Last Thursday, May 17, the Committee of the Joint Boards of Nursing and Medicine convened to discuss draft regulations for HB 793. At the beginning of the meeting, representatives from VCNP and organized medicine testified, with each side given just fifteen minutes to make its case. VCNP’s strong presence included attendance and testimonies from VCNP leadership and members, as well as esteemed guests from schools of nursing throughout Virginia. Thank you to everyone who took the time out of their busy schedule to participate! You may view the draft of the official minutes for the meeting by clicking here.
 
The committee reviewed the draft regulations and each of the proposed updates to the Virginia Administrative Code, discussing and voting upon each revision. Important highlights of the draft regulations include:

• 18VAC90-30-20: Fees – An autonomous practice attestation application will be a one-time cost of $100. Please keep in mind that the prescriptive authority fee of $75 and $35 for renewal will soon be eliminated.

 

• 18VAC90-30-86-A-1: Autonomous practice (for nurse practitioners other than certified nurse midwives or certified registered nurse anesthetists) – The Transition to Practice period must include the “completion of the equivalent of five years of full-time clinical experience as a nurse practitioner”. Five years of full-time experience will be defined as a minimum of 1,600 hours/year, for a total of 8,000 hours. This is an average of 32 hours/week, minimum.

 

• 18VAC90-30-86-C: “The nurse practitioner may submit attestations for more than one patient care team physician with whom he practiced during the equivalent of five years of practice, but all attestations shall be submitted to the boards at the same time.”

 

• 18VAC90-30-86-D: “If a nurse practitioner is licensed and certified in more than one category, as specified in 18VAC-90-30-70, a separate fee and attestation that meets the requirements of subsection B shall be submitted for each category. If the hours of practice are applicable to the patient population and in practice areas included within each of the categories of licensure and certification, those hours may be counted towards a second attestation.”

 

• 18VAC90-30-86-E: If an NP’s physician is unwilling to sign the attestation, “The burden shall be on the nurse practitioner to provide sufficient evidence to support the NP’s inability to attain an attestation”. The NP may then provide other evidence that shows they have met the qualifications for attestation.

 

• Much to the benefit of NPs, the draft regulations did NOT include any mention of establishing “core competencies,” as proposed by organized medicine’s original commentary. As we know, NP education and licensing already establishes competency and maintains strong, nationally-recognized standards. Further, the draft regulations ensure that the attestation will be an attestation of TIME, not “quality”.

 
The draft regulations are also posted on the Virginia Regulatory Town Hall site. The regulations for HB 793 are considered “emergency regulations,” which ensures that they must be finalized by the end of the year at the very latest. The regulations will become effective the day they are published.
 
Board of Nursing Executive Director Jay Douglas has assured us that she and her team will develop a “robust communication plan” to ensure that all NP licensees receive notice of the regulations’ progress; and we will continue to keep all VCNP members apprised of the latest developments.

WHAT’S NEXT?

 
Given that the Committee of the Joint Boards was able to effectively work through the draft regulations on Thursday, another Committee meeting is not required. However, the regulations still must pass the Board of Nursing, as well as the Board of Medicine. Should they pass both Boards, they will move on to the Attorney General and Governor for final review. Jay Douglas and her team will handle the implementation phase, which will include developing online resources, crafting the attestation form, and creating a special license format that will distinguish NPs who have attained autonomous practice.
 
A second 30-day Town Hall Forum comment period is scheduled to soon begin. Our goal is now to ensure that the Board of Nursing passes the regulations as they stand. We will send an email with more details about the comment period as soon as the forum is made available.
 
Timeline

• 7/17/18 – Board of Nursing meeting to adopt the emergency regulations
• 8/3/18 – Board of Medicine meeting to adopt the emergency regulations
• Regulations will undergo review by the Attorney General and Governor.
• End of December – Regulations must be complete.

The regulations will become effective the day they are published.
 
HB 793 is ultimately not about an independent practice model – it’s about a NP’s ability to utilize their knowledge, skills, and judgment to provide care without mandated supervision or collaboration from a physician. This will lower barriers to practice, expand access to care. We are excited to continue to work on behalf of NPs throughout the Commonwealth and are thrilled to see the legislation come to fruition!