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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-ASA1,10 11Section 10 . 46.03 (44) of the statutes, as affected by 2021 Wisconsin Act 23,
12is amended to read:
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-ASA1,12 24Section 12 . 50.08 (2) of the statutes, as affected by 2021 Wisconsin Act 23, is
25amended to read:
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:
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