The Confidence of Trusted Counsel 2009 and 2010 Legislative Changes to the MPA and NPA

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1 The Confidence of Trusted Counsel 2009 and 2010 Legislative Changes to the MPA and NPA By: Linda Siderius, BSN, JD Ranmali Bopitiya, JD, MPH March 16, 2011

2 Times They Are a Changin The legislature in 2009 and 2010 revised both: The Medical Practice Act and The Nurse Practice Act Today we will review the highlights g of the recent changes

3 What to Expect Today? Review new grounds for discipline with both agencies Review amended or new provisions in each act limited to substantive changes Skolnik 2.0 APN Prescriptive Authority 2010 Rules and Regulations from both Boards

4 A Rose By Any Other Name The New Medical Practice Act became effective July 10, 2010 It impacts both MDs and PAs It renamed the BME to the CMB! The Colorado Medical Board

5 New: Pro Bono License To get it you must: Hold active unrestricted license (or inactive for not more than 2 years) Never have been revoked or suspended Not practice more than 60 days per year Not charge for your services Maintain professional liability insurance Perks? Half the fee.

6 New: The Re-Entry License It is available for MDs and PAs Can be issued for up to 3 years For people who have not been in active practice or maintained CMEs for 2 years prior to application You must agree to evaluations and education Full licensure can be applied for after completion of supervision or education

7 New: The 2 Year Wait If MD s license revoked in another state OR MD surrenders license to avoid discipline Must wait 2 years before MD can apply for a license in Colorado

8 New: Confidential Agreements If MD has a mental illness or other condition that affects his/her skill or the safety of care, then MD must notify the Board CMB may decide that MD can continue to provide limited services Applies also to PAs

9 Confidential Agreements (2) Limit scope of practice Are not considered discipline Requires evaluations and monitoring May be dissolved when the condition changes Must notify Board within 30 days of diagnosis (Rule 295) Rule 295 outlines the information that must be reported

10 Isn t HIPAA Enough? New Medical Records Protection Requirements Must develop a plan for: Proper storage and disposal of patient records Disposition of charts at the end of your practice Method for patients to promptly get charts Patients must be informed of these methods Must certify compliance at every license renewal

11 New But Not Really: Professional Liability Insurance CMB has caught up with industry standards: Now MDs need 1M per claim, 3M annual Up from 500K per incident and 1.5M annual

12 New: Grounds for Discipline Must report adverse actions within 30 days by the following: Another licensing agency Peer review Body Healthcare facility Professional association Governmental agency Law enforcement agency Court

13 New: Grounds for Discipline Must report a surrender while under investigation within 30 days: License Medical staff membership Association membership

14 New: Levels of Discipline Bad News: CMB can now impose fines in addition to other discipline Good News: $5000 per violation (down from $10K)

15 New: Confidentiality in Discipline CMB records related to complaints are protected from discovery specific response to the DeSantis case

16 New: For PA s One MD may be the primary supervisor for up to 4 PAs (used to be only 2) Laws prohibiting the practice of medicine without a license were expanded to apply to persons acting as PAs without a license

17 New: PA Ownership PAs may now be shareholders in professional corporations providing medical services The majority of shareholders must still be physicians

18 Changes to Skolnik Act Skolnik Act of 2010 Online profiles for the following providers required as of July 1, 2011: Acupuncture Podiatry Chiropractic Dentistry PAs Nurses Optometry PTs Social Work Counseling Dental Hygiene Hearing Aid Providers Audiology Psychology And More

19 Skolnik 2.0 Must report: Stipulations with the relevant Board Disciplinary action after Sept. 1, 1990 Final judgments, settlements or arbitration awards for malpractice after Sept. 1, 1990 Termination by employer where grounds constitute a violation of the relevant practice act Criminal convictions after licensure for crimes of moral turpitude

20 New Skolnik Regs and Policies DORA promulgated new rules and policies See the Healthcare Professions Profiling Program website CMB has repealed their rules and policies

21 DORA Regulations General Timelines for Reporting: Employment, healthcare-related business ownership and healthcare-related contracts must be updated within 1 year of change Other incidents must be reported within 30 days; includes interim i agreements not to practice even though not disciplinary DORA is sending out letters! Fines of up to 5K possible in addition to disciplinary action

22 Halftime!

23 The New Nurse Practice Act Effective July 1, 2009 Major changes for APNs!

24 Working Together Nurses can now perform medical functions delegated by PAs

25 New: Types of Discipline Board can now impose fines on nurses who violate the NPA From $250-$1000 per violation

26 New: Grounds for Discipline Board cracking down on Alcohol and Controlled substances Before addiction and dependency was the standard Now it is excessive use and abuse Before was habitual use of controlled substance Now simply use

27 New: Grounds for Discipline Failure to maintain professional liability insurance (if independent practice) Failure to submit completed questionnaire at time of licensure renewal Used to be only if negligent or willful Failure to report conviction of a crime within 45 days after final conviction

28 New: On Imposing Discipline Good News: If formal charges are filed with the BON, they are no longer subject to the open records act Bad News: BON can conduct a criminal history check of any licensee at any time

29 What Happens In Vegas Does not stay in Vegas Applications may be denied if you had a license revoked by another state If so, you must wait 2 years from the date of revocation before you apply in Colorado Then you may be required to take a written exam before you can apply ppy Board may refuse to issue a license if license is suspended in another state

30 The 2 Year Wait (Nurses Too!) You must wait 2 years to apply for a license if: Your license is revoked OR You voluntarily surrender your license to avoid discipline

31 New Lingo: Continued Competence Board can refuse to issue license or impose probation on applicant if: Notinactivepracticeforthe2yearspriorto the prior to the application Board determines that you have not maintained continued competence

32 New Lingo: Population Focus New requirement for APNs Board must approve a population focus Specialties like: Maternal and Child Health Psych Family Medicine

33 New: APN Certification As of July 2010, APN s must get national certification in their specialty How to avoid certification? Too late! Nurses had to be in the registry before June 30, 2010

34 New: Requirements for Rx Authority As of July 2010, nurses need to first obtain Provisional Prescriptive Authority How? Graduate Degree in Nursing Specialty Education in Controlled Substances National Certification Professional Liability Insurance (500K/1.5M) 1800 Hours of Post-Grad Proctoring

35 New: Post-Graduate Preceptorship At least 1800 hours Completed within 5 years of application Mentors can be either: MD, or MD plus APN Mentors must share your population focus

36 Wake Up, Docs! To be a preceptor MDs must: Practice in Colorado Share the APN s population focus Have no disciplinary action against you by the BME Have unrestricted DEA license Not require payment or employment of the APN But may request reimbursement for expenses, including time spent

37 Doctors Beware! It is considered unprofessional conduct to sign an articulated plan if it fails to comply with the requirements set out in the law So- MDs must actually read the plan!

38 New: Path to Full Rx Authority Nurses must also do a mentorship Additional 1800 hours (that s 3600 total!) Completed within 5 years of obtaining provisional status Mentors need not be the same as first round Failure to do so will result in the expiration of your provisional authority And

39 Goodbye Collaborative Agreement, Hello Articulated Plan Last but not least, before getting Full Rx Authority, nurses must develop an articulated plan Document plan for safe prescribing in your population focus Mentor must sign it Must retain it on file Review it annually Revise it as necessary Be prepared for random audits by the Board

40 Articulated Plans Articulated Plans must include: Mechanism for consultation and referral for issues regarding g prescriptive p authority Quality assurance plan Decision support tools Documentation of continuing education in pharmacology

41 Grandmothering What if you already have Rx Authority? Must still develop an articulate plan by July 2011 Must get certified, UNLESS: On the APN registry before July 2010 On the APN registry before July 2008 AND have not completed a graduate degree The Board grants an exception

42 Grandmothering Discussions with Board about the intent of the statute Possible guidance forthcoming?

43 The Confidence of Trusted Counsel Questions? Linda: Ranmali:

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