WSR 01-16-008

PERMANENT RULES

DEPARTMENT OF HEALTH


(Board of Osteopathic Medicine and Surgery)

[ Filed July 19, 2001, 3:36 p.m. ]

     Date of Adoption: June 23, 2001.

     Purpose: Adopt rules for completion of prescriptive authority for Schedule II-IV drugs for advanced registered nurse practitioners. Rules outline qualifications, criteria for joint practice agreements, termination of joint practice agreements, the limit on dispensing, education and jurisdiction of the board/commissions.

     Statutory Authority for Adoption: RCW 18.57.005 and 18.57.280.

      Adopted under notice filed as WSR 01-10-128 on May 2, 2001.

     Changes Other than Editing from Proposed to Adopted Version: Grammatical corrections made to WAC 246-853-222 Criteria for joint practice arrangement, subsections (1) and (2), to ensure they are correct sentences.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 7, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 7, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

July 3, 2001

Mark E. Hunt, D.O., Chair

Board of Osteopathic

Medicine and Surgery

OTS-4695.5


NEW SECTION
WAC 246-853-221   How do advanced registered nurse practitioners qualify for prescriptive authority for Schedule II - IV drugs?   Applicants must:

     (1) Hold a valid and unrestricted registered nurse license.

     (2) Hold or be eligible for an advanced registered nurse practitioner license with authority for legend drugs and Schedule V drugs. (See also WAC 246-840-410.) As noted in RCW 18.79.250, each advanced registered nurse practitioner prescribes within his or her scope of practice for a particular license specialty.

     (3) Have a joint practice arrangement that meets requirements of WAC 246-853-222 with a physician or physicians licensed under chapter 18.71 or 18.57 RCW who holds a license without restrictions related to prescribing scheduled drugs.

     (4) Submit a completed application form for Schedule II - IV endorsement on a form provided by the department of health, nursing care quality assurance commission accompanied by a fee as specified in WAC 246-840-990.

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NEW SECTION
WAC 246-853-222   Criteria for joint practice arrangement.   The joint practice arrangement shall include:

     (1) The names of both the licensed advanced registered nurse practitioner and the licensed physician, both license numbers and both practice addresses;

     (2) A written agreement that describes how collaboration will occur between the practitioners; and

     (3) The description of the collaboration will vary according to the relationship between the advanced registered nurse practitioner and physician, but must include a description of:

     (a) When the advanced registered nurse practitioner will consult with a physician;

     (b) How consultation will occur (e.g., face-to-face, phone, fax, e-mail, etc.);

     (c) How consultation will be documented.

     (4) Joint practice arrangements may be made with more than one physician.

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NEW SECTION
WAC 246-853-223   Endorsement of joint practice arrangements for ARNP licensure.   (1) The joint practice arrangement shall be submitted by the advanced registered nurse practitioner to the department of health, nursing care quality assurance commission at the time of initial licensure or endorsement and biennially with renewal.

     (2) A notice of the joint practice arrangement shall be forwarded by the nursing care quality assurance commission to either the medical quality assurance commission or to the board of osteopathic medicine and surgery for review to assure the physician's license is unrestricted. The medical quality assurance commission or the board of osteopathic medicine and surgery will notify the nursing care quality assurance commission in the event a physician who has signed a joint practice arrangement, has a license with restrictions related to prescribing scheduled drugs.

     (3) The advanced registered nurse practitioner can only begin prescribing Schedule II - IV drugs after his or her license endorsement has been issued and he or she has obtained the appropriate Drug Enforcement Administration registration.

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NEW SECTION
WAC 246-853-224   Process for joint practice arrangement termination.   (1) The joint practice arrangement between the advanced registered nurse practitioner and the physician shall provide for written notice of termination of the arrangement. The nursing care quality assurance commission shall be notified of the termination. Once the joint practice arrangement is terminated, the advanced registered nurse practitioner must submit a new joint practice arrangement before resuming prescribing Schedule II - IV drugs.

     (2) The nursing care quality assurance commission will notify either the medical quality assurance commission or the board of osteopathic medicine and surgery that the joint practice arrangement has been terminated.

     (3) A joint practice arrangement may be terminated as a result of disciplining action taken by a disciplining authority.

     (4) In the event either the advanced registered nurse practitioner or the physician is disciplined, the disciplining authority for the other party will be notified that the joint practice arrangement no longer exists due to disciplinary action.

     (5) If an advanced registered nurse practitioner has multiple approved joint practice arrangements and one is terminated, he or she may continue to prescribe Schedule II - IV drugs under the other joint practice arrangement(s).

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NEW SECTION
WAC 246-853-225   Seventy-two-hour limit.   (1) Advanced registered nurse practitioners can dispense up to a seventy-two-hour supply of Schedule II - IV drugs.

     (2) The seventy-two-hour limit on dispensing does not apply to prescribing Schedule II - IV drugs.

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NEW SECTION
WAC 246-853-226   Education for prescribing Schedule II - IV drugs.   Special education for advanced registered nurse practitioners is strongly recommended in the areas of pain management and drug seeking behaviors and/or addiction. Continuing education credit in these subjects may be applied to the biennial pharmacotherapeutics requirement found in WAC 246-840-450.

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NEW SECTION
WAC 246-853-227   Jurisdiction.   Nothing in WAC 246-853-221 through 246-853-226 shall be interpreted as giving a disciplining authority jurisdiction over a practitioner not licensed by that commission or board.

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