Amendments for HB20-1216

House Journal, February 12
46 HB20-1216 be amended as follows, and as so amended, be referred to
47 the Committee on Finance with favorable
48 recommendation:
49
50 Amend printed bill, page 3, after line 1 insert:
51
52 "SECTION 1. Legislative declaration. The general assembly
53 finds and determines that the experience hours for advanced practice
54 registered nurses to obtain prescriptive authority, as specified in section
55 12-255-112 (4)(b), Colorado Revised Statutes, should be reduced in order
1 to remove barriers to advanced practice registered nurses obtaining full
2 prescriptive authority and to align with standards of the National Council
3 of State Boards of Nursing and should not be adjusted downward again
4 until after the next scheduled review of the state board of nursing
5 pursuant to section 24-34-104, Colorado Revised Statutes, at which time
6 the department of regulatory agencies should review and determine
7 whether the experience hours require further adjustments.".
8
9 Renumber succeeding sections accordingly.
10
11 Page 4, line 7, strike "(1)(aa), and (1)(bb);" and substitute "and (1)(aa);
12 repeal (1)(bb);".
13
14 Page 5, strike lines 22 through 25 and substitute:
15
16 "(bb) Has verified by signature the articulated plan developed by
17 an advanced practice nurse pursuant to sections 12-240-108 and
18 12-255-112 (4) if the articulated plan fails to comply with the
19 requirements of section 12-255-112 (4)(b)(II).".
20
21 Page 9, strike line 8 and substitute "(1), (2), (4), (7), (8)(a), (8)(b), (9),
22 (10)(a), (10)(b) introductory portion, (10)(b)(IV), and (12); and add (3.5),
23 (4.5), and (5.5) as follows:".
24
25 Page 9, after line 17 insert:
26
27 "(2) "Approved education program" means a course of training
28 EDUCATION conducted by an educational or health care institution that
29 implements the basic practical or professional nursing curriculum
30 prescribed and approved by the board.
31 (3.5) "COLLABORATION" MEANS THE ACT OF LICENSED HEALTH
32 CARE PROVIDERS WORKING COOPERATIVELY, SHARING RESPONSIBILITY
33 AND ACCOUNTABILITY WITHIN EACH LICENSED HEALTH CARE PROVIDER'S
34 SCOPE OF PRACTICE, TO FORMULATE AND CARRY OUT THE PLAN OF
35 PATIENT CARE.
36 (4) (a) "Delegated medical function" means an aspect of care that
37 implements and is consistent with the medical plan as prescribed by a
38 licensed or otherwise legally authorized physician, podiatrist, or dentist,
39 PHYSICIAN ASSISTANT, OR ADVANCED PRACTICE REGISTERED NURSE and
40 is delegated to a registered professional nurse or a practical nurse by a
41 physician, A podiatrist, A dentist, or A physician assistant, OR AN
42 ADVANCED PRACTICE REGISTERED NURSE. NOTHING IN THIS SUBSECTION
43 (4) LIMITS THE PRACTICE OF NURSING AS DEFINED IN THIS ARTICLE 255.
44 (b) For purposes of this subsection (4), "medical plan" means a
45 written plan, verbal order, standing order, or protocol, whether patient
46 specific or not, that authorizes specific or discretionary medical action
47 which AND THAT may include but is not limited to the selection of
48 medication. Nothing in this subsection (4) shall limit the practice of
49 nursing as defined in this article 255.
50 (4.5) (a) "DELEGATION OF PATIENT CARE" MEANS ASPECTS OF
51 PATIENT CARE THAT ARE CONSISTENT WITH A PLAN OF PATIENT CARE
52 PRESCRIBED BY A LICENSED HEALTH CARE PROVIDER WITHIN THE SCOPE OF
53 THE PROVIDER'S PRACTICE AND THAT MAY BE DELEGATED TO A
54 REGISTERED NURSE OR LICENSED PRACTICAL NURSE WITHIN THE SCOPE OF
55 THE NURSE'S PRACTICE. "DELEGATION OF PATIENT CARE" INCLUDES
1 ASPECTS OF PATIENT CARE THAT MAY BE DELEGATED BY A LICENSED
2 HEALTH CARE PROVIDER, AN ADVANCED PRACTICE REGISTERED NURSE, A
3 REGISTERED NURSE, OR A LICENSED PRACTICAL NURSE WITHIN THE SCOPE
4 OF THE PROVIDER'S OR NURSE'S PRACTICE AND WITHIN THE PROVIDER'S OR
5 NURSE'S PROFESSIONAL JUDGMENT TO A LICENSED OR AN UNLICENSED
6 HEALTH CARE PROVIDER WITHIN THE SCOPE OF THAT PROVIDER'S
7 PRACTICE. NOTHING IN THIS SUBSECTION (4.5) LIMITS OR EXPANDS THE
8 SCOPE OF PRACTICE OF ANY NURSE LICENSED PURSUANT TO THIS ARTICLE
9 255.
10 (b) FOR PURPOSES OF THIS SUBSECTION (4.5), "PLAN OF PATIENT
11 CARE" MEANS A WRITTEN PLAN, VERBAL ORDER, STANDING ORDER, OR
12 PROTOCOL, WHETHER PATIENT SPECIFIC OR NOT, THAT AUTHORIZES
13 SPECIFIC OR DISCRETIONARY NURSING ACTION AND THAT MAY INCLUDE
14 THE ADMINISTRATION OF MEDICATION.
15 (5.5) "LICENSED HEALTH CARE PROVIDER" MEANS AN INDIVIDUAL
16 WHO IS LICENSED OR OTHERWISE AUTHORIZED BY THE STATE PURSUANT
17 TO THIS TITLE 12 OR ARTICLE 3.5 OF TITLE 25 TO PROVIDE HEALTH CARE
18 SERVICES.
19 (7) "Practical nurse", "trained practical nurse", "licensed
20 vocational nurse", or "licensed practical nurse" means a person who holds
21 a license to practice pursuant to this article 255 as a licensed practical
22 nurse in this state or is licensed in another state and is practicing in this
23 state pursuant to section 24-60-3802, with the right to use the title
24 "licensed practical nurse" and its abbreviation, "L.P.N." OR "LICENSED
25 VOCATIONAL NURSE" AND ITS ABBREVIATION "L.V.N.".".
26
27 Page 9, after line 24 insert:
28
29 "(9) (a) "Practice of practical nursing" means the performance,
30 under the supervision of a dentist, physician, podiatrist, or professional
31 nurse LICENSED HEALTH CARE PROVIDER authorized to practice in this
32 state, of those services requiring the education, training, and experience,
33 as evidenced by knowledge, abilities, and skills required in this article
34 255 for licensing as a practical nurse pursuant to section 12-255-114, in:
35 (I) Caring for the ill, injured, or infirm;
36 (II) Teaching and promoting preventive health measures;
37 (III) Acting to safeguard life and health; or
38 (IV) Administering treatments and medications prescribed by A
39 LICENSED HEALTH CARE PROVIDER; OR
40 (A) A legally authorized dentist, podiatrist, or physician; or
41 (B) A physician assistant implementing a medical plan pursuant
42 to subsection (4) of this section.
43 (V) PARTICIPATING IN THE ASSESSMENT, PLANNING,
44 IMPLEMENTATION, AND EVALUATION OF THE DELIVERY OF PATIENT CARE
45 SERVICES THAT IS COMMENSURATE WITH THE PRACTICAL NURSE'S
46 EDUCATION.
47 (b) "Practice of practical nursing" includes:
48 (I) The performance of delegated medical functions AND
49 DELEGATED PATIENT CARE FUNCTIONS;
50 (II) THE ASSUMPTION OF RESPONSIBILITIES AND ACCOUNTABILITIES
51 FOR THE PERFORMANCE OF ACTS WITHIN THE PRACTICAL NURSE'S
52 EDUCATIONAL BACKGROUND AND USING PROCEDURES LEADING TO
53 PREDICTABLE OUTCOMES; AND
54 (III) THE ADMINISTRATION AND MANAGEMENT OF NURSING,
55 INCLUDING DIRECTING AND ASSIGNING NURSING INTERVENTIONS THAT
1 MAY BE PERFORMED BY OTHER LICENSED OR UNLICENSED HEALTH CARE
2 PERSONNEL.
3 (c) Nothing in this article 255 shall limit or deny LIMITS OR DENIES
4 a practical nurse from supervising other practical nurses or other
5 LICENSED OR UNLICENSED health care personnel.
6 (10) (a) "Practice of professional nursing" means the performance
7 of both independent nursing functions and delegated medical functions
8 in accordance with accepted practice standards AUTONOMOUS AND
9 COLLABORATIVE CARE OF INDIVIDUALS OF ALL AGES, FAMILIES, GROUPS,
10 AND COMMUNITIES, WHETHER SICK OR WELL, IN ALL SETTINGS. The
11 functions include the initiation and performance of nursing care through
12 health promotion, supportive or restorative care, disease prevention,
13 diagnosis and treatment of human disease, ailment, pain, injury,
14 deformity, and physical or mental condition using specialized knowledge,
15 judgment, and skill involving the application of biological, physical,
16 social, and behavioral science principles required for licensure as a
17 professional nurse pursuant to section 12-255-110.
18 (b) The "practice of professional nursing" shall include INCLUDES
19 the performance of such services as:
20 (IV) Executing delegated medical functions AND DELEGATED
21 PATIENT CARE FUNCTIONS;
22 (12) "Treating" means the selection, recommendation, execution,
23 and monitoring of those nursing measures essential to the effective
24 determination and management of actual or potential human health
25 problems and to the execution of the delegated medical functions AND
26 DELEGATED PATIENT CARE FUNCTIONS. The delegated medical functions
27 AND DELEGATED PATIENT CARE FUNCTIONS shall be performed under the
28 responsible direction and supervision of a person licensed under the laws
29 of this state to practice medicine, podiatry, or dentistry, OR NURSING.
30 "Treatment" has a corresponding meaning.".
31
32 Page 11, line 3, strike "(2), (3)(c)(I)," and substitute "(1), (2), (3)(b),
33 (3)(c),".
34
35 Page 11, strike line 6 and substitute "registry - rules. (1) The general
36 assembly hereby recognizes that some individuals REGISTERED
37 PROFESSIONAL NURSES practicing pursuant to this article 255 have
38 acquired additional preparation for advanced NURSING practice and
39 hereby determines that it is appropriate for the state to maintain a registry
40 of those individuals. The registry shall be known as the "advanced
41 practice registry".
42 (2) The board shall establish the advanced practice".
43
44 Page 11, line 7, before "nurse" insert "REGISTERED PROFESSIONAL" and
45 after "registration" insert "ON THE ADVANCED PRACTICE REGISTRY".
46
47 Page 11, line 10, before "nurse" insert "REGISTERED PROFESSIONAL".
48
49 Page 11, strike line 19 and substitute:
50
51 "(3) (b) On and after July 1, 2010, in addition to the requirements
52 of subsection (3)(a) of this section, a REGISTERED professional nurse shall
53 obtain national certification from a nationally recognized accrediting
54 agency, as defined by the board by rule, in the appropriate role and
55 population focus in order to be included in the advanced practice registry;
1 except that REGISTERED professional nurses who are included in the
2 registry as of June 30, 2010, but have not obtained the national
3 certification, may thereafter continue to be included in the registry and to
4 use the appropriate title and abbreviation.
5 (c) A REGISTERED professional nurse may be included in the
6 advanced".
7
8 Page 11, line 20, before "professional" insert "REGISTERED".
9
10 Page 11, line 22, before "professional" insert "REGISTERED".
11
12 Page 11, after line 26 insert:
13
14 "(II) The REGISTERED professional nurse holds national
15 certification as provided in subsection (3)(b) of this section and possesses
16 an appropriate graduate degree as determined by the board.".
17
18 Page 12, line 21, strike "(4)(b)(II) introductory portion,".
19
20 Page 12, line 22, strike "(4)(e),".
21
22 Page 12, line 23, after "(12);" insert "repeal (4)(b)(II) and (4)(e);".
23
24 Page 14, line 6, strike "one thousand" and substitute "one thousand SEVEN
25 HUNDRED FIFTY".
26
27 Page 15, strike lines 6 through 27.
28
29 Page 16, strike lines 1 through 3 and substitute:
30
31 "(II) The advanced practice nurse with provisional prescriptive
32 authority shall develop an articulated plan for safe prescribing that
33 documents how the advanced practice nurse intends to maintain ongoing
34 collaboration with physicians and other health care professionals in
35 connection with the advanced practice nurse's practice of prescribing
36 medication within his or her role and population focus. The articulated
37 plan shall guide the advanced practice nurse's prescriptive practice. The
38 physician or advanced practice nurse that serves as a mentor as described
39 in subsection (4)(b)(I) of this section shall provide his or her signature
40 and attestation on the articulated plan to verify that the advanced practice
41 nurse has developed an articulated plan. The advanced practice nurse
42 shall retain the articulated plan on file, shall review the plan annually, and
43 shall update the plan as necessary. The articulated plan is subject to
44 review by the board, and the advanced practice nurse shall provide the
45 plan to the board upon request. If an advanced practice nurse with
46 provisional prescriptive authority fails to develop the required articulated
47 plan within three years or otherwise fails to demonstrate competence as
48 determined by the board, the advanced practice nurse's provisional
49 prescriptive authority expires for failure to comply with the statutory
50 requirements. An articulated plan developed pursuant to this subsection
51 (4)(b)(II) must include at least the following:
52 (A) A mechanism for consultation and referral for issues
53 regarding prescriptive authority;
54 (B) A quality assurance plan;
55 (C) Decision support tools; and
1 (D) Documentation of ongoing continuing education in
2 pharmacology and safe prescribing.".
3
4 Page 16, strike lines 12 through 20 and substitute:
5
6 "(I) The advanced practice nurse shall develop an articulated plan
7 as specified in subsection (4)(b)(II) of this section; except that to verify
8 development of an articulated plan, the advanced practice nurse shall
9 obtain the signature of either a physician or an advanced practice nurse
10 who has prescriptive authority and experience in prescribing medications,
11 is practicing in Colorado, and has education, training, experience, and
12 active practice that corresponds with the role and population focus of the
13 advanced practice nurse developing the plan.".
14
15 Page 17, strike lines 11 through 13 and substitute:
16
17 "(e) The board shall conduct random audits of articulated plans to
18 ensure that the plans satisfy the requirements of this subsection (4) and
19 rules adopted by the board.".
20
21 Page 26, strike lines 10 through 17 and insert:
22
23 "SECTION 26. In Colorado Revised Statutes, 12-255-131,
24 amend (1) as follows:
25 12-255-131. Delegation of nursing tasks - rules. (1) Any
26 LICENSED PRACTICAL NURSE, registered nurse, OR ADVANCED PRACTICE
27 REGISTERED NURSE may delegate any task included in the practice of
28 professional nursing NURSE'S LICENSED SCOPE OF PRACTICE, subject to the
29 requirements of this section. A LICENSED PRACTICAL NURSE, REGISTERED
30 NURSE, OR ADVANCED PRACTICE REGISTERED NURSE MAY DELEGATE
31 NURSING TASKS TO LICENSED, CERTIFIED, REGISTERED, OR UNLICENSED OR
32 UNREGULATED ASSISTIVE PERSONNEL. In no event may a registered nurse
33 delegate to another person the authority to select medications if the person
34 is not, independent of the delegation, authorized by law to select
35 medications.
36 SECTION 27. In Colorado Revised Statutes, 12-30-105, amend
37 (1)(d); and repeal (5)(a) and (5)(b) as follows:
38 12-30-105. Nurse-physician advisory task force for Colorado
39 health care - creation - duties - definition - repeal. (1) There is hereby
40 created, within the division, the nurse-physician advisory task force for
41 Colorado health care, referred to in this section as "NPATCH". The
42 purpose of the NPATCH is to promote public safety and improve health
43 care in Colorado by supporting collaboration and communication between
44 the practices of nursing and medicine. The NPATCH shall:
45 (d) Make consensus recommendations to policy-making and
46 rule-making entities, including RECOMMENDATIONS TO THE EXECUTIVE
47 DIRECTOR.
48 (I) Recommendations to the state board of nursing created in
49 section 12-255-105 and the Colorado medical board created in section
50 12-240-105 regarding the transition to the articulated plan model and
51 harmonizing language for articulated plans; and
52 (II) Recommendations to the executive director.
53 (5) The NPATCH shall prioritize consideration of and make
54 recommendations on the following topics:
55 (a) Facilitating a smooth transition to the articulated plan model,
1 as described in sections 12-240-108 and 12-255-112 (4);
2 (b) The framework for articulated plans, including creation of
3 sample plans;
4 SECTION 28. In Colorado Revised Statutes, 12-240-108, repeal
5 (2) and (3) as follows:
6 12-240-108. Collaboration with advanced practice nurses with
7 prescriptive authority - mentorships. (2) While serving as a mentor
8 pursuant to section 12-255-112 (4)(b)(I), a physician shall assist the
9 advanced practice nurse in developing an articulated plan for safe
10 prescribing, as described in section 12-255-112 (4)(b)(II), and shall verify
11 through his or her signature that the advanced practice nurse has
12 developed an articulated plan in compliance with that section.
13 (3) For purposes of an advanced practice nurse who obtained
14 prescriptive authority prior to July 1, 2010, as described in section
15 12-255-112 (4)(c), or who has prescriptive authority from another state
16 and obtains prescriptive authority in this state, as described in section
17 12-255-112 (4)(d), physicians may, and are encouraged to, assist those
18 advanced practice nurses in developing the articulated plans required by
19 those sections and verifying, through the physician's signature, the
20 development of the required plans. The physician verifying an advanced
21 practice nurse's articulated plan shall be practicing in Colorado and have
22 education, training, experience, and active practice that corresponds with
23 the role and population focus of the advanced practice nurse.
24 SECTION 29. In Colorado Revised Statutes, 12-240-121, repeal
25 (1)(cc) as follows:
26 12-240-121. Unprofessional conduct - definitions.
27 (1) "Unprofessional conduct" as used in this article 240 means:
28 (cc) Verifying by signature the articulated plan developed by an
112 29 advanced practice nurse pursuant to sections 12-240-108 and 12-255-
30 (4) if the articulated plan fails to comply with the requirements of section
31 12-255-112 (4)(b)(II);
32 SECTION 30. In Colorado Revised Statutes, 12-280-103, amend
33 (39)(c)(II)(C) as follows:
34 12-280-103. Definitions - rules. As used in this article 280, unless
35 the context otherwise requires or the term is otherwise defined in another
36 part of this article 280:
37 (39) "Practice of pharmacy" means:
38 (c) The provision of a therapeutic interchange selection or a
39 therapeutically equivalent selection to a patient if, during the patient's stay
40 at a nursing care facility or a long-term acute care hospital licensed under
41 part 1 of article 3 of title 25, the selection has been approved for the
42 patient:
43 (II) By one of the following health care providers:
44 (C) An advanced practice nurse prescriber licensed as a
45 professional nurse under section 12-255-110, registered as an advanced
46 practice nurse under section 12-255-111, and authorized to prescribe
47 controlled substances or prescription drugs pursuant to section
48 12-255-112; if the advanced practice nurse prescriber has developed an
49 articulated plan to maintain ongoing collaboration with physicians and
50 other health care professionals; and
51 SECTION 31. In Colorado Revised Statutes, 12-280-502, amend
52 (1)(b)(III) as follows:
53 12-280-502. Therapeutic interchange and therapeutically
54 equivalent selections for nursing care facility or long-term acute care
55 hospital patients - rules. (1) A pharmacy used by a nursing care facility
1 or a long-term acute care hospital licensed under part 1 of article 3 of title
2 25 may make a therapeutic interchange or a therapeutically equivalent
3 selection for a patient if, during the patient's stay at the facility, the
4 selection has been approved for the patient:
5 (b) By one of the following health care providers:
6 (III) An advanced practice nurse prescriber licensed as a
7 professional nurse under section 12-255-110, registered as an advanced
8 practice nurse under section 12-255-111, and authorized to prescribe
9 controlled substances or prescription drugs pursuant to section
10 12-255-112. if the advanced practice nurse prescriber has developed an
11 articulated plan to maintain ongoing collaboration with physicians and
12 other health care professionals.".
13
14 Renumber succeeding sections accordingly.
15
16

House Journal, March 10
19 Amendment No. 1, Health & Insurance Report, dated February 11, 2020,
20 and placed in member's bill file; Report also printed in House Journal,
21 February 12, 2020.
22
23 Amendment No. 2, by Representative Mullica.
24
25 Amend the Health and Insurance Committee Report, dated February 11,
26 2020, page 2, line 1, strike "(4),".
27
28 Page 2, lines 10 and 11, strike "COOPERATIVELY, SHARING
29 R E SP O N S IB ILIT Y A N D A C C O U N T A B ILIT Y " and substi tute
30 "COLLABORATIVELY".
31
32 Page 2, line 12, strike "PRACTICE," and substitute "PRACTICE".
33
34 Page 2, strike lines 14 through 27.
35
36 Page 2, strike lines 35 and 36 and substitute "HEALTH CARE PROVIDER
37 WITHIN THE SCOPE".
38
39 Page 2, line 37, strike "OR NURSE'S".
40
41 Page 2, lines 37 and 38, strike "OR NURSE'S".
42
43 Page 4, lines 15 and 16, strike "performance of" and substitute
44 "performance of".
45
46 Page 4, line 17, strike "AUTONOMOUS" and substitute "DELIVERY OF
47 INDEPENDENT".
48
49 Page 4, line 18, after "COLLABORATIVE" insert "NURSING", and strike the
50 first "OF" and substitute "TO".
51
52 Page 4, strike lines 37 and 38 and substitute "responsible direction and
53 supervision of a person licensed under the laws of this state to practice
54 medicine, podiatry, or dentistry LICENSED HEALTH CARE PROVIDER.".
55
1 As amended, ordered engrossed and placed on the Calendar for Third
2 Reading and Final Passage.
3

House Journal, March 11
22 Amend engrossed bill, page 10, line 8, strike "COLLABORATIVELY" and
23 substitute "COOPERATIVELY".
24
25 The amendment was declared passed by the following roll call vote:
26
27 YES 57 NO 3 EXCUSED 5 ABSENT
28 Arndt Y Exum Y Larson Y Singer Y
29 Baisley Y Froelich Y Liston Y Sirota Y
30 Benavidez Y Garnett Y Lontine Y Snyder Y
31 Bird Y Geitner E McCluskie Y Soper E
32 Bockenfeld Y Gonzales-Gutierrez Y McKean Y Sullivan Y
33 Buck Y Gray Y McLachlan Y Tipper Y
34 Buckner Y Herod Y Melton Y Titone Y
35 Buentello Y Holtorf Y Michaelson Jenet E Valdez A. Y
36 Caraveo Y Hooton Y Mullica Y Valdez D. Y
37 Carver Y Humphrey N Neville Y Van Winkle Y
38 Catlin Y Jackson E Pelton Y Weissman Y
39 Champion Y Jaquez Lewis Y Ransom Y Will Y
40 Coleman Y Kennedy Y Rich Y Williams D. Y
41 Cutter Y Kipp Y Roberts Y Wilson Y
42 Duran Y Kraft-Tharp Y Saine N Woodrow Y
43 Esgar E Landgraf Y Sandridge N Young Y
44 Speaker Y
45
46 The question being, "Shall the bill, as amended, pass?".
47 A roll call vote was taken. As shown by the following recorded vote, a
48 majority of those elected to the House voted in the affirmative, and the
49 bill, as amended, was declared passed.
50
51 YES 51 NO 9 EXCUSED 5 ABSENT
52 Arndt Y Exum Y Larson N Singer Y
53 Baisley Y Froelich Y Liston Y Sirota Y
54 Benavidez Y Garnett Y Lontine Y Snyder Y
55 Bird Y Geitner E McCluskie Y Soper E
1 Bockenfeld Y Gonzales-Gutierrez Y McKean Y Sullivan Y
2 Buck N Gray Y McLachlan Y Tipper Y
3 Buckner Y Herod Y Melton Y Titone Y
4 Buentello Y Holtorf Y Michaelson Jenet E Valdez A. Y
5 Caraveo Y Hooton Y Mullica Y Valdez D. Y
6 Carver N Humphrey N Neville N Van Winkle Y
7 Catlin Y Jackson E Pelton Y Weissman Y
8 Champion Y Jaquez Lewis Y Ransom N Will Y
9 Coleman Y Kennedy Y Rich Y Williams D. N
10 Cutter Y Kipp Y Roberts Y Wilson Y
11 Duran Y Kraft-Tharp Y Saine N Woodrow Y
12 Esgar E Landgraf Y Sandridge N Young Y
13 Speaker Y
14 Co-sponsor(s) added: Representative(s) Bird, Exum, Herod, Hooton, Melton,
15 Valdez A., Young
16