing education and initiate
2085	2085	promulgate rules and policies to improve it.
2086	2086	SECTION 105. 441.01 (7) (a) (intro.) of the statutes is amended to read:
2087	2087	441.01 (7) (a) (intro.) The board shall require each applicant for the renewal of
2088	2088	a registered nurse or, licensed practical nurse, or advanced practice registered
2089	2089	nurse license issued under this chapter to do all of the following as a condition for
2090	2090	renewing the license:
2091	2091	SECTION 106. 441.01 (7) (b) of the statutes is amended to read:
2092	2092	441.01 (7) (b) The board may not renew a registered nurse or, licensed
2093	2093	practical nurse, or advanced practice registered nurse license under this chapter
2094	2094	unless the renewal applicant has completed the nursing workforce survey to the
2095	2095	satisfaction of the board. The board shall establish standards to determine whether
2096	2096	the survey has been completed. The board shall, by no later than June 30 of each
2097	2097	odd-numbered year, submit all completed nursing workforce survey forms to the
2098	2098	department of workforce development.
2099	2099	SECTION 107. 441.01 (7) (c) of the statutes is created to read:
2100	2100	441.01 (7) (c) An applicant who is renewing both a registered nurse and
2101	2101	advanced practice registered nurse license under s. 441.09 (1) (c) is only required to
2102	2102	pay a single fee under par. (a) 2.
2103	2103	SECTION 108. 441.06 (title) of the statutes is repealed and recreated to read:
2104	2104	441.06 (title) Registered nurses; civil liability exemption.
2105	2105	SECTION 109. 441.06 (3) of the statutes is amended to read:
2106	2106	441.06 (3) A Except as provided in s. 441.09 (1) (c), a registered nurse
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2108	2108	2
2109	2109	3
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2127	2127	21
2128	2128	22
2129	2129	23 2025 - 2026 Legislature
2130	2130	SENATE BILL 258
2131	2131	- 44 - LRB-1565/1
2132	2132	JPC:emw&wlj
2133	2133	SECTION 109
2134	2134	practicing for compensation shall, on or before the applicable renewal date specified
2135	2135	under s. 440.08 (2) (a), submit to the board on furnished forms a statement giving
2136	2136	name, residence, and other facts that the board requires, with the nursing
2137	2137	workforce survey and fee required under s. 441.01 (7) and the applicable renewal fee
2138	2138	determined by the department under s. 440.03 (9) (a).
2139	2139	SECTION 110. 441.06 (4) of the statutes is amended to read:
2140	2140	441.06 (4) Except as provided in ss. 257.03 and 440.077, no person may
2141	2141	practice or attempt to practice professional nursing, nor use the title, letters, or
2142	2142	anything else to indicate that he or she is a registered or professional nurse unless
2143	2143	he or she is licensed under this section. Except as provided in ss. 257.03 and
2144	2144	440.077, no person not so licensed may use in connection with his or her nursing
2145	2145	employment or vocation any title or anything else to indicate that he or she is a
2146	2146	trained, certified or graduate nurse. This subsection does not apply to any
2147	2147	registered nurse who holds a multistate license, as defined in s. 441.51 (2) (h),
2148	2148	issued by a jurisdiction, other than this state, that has adopted the nurse licensure
2149	2149	compact under s. 441.51.
2150	2150	SECTION 111. 441.06 (7) of the statutes is renumbered 441.09 (7) and
2151	2151	amended to read:
2152	2152	441.09 (7) CIVIL LIABILITY. No person certified licensed as an advanced
2153	2153	practice registered nurse prescriber under s. 441.16 (2) this section is liable for civil
2154	2154	damages for any of the following:
2155	2155	(a) Reporting in good faith to the department of transportation under s.
2156	2156	146.82 (3) a patient[s name and other information relevant to a physical or mental
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2158	2158	2
2159	2159	3
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2179	2179	23 2025 - 2026 Legislature
2180	2180	SENATE BILL 258
2181	2181	- 45 - LRB-1565/1
2182	2182	JPC:emw&wlj
2183	2183	SECTION 111
2184	2184	condition of the patient that in the advanced practice nurse prescriber[s registered
2185	2185	nurse[s judgment impairs the patient[s ability to exercise reasonable and ordinary
2186	2186	control over a motor vehicle.
2187	2187	(b) In good faith, not reporting to the department of transportation under s.
2188	2188	146.82 (3) a patient[s name and other information relevant to a physical or mental
2189	2189	condition of the patient that in the advanced practice nurse prescriber[s registered
2190	2190	nurse[s judgment does not impair the patient[s ability to exercise reasonable and
2191	2191	ordinary control over a motor vehicle.
2192	2192	SECTION 112. 441.065 of the statutes is created to read:
2193	2193	441.065 Use of titles. (1) Except as provided in sub. (2), no person licensed
2194	2194	under this chapter may use, assume, or append to his or her name any title that is
2195	2195	not granted under this chapter unless the person holds another credential, as
2196	2196	defined in s. 440.01 (2) (a), that entitles the person to use, assume, or append to his
2197	2197	or her name the title or the person is permitted to use, assume, or append to his or
2198	2198	her name the title under any law of this state.
2199	2199	(2) (a) Subsection (1) does not prohibit a person who holds a doctorate degree
2200	2200	from using, assuming, or appending to his or her name the title XdoctorY or any
2201	2201	other words, letters, or abbreviations that represent that the person holds that
2202	2202	doctorate degree or the field in which the degree was received. If a person to whom
2203	2203	this paragraph applies uses, assumes, or appends to his or her name the title
2204	2204	Xdoctor,Y the person shall also use, assume, or append to his or her name words,
2205	2205	letters, or abbreviations that represent the field in which the person received the
2206	2206	doctorate degree.
2207	2207	(b) Subsection (1) does not prohibit a person who holds a bachelor[s degree or
2208	2208	1
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2230	2230	23
2231	2231	24 2025 - 2026 Legislature
2232	2232	SENATE BILL 258
2233	2233	- 46 - LRB-1565/1
2234	2234	JPC:emw&wlj
2235	2235	SECTION 112
2236	2236	master[s degree from using, assuming, or appending to his or her name any words,
2237	2237	letters, or abbreviations that represent that the person holds that degree or the
2238	2238	field in which the degree was received.
2239	2239	SECTION 113. 441.07 (1g) (intro.), (a), (c) and (e) of the statutes are amended
2240	2240	to read:
2241	2241	441.07 (1g) (intro.) Subject to the rules promulgated under s. 440.03 (1), the
2242	2242	board may deny an initial license or revoke, limit, suspend, or deny the renewal of a
2243	2243	license of a registered nurse, nurse-midwife advanced practice registered nurse, or
2244	2244	licensed practical nurse; deny an initial certificate or revoke, limit, suspend, or deny
2245	2245	the renewal of a certificate to prescribe drugs or devices granted under s. 441.16; or
2246	2246	reprimand a registered nurse, nurse-midwife advanced practice registered nurse,
2247	2247	or licensed practical nurse, if the board finds that the applicant or licensee
2248	2248	committed any of the following:
2249	2249	(a) Fraud in the procuring or renewal of the certificate or license.
2250	2250	(c) Acts which that show the registered nurse, nurse-midwife advanced
2251	2251	practice registered nurse, or licensed practical nurse to be unfit or incompetent by
2252	2252	reason of negligence, abuse of alcohol or other drugs, or mental incompetency.
2253	2253	(e) A violation of any state or federal law that regulates prescribing or
2254	2254	dispensing drugs or devices, if the person has a certificate to prescribe drugs or
2255	2255	devices under s. 441.16 may issue prescription orders under s. 441.09 (2).
2256	2256	SECTION 114. 441.07 (1r) of the statutes is created to read:
2257	2257	441.07 (1r) If the board finds that a person licensed under this chapter has
2258	2258	violated s. 441.065, the board shall discipline the person as follows:
2259	2259	(a) For a 1st violation, issue a written warning.
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2261	2261	2
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2282	2282	23
2283	2283	24 2025 - 2026 Legislature
2284	2284	SENATE BILL 258
2285	2285	- 47 - LRB-1565/1
2286	2286	JPC:emw&wlj
2287	2287	SECTION 114
2288	2288	(b) For a 2nd violation, suspend the license of the person.
2289	2289	(c) For a 3rd violation, revoke the license of the person.
2290	2290	SECTION 115. 441.07 (2) of the statutes is amended to read:
2291	2291	441.07 (2) The board may reinstate a revoked license, no earlier than one year
2292	2292	following revocation, upon receipt of an application for reinstatement. This
2293	2293	subsection does not apply to a license that is revoked under sub. (1r) or s. 440.12.
2294	2294	SECTION 116. 441.09 of the statutes is created to read:
2295	2295	441.09 Advanced practice registered nurses; civil liability exemption.
2296	2296	(1) LICENSE. (a) An applicant who satisfies all of the following requirements may
2297	2297	apply to the board for initial licensure by the board as an advanced practice
2298	2298	registered nurse:
2299	2299	1. The applicant satisfies one of the following criteria:
2300	2300	a. The applicant holds a valid license to practice as a registered nurse issued
2301	2301	under s. 441.06 (1), (1c), or (1m).
2302	2302	b. The applicant applies concurrently for a license under s. 441.06 (1), (1c), or
2303	2303	(1m) with the application for a license under this paragraph.
2304	2304	c. The applicant is a registered nurse who holds a multistate license, as
2305	2305	defined in s. 441.51 (2) (h), issued by a jurisdiction, other than this state, that has
2306	2306	adopted the nurse licensure compact.
2307	2307	2. The applicant provides evidence satisfactory to the board that he or she
2308	2308	satisfies one of the following criteria:
2309	2309	a. The applicant has completed a graduate-level or postgraduate-level
2310	2310	education program that is approved by the board and that prepares the applicant
2311	2311	for the practice of advanced practice registered nursing in one of the 4 recognized
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2313	2313	2
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2320	2320	9
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2324	2324	13
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2327	2327	16
2328	2328	17
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2333	2333	22
2334	2334	23
2335	2335	24 2025 - 2026 Legislature
2336	2336	SENATE BILL 258
2337	2337	- 48 - LRB-1565/1
2338	2338	JPC:emw&wlj
2339	2339	SECTION 116
2340	2340	roles, and the applicant holds a current certification by a national certifying body
2341	2341	approved by the board.
2342	2342	b. On January 1, 2026, the applicant was licensed as a registered nurse in this
2343	2343	state and was practicing in a recognized role, and the applicant satisfies additional
2344	2344	criteria established by the board by rule under sub. (6) (a) 3. relating to practice,
2345	2345	education, or certification.
2346	2346	3. The applicant pays the fee specified under s. 440.05 (1).
2347	2347	4. The applicant provides to the board evidence of any malpractice liability
2348	2348	insurance coverage required under sub. (5).
2349	2349	5. If the applicant is applying to receive a certified nurse-midwife specialty
2350	2350	designation under par. (b) 1., the applicant does all of the following:
2351	2351	a. Provides evidence satisfactory to the board that the applicant is currently
2352	2352	certified by the American Midwifery Certification Board or its successor.
2353	2353	b. Files with the board any plan required under sub. (3m) (f).
2354	2354	6. The applicant does not have an arrest or conviction record, subject to ss.
2355	2355	111.321, 111.322, and 111.335.
2356	2356	7. The applicant meets any other criteria established by the board by rule
2357	2357	under sub. (6) (a) 3. relating to the education, training, or experience required for
2358	2358	each recognized role.
2359	2359	(b) 1. a. Subject to subd. 3. and s. 441.07 (1g), the board shall grant an
2360	2360	advanced practice registered nurse license to an applicant the board determines
2361	2361	meets the requirements under par. (a). The board shall also grant a person who is
2362	2362	granted a license under this subd. 1. a. one or more specialty designations
2363	2363	1
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2384	2384	22
2385	2385	23 2025 - 2026 Legislature
2386	2386	SENATE BILL 258
2387	2387	- 49 - LRB-1565/1
2388	2388	JPC:emw&wlj
2389	2389	SECTION 116
2390	2390	corresponding to the recognized roles for which the board determines that the
2391	2391	person qualifies based on the person[s qualifications under par. (a).
2392	2392	b. The board shall grant an advanced practice registered nurse license to each
2393	2393	individual who, on the day before the effective date of this subd. 1. b. .... [LRB
2394	2394	inserts date], was certified to issue prescription orders under s. 441.16, 2023 stats.
2395	2395	The board shall also grant a person who is granted a license under this subd. 1. b.
2396	2396	one or more specialty designations corresponding to the recognized roles for which
2397	2397	the board determines that the person qualifies based on the person[s qualifications.
2398	2398	c. The board shall grant an advanced practice registered nurse license to each
2399	2399	individual who, on the day before the effective date of this subd. 1. c. .... [LRB
2400	2400	inserts date], was licensed as a nurse-midwife under s. 441.15, 2023 stats. The
2401	2401	board shall also grant a person who is granted a license under this subd. 1. c. a
2402	2402	nurse-midwife specialty designation.
2403	2403	2. Each specialty designation granted under subd. 1. shall appear on the
2404	2404	person[s advanced practice registered nurse license.
2405	2405	3. The board may not grant an advanced practice registered nurse license to a
2406	2406	person applying concurrently for a license under s. 441.06 (1), (1c), or (1m), unless
2407	2407	the board also grants the person the license under s. 441.06 (1), (1c), or (1m).
2408	2408	4. The board may place specific limitations on a person licensed as an
2409	2409	advanced practice registered nurse as a condition of licensure.
2410	2410	5. If all of the following apply to a person, a notation indicating that the person
2411	2411	may not issue prescription orders shall appear on the person[s advanced practice
2412	2412	registered nurse license:
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2435	2435	23 2025 - 2026 Legislature
2436	2436	SENATE BILL 258
2437	2437	- 50 - LRB-1565/1
2438	2438	JPC:emw&wlj
2439	2439	SECTION 116
2440	2440	a. The person is granted an advanced practice registered nurse license under
2441	2441	subd. 1. a. and satisfies only par. (a) 2. b. but not par. (a) 2. a., or the person is
2442	2442	granted an advanced practice registered nurse license under subd. 1. c.
2443	2443	b. On January 1, 2026, the person did not hold a certificate under s. 441.16
2444	2444	(2), 2023 stats.
2445	2445	(c) On or before the applicable renewal date specified under s. 440.08 (2) (a),
2446	2446	an advanced practice registered nurse shall submit to the board on a form
2447	2447	furnished by the board a statement giving his or her name and residence, the
2448	2448	nursing workforce survey and fee required under s. 441.01 (7), evidence of having
2449	2449	satisfied the continuing education requirements under sub. (4), evidence of any
2450	2450	malpractice liability insurance coverage required under sub. (5), any plan required
2451	2451	under sub. (3m) (f), current evidence that the person satisfies each of the
2452	2452	requirements under par. (a) 1., 2., 5. a., and 7. that apply with respect to the person,
2453	2453	and any other information that the board requires by rule, with the applicable
2454	2454	renewal fee determined by the department under s. 440.03 (9) (a). The board shall
2455	2455	grant to a person who satisfies the requirements under this paragraph the renewal
2456	2456	of his or her advanced practice registered nurse license and specialty designations
2457	2457	granted under par. (b) 1. and shall, if the person holds a license under s. 441.06 (1),
2458	2458	(1c), or (1m), also grant the renewal of that license.
2459	2459	(2) PRESCRIBING AUTHORITY. (a) Except as provided in par. (b), an advanced
2460	2460	practice registered nurse may issue prescription orders, subject to the rules
2461	2461	promulgated under sub. (6) (a) 1. and 4., and may provide expedited partner
2462	2462	therapy in the manner described in s. 441.092.
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2486	2486	SENATE BILL 258
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2488	2488	JPC:emw&wlj
2489	2489	SECTION 116
2490	2490	(b) An advanced practice registered nurse may not issue prescription orders if
2491	2491	a notation under sub. (1) (b) 5. indicating that the advanced practice registered
2492	2492	nurse may not issue prescription orders appears on the advanced practice
2493	2493	registered nurse[s license.
2494	2494	(3) LICENSE REQUIRED; USE OF TITLES. (a) 1. The holder of a license issued
2495	2495	under this section is an Xadvanced practice registered nurse,Y may append to his or
2496	2496	her name the title XA.P.R.N.,Y and is authorized to practice advanced practice
2497	2497	registered nursing.
2498	2498	2. The holder of a specialty designation for a recognized role granted under
2499	2499	sub. (1) (b) 1. may append to his or her name the title and an abbreviation
2500	2500	corresponding to that recognized role.
2501	2501	(b) 1. Except as provided in sub. (3m) (e) and s. 257.03, no person may practice
2502	2502	or attempt to practice advanced practice registered nursing, nor use the title
2503	2503	Xadvanced practice registered nurse,Y the title XA.P.R.N.,Y or anything else to
2504	2504	indicate that he or she is an advanced practice registered nurse unless he or she is
2505	2505	licensed under this section.
2506	2506	2. Except as provided in s. 257.03, no person may do any of the following:
2507	2507	a. Use the title Xcertified nurse-midwife,Y the title XC.N.M.,Y or anything else
2508	2508	to indicate that he or she is a certified nurse-midwife unless he or she has been
2509	2509	granted a certified nurse-midwife specialty designation under sub. (1) (b) 1.
2510	2510	b. Use the title Xcertified registered nurse anesthetist,Y the title XC.R.N.A.,Y
2511	2511	or anything else to indicate that he or she is a certified registered nurse anesthetist
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2534	2534	SENATE BILL 258
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2536	2536	JPC:emw&wlj
2537	2537	SECTION 116
2538	2538	unless he or she has been granted a certified registered nurse anesthetist specialty
2539	2539	designation under sub. (1) (b) 1.
2540	2540	c. Use the title Xclinical nurse specialist,Y the title XC.N.S.,Y or anything else
2541	2541	to indicate that he or she is a clinical nurse specialist unless he or she has been
2542	2542	granted a clinical nurse specialist specialty designation under sub. (1) (b) 1.
2543	2543	d. Use the title Xnurse practitioner,Y the title XN.P.,Y or anything else to
2544	2544	indicate that he or she is a nurse practitioner unless he or she has been granted a
2545	2545	nurse practitioner specialty designation under sub. (1) (b) 1.
2546	2546	(3m) PRACTICE REQUIREMENTS AND LIMITATIONS. (a) 1. An advanced practice
2547	2547	registered nurse licensed under this section may, except as provided in subd. 2. and
2548	2548	par. (b), practice advanced practice registered nursing only in collaboration with a
2549	2549	physician or dentist.
2550	2550	2. Subdivision 1. does not apply to an advanced practice registered nurse with
2551	2551	a certified nurse-midwife specialty designation.
2552	2552	(b) An advanced practice registered nurse to whom par. (a) 1. applies may,
2553	2553	except as provided in pars. (bg) 1. and (c), practice advanced practice registered
2554	2554	nursing in a recognized role without being supervised by or collaborating with, and
2555	2555	independent of, a physician or dentist if the board verifies, upon application of the
2556	2556	advanced practice registered nurse, that the advanced practice registered nurse
2557	2557	satisfies all of the following:
2558	2558	1. The advanced practice registered nurse has completed 3,840 hours of
2559	2559	professional nursing in a clinical setting. Clinical hours completed as a
2560	2560	requirement of a nursing program offered by a qualifying school of nursing under s.
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2584	2584	SENATE BILL 258
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2586	2586	JPC:emw&wlj
2587	2587	SECTION 116
2588	2588	441.06 (1) (c) may be used to satisfy the requirement under this subdivision. Hours
2589	2589	completed to satisfy a requirement of an education program described in sub. (1) (a)
2590	2590	2. a. may not be used to satisfy the requirement under this subdivision.
2591	2591	2. At least 24 months have elapsed since the advanced practice registered
2592	2592	nurse first began completing the clinical hours required by a nursing program
2593	2593	described under subd. 1.
2594	2594	3. The advanced practice registered nurse has completed 3,840 clinical hours
2595	2595	of advanced practice registered nursing practice in that recognized role while
2596	2596	working with a physician or dentist who was immediately available for consultation
2597	2597	and accepted responsibility for the actions of the advanced practice registered nurse
2598	2598	during those 3,840 hours of practice. The advanced practice registered nurse may
2599	2599	substitute additional hours of advanced practice registered nursing working with a
2600	2600	physician or dentist described under this subdivision to count toward the
2601	2601	requirement under subd. 1. Each such additional hour shall count toward one hour
2602	2602	of the requirement under subd. 1.
2603	2603	4. At least 24 months have elapsed since the advanced practice registered
2604	2604	nurse first began practicing advanced practice registered nursing in that
2605	2605	recognized role as described under subd. 3.
2606	2606	(bd) For purposes of par. (b) 3., hours of advanced practice registered nursing
2607	2607	practice may include the lawful practice of advanced practice registered nursing
2608	2608	outside this state or the lawful practice of advanced practice registered nursing in
2609	2609	this state prior to the effective date of this paragraph .... [LRB inserts date].
2610	2610	(bg) 1. An advanced practice registered nurse may provide treatment of pain
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2634	2634	SENATE BILL 258
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2636	2636	JPC:emw&wlj
2637	2637	SECTION 116
2638	2638	syndromes, as defined in s. 50.60 (5), through the use of invasive techniques only
2639	2639	while working in a collaborative relationship with a physician who, through
2640	2640	education, training, and experience, specializes in pain management. Except as
2641	2641	provided in subd. 2., this subdivision applies regardless of whether the advanced
2642	2642	practice registered nurse has qualified for independent practice under par. (b).
2643	2643	2. Except as provided in par. (c), subd. 1. does not apply to an advanced
2644	2644	practice registered nurse who is providing treatment of pain syndromes, as defined
2645	2645	in s. 50.60 (5), through the use of invasive techniques in a hospital, as defined in s.
2646	2646	50.33 (2), or in a clinic associated with a hospital, and who has qualified for
2647	2647	independent practice under par. (b).
2648	2648	3. Except as provided in par. (c), subd. 1. does not apply to an advanced
2649	2649	practice registered nurse who has qualified for independent practice under par. (b)
2650	2650	and has privileges in a hospital, as defined in s. 50.33 (2), to provide treatment of
2651	2651	pain syndromes, as defined in s. 50.60 (5), through the use of invasive techniques
2652	2652	without a collaborative relationship with a physician.
2653	2653	(bm) For purposes of pars. (a) 1. and (bg) 1., a collaborative relationship is a
2654	2654	process in which an advanced practice registered nurse is working with a physician
2655	2655	or dentist, in each other[s presence when necessary, to deliver health care services
2656	2656	within the scope of the advanced practice registered nurse[s training, education,
2657	2657	and experience. The advanced practice registered nurse shall document such a
2658	2658	collaborative relationship.
2659	2659	(c) Nothing in this section prohibits an entity employing or with a relationship
2660	2660	with an advanced practice registered nurse from establishing additional
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2684	2684	SENATE BILL 258
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2686	2686	JPC:emw&wlj
2687	2687	SECTION 116
2688	2688	requirements for an advanced practice registered nurse as a condition of
2689	2689	employment or relationship.
2690	2690	(d) An advanced practice registered nurse shall adhere to professional
2691	2691	standards when managing situations that are beyond the advanced practice
2692	2692	registered nurse[s expertise. If a particular patient[s needs are beyond the
2693	2693	advanced practice registered nurse[s expertise, the advanced practice registered
2694	2694	nurse shall, as warranted by the patient[s needs, consult or collaborate with or refer
2695	2695	the patient to at least one of the following:
2696	2696	1. A physician licensed under ch. 448.
2697	2697	2. Another health care provider for whom the advanced practice registered
2698	2698	nurse has reasonable evidence of having a scope of practice that includes the
2699	2699	authorization to address the patient[s needs.
2700	2700	(e) An advanced practice registered nurse licensed under this section may
2701	2701	delegate a task or order to another clinically trained health care worker if the task
2702	2702	or order is within the scope of the advanced practice registered nurse[s practice, the
2703	2703	advanced practice registered nurse is competent to perform the task or issue the
2704	2704	order, and the advanced practice registered nurse has reasonable evidence that the
2705	2705	health care worker is minimally competent to perform the task or issue the order
2706	2706	under the circumstances.
2707	2707	(f) An advanced practice registered nurse with a certified nurse-midwife
2708	2708	specialty designation may not offer to deliver babies outside of a hospital setting
2709	2709	unless the advanced practice registered nurse files with the board, and the board
2710	2710	approves, a proactive plan for ensuring appropriate care or care transitions
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2734	2734	SENATE BILL 258
2735	2735	- 56 - LRB-1565/1
2736	2736	JPC:emw&wlj
2737	2737	SECTION 116
2738	2738	conforming with professional standards for patients with higher acuity or
2739	2739	emergency care needs that exceed the advanced practice registered nurse[s scope of
2740	2740	practice. An advanced practice registered nurse who offers to deliver babies outside
2741	2741	of a hospital setting shall file a plan under this paragraph when applying for an
2742	2742	initial license under this section or a renewal of a license under this section, shall
2743	2743	keep the plan current with the board, and shall follow the plan.
2744	2744	(4) CONTINUING EDUCATION. Every advanced practice registered nurse shall
2745	2745	submit to the board evidence of having completed at least 16 contact hours per
2746	2746	biennium in clinical pharmacology or therapeutics relevant to the advanced
2747	2747	practice registered nurse[s area of practice. The board may promulgate rules
2748	2748	regarding the continuing education requirements under this subsection.
2749	2749	(5) MALPRACTICE LIABILITY INSURANCE. No person may practice advanced
2750	2750	practice registered nursing unless he or she at all times has in effect malpractice
2751	2751	liability insurance coverage evidenced by personal liability coverage in the amounts
2752	2752	specified for health care providers under s. 655.23 (4) or coverage under a group
2753	2753	liability policy providing individual coverage for the person in the amounts
2754	2754	specified under s. 655.23 (4). An advanced practice registered nurse shall submit
2755	2755	evidence of that coverage to the board when applying for an initial license under
2756	2756	this section or a renewal of a license under this section. An advanced practice
2757	2757	registered nurse shall also submit such evidence to the board upon request of the
2758	2758	board.
2759	2759	(6) RULES. (a) The board shall promulgate rules necessary to administer this
2760	2760	section, including rules for all of the following:
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2784	2784	SENATE BILL 258
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2786	2786	JPC:emw&wlj
2787	2787	SECTION 116
2788	2788	1. Further defining the scope of practice of an advanced practice registered
2789	2789	nurse, practice of a certified nurse-midwife, practice of a certified registered nurse
2790	2790	anesthetist, practice of a nurse practitioner, and practice of a clinical nurse
2791	2791	specialist and defining the scope of practice within which an advanced practice
2792	2792	registered nurse may issue prescription orders under sub. (2).
2793	2793	2. Determining acceptable national certification for purposes of sub. (1) (a) 2.
2794	2794	a.
2795	2795	3. Establishing the appropriate education, training, or experience
2796	2796	requirements that a registered nurse must satisfy in order to be an advanced
2797	2797	practice registered nurse and to obtain each specialty designation corresponding to
2798	2798	the recognized roles.
2799	2799	4. Specifying the classes of drugs, individual drugs, or devices that may not be
2800	2800	prescribed by an advanced practice registered nurse under sub. (2).
2801	2801	5. Specifying the conditions to be met for registered nurses to do the following:
2802	2802	a. Administer a drug prescribed by an advanced practice registered nurse.
2803	2803	b. Administer a drug at the direction of an advanced practice registered nurse.
2804	2804	6. Establishing standards of professional conduct for advanced practice
2805	2805	registered nurses generally and for practicing in each recognized role.
2806	2806	(am) The board may promulgate rules to implement sub. (3m) (b).
2807	2807	(b) The board may not promulgate rules that expand the scope of practice of
2808	2808	an advanced practice registered nurse beyond the practices within advanced
2809	2809	practice registered nursing.
2810	2810	SECTION 117. 441.092 of the statutes is created to read:
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2834	2834	SENATE BILL 258
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2836	2836	JPC:emw&wlj
2837	2837	SECTION 117
2838	2838	441.092 Expedited partner therapy. (1) In this section:
2839	2839	(b) XAntimicrobial drugY has the meaning given in s. 448.035 (1) (b).
2840	2840	(c) XExpedited partner therapyY has the meaning given in s. 448.035 (1) (c).
2841	2841	(2) Notwithstanding the requirements of s. 448.9785, an advanced practice
2842	2842	registered nurse who may issue prescription orders under s. 441.09 (2) may provide
2843	2843	expedited partner therapy if a patient is diagnosed as infected with a chlamydial
2844	2844	infection, gonorrhea, or trichomoniasis and the patient has had sexual contact with
2845	2845	a sexual partner during which the chlamydial infection, gonorrhea, or
2846	2846	trichomoniasis may have been transmitted to or from the sexual partner. The
2847	2847	advanced practice registered nurse shall attempt to obtain the name of the patient[s
2848	2848	sexual partner. A prescription order for an antimicrobial drug prepared under this
2849	2849	subsection shall include the name and address of the patient[s sexual partner, if
2850	2850	known. If the advanced practice registered nurse is unable to obtain the name of
2851	2851	the patient[s sexual partner, the prescription order shall include, in ordinary, bold-
2852	2852	faced capital letters, the words, Xexpedited partner therapyY or the letters XEPT.Y
2853	2853	(3) The advanced practice registered nurse shall provide the patient with a
2854	2854	copy of the information sheet prepared by the department of health services under
2855	2855	s. 46.03 (44) and shall request that the patient give the information sheet to the
2856	2856	person with whom the patient had sexual contact.
2857	2857	(4) (a) Except as provided in par. (b), an advanced practice registered nurse is
2858	2858	immune from civil liability for injury to or the death of a person who takes any
2859	2859	antimicrobial drug if the antimicrobial drug is prescribed, dispensed, or furnished
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2882	2882	SENATE BILL 258
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2885	2885	SECTION 117
2886	2886	under this section and if expedited partner therapy is provided as specified under
2887	2887	this section.
2888	2888	(b) The immunity under par. (a) does not extend to the donation, distribution,
2889	2889	furnishing, or dispensing of an antimicrobial drug by an advanced practice
2890	2890	registered nurse whose act or omission involves reckless, wanton, or intentional
2891	2891	misconduct.
2892	2892	SECTION 118. 441.10 (7) of the statutes is amended to read:
2893	2893	441.10 (7) No license is required for practical nursing, but, except as provided
2894	2894	in s. 257.03, no person without a license may hold himself or herself out as a
2895	2895	licensed practical nurse or licensed attendant, use the title or letters XTrained
2896	2896	Practical NurseY or XT.P.N.Y, XLicensed Practical NurseY or XL.P.N.Y, XLicensed
2897	2897	AttendantY or XL.A.Y, XTrained AttendantY or XT.A.Y, or otherwise seek to indicate
2898	2898	that he or she is a licensed practical nurse or licensed attendant. No licensed
2899	2899	practical nurse or licensed attendant may use the title, or otherwise seek to act as a
2900	2900	registered, licensed, graduate or professional nurse. Anyone violating this
2901	2901	subsection shall be subject to the penalties prescribed by s. 441.13. The board shall
2902	2902	grant without examination a license as a licensed practical nurse to any person who
2903	2903	was on July 1, 1949, a licensed attendant. This subsection does not apply to any
2904	2904	licensed practical nurse who holds a multistate license, as defined in s. 441.51 (2)
2905	2905	(h), issued by a jurisdiction, other than this state, that has adopted the nurse
2906	2906	licensure compact under s. 441.51.
2907	2907	SECTION 119. 441.11 (title) of the statutes is repealed.
2908	2908	SECTION 120. 441.11 (1) of the statutes is repealed.
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2934	2934	JPC:emw&wlj
2935	2935	SECTION 121
2936	2936	SECTION 121. 441.11 (2) of the statutes is renumbered 441.09 (5m) and
2937	2937	amended to read:
2938	2938	441.09 (5m) LICENSURE EXEMPTION. The provisions of s. 448.04 (1) (g) 448.03
2939	2939	(1) (d) do not apply to a an advanced practice registered nurse licensed under this
2940	2940	section who possesses a certified registered nurse anesthetist specialty designation
2941	2941	under sub. (1) (b) 1. or to a person who engages in the practice of a nurse anesthetist
2942	2942	while performing official duties for the armed services or federal health services of
2943	2943	the United States.
2944	2944	SECTION 122. 441.11 (3) of the statutes is repealed.
2945	2945	SECTION 123. 441.15 of the statutes is repealed.
2946	2946	SECTION 124. 441.16 of the statutes is repealed.
2947	2947	SECTION 125. 441.18 (2) (a) (intro.) of the statutes is amended to read:
2948	2948	441.18 (2) (a) (intro.) An advanced practice registered nurse certified to who
2949	2949	may issue prescription orders under s. 441.16 441.09 (2) may do any of the
2950	2950	following:
2951	2951	SECTION 126. 441.18 (2) (b) of the statutes is amended to read:
2952	2952	441.18 (2) (b) An advanced practice registered nurse who prescribes or
2953	2953	delivers an opioid antagonist under par. (a) 1. shall ensure that the person to whom
2954	2954	the opioid antagonist is prescribed has or has the capacity to provide the knowledge
2955	2955	and training necessary to safely administer the opioid antagonist to an individual
2956	2956	undergoing an opioid-related overdose and that the person demonstrates the
2957	2957	capacity to ensure that any individual to whom the person further delivers the
2958	2958	opioid antagonist has or receives that knowledge and training.
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2982	2982	SENATE BILL 258
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2984	2984	JPC:emw&wlj
2985	2985	SECTION 127
2986	2986	SECTION 127. 441.18 (3) of the statutes is amended to read:
2987	2987	441.18 (3) An advanced practice registered nurse who, acting in good faith,
2988	2988	prescribes or delivers an opioid antagonist in accordance with sub. (2), or who,
2989	2989	acting in good faith, otherwise lawfully prescribes or dispenses an opioid
2990	2990	antagonist, shall be immune from criminal or civil liability and may not be subject
2991	2991	to professional discipline under s. 441.07 for any outcomes resulting from
2992	2992	prescribing, delivering, or dispensing the opioid antagonist.
2993	2993	SECTION 128. 441.19 of the statutes is repealed.
2994	2994	SECTION 129. 448.03 (2) (a) of the statutes is amended to read:
2995	2995	448.03 (2) (a) Any person lawfully practicing within the scope of a license,
2996	2996	permit, registration, certificate, or certification granted to practice midwifery
2997	2997	under subch. XIII of ch. 440, to practice professional or, practical, or advanced
2998	2998	practice registered nursing or nurse-midwifery under ch. 441, to practice
2999	2999	chiropractic under ch. 446, to practice dentistry, dental therapy, or dental hygiene
3000	3000	or as an expanded function dental auxiliary under ch. 447, to practice optometry
3001	3001	under ch. 449, to practice as a physician assistant under subch. IX, to practice
3002	3002	acupuncture under ch. 451 or under any other statutory provision, to practice
3003	3003	naturopathic medicine under ch. 466, or as otherwise provided by statute.
3004	3004	SECTION 130. 448.035 (1) (a) of the statutes is repealed.
3005	3005	SECTION 131. 448.035 (2) to (4) of the statutes are amended to read:
3006	3006	448.035 (2) Notwithstanding the requirements of s. 448.30, a physician or
3007	3007	certified advanced practice nurse prescriber may provide expedited partner
3008	3008	therapy if the patient is diagnosed as infected with a chlamydial infection,
3009	3009	gonorrhea, or trichomoniasis and the patient has had sexual contact with a sexual
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3034	3034	SENATE BILL 258
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3037	3037	SECTION 131
3038	3038	partner during which the chlamydial infection, gonorrhea, or trichomoniasis may
3039	3039	have been transmitted to or from the sexual partner. The physician or certified
3040	3040	advanced practice nurse prescriber shall attempt to obtain the name of the patient[s
3041	3041	sexual partner. A prescription order for an antimicrobial drug prepared under this
3042	3042	subsection shall include the name and address of the patient[s sexual partner, if
3043	3043	known. If the physician or certified advanced practice nurse prescriber is unable to
3044	3044	obtain the name of the patient[s sexual partner, the prescription order shall
3045	3045	include, in ordinary bold-faced capital letters, the words, Xexpedited partner
3046	3046	therapyY or the letters XEPT.Y
3047	3047	(3) The physician or certified advanced practice nurse prescriber shall
3048	3048	provide the patient with a copy of the information sheet prepared by the
3049	3049	department of health services under s. 46.03 (44) and shall request that the patient
3050	3050	give the information sheet to the person with whom the patient had sexual contact.
3051	3051	(4) (a) Except as provided in par. (b), a physician or certified advanced
3052	3052	practice nurse prescriber is immune from civil liability for injury to or the death of
3053	3053	a person who takes any antimicrobial drug if the antimicrobial drug is prescribed,
3054	3054	dispensed, or furnished under this section and if expedited partner therapy is
3055	3055	provided as specified under this section.
3056	3056	(b) The immunity under par. (a) does not extend to the donation, distribution,
3057	3057	furnishing, or dispensing of an antimicrobial drug by a physician or certified
3058	3058	advanced practice nurse prescriber whose act or omission involves reckless,
3059	3059	wanton, or intentional misconduct.
3060	3060	SECTION 132. 448.56 (1) and (1m) (b) of the statutes are amended to read:
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3084	3084	SENATE BILL 258
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3086	3086	JPC:emw&wlj
3087	3087	SECTION 132
3088	3088	448.56 (1) WRITTEN REFERRAL. Except as provided in this subsection and s.
3089	3089	448.52, a person may practice physical therapy only upon the written referral of a
3090	3090	physician, naturopathic doctor, physician assistant, chiropractor, dentist,
3091	3091	podiatrist, or advanced practice registered nurse prescriber certified under s.
3092	3092	441.16 (2). Written referral is not required if a physical therapist provides services
3093	3093	in schools to children with disabilities, as defined in s. 115.76 (5), pursuant to rules
3094	3094	promulgated by the department of public instruction; provides services as part of a
3095	3095	home health care agency; provides services to a patient in a nursing home pursuant
3096	3096	to the patient[s plan of care; provides services related to athletic activities,
3097	3097	conditioning, or injury prevention; or provides services to an individual for a
3098	3098	previously diagnosed medical condition after informing the individual[s physician,
3099	3099	naturopathic doctor, physician assistant, chiropractor, dentist, podiatrist, or
3100	3100	advanced practice registered nurse prescriber certified under s. 441.16 (2) who
3101	3101	made the diagnosis. The examining board may promulgate rules establishing
3102	3102	additional services that are excepted from the written referral requirements of this
3103	3103	subsection.
3104	3104	(1m) (b) The examining board shall promulgate rules establishing the
3105	3105	requirements that a physical therapist must satisfy if a physician, naturopathic
3106	3106	doctor, physician assistant, chiropractor, dentist, podiatrist, or advanced practice
3107	3107	registered nurse prescriber makes a written referral under sub. (1). The purpose of
3108	3108	the rules shall be to ensure continuity of care between the physical therapist and
3109	3109	the health care practitioner.
3110	3110	SECTION 133. 448.62 (2m) of the statutes is amended to read:
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3134	3134	SENATE BILL 258
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3136	3136	JPC:emw&wlj
3137	3137	SECTION 133
3138	3138	448.62 (2m) An advanced practice registered nurse who is certified to issue
3139	3139	prescription orders under s. 441.16 and who is providing nonsurgical patient
3140	3140	services as directed, supervised, and inspected by a podiatrist who has the power to
3141	3141	direct, decide, and oversee the implementation of the patient services rendered.
3142	3142	SECTION 134. 448.67 (2) of the statutes is amended to read:
3143	3143	448.67 (2) SEPARATE BILLING REQUIRED. Except as provided in sub. (4), a
3144	3144	licensee who renders any podiatric service or assistance, or gives any podiatric
3145	3145	advice or any similar advice or assistance, to any patient, podiatrist, physician,
3146	3146	physician assistant, advanced practice registered nurse prescriber certified under
3147	3147	s. 441.16 (2), partnership, or corporation, or to any other institution or organization,
3148	3148	including a hospital, for which a charge is made to a patient, shall, except as
3149	3149	authorized by Title 18 or Title 19 of the federal Social Security Act, render an
3150	3150	individual statement or account of the charge directly to the patient, distinct and
3151	3151	separate from any statement or account by any other podiatrist, physician,
3152	3152	physician assistant, advanced practice registered nurse prescriber, or other person.
3153	3153	SECTION 135. 448.956 (1m) of the statutes is amended to read:
3154	3154	448.956 (1m) Subject to sub. (1) (a), a licensee may provide athletic training to
3155	3155	an individual without a referral, except that a licensee may not provide athletic
3156	3156	training as described under s. 448.95 (5) (d) or (e) in an outpatient rehabilitation
3157	3157	setting unless the licensee has obtained a written referral for the individual from a
3158	3158	practitioner licensed or certified under subch. II, III, IV, V, or VII of this chapter;
3159	3159	under ch. 446; or under s. 441.16 (2) 441.09 or from a practitioner who holds a
3160	3160	compact privilege under subch. XI or XII of ch. 448.
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3184	3184	SENATE BILL 258
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3186	3186	JPC:emw&wlj
3187	3187	SECTION 136
3188	3188	SECTION 136. 450.01 (1m) of the statutes is repealed.
3189	3189	SECTION 137. 450.01 (16) (h) 2. of the statutes is amended to read:
3190	3190	450.01 (16) (h) 2. The patient[s advanced practice registered nurse prescriber,
3191	3191	if the advanced practice registered nurse prescriber has entered into a written
3192	3192	agreement to collaborate with a physician may issue prescription orders under s.
3193	3193	441.09 (2).
3194	3194	SECTION 138. 450.01 (16) (hr) 2. of the statutes is amended to read:
3195	3195	450.01 (16) (hr) 2. An advanced practice registered nurse prescriber who may
3196	3196	issue prescription orders under s. 441.09 (2).
3197	3197	SECTION 139. 450.03 (1) (e) of the statutes is amended to read:
3198	3198	450.03 (1) (e) Any person lawfully practicing within the scope of a license,
3199	3199	permit, registration, certificate, or certification granted to practice as a pharmacy
3200	3200	technician under s. 450.068, to provide home medical oxygen under s. 450.076, to
3201	3201	practice professional or, practical, or advanced practice registered nursing or nurse-
3202	3202	midwifery under ch. 441, to practice dentistry, dental therapy, or dental hygiene or
3203	3203	as an expanded function dental auxiliary under ch. 447, to practice medicine and
3204	3204	surgery under ch. 448, to practice optometry under ch. 449, to practice naturopathic
3205	3205	medicine under ch. 466, or to practice veterinary medicine under ch. 89, or as
3206	3206	otherwise provided by statute.
3207	3207	SECTION 140. 450.11 (1g) (b) of the statutes is amended to read:
3208	3208	450.11 (1g) (b) A pharmacist may, upon the prescription order of a
3209	3209	practitioner providing expedited partner therapy, as specified in s. 441.092,
3210	3210	448.035, or 448.9725, that complies with the requirements of sub. (1), dispense an
3211	3211	antimicrobial drug as a course of therapy for treatment of chlamydial infections,
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3236	3236	SENATE BILL 258
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3238	3238	JPC:emw&wlj
3239	3239	SECTION 140
3240	3240	gonorrhea, or trichomoniasis to the practitioner[s patient or a person with whom
3241	3241	the patient has had sexual contact for use by the person with whom the patient has
3242	3242	had sexual contact. The pharmacist shall provide a consultation in accordance with
3243	3243	rules promulgated by the board for the dispensing of a prescription to the person to
3244	3244	whom the antimicrobial drug is dispensed. A pharmacist providing a consultation
3245	3245	under this paragraph shall ask whether the person for whom the antimicrobial
3246	3246	drug has been prescribed is allergic to the antimicrobial drug and advise that the
3247	3247	person for whom the antimicrobial drug has been prescribed must discontinue use
3248	3248	of the antimicrobial drug if the person is allergic to or develops signs of an allergic
3249	3249	reaction to the antimicrobial drug.
3250	3250	SECTION 141. 450.11 (1i) (a) 1. of the statutes is amended to read:
3251	3251	450.11 (1i) (a) 1. A pharmacist may, upon and in accordance with the
3252	3252	prescription order of an advanced practice registered nurse prescriber under s.
3253	3253	441.18 (2) (a) 1., of a physician under s. 448.037 (2) (a) 1., or of a physician assistant
3254	3254	under s. 448.9727 (2) (a) 1. that complies with the requirements of sub. (1), deliver
3255	3255	an opioid antagonist to a person specified in the prescription order and may, upon
3256	3256	and in accordance with the standing order of an advanced practice registered nurse
3257	3257	prescriber under s. 441.18 (2) (a) 2., of a physician under s. 448.037 (2) (a) 2., or of a
3258	3258	physician assistant under s. 448.9727 (2) (a) 2. that complies with the requirements
3259	3259	of sub. (1), deliver an opioid antagonist to an individual in accordance with the
3260	3260	order. The pharmacist shall provide a consultation in accordance with rules
3261	3261	promulgated by the board for the delivery of a prescription to the person to whom
3262	3262	the opioid antagonist is delivered.
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3288	3288	JPC:emw&wlj
3289	3289	SECTION 142
3290	3290	SECTION 142. 450.11 (1i) (b) 2. b. of the statutes is amended to read:
3291	3291	450.11 (1i) (b) 2. b. An advanced practice registered nurse prescriber may only
3292	3292	deliver or dispense an opioid antagonist in accordance with s. 441.18 (2) or in
3293	3293	accordance with his or her other legal authority to dispense prescription drugs.
3294	3294	SECTION 143. 450.11 (7) (b) of the statutes is amended to read:
3295	3295	450.11 (7) (b) Information communicated to a physician, physician assistant,
3296	3296	or advanced practice registered nurse prescriber in an effort to procure unlawfully
3297	3297	a prescription drug or the administration of a prescription drug is not a privileged
3298	3298	communication.
3299	3299	SECTION 144. 450.11 (8) (e) of the statutes is amended to read:
3300	3300	450.11 (8) (e) The board of nursing, insofar as this section applies to advanced
3301	3301	practice nurse prescribers registered nurses.
3302	3302	SECTION 145. 450.13 (5) (b) of the statutes is amended to read:
3303	3303	450.13 (5) (b) The patient[s advanced practice registered nurse prescriber, if
3304	3304	the advanced practice registered nurse prescriber has entered into a written
3305	3305	agreement to collaborate with a physician may issue prescription orders under s.
3306	3306	441.09 (2).
3307	3307	SECTION 146. 450.135 (7) (b) of the statutes is amended to read:
3308	3308	450.135 (7) (b) The patient[s advanced practice registered nurse prescriber, if
3309	3309	the advanced practice registered nurse prescriber has entered into a written
3310	3310	agreement to collaborate with a physician may issue prescription orders under s.
3311	3311	441.09 (2).
3312	3312	SECTION 147. 462.04 of the statutes is amended to read:
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3339	3339	SECTION 147
3340	3340	462.04 Prescription or order required. A person who holds a license or
3341	3341	limited X-ray machine operator permit under this chapter may not use diagnostic
3342	3342	X-ray equipment on humans for diagnostic purposes unless authorized to do so by
3343	3343	prescription or order of a physician licensed under s. 448.04 (1) (a), a naturopathic
3344	3344	doctor licensed under s. 466.04 (1), a dentist who is licensed under s. 447.04 (1) or
3345	3345	who holds a compact privilege under subch. II of ch. 447, a dental therapist licensed
3346	3346	under s. 447.04 (1m), a podiatrist licensed under s. 448.63, a chiropractor licensed
3347	3347	under s. 446.02, an advanced practice registered nurse certified licensed under s.
3348	3348	441.16 (2) 441.09, a physician assistant who is licensed under s. 448.974 or who
3349	3349	holds a compact privilege under subch. XIII of ch. 448, or, subject to s. 448.56 (7) (a),
3350	3350	a physical therapist who is licensed under s. 448.53 or who holds a compact
3351	3351	privilege under subch. XI of ch. 448.
3352	3352	SECTION 148. 655.001 (1) of the statutes is renumbered 655.001 (1r).
3353	3353	SECTION 149. 655.001 (1g) of the statutes is created to read:
3354	3354	655.001 (1g) XAdvanced practice registered nurseY means an individual who
3355	3355	is licensed under s. 441.09, who has qualified to practice independently in his or her
3356	3356	recognized role under s. 441.09 (3m) (b), and who practices advanced practice
3357	3357	registered nursing, as defined under s. 441.001 (1c), outside of a collaborative
3358	3358	relationship with a physician or dentist, as described under s. 441.09 (3m) (a) 1., or
3359	3359	other employment relationship.
3360	3360	SECTION 150. 655.001 (7t) of the statutes is amended to read:
3361	3361	655.001 (7t) XHealth care practitionerY means a health care professional, as
3362	3362	defined in s. 180.1901 (1m), who is an employee of a health care provider described
3363	3363	in s. 655.002 (1) (d), (e), (em), or (f) and who has the authority to provide health care
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3390	3390	JPC:emw&wlj
3391	3391	SECTION 150
3392	3392	services that are not in collaboration with a physician under s. 441.15 (2) (b) or
3393	3393	under the direction and supervision of a physician or nurse anesthetist advanced
3394	3394	practice registered nurse.
3395	3395	SECTION 151. 655.001 (9) of the statutes is repealed.
3396	3396	SECTION 152. 655.002 (1) (a) of the statutes is amended to read:
3397	3397	655.002 (1) (a) A physician or a nurse anesthetist an advanced practice
3398	3398	registered nurse for whom this state is a principal place of practice and who
3399	3399	practices his or her profession in this state more than 240 hours in a fiscal year.
3400	3400	SECTION 153. 655.002 (1) (b) of the statutes is amended to read:
3401	3401	655.002 (1) (b) A physician or a nurse anesthetist an advanced practice
3402	3402	registered nurse for whom Michigan is a principal place of practice, if all of the
3403	3403	following apply:
3404	3404	1. The physician or nurse anesthetist advanced practice registered nurse is a
3405	3405	resident of this state.
3406	3406	2. The physician or nurse anesthetist advanced practice registered nurse
3407	3407	practices his or her profession in this state or in Michigan or a combination of both
3408	3408	more than 240 hours in a fiscal year.
3409	3409	3. The physician or nurse anesthetist advanced practice registered nurse
3410	3410	performs more procedures in a Michigan hospital than in any other hospital. In this
3411	3411	subdivision, XMichigan hospitalY means a hospital located in Michigan that is an
3412	3412	affiliate of a corporation organized under the laws of this state that maintains its
3413	3413	principal office and a hospital in this state.
3414	3414	SECTION 154. 655.002 (1) (c) of the statutes is amended to read:
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3441	3441	SECTION 154
3442	3442	655.002 (1) (c) A physician or nurse anesthetist an advanced practice
3443	3443	registered nurse who is exempt under s. 655.003 (1) or (3), but who practices his or
3444	3444	her profession outside the scope of the exemption and who fulfills the requirements
3445	3445	under par. (a) in relation to that practice outside the scope of the exemption. For a
3446	3446	physician or a nurse anesthetist an advanced practice registered nurse who is
3447	3447	subject to this chapter under this paragraph, this chapter applies only to claims
3448	3448	arising out of practice that is outside the scope of the exemption under s. 655.003 (1)
3449	3449	or (3).
3450	3450	SECTION 155. 655.002 (1) (d) of the statutes is amended to read:
3451	3451	655.002 (1) (d) A partnership comprised of physicians or nurse anesthetists
3452	3452	advanced practice registered nurses and organized and operated in this state for the
3453	3453	primary purpose of providing the medical services of physicians or nurse
3454	3454	anesthetists advanced practice registered nurses.
3455	3455	SECTION 156. 655.002 (1) (e) of the statutes is amended to read:
3456	3456	655.002 (1) (e) A corporation organized and operated in this state for the
3457	3457	primary purpose of providing the medical services of physicians or nurse
3458	3458	anesthetists advanced practice registered nurses.
3459	3459	SECTION 157. 655.002 (1) (em) of the statutes is amended to read:
3460	3460	655.002 (1) (em) Any organization or enterprise not specified under par. (d) or
3461	3461	(e) that is organized and operated in this state for the primary purpose of providing
3462	3462	the medical services of physicians or nurse anesthetists advanced practice
3463	3463	registered nurses.
3464	3464	SECTION 158. 655.002 (2) (a) of the statutes is amended to read:
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3491	3491	SECTION 158
3492	3492	655.002 (2) (a) A physician or nurse anesthetist advanced practice registered
3493	3493	nurse for whom this state is a principal place of practice but who practices his or her
3494	3494	profession fewer than 241 hours in a fiscal year, for a fiscal year, or a portion of a
3495	3495	fiscal year, during which he or she practices his or her profession.
3496	3496	SECTION 159. 655.002 (2) (b) of the statutes is amended to read:
3497	3497	655.002 (2) (b) Except as provided in sub. (1) (b), a physician or nurse
3498	3498	anesthetist advanced practice registered nurse for whom this state is not a
3499	3499	principal place of practice, for a fiscal year, or a portion of a fiscal year, during
3500	3500	which he or she practices his or her profession in this state. For a health care
3501	3501	provider who elects to be subject to this chapter under this paragraph, this chapter
3502	3502	applies only to claims arising out of practice that is in this state and that is outside
3503	3503	the scope of an exemption under s. 655.003 (1) or (3).
3504	3504	SECTION 160. 655.003 (1) of the statutes is amended to read:
3505	3505	655.003 (1) A physician or a nurse anesthetist an advanced practice
3506	3506	registered nurse who is a state, county or municipal employee, or federal employee
3507	3507	or contractor covered under the federal tort claims act, as amended, and who is
3508	3508	acting within the scope of his or her employment or contractual duties.
3509	3509	SECTION 161. 655.003 (3) of the statutes is amended to read:
3510	3510	655.003 (3) Except for a physician or nurse anesthetist advanced practice
3511	3511	registered nurse who meets the criteria under s. 146.89 (5) (a), a physician or a
3512	3512	nurse anesthetist an advanced practice registered nurse who provides professional
3513	3513	services under the conditions described in s. 146.89, with respect to those
3514	3514	professional services provided by the physician or nurse anesthetist advanced
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3541	3541	SECTION 161
3542	3542	practice registered nurse for which he or she is covered by s. 165.25 and considered
3543	3543	an agent of the department, as provided in s. 165.25 (6) (b).
3544	3544	SECTION 162. 655.005 (2) (a) of the statutes is amended to read:
3545	3545	655.005 (2) (a) An employee of a health care provider if the employee is a
3546	3546	physician or a nurse anesthetist an advanced practice registered nurse or is a
3547	3547	health care practitioner who is providing health care services that are not in
3548	3548	collaboration with a physician under s. 441.15 (2) (b) or under the direction and
3549	3549	supervision of a physician or nurse anesthetist advanced practice registered nurse.
3550	3550	SECTION 163. 655.005 (2) (b) of the statutes is amended to read:
3551	3551	655.005 (2) (b) A service corporation organized under s. 180.1903 by health
3552	3552	care professionals, as defined under s. 180.1901 (1m), if the board of governors
3553	3553	determines that it is not the primary purpose of the service corporation to provide
3554	3554	the medical services of physicians or nurse anesthetists advanced practice
3555	3555	registered nurses. The board of governors may not determine under this paragraph
3556	3556	that it is not the primary purpose of a service corporation to provide the medical
3557	3557	services of physicians or nurse anesthetists advanced practice registered nurses
3558	3558	unless more than 50 percent of the shareholders of the service corporation are
3559	3559	neither physicians nor nurse anesthetists advanced practice registered nurses.
3560	3560	SECTION 164. 655.23 (5m) of the statutes is amended to read:
3561	3561	655.23 (5m) The limits set forth in sub. (4) shall apply to any joint liability of
3562	3562	a physician or nurse anesthetist advanced practice registered nurse and his or her
3563	3563	corporation, partnership, or other organization or enterprise under s. 655.002 (1)
3564	3564	(d), (e), or (em).
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3591	3591	SECTION 165
3592	3592	SECTION 165. 655.27 (3) (a) 4. of the statutes is amended to read:
3593	3593	655.27 (3) (a) 4. For a health care provider described in s. 655.002 (1) (d), (e),
3594	3594	(em), or (f), risk factors and past and prospective loss and expense experience
3595	3595	attributable to employees of that health care provider other than employees
3596	3596	licensed as a physician or nurse anesthetist advanced practice registered nurse.
3597	3597	SECTION 166. 655.27 (3) (b) 2m. of the statutes is amended to read:
3598	3598	655.27 (3) (b) 2m. In addition to the fees and payment classifications
3599	3599	described under subds. 1. and 2., the commissioner, after approval by the board of
3600	3600	governors, may establish a separate payment classification for physicians satisfying
3601	3601	s. 655.002 (1) (b) and a separate fee for nurse anesthetists advanced practice
3602	3602	registered nurses satisfying s. 655.002 (1) (b) which take into account the loss
3603	3603	experience of health care providers for whom Michigan is a principal place of
3604	3604	practice.
3605	3605	SECTION 167. 655.275 (2) of the statutes is amended to read:
3606	3606	655.275 (2) APPOINTMENT. The board of governors shall appoint the members
3607	3607	of the council. Section 15.09, except s. 15.09 (4) and (8), does not apply to the
3608	3608	council. The board of governors shall designate the chairperson, who shall be a
3609	3609	physician, the vice chairperson, and the secretary of the council and the terms to be
3610	3610	served by council members. The council shall consist of 5 or 7 persons, not more
3611	3611	than 3 of whom are physicians who are licensed and in good standing to practice
3612	3612	medicine in this state and one of whom is a nurse anesthetist an advanced practice
3613	3613	registered nurse who is licensed and in good standing to practice nursing in this
3614	3614	state. The chairperson or another peer review council member designated by the
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3641	3641	SECTION 167
3642	3642	chairperson shall serve as an ex officio nonvoting member of the medical examining
3643	3643	board and may attend meetings of the medical examining board, as appropriate.
3644	3644	SECTION 168. 655.275 (5) (b) 2. of the statutes is amended to read:
3645	3645	655.275 (5) (b) 2. If a claim was paid for damages arising out of the rendering
3646	3646	of care by a nurse anesthetist an advanced practice registered nurse, with at least
3647	3647	one nurse anesthetist advanced practice registered nurse.
3648	3648	SECTION 169. 895.478 (3m) of the statutes is amended to read:
3649	3649	895.478 (3m) ELEMENTARY AND SECONDARY SCHOOLS. An elementary or
3650	3650	secondary school and its designated school personnel, and a physician, advanced
3651	3651	practice registered nurse prescriber, or physician assistant who provides or
3652	3652	administers an opioid antagonist, are not liable for any injury that results from the
3653	3653	opioid antagonist, regardless of whether authorization was given by the pupil[s
3654	3654	parent or guardian or by the pupil[s physician, advanced practice registered nurse
3655	3655	prescriber, or physician assistant, unless the injury is the result of an act or
3656	3656	omission that constitutes gross negligence or willful or wanton misconduct. The
3657	3657	immunity from liability provided under this subsection is in addition to and not in
3658	3658	lieu of that provided under s. 895.48.
3659	3659	SECTION 170. 961.01 (19) (a) of the statutes is amended to read:
3660	3660	961.01 (19) (a) A physician, advanced practice registered nurse, dentist,
3661	3661	veterinarian, podiatrist, optometrist, scientific investigator or, subject to s. 448.975
3662	3662	(1) (b), a physician assistant, or other person licensed, registered, certified or
3663	3663	otherwise permitted to distribute, dispense, conduct research with respect to,
3664	3664	administer or use in teaching or chemical analysis a controlled substance in the
3665	3665	course of professional practice or research in this state.
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3693	3693	SECTION 171
3694	3694	SECTION 171. 961.395 of the statutes is amended to read:
3695	3695	961.395 Limitation on advanced practice registered nurses. (1) An
3696	3696	advanced practice registered nurse who is certified may issue prescription orders
3697	3697	under s. 441.16 441.09 (2) may prescribe controlled substances only as permitted by
3698	3698	the rules promulgated under s. 441.16 (3) 441.09 (6) (a) 4.
3699	3699	(2) An advanced practice registered nurse certified under s. 441.16 who may
3700	3700	issue prescription orders under s. 441.09 (2) shall include with each prescription
3701	3701	order the advanced practice nurse prescriber certification license number issued to
3702	3702	him or her by the board of nursing.
3703	3703	(3) An advanced practice registered nurse certified under s. 441.16 who may
3704	3704	issue prescription orders under s. 441.09 (2) may dispense a controlled substance
3705	3705	only by prescribing or administering the controlled substance or as otherwise
3706	3706	permitted by the rules promulgated under s. 441.16 (3) 441.09 (6) (a) 4.
3707	3707	SECTION 172. Nonstatutory provisions.
3708	3708	(1) Using the procedure under s. 227.24, the board of nursing may promulgate
3709	3709	rules under ch. 441 that are necessary to implement the changes in this act.
3710	3710	Notwithstanding s. 227.24 (1) (a) and (3), the board is not required to provide
3711	3711	evidence that promulgating a rule under this subsection as an emergency rule is
3712	3712	necessary for the preservation of the public peace, health, safety, or welfare and is
3713	3713	not required to provide a finding of emergency for a rule promulgated under this
3714	3714	subsection. A rule under this subsection may take effect no later than the date
3715	3715	specified in SECTION 173 (intro.) of this act. Notwithstanding s. 227.24 (1) (c) and
3716	3716	(2), a rule promulgated under this subsection is effective for 2 years after its
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3743	3743	SECTION 172
3744	3744	promulgation, or until permanent rules take effect, whichever is sooner, and the
3745	3745	effective period of a rule promulgated under this subsection may not be further
3746	3746	extended under s. 227.24 (2).
3747	3747	(2) (a) In this subsection, the definitions under s. 441.001 apply.
3748	3748	(b) Notwithstanding s. 441.09 (3), an individual who, on January 1, 2026, is
3749	3749	licensed as a registered nurse in this state and is practicing in a recognized role may
3750	3750	continue to practice advanced practice registered nursing and the corresponding
3751	3751	recognized role in which he or she is practicing and may continue to use the titles
3752	3752	corresponding to the recognized roles in which he or she is practicing during the
3753	3753	period before which the board takes final action on the person[s application under s.
3754	3754	441.09. This paragraph does not apply after the first day of the 13th month
3755	3755	beginning after the effective date of this paragraph.
3756	3756	SECTION 173. Effective dates. This act takes effect on the first day of the
3757	3757	13th month beginning after publication, except as follows:
3758	3758	(1) SECTION 172 (1) of this act takes effect on the day after publication.
3759	3759	(END)
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