Title of Regulation: 18VAC90-40. Regulations for Prescriptive Authority for Nurse Practitioners (amending 18VAC90-40-20, 18VAC90-40-55, 18VAC90-40-70, 18VAC90-40-110; repealing 18VAC90-40-50, 18VAC90-40-60).

Statutory Authority: §§ 54.1-2400 and 54.1-2957.1 of the Code of Virginia.

Public Hearing Information:

August 27, 2019 - 8:30 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 201, Training Room 2, Henrico, VA 23233

Public Comment Deadline: September 20, 2019.

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: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Boards of Nursing and Medicine the authority to promulgate regulations to administer the regulatory system. Section 54.1-2957.01 of the Code of Virginia provides requirements for prescription of certain controlled substances and devices by licensed nurse practitioners.

Purpose: The purpose of the proposed regulatory action is to eliminate unnecessary regulations and costs for nurse practitioners. The Code of Virginia specifies certain requirements for prescriptive authority for nurse practitioners but does not require maintenance of a separate license, which is required by regulation. Therefore, the boards propose to retain the requirements for prescriptive authority and for continuing education, but eliminate the requirement to renew the license. Requirements for continuing competency and disclosure to patients in accordance with § 54.1-2957.1 will remain in effect to protect the health and safety of patients.

Substance: This regulatory action eliminates the requirement for renewal of prescriptive authority for nurse practitioners and reduces the fee for an application for prescriptive from $75 to $35. Requirements for continuing competency and disclosure to patients remain in effect, as mandated by the Code of Virginia.

Issues: There are no advantages or disadvantages to the public. The amendments will benefit nurse practitioners and make their practice less costly. There are no advantages or disadvantages to the agency or the Commonwealth. The loss of revenue can be absorbed in the budget of the Board of Nursing without necessitating any increase in fees.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Boards of Nursing and Medicine (Boards) propose to eliminate the requirement for renewal of prescriptive authority for a nurse practitioner and reduce the fee for initial application for prescriptive authority from $75 to $35.

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

Estimated Economic Impact. The current regulation includes a $35 biennial fee for renewal of prescriptive authority for nurse practitioners. The proposal to eliminate the requirement for renewal of prescriptive authority would save nurse practitioners $35 every other year, as well as the time associated with applying for renewal. The Boards do not believe eliminating this requirement would affect health and safety.

The Boards' proposal to reduce the fee for initial application for prescriptive authority from $75 to $35 would save nurse practitioners $40 when they first apply for the authority. The proposed reduction of the fee for initial application for prescriptive authority, and the proposed elimination of the requirement for renewal of prescriptive authority, would both reduce revenue received by the Board of Nursing (Board). According to the Department of Health Professions, the Board would continue to have sufficient resources with the reduction of revenue. Given the benefits for nurse practitioners and lack of impact on health and safety and the Board's ability to operate, both proposals should produce net benefits.

Businesses and Entities Affected. The proposed amendments affect the 7,417 licensed nurse practitioners with prescriptive authority, as well as future applicants for nurse practitioners prescriptive authority

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments do not significantly affect employment.

Effects on the Use and Value of Private Property. The proposed amendments are unlikely to significantly affect the use and value of private property.

Real Estate Development Costs. The proposed amendments do not affect real estate development costs.

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. The proposed amendments are unlikely to significantly affect costs for small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Adverse Impacts:

Businesses. The proposed amendments do not adversely affect 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 Boards of Nursing and Medicine concur with the analysis of the Department of Planning and Budget.

Summary:

The proposed amendments eliminate the requirement for renewal of prescriptive authority for a nurse practitioner and reduce the fee for an application for prescriptive authority to $35.

18VAC90-40-20. Authority and administration of regulations.

A. The statutory authority for this chapter is found in §§ 54.1-2957.01, 54.1-3303, 54.1-3401, and 54.1-3408 of the Code of Virginia.

B. Joint boards of nursing and medicine.

1. The Committee of the Joint Boards of Nursing and Medicine shall be appointed to administer this chapter governing prescriptive authority.

2. The boards hereby delegate to the Executive Director of the Virginia Board of Nursing the authority to issue the initial authorization and biennial renewal to those persons who meet the requirements set forth in this chapter and to grant extensions or exemptions for compliance with continuing competency requirements as set forth in subsection E of 18VAC90-40-55. Questions of eligibility shall be referred to the committee.

3. All records and files related to prescriptive authority for nurse practitioners shall be maintained in the office of the Board of Nursing.

18VAC90-40-50. Renewal of prescriptive authority. (Repealed.)

An applicant for renewal of prescriptive authority shall:

1. Renew biennially at the same time as the renewal of licensure to practice as a nurse practitioner in Virginia.

2. Submit a completed renewal form attesting to compliance with continuing competency requirements set forth in 18VAC90-40-55 and the renewal fee as prescribed in 18VAC90-40-70.

18VAC90-40-55. Continuing competency requirements.

A. In order to renew prescriptive authority, a A licensee with prescriptive authority shall meet continuing competency requirements for biennial renewal as a licensed nurse practitioner. Such requirements shall address issues such as ethical practice, an appropriate standard of care, patient safety, and appropriate communication with patients.

B. A nurse practitioner with prescriptive authority shall obtain a total of eight hours of continuing education in pharmacology or pharmacotherapeutics for each biennium in addition to the minimal requirements for compliance with subsection B of 18VAC90-30-105.

C. The nurse practitioner with prescriptive authority shall retain evidence of compliance and all supporting documentation for a period of four years following the renewal period for which the records apply.

D. The boards shall periodically conduct a random audit of its their licensees to determine compliance. The nurse practitioners selected for the audit shall provide the evidence of compliance and supporting documentation within 30 days of receiving notification of the audit.

E. The boards may delegate to the committee the authority to grant an extension or an exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

18VAC90-40-60. Reinstatement of prescriptive authority. (Repealed.)

A. A nurse practitioner whose prescriptive authority has lapsed may reinstate within one renewal period by payment of the current renewal fee and the late renewal fee.

B. A nurse practitioner who is applying for reinstatement of lapsed prescriptive authority after one renewal period shall:

1. File the required application;

2. Provide evidence of a current, unrestricted license to practice as a nurse practitioner in Virginia;

3. Pay the fee required for reinstatement of a lapsed authorization as prescribed in 18VAC90-40-70; and

4. If the authorization has lapsed for a period of two or more years, the applicant shall provide proof of:

a. Continued practice as a licensed nurse practitioner with prescriptive authority in another state; or

b. Continuing education, in addition to the minimal requirements for current professional certification, consisting of four contact hours in pharmacology or pharmacotherapeutics for each year in which the prescriptive authority has been lapsed in the Commonwealth, not to exceed a total of 16 hours.

C. An applicant for reinstatement of suspended or revoked authorization shall:

1. Petition for reinstatement and pay the fee for reinstatement of a suspended or revoked authorization as prescribed in 18VAC90-40-70;

2. Present evidence of competence to resume practice as a nurse practitioner with prescriptive authority; and

3. Meet the qualifications and resubmit the application required for initial authorization in 18VAC90-40-40.

18VAC90-40-70. Fees for prescriptive authority.

A. The following fees have been established by the boards:

1. Initial issuance of prescriptive authority	$75 $35
2. Biennial renewal	$35
3. Late renewal	$15
4. Reinstatement of lapsed authorization	$90
5. Reinstatement of suspended or revoked authorization	$85
6. Duplicate of authorization	$15
7. 2. Return check charge	$35

B. For renewal of licensure from July 1, 2017, through June 30, 2019, the following fee shall be in effect:

Biennial renewal

$26

18VAC90-40-110. Disclosure.

A. The nurse practitioner shall include on each prescription written issued or dispensed his signature and the Drug Enforcement Administration (DEA) number, when applicable. If his the nurse practitioner's practice agreement authorizes prescribing of only Schedule VI drugs and the nurse practitioner does not have a DEA number, he shall include the prescriptive authority number as issued by the boards.

B. The nurse practitioner shall disclose to patients at the initial encounter that he is a licensed nurse practitioner. Such disclosure may be included on a prescription pad or may be given in writing to the patient.

C. The nurse practitioner shall disclose, upon request of a patient or a patient's legal representative, the name of the patient care team physician and information regarding how to contact the patient care team physician.