Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-181).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: December 9, 2009.

Effective Date: December 24, 2009.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4515, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia establishes the general powers and duties of health regulatory boards including the responsibility to promulgate regulations.

Purpose: The purpose of the action is to update requirements for issuance of a license with a multistate licensure privilege. Consistency with Model Rules for the Compact is necessary to ensure that nurses with a multistate privilege are appropriately licensed and able to provide services to protect the health and safety of patients in Virginia. If a compact state has restricted the privilege and only issued a single state license, such action must be acknowledged on the license.

Rationale for Using Fast-Track Process: The board is merely conforming language in its regulations with the Model Rules for the Nurse Licensure Compact, so the changes are not more restrictive and not expected to be controversial.

Substance: Two new identification forms would be acceptable evidence as primary residency, and a nurse from another country would have a choice of declaring either the country of origin or Virginia as the primary state. Additionally, a new regulation would specify that a single state license should be clearly marked that it is valid only in the state of issuance.

Issues: There are no advantages or disadvantages to the public. The primary advantage to the agency is consistency with the Nurse Licensure Compact of which Virginia is a member. There are no pertinent issues.

The Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Nursing (Board) proposes to amend its Regulations Governing the Practice of Nursing to allow two new forms of identification as proof of primary residency for the purposes of obtaining a license with multistate licensure privileges. The board also proposes to allow foreign nurses who are in the United States on a visa and are applying for licensure in Virginia to declare either Virginia or their country of origin as their primary state of residence.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Current regulations allow Virginia to issue a license with a multistate licensure privilege, for nurses who are currently licensed in Virginia or who are applying for licensure in Virginia, so long as the primary residence of the nurse seeking such a license is in Virginia. Currently, nurses may offer 1) a driver's license with a home address listed, 2) a voter registration card with a home address listed or 3) a federal or state tax return declaring Virginia as primary state of residence as evidence that they meet the requirements for the multistate licensure privilege.

The Board proposes to add two new forms of identification, 1) Military Form No. 2058— state of legal residence and 2) form W2 from the United States Government or any bureau, division or agency thereof indicating Virginia as a declared state of residence, to this list of acceptable proof of residence. The Board also proposes to allow foreign nurses who are in the United States on a visa, and are applying for Virginia licensure, to choose whether they will list Virginia or their home country as their primary state of residence. If a foreign nurse declares his or her home country as the primary state of residence, he/she will only be eligible for a single state (Virginia) license. These proposed changes will make Virginia regulations consistent with the model rules for the compact that governs multistate licensure.

Since the proposed changes do not impose any new restrictions on licensees, no entity is likely to incur any additional costs on account of this regulatory action. Licensed Nurses, and applicants for nursing licensure, are likely to benefit from being able to use a wider variety of proof of residency as this will allow nurses who, for instance, have recently moved to Virginia and who have changed their addresses on their W2s… but who have not yet obtained a Virginia driver's license or registered to vote… to obtain multistate licensure.

Businesses and Entities Affected. The Department of Health Professions (DHP) reports that the Board currently licenses 5,200 registered nurses and 784 licensed practical nurses.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. This regulatory action will likely have no impact on employment in the Commonwealth.

Effects on the Use and Value of Private Property. This regulatory action will likely have no effect on the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects Small businesses in the Commonwealth are unlikely to incur any costs on account of this regulatory action.

Small Businesses: Alternative Method that Minimizes Adverse Impact. Small businesses in the Commonwealth are unlikely to incur any costs on account of this regulatory action.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to the Department of Planning and Budget's Economic Impact Analysis: The Board of Nursing concurs with the analysis of the Department of Planning and Budget on proposed amended regulations for 18VAC90-20, Regulations Governing the Practice of Nursing.

Summary:

The proposed amendments make board regulations for the issuance of a multistate licensure privilege consistent with the Model Rules of the Nurse Licensure Compact. Two new identification forms are acceptable evidence as primary residency, and a nurse from another country has a choice of declaring either the country of origin or Virginia as the primary state. Additionally, a new regulation specifies that a single state license should be clearly marked that it is valid only in the state of issuance.

18VAC90-20-181. Issuance of a license with a multistate licensure privilege.

A. In order to be issued a license with a multistate licensure privilege by the board, a nurse currently licensed in Virginia or a person applying for licensure in Virginia shall submit a declaration stating that his primary residence is in Virginia. Evidence of a primary state of residence may be required to include but not be limited to:

1. A driver's license with a home address;

2. A voter registration card displaying a home address; or

3. A federal or state tax return declaring the primary state of residence. ;

4. A Military Form No. 2058 – state of legal residence; or

5. A W-2 from the United States government or any bureau, division, or agency thereof indicating the declared state of residence.

B. A nurse on a visa from another country applying for licensure in Virginia may declare either the country of origin or Virginia as the primary state of residence. If the foreign country is declared as the primary state of residence, a single state license shall be issued by Virginia.

C. A nurse changing the primary state of residence from another party state to Virginia may continue to practice under the former party state license and multistate licensure privilege during the processing of the nurse's licensure application by the board for a period not to exceed 30 days.

1. If a nurse is under a pending investigation by a former home state, the licensure application in Virginia shall be held in abeyance and the 30-day authorization to practice stayed until resolution of the pending investigation.

2. A license issued by a former party state shall no longer be valid upon issuance of a license by the board.

3. If the board denies licensure to an applicant from another party state, it shall notify the former home state within 10 business days, and the former home state may take action in accordance with the laws and regulations of that state.

D. A license issued by a party state is valid for practice in all other party states, unless clearly designated as valid only in the state that issued the license. When a party state issues a license authorizing practice only in that state and not authorizing practice in other party states, the license shall be clearly marked with words indicating that it is valid only in the state of issuance.