HOUSE BILL REPORT

HB 1432

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by House Committee On:

Health Care & Wellness

Title: An act relating to hospital privileges for advanced registered nurse practitioners and physician assistants.

Brief Description: Concerning hospital privileges for advanced registered nurse practitioners and physician assistants.

Sponsors: Representatives Cody, DeBolt, Robinson, Harris, Macri, Slatter, Jinkins, Doglio, Tharinger and Ormsby.

Brief History:

Committee Activity:

Health Care & Wellness: 2/1/19 [DP].

Brief Summary of Bill

  • Requires hospitals to request certain information from any advanced registered nurse practitioner or physician assistant prior to granting or renewing clinical privileges or association with the hospital, and advanced registered practice nurses or physician assistants to provide that information.

  • Requires hospitals or facilities to notify the Nursing Care Quality Assurance Commission or Medical Quality Assurance Commission of any denied privileges.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: Do pass. Signed by 14 members: Representatives Cody, Chair; Macri, Vice Chair; Schmick, Ranking Minority Member; Caldier, Assistant Ranking Minority Member; Chambers, Davis, Harris, Jinkins, Maycumber, Riccelli, Robinson, Stonier, Thai and Tharinger.

Staff: Kim Weidenaar (786-7120).

Background:

Advanced Registered Nurse Practitioners.

Advanced registered nursing practice is defined as the performance of the acts of a registered nurse and the performance of an expanded role in providing health care services as recognized by the medical and nursing professions. Advanced registered nurse practitioners (ARNPs) are authorized to perform all activities that registered nurses perform, perform specialized and advanced levels of nursing, and prescribe legend drugs and certain controlled substances.

The Nursing Care Quality Assurance Commission (Nursing Commission) regulates the nursing profession in Washington and establishes, monitors, and enforces licensing, standards of practice, and discipline. There are currently no provisions in statute that require a hospital to request certain information from ARNPs, or for ARNPs to provide certain information to hospitals, before granting or renewing clinical privileges or association.

Physician Assistants.

A physician assistant (PA) is defined as a person who is licensed by the Medical Quality Assurance Commission (Medical Commission) or the Board of Osteopathic Medicine and Surgery (Osteopathic Board) to practice medicine to a limited extent only under the supervision and control of a physician and who is academically and clinically prepared to provide health care services and perform diagnostic, therapeutic, preventative, and health maintenance services. A PA may practice medicine only under a delegation agreement with a sponsoring physician and the delegation agreement must be approved by the Medical Commission or Osteopathic Board. There are currently no provisions in statute that require a hospital to request certain information from PAs, or for PAs to provide certain information to hospitals, before granting clinical privileges or association.

Physician Privileging.

Before granting or renewing clinical privileges or association of any physician or hiring a physician, a hospital or facility must request from the physician and the physician must provide the following information:

During this process, a hospital or facility must also request the following information from any hospital or facility at which the physician has or had privileges:

The Medical Commission or Osteopathic Board must be advised within 30 days of the name of any physician denied staff privileges, association, or employment on the basis of adverse findings. A hospital or facility that receives a request for information concerning a physician must provide the information to the extent the information is known to the hospital or facility, including the reasons for suspension, termination, or curtailment of employment or privileges. Hospitals must be granted access to information held by the Medical Commission or the Osteopathic Board pertinent to decisions of the hospital regarding credentialing and recredentialing of practitioners.

Telemedicine.

Telemedicine is the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. Telemedicine can also include store and forward technology, which is the use of asynchronous transmission of a patient's medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the patient. When granting or renewing privileges or association of any physician providing telemedicine services, an originating site hospital may rely on a distant site hospital's decision to grant or renew clinical privileges or association of the physician if the originating site hospital obtains reasonable assurances, through a written agreement with the distant site hospital, that:

The information must include all adverse events that result from the telemedicine services and all complaints the originating site hospital has received about the physician.

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Summary of Bill:

When granting or renewing privileges or association of any advanced registered nurse practitioner (ARNP) or physician assistant (PA) or hiring any ARNP or PA, the provisions that apply to physicians apply to ARNPs and PAs. Those provisions include:

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Appropriation: None.

Fiscal Note: Requested on January 28, 2019.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.

Staff Summary of Public Testimony:

(In support) This bill adds advanced registered nurse practitioners (ARNPs) and physicians assistants (PAs) to the state's privileging laws.  Currently, hospitals must perform background checks and scrutinize the past of a physician before granting privileges, but there are no such requirements for ARNPs and PAs. When the law was written ARNPs and PAs were not working in hospitals very often, but that is not the case today. Advanced registered nurse practitioners and PAs are an integral part of the health care team and provide a wide range of services.  While many hospitals do apply privileging requirements to ARNPs and PAs, this would be a technical fix to require that everyone comply.  This bill could also prevent any inconsistencies of application, such as a hospital thinking that ARNPs and PAs cannot be privileged because they are not included in the statute.  Last year this bill passed the House, but ran out of time in the Senate.

(Opposed) None.

Persons Testifying: Devon Connor-Green, ARNPs United of Washington; and Linda Dale, Washington Academy of Physician Assistants.

Persons Signed In To Testify But Not Testifying: None.