LRBs0276/1
KP/MED/TJD:emw
2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 396
November 11, 2021 - Offered by Representative Cabral-Guevara.
AB396-ASA1,2,20
1An Act to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 8.,
2252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a) 4m., 440.08 (2)
3(a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16, 441.19, 448.035 (1)
4(a) and 450.01 (1m);
to renumber and amend 146.89 (1) (r) 3., 253.13 (1),
5255.06 (1) (d), 441.06 (7) and 441.11 (2);
to amend 14.87 (title), 29.193 (1m) (a)
62. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd)
72. c., 29.193 (2) (e), 29.193 (3) (a), 45.40 (1g) (a), 46.03 (44), 50.08 (2), 50.09 (1)
8(a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k), 50.49 (1) (b) (intro.), 51.41
9(1d) (b) 4., 70.47 (8) (intro.), 77.54 (14) (f) 4., 97.59, 102.13 (1) (a), 102.13 (1) (b)
10(intro.), 1., 3. and 4., 102.13 (1) (d) 1., 2., 3. and 4., 102.13 (2) (a), 102.13 (2) (b),
11102.17 (1) (d) 1. and 2., 102.29 (3), 102.42 (2) (a), 106.30 (1), 118.15 (3) (a), 118.25
12(1) (a), 118.29 (1) (e), 118.2925 (3), 118.2925 (4) (c), 118.2925 (5), 146.343 (1) (c),
13146.82 (3) (a), 146.89 (1) (r) 1., 146.89 (6), 154.01 (1g), 252.07 (8) (a) 2., 252.07
1(9) (c), 252.10 (7), 252.11 (2), (4), (5), (7) and (10), 252.15 (3m) (d) 11. b. and 13.,
2(5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m) (intro.) and (b), 252.16 (3) (c)
3(intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d), 253.115 (4), 253.115 (7) (a) (intro.),
4253.15 (2), 255.06 (2) (d), 255.07 (1) (d), 257.01 (5) (a) and (b), 341.14 (1a), (1e)
5(a), (1m) and (1q), 343.16 (5) (a), 343.51 (1), 343.62 (4) (a) 4., 440.094 (1) (c) 1.,
6440.094 (2) (a) (intro.), 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (3), 441.01
7(4), 441.01 (7) (a) (intro.), 441.01 (7) (b), 441.06 (3), 441.06 (4), 441.07 (1g)
8(intro.), (a), (c) and (e), 441.10 (7), 441.18 (2) (a) (intro.), 441.18 (2) (b), 441.18
9(3), subchapter II (title) of chapter 441 [precedes 441.51], 441.51 (title), 448.03
10(2) (a), 448.035 (2) to (4), 448.56 (1) and (1m) (b), 448.62 (2m), 448.67 (2), 448.956
11(1m), 450.01 (16) (h) 2., 450.01 (16) (hr) 2., 450.03 (1) (e), 450.11 (1g) (b), 450.11
12(1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11 (8) (e), 450.13 (5) (b), 450.135
13(7) (b), 462.04, 655.001 (7t), 655.001 (9), 655.005 (2) (a), 961.01 (19) (a) and
14961.395;
to repeal and recreate 155.01 (1g) (b) and 441.06 (title); and
to
15create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em), 255.06 (1) (f) 2., 440.03 (13)
16(b) 39m., 440.08 (2) (a) 47., 441.001 (1c), 441.001 (3c), 441.001 (3g), 441.001 (3n),
17441.001 (3r), 441.001 (3w), 441.001 (5), 441.01 (7) (c), 441.09 and 441.092 of the
18statutes;
relating to: advanced practice registered nurses, extending the time
19limit for emergency rule procedures, providing an exemption from emergency
20rule procedures, and granting rule-making authority.
Analysis by the Legislative Reference Bureau
Nursing practice and licensure
This bill makes various changes to practice, licensure, and certification
requirements for nurses, which are administered by the Board of Nursing.
Licensure of advanced practice registered nurses
Under current law, a person who wishes to practice professional nursing must
be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
additional system of licensure for advanced practice registered nurses (APRNs), to
be administered by the board. Under the bill, in order to apply for an APRN license,
a person must 1) hold, or concurrently apply for, an RN license; 2) have completed
an accredited graduate-level or postgraduate-level education program preparing
the person to practice as an APRN in one of four recognized roles and hold a current
national certification approved by the board; 3) possess malpractice liability
insurance in an amount determined as provided in the bill; 4) pay a fee determined
by the Department of Safety and Professional Services; and 5) satisfy certain other
criteria specified in the bill. The bill also allows a person who has not completed an
accredited education program described above to receive an APRN license if the
person 1) on January 1, 2022, is both licensed as an RN in Wisconsin and practicing
in one of the four recognized roles; and 2) satisfies additional practice or education
criteria established by the board. The bill also, however, automatically grants
licenses to certain RNs, as further described below. The four recognized roles, as
defined in the bill, are 1) certified nurse-midwife; 2) certified registered nurse
anesthetist; 3) clinical nurse specialist; and 4) nurse practitioner. The bill requires
the board, upon granting a person an APRN license, to also grant the person one or
more specialty designations corresponding to the recognized role or roles for which
the person qualifies.
The holder of an APRN license may append the title “A.P.R.N." to his or her
name, as well as a title corresponding to whichever specialty designations that the
person possesses. The bill prohibits any person from using the title “A.P.R.N.," and
from otherwise indicating that he or she is an APRN, unless the person is licensed
by the board as an APRN. The bill also prohibits the use of titles and abbreviations
corresponding to a recognized role unless the person has a specialty designation for
that role. However, the bill allows an APRN to delegate a task or order to another
clinically trained health care worker if the task or order is within the scope of the
APRN's practice, the APRN is competent to perform the task or issue the order, and
the APRN has reasonable evidence that the health care worker is minimally
competent to perform the task or issue the order under the circumstances. The bill
requires an APRN to adhere to professional standards when managing situations
that are beyond the APRN's expertise.
Under the bill, when an APRN renews his or her APRN license, the board must
grant the person the renewal of both the person's RN license and the person's APRN
license. The bill requires all APRNs to complete continuing education requirements
each biennium in clinical pharmacology or therapeutics relevant to the APRN's area
of practice and to satisfy certain other requirements when renewing a license.
Practice of nurse-midwifery
This bill repeals licensure and practice requirements specific to
nurse-midwives and the practice of nurse-midwifery, including specific
requirements to practice with an obstetrician. Under the bill, “certified
nurse-midwife" is one of the four recognized roles for APRNs, and a person who is
licensed as a nurse-midwife under current law is automatically granted an APRN
license with a certified nurse-midwife specialty designation. The bill otherwise
allows nurse-midwives to be licensed as APRNs if they satisfy the licensure
requirements, except that the bill also requires that a person applying for a certified
nurse-midwife specialty designation be certified by the American Midwifery
Certification Board. The bill also requires an APRN with a specialty designation as
a certified nurse-midwife to file with the board, and obtain the board's approval of,
a plan for ensuring appropriate care or care transitions in treating certain patients
if the APRN offers to deliver babies outside of a hospital setting.
Prescribing authority
Under current law, a person licensed as an RN may apply to the board for a
certificate to issue prescription orders if the person meets certain requirements
established by the board. An RN holding a certificate is subject to various practice
requirements and limitations established by the board and must possess malpractice
liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and generally
authorizes APRNs to issue prescription orders. A person who is certified to issue
prescription orders under current law is automatically granted an APRN license
with his or her appropriate specialty designation. RNs who are practicing in a
recognized role on January 1, 2022, but who do not hold a certificate to issue
prescription orders on that date and who are granted an APRN license under the bill
may not issue prescription orders. As under current law, an APRN issuing
prescription orders is subject to various practice requirements and limitations
established by the board.
The bill repeals a provision concerning the ability of advanced practice nurses
who are certified to issue prescription orders and who are required to work in
collaboration with or under the supervision of a physician to obtain and practice
under a federal waiver to dispense narcotic drugs to individuals for addiction
treatment.
Other changes
The bill makes numerous other changes throughout the statutes relating to
APRNs, including various terminology changes and technical changes relating to the
Nurse Licensure Compact.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB396-ASA1,1
1Section 1
. 14.87 (title) of the statutes is amended to read:
AB396-ASA1,4,2
214.87 (title)
Enhanced nurse Nurse licensure compact.
AB396-ASA1,2
3Section 2
. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
AB396-ASA1,5,5
129.193
(1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
2or both arms or one or both hands and fails to meet the minimum standards of any
3one of the following standard tests, administered under the direction of a licensed
4physician, a licensed physician assistant, a licensed chiropractor, or a
certified 5licensed advanced practice
registered nurse
prescriber:
AB396-ASA1,3
6Section 3
. 29.193 (2) (b) 2. of the statutes is amended to read:
AB396-ASA1,5,127
29.193
(2) (b) 2. An applicant shall submit an application on a form prepared
8and furnished by the department, which shall include a written statement or report
9prepared and signed by a licensed physician, a licensed physician assistant, a
10licensed chiropractor, a licensed podiatrist, or a
certified licensed advanced practice
11registered nurse
prescriber prepared no more than 6 months preceding the
12application and verifying that the applicant is physically disabled.
AB396-ASA1,4
13Section 4
. 29.193 (2) (c) 3. of the statutes is amended to read:
AB396-ASA1,5,2514
29.193
(2) (c) 3. The department may issue a Class B permit to an applicant
15who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
16subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
17applicant and the recommendation of a licensed physician, a licensed physician
18assistant, a licensed chiropractor, a licensed podiatrist, or a
certified licensed 19advanced practice
registered nurse
prescriber selected by the applicant from a list
20of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
21podiatrists, and
certified licensed advanced practice
nurse prescribers registered
22nurses compiled by the department, the department finds that issuance of a permit
23complies with the intent of this subsection. The use of this review procedure is
24discretionary with the department and all costs of the review procedure shall be paid
25by the applicant.
AB396-ASA1,5
1Section
5. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
AB396-ASA1,6,72
29.193
(2) (cd) 2. b. The person has a permanent substantial loss of function
3in one or both arms and fails to meet the minimum standards of the standard upper
4extremity pinch test, the standard grip test, or the standard nine-hole peg test,
5administered under the direction of a licensed physician, a licensed physician
6assistant, a licensed chiropractor, or a
certified
licensed advanced practice
registered 7nurse
prescriber.
AB396-ASA1,6
8Section 6
. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
AB396-ASA1,6,139
29.193
(2) (cd) 2. c. The person has a permanent substantial loss of function in
10one or both shoulders and fails to meet the minimum standards of the standard
11shoulder strength test, administered under the direction of a licensed physician, a
12licensed physician assistant, a licensed chiropractor, or a
certified licensed advanced
13practice
registered nurse
prescriber.
AB396-ASA1,7
14Section 7
. 29.193 (2) (e) of the statutes is amended to read:
AB396-ASA1,6,2415
29.193
(2) (e)
Review of decisions. An applicant denied a permit under this
16subsection, except a permit under par. (c) 3., may obtain a review of that decision by
17a licensed physician, a licensed physician assistant, a licensed chiropractor, a
18licensed podiatrist, or a
certified licensed advanced practice
registered nurse
19prescriber designated by the department and with an office located in the
20department district in which the applicant resides. The department shall pay for the
21cost of a review under this paragraph unless the denied application on its face fails
22to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
23the only method of review of a decision to deny a permit under this subsection and
24is not subject to further review under ch. 227.
AB396-ASA1,8
25Section 8
. 29.193 (3) (a) of the statutes is amended to read:
AB396-ASA1,7,4
129.193
(3) (a) Produces a certificate from a licensed physician, a licensed
2physician assistant, a licensed optometrist, or a
certified licensed advanced practice
3registered nurse
prescriber stating that his or her sight is impaired to the degree that
4he or she cannot read ordinary newspaper print with or without corrective glasses.
AB396-ASA1,9
5Section 9
. 45.40 (1g) (a) of the statutes is amended to read:
AB396-ASA1,7,106
45.40
(1g) (a) “Health care provider" means an advanced practice
registered 7nurse
prescriber certified who may issue prescription orders under s.
441.16
441.09 8(2), an audiologist licensed under ch. 459, a dentist licensed under ch. 447, an
9optometrist licensed under ch. 449, a physician licensed under s. 448.02, or a
10podiatrist licensed under s. 448.63.
AB396-ASA1,7,2213
46.03
(44) Sexually transmitted disease treatment information. Prepare and
14keep current an information sheet to be distributed to a patient by a physician,
a 15physician assistant, or
certified an advanced practice
registered nurse
prescriber 16who may issue prescription orders under s. 441.09 (2) providing expedited partner
17therapy to that patient under s.
441.092, 448.035
, or 448.9725. The information
18sheet shall include information about sexually transmitted diseases and their
19treatment and about the risk of drug allergies. The information sheet shall also
20include a statement advising a person with questions about the information to
21contact his or her physician,
advanced practice registered nurse, pharmacist, or local
22health department, as defined in s. 250.01 (4).
AB396-ASA1,11
23Section
11. 50.01 (1b) of the statutes is repealed.
AB396-ASA1,8,5
150.08
(2) A physician, an advanced practice
registered nurse
prescriber 2certified who may issue prescription orders under s.
441.16 441.09 (2), or a physician
3assistant who prescribes a psychotropic medication to a nursing home resident who
4has degenerative brain disorder shall notify the nursing home if the prescribed
5medication has a boxed warning under
21 CFR 201.57.
AB396-ASA1,13
6Section 13
. 50.09 (1) (a) (intro.) of the statutes is amended to read:
AB396-ASA1,8,147
50.09
(1) (a) (intro.) Private and unrestricted communications with the
8resident's family, physician, physician assistant, advanced practice
registered nurse
9prescriber, attorney, and any other person, unless medically contraindicated as
10documented by the resident's physician, physician assistant, or advanced practice
11registered nurse
prescriber in the resident's medical record, except that
12communications with public officials or with the resident's attorney shall not be
13restricted in any event. The right to private and unrestricted communications shall
14include, but is not limited to, the right to:
AB396-ASA1,14
15Section 14
. 50.09 (1) (f) 1. of the statutes is amended to read:
AB396-ASA1,8,2016
50.09
(1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
17or both domestic partners under ch. 770 are residents of the same facility, the spouses
18or domestic partners shall be permitted to share a room unless medically
19contraindicated as documented by the resident's physician, physician assistant, or
20advanced practice
registered nurse
prescriber in the resident's medical record.
AB396-ASA1,15
21Section 15
. 50.09 (1) (h) of the statutes is amended to read:
AB396-ASA1,8,2522
50.09
(1) (h) Meet with, and participate in activities of social, religious, and
23community groups at the resident's discretion, unless medically contraindicated as
24documented by the resident's physician, physician assistant, or advanced practice
25registered nurse
prescriber in the resident's medical record.
AB396-ASA1,16
1Section
16. 50.09 (1) (k) of the statutes is amended to read:
AB396-ASA1,9,132
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
3and physical restraints except as authorized in writing by a physician, physician
4assistant, or advanced practice
registered nurse
prescriber for a specified and
5limited period of time and documented in the resident's medical record. Physical
6restraints may be used in an emergency when necessary to protect the resident from
7injury to himself or herself or others or to property. However, authorization for
8continuing use of the physical restraints shall be secured from a physician, physician
9assistant, or advanced practice
registered nurse
prescriber within 12 hours. Any use
10of physical restraints shall be noted in the resident's medical records. “
Physical
11restraints" includes, but is not limited to, any article, device, or garment that
12interferes with the free movement of the resident and that the resident is unable to
13remove easily, and confinement in a locked room.
AB396-ASA1,17
14Section 17
. 50.49 (1) (b) (intro.) of the statutes is amended to read:
AB396-ASA1,9,2315
50.49
(1) (b) (intro.) “Home health services" means the following items and
16services that are furnished to an individual, who is under the care of a physician,
17physician assistant, or advanced practice
registered nurse
prescriber, by a home
18health agency, or by others under arrangements made by the home health agency,
19that are under a plan for furnishing those items and services to the individual that
20is established and periodically reviewed by a physician, physician assistant, or
21advanced practice
registered nurse
prescriber and that are, except as provided in
22subd. 6., provided on a visiting basis in a place of residence used as the individual's
23home:
AB396-ASA1,18
24Section 18
. 51.41 (1d) (b) 4. of the statutes is amended to read:
AB396-ASA1,10,10
151.41
(1d) (b) 4. A psychiatric mental health advanced practice
registered 2nurse who is suggested by the Milwaukee County board of supervisors. The
3Milwaukee County board of supervisors shall solicit suggestions from organizations
4including the Wisconsin Nurses Association for individuals who specialize in a full
5continuum of behavioral health and medical services including emergency
6detention, inpatient, residential, transitional, partial hospitalization, intensive
7outpatient, and wraparound community-based services. The Milwaukee County
8board of supervisors shall suggest to the Milwaukee County executive 4 psychiatric
9mental health advanced practice
registered nurses for this board membership
10position.
AB396-ASA1,10,2513
70.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
14appear before it in relation to the assessment. Instead of appearing in person at the
15hearing, the board may allow the property owner, or the property owner's
16representative, at the request of either person, to appear before the board, under
17oath, by telephone or to submit written statements, under oath, to the board. The
18board shall hear upon oath, by telephone, all ill or disabled persons who present to
19the board a letter from a physician, physician assistant, or advanced practice
20registered nurse
prescriber certified under s. 441.16 (2) licensed under ch. 441 that
21confirms their illness or disability. At the request of the property owner or the
22property owner's representative, the board may postpone and reschedule a hearing
23under this subsection, but may not postpone and reschedule a hearing more than
24once during the same session for the same property. The board at such hearing shall
25proceed as follows:
AB396-ASA1,20
1Section
20. 77.54 (14) (f) 3. of the statutes is repealed.
AB396-ASA1,21
2Section 21
. 77.54 (14) (f) 4. of the statutes is amended to read:
AB396-ASA1,11,43
77.54
(14) (f) 4. An advanced practice
registered nurse
who may issue
4prescription orders under s. 441.09 (2).
AB396-ASA1,22
5Section 22
. 97.59 of the statutes is amended to read:
AB396-ASA1,11,18
697.59 Handling foods. No person in charge of any public eating place or other
7establishment where food products to be consumed by others are handled may
8knowingly employ any person handling food products who has a disease in a form
9that is communicable by food handling. If required by the local health officer or any
10officer of the department for the purposes of an investigation, any person who is
11employed in the handling of foods or is suspected of having a disease in a form that
12is communicable by food handling shall submit to an examination by the officer or
13by a physician, physician assistant, or advanced practice
registered nurse
prescriber 14designated by the officer. The expense of the examination, if any, shall be paid by the
15person examined. Any person knowingly infected with a disease in a form that is
16communicable by food handling who handles food products to be consumed by others
17and any persons knowingly employing or permitting such a person to handle food
18products to be consumed by others shall be punished as provided by s. 97.72.
AB396-ASA1,23
19Section 23
. 102.13 (1) (a) of the statutes is amended to read:
AB396-ASA1,12,620
102.13
(1) (a) Except as provided in sub. (4), whenever compensation is claimed
21by an employee, the employee shall, upon the written request of the employee's
22employer or worker's compensation insurer, submit to reasonable examinations by
23physicians, chiropractors, psychologists, dentists, physician assistants, advanced
24practice
nurse prescribers registered nurses, or podiatrists provided and paid for by
25the employer or insurer. No employee who submits to an examination under this
1paragraph is a patient of the examining physician, chiropractor, psychologist,
2dentist, physician assistant, advanced practice
registered nurse
prescriber, or
3podiatrist for any purpose other than for the purpose of bringing an action under ch.
4655, unless the employee specifically requests treatment from that physician,
5chiropractor, psychologist, dentist, physician assistant, advanced practice
registered 6nurse
prescriber, or podiatrist.
AB396-ASA1,24
7Section 24
. 102.13 (1) (b) (intro.), 1., 3. and 4. of the statutes are amended to
8read:
AB396-ASA1,12,229
102.13
(1) (b) (intro.) An employer or insurer who requests that an employee
10submit to reasonable examination under par. (a) or (am) shall tender to the employee,
11before the examination, all necessary expenses including transportation expenses.
12The employee is entitled to have a physician, chiropractor, psychologist, dentist,
13physician assistant, advanced practice
registered nurse
prescriber, or podiatrist
14provided by himself or herself present at the examination and to receive a copy of all
15reports of the examination that are prepared by the examining physician,
16chiropractor, psychologist, podiatrist, dentist, physician assistant, advanced
17practice
registered nurse
prescriber, or vocational expert immediately upon receipt
18of those reports by the employer or worker's compensation insurer. The employee is
19also entitled to have a translator provided by himself or herself present at the
20examination if the employee has difficulty speaking or understanding the English
21language. The employer's or insurer's written request for examination shall notify
22the employee of all of the following:
AB396-ASA1,13,223
1. The proposed date, time, and place of the examination and the identity and
24area of specialization of the examining physician, chiropractor, psychologist, dentist,
1podiatrist, physician assistant, advanced practice
registered nurse
prescriber, or
2vocational expert.
AB396-ASA1,13,53
3. The employee's right to have his or her physician, chiropractor, psychologist,
4dentist, physician assistant, advanced practice
registered nurse
prescriber, or
5podiatrist present at the examination.
AB396-ASA1,13,106
4. The employee's right to receive a copy of all reports of the examination that
7are prepared by the examining physician, chiropractor, psychologist, dentist,
8podiatrist, physician assistant, advanced practice
registered nurse
prescriber, or
9vocational expert immediately upon receipt of these reports by the employer or
10worker's compensation insurer.
AB396-ASA1,25
11Section 25
. 102.13 (1) (d) 1., 2., 3. and 4. of the statutes are amended to read:
AB396-ASA1,13,1512
102.13
(1) (d) 1. Any physician, chiropractor, psychologist, dentist, podiatrist,
13physician assistant, advanced practice
registered nurse
prescriber, or vocational
14expert who is present at any examination under par. (a) or (am) may be required to
15testify as to the results of the examination.