Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-225, 18VAC90-20-230).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: January 25, 2017.

Effective Date: February 10, 2017.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4520, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia establishes the general powers and duties of health regulatory boards including the responsibility to (i) promulgate regulations that are reasonable and necessary to administer effectively the regulatory system; (ii) establish the qualifications for registration, certification, licensure or the issuance of a multistate licensure privilege in accordance with the applicable law that are necessary to ensure competence and integrity to engage in the regulated professions; and (iii) issue inactive licenses or certificates and promulgate regulations to carry out such purpose, which shall include the qualifications, renewal fees, and conditions for reactivation of licenses or certificates.

Purpose: On April 13, 2016, a petition for rulemaking was received requesting that the Board of Nursing consider amending the sections on reactivation and reinstatement because requirements in those sections appear to allow a person to let his license lapse and then pay the reinstatement fee without meeting the requirements for continued competency for renewal of licensure.

The board concurred with the petitioner and voted to amend its regulations using the fast-track rulemaking process. While the board currently expects nurses reactivating or reinstating within one renewal cycle to meet the continuing competency requirements, the regulations do not specifically include that provision. As such, regulations may not adequately ensure the current competency of a person seeking reactivation or reinstatement. To protect the health and safety of patients, the board must require some evidence that the nurse is competent to resume active practice.

Rationale for Using Fast-Track Rulemaking Process: There was only one comment on the petition for rulemaking; a comment in support was received from the petitioner. Therefore, the board is confident that the rulemaking is noncontroversial and should be promulgated as a fast-track rulemaking action.

Substance: The amendments clarify that when a nurse reactivates an inactive license or reinstates a lapsed license with one renewal period of going inactive or allowing the license to lapse, he must provide evidence of completion of at least one of the learning activities or courses specified in 18VAC90-20-221 during the two years immediately preceding reactivation or reinstatement.

Issues: The primary advantage to the public of the amendment is better assurance that nurses returning to active practice have minimal competency to provide services to patients in Virginia. There are no disadvantages to the public.

There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The proposed regulation will clarify that compliance with continuing education requirements is required to reactivate an inactive license and to reinstate a lapsed license.

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

Estimated Economic Impact. The Board of Nursing (Board) currently expects nurses reactivating or reinstating their licenses within one renewal cycle to meet the continuing education requirements for nurses renewing their active licenses. That is a nurse who has not kept his or her knowledge and skills up-to-date is expected to obtain 30 hours of continuing education and a nurse who actively practiced in another state and is returning to Virginia is expected to obtain 15 hours of continuing education. However, the current regulation does not specify these requirements. The proposed language clarifies that nurses reactivating or reinstating their licenses are subject to the same continuing education requirements established in subdivisions 8 and 9 of 18VAC90-20-221. Since compliance with the proposed requirements is already expected by the Board and enforced, no significant economic effect is expected other than improving the clarity of the regulation.

Businesses and Entities Affected. In June 2016, there were 217,195 registered nurses and 29,718 licensed practical nurses in Virginia. Of this population, 1,013 registered nurses and 631 licensed practical nurses had their licenses go inactive or lapse and, later, in fiscal year 2016, applied for reactivation or reinstatement.

Localities Particularly Affected. The proposed changes apply statewide.

Projected Impact on Employment. No impact on employment is expected.

Effects on the Use and Value of Private Property. No impact on the use and value of private property is expected.

Real Estate Development Costs. No impact on real estate development costs is expected.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. No costs or other effects on small businesses are expected.

Alternative Method that Minimizes Adverse Impact. The proposed amendments do not have an adverse impact on small businesses.

Adverse Impacts:

Businesses. The proposed amendments do not have an adverse impact on non-small businesses.

Localities. The proposed amendments do not adversely affect localities.

Other Entities. The proposed amendments do not adversely affect other entities.

Agency's Response to Economic Impact Analysis: The Board of Nursing concurs with the analysis of the Department of Planning and Budget.

Summary:

The amendments clarify that compliance with continuing education requirements is required to reactivate an inactive license and to reinstate a lapsed license.

18VAC90-20-225. Inactive licensure.

A. A registered nurse or licensed practical nurse who holds a current, unrestricted license in Virginia may, upon a request on the renewal application and submission of the required fee, be issued an inactive license. The holder of an inactive license shall not be entitled to practice nursing in Virginia or practice on a multistate licensure privilege but may use the title "registered nurse" or "licensed practical nurse."

B. Reactivation of an inactive license.

1. A nurse whose license is inactive may reactivate within one renewal period by payment:

a. Payment of the difference between the inactive renewal and the active renewal fee; and

b. Providing attestation of completion of at least one of the learning activities or courses specified in 18VAC90-20-221 during the two years immediately preceding reactivation.

2. A nurse whose license has been inactive for more than one renewal period may reactivate by:

a. Submitting an application;

b. Paying the difference between the inactive renewal and the active renewal fee; and

c. Providing evidence of completion of at least one of the learning activities or courses specified in 18VAC90-20-221 during the two years immediately preceding application for reactivation.

3. The board may waive all or part of the continuing education requirement for a nurse who holds a current, unrestricted license in another state and who has engaged in active practice during the period the Virginia license was inactive.

4. The board may request additional evidence that the nurse is prepared to resume practice in a competent manner.

5. The board reserves the right to deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-3007 of the Code of Virginia or any provision of this chapter.

18VAC90-20-230. Reinstatement of lapsed licenses or license suspended or revoked.

A. A nurse whose license has lapsed may be reinstated within one renewal period by payment:

1. Payment of the current renewal fee and the late renewal fee; and

2. Providing attestation of completion of at least one of the learning activities or courses specified in 18VAC90-20-221 during the two years immediately preceding reinstatement.

B. A nurse whose license has lapsed for more than one renewal period shall:

1. File a reinstatement application and pay the reinstatement fee;

2. Provide evidence of completing at least one of the learning activities or courses specified in 18VAC90-20-221 during the two years immediately preceding application for reinstatement; and

3. Submit a criminal history background check as required by § 54.1-3005.1 of the Code of Virginia.

C. The board may waive all or part of the continuing education requirement for a nurse who holds a current, unrestricted license in another state and who has engaged in active practice during the period the Virginia license was lapsed.

D. A nurse whose license has been suspended or revoked by the board may apply for reinstatement by filing a reinstatement application, fulfilling requirements for continuing competency as required in subsection B of this section, and paying the fee for reinstatement after suspension or revocation. A nurse whose license has been revoked may not apply for reinstatement sooner than three years from entry of the order of revocation.

E. The board may request additional evidence that the nurse is prepared to resume practice in a competent manner.