RX AUTHORITY HAS BEEN PASSED!

On July 20, 2007 Governor Rendell signed the nurse-midwives prescriptive authority bill (HB 1255) at the University Of Pennsylvania School Of Nursing. The governor signed all of the Scope of Practice Bills and the Infection Control Act and spoke about his plans to pass legislation to so that all Pennsylvanians are covered with health insurance.

The prescriptive authority bill was introduced in May by Representative Ron Waters from West Philadelphia. The process of moving the bill was very fast but took lots of negotiations and compromise. Many midwives, midwifery supporters and physicians gave their testimonies at a hearing on May 31,2007 (testimony). A group of midwives, Susan Stapleton, Sr. Teresita Hinnegan, Kate McHugh, Denise Roy and I, traveled to Harrisburg to meet with the PMS (PA Medical Society) to begin the process of changes that would be made to the original draft of HB1255. Rosemarie Greco, the director of the Office of Health Care Reform facilitated this and other meetings and was a great help for midwives, making sure that language was not restrictive.

Kate McHugh and I also met with Rep. Mike Sturla, legislative staffers and legal counsel and the PMS to complete the final compromises of the house bill. The PMS asked that a moratorium statement be agreed upon to say that nurse-midwives would agree not to change scope of practice language in the next 5 years and the PMS would not ask for physician ratios for the next 3 years.

The bill passed unanimously in the house and then went to the Senate. In the Senate, Senator Pat Vance asked that a Masters degree be required for nurse-midwives that prescribe. The wording on the legislation is “a Masters degree or its substantial equivalent”, which will recognize the DNS. With this new language the bill was passed in the senate unanimously.

The key points to HB 1255 are nurse-midwives who prescribe:
1) Must have a Masters degree or its substantial equivalent. CNM’s are not required to have a Master’s degree to practice.
2) Complete at least 45 hours of coursework specific to advanced pharmacology.
3) Of the 30 CEU’s required to renew the RN license every 2 years, at least 16 hours in pharmacology are needed to continue to prescribe.
4) The collaborative agreement with a physician “shall at a minimum identify the categories of drugs the CNM may prescribe or dispense and the drugs which require referral, consultation or co-management.
5) Schedule II drugs are limited to 72 hours and can be extended with the approval of the collaborating physician.
6) Schedule III-IV can be prescribed for 30 days and refilled with the approval of the collaborating physician.
7) Psychotropic drugs can only be prescribed after consulting with the collaborating physician.
8) The physician with whom the CNM has a collaborative agreement “shall have hospital clinical privileges in the specialty area of the care which the physician is providing collaborative services.”
9) The Board of Medicine has 12 months to write the regulations to implement this legislation.

What’s next?
Now we will work with the Board of Medicine to update our regulations so that they include prescriptive authority. The ideal would be that the legislative language from HB 1255 is used to update our regulations. We will work to make sure that none of our current regulations are changed, there is no language added on physician oversight, direction or supervision and no further restrictions are placed on our ability to practice affecting access to care. The regulations were drafted by the Board of Medicine with limited input from the nurse-midwives. The proposed regulations were then published in PA bulletin on Dec. 14, 2007, for public comment.

To see the changes click on PA Bulletin. PALM wrote a response to the proposed regulations identifying the areas that were not the intent of the Rx authority legislation and also areas that were confusing. To see the PALM response click on PA Bulletin response and grid. The Independent Regulatory Review Commission will be reviewing all of the public comments and offering their comments. The Board of Medicine has scheduled a committee meeting on February 25, 2007 to review the public comments and the IRRC review. Our goal is to get the regulations back in line with the legislation passed in July 2007 and completed by July 2008!

Our lobbyist, Peg Moyer represents all midwives in the state. PALM is now paying the lobbyist’s salary. Peg and Mark Singel of the Winter Group are enthusiastic, worked SO hard in the past 6 weeks to see our bill through and are great to work with. If you have a question or concern for Peg, please call or e-mail me. She is able to speak with PALM members but would rather have communication coordinated through one person.

PALM is moving forward to make prescriptive authority a reality, to begin to tackle the legislative issues that midwives feel are most important and to represent all midwives in PA. Join PALM and be part of this positive movement –we need every midwife to be a part of our state organization!

Sincerely,
Vivian Lowenstein, CNM, MSN
President, Pennsylvania Association of Licensed Midwives (PALM)

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