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Minutes for SB174 - Committee on Public Health and Welfare
Short Title
Updating scope of practice requirements for advanced practice registered nurses without a supervising physician, imposing requirements therefor and updating certain licensure requirements.
Minutes Content for Thu, Feb 18, 2021
Chairman Hilderbrand opened the hearing on SB174.
Jenna Moyer, Staff Revisor gave an overview of the bill.
Amy Siple stated in her proponent testimony that SB174 removes the requirement for a collaborative practice agreement (CPA) with a physician. The bill does not eliminate collaboration, just the written agreement requirement. SB174 requires a transition to practice for new APRN graduate of 4,000 hours during which a collaborative practice agreement with a physician or a full practice authority APRN is required. It also requires APRNS to be nationally certified, to carry malpractice insurance coverage and keeps APRNS under the Board of Nursing. (Attachment 1)
Sonia Slaba testified as a proponent, stating that this is the time to increase access to healthcare and to remove the restrictive barrier of a written collaborative practice agreement. The law needs to be updated to meet the evolving real-world healthcare. (Attachment 2)
Michelle Knowles gave her proponent testimony and stated that hundreds of studies confirm there are equal or better patient outcomes when the collaborative practice agreement requirement is removed. It is not a new concept and is already working in Veterans Administration, Tribal and military clinics across Kansas. (Attachment 3)
Matthew Allen spoke in support of SB174 stating that he is in support of legislation to remove policy barriers which restrict the ability of Nurse Practitioners to practice within the full range of their credentials. He offered a case study to provide evidence of the transformative impact from unshackling Nurse Practitioners to do what they are trained and capable of doing. (Attachment 4)
Cathy Gordon presented her proponent testimony and stated that access to healthcare is a growing problem, in Kansas. SB174 will allow for more health care providers in Kansas to actually provide healthcare in many counties currently lacking adequate providers. Removing the restriction in this bill, would open the nurse practitioners to serve in the many counties of Kansas where there is no provider able to serve currently. (Attachment 5)
Nicole Livanos testified in support of SB174. In states that have enacted policies as in SB174 have improved access to health care by removing burdensome barriers to APRN care. During the COVID-19 pandemic, twelve states that restrict APRNs like Kansas with collaborative practice agreements, took emergency action to remove the need for APRNs to enter into costly collaborative agreements in order to provide safe and quality care. Now these states are continuing to push for permanently removing barriers - recognizing acutely how those policies limit the ability for facilities to recruit practitioners. (Attachment 6)
Dr. Jamie Harrington spoke as a proponent of SB174 saying that SB174 eliminates collaborative practice requirements for Certified Nurse-Midwives and its passage is an important stepping stone to improving maternal and neonatal outcomes, increasing access, and reducing costly and unnecessary regulations that are a barrier to care. (Attachment 7)
Judy Davis Cole gave proponent testimony stating that in passing SB174 it will remove barriers to APRNs that prevent full practice and will allow APRNs to function under their own professional regulatory board. (Attachment 8)
Jon Leuth speaking on behalf of Elizabeth Patton gave testimony in support of SB174. He stated that over the past several month, APRNs have played an important role helping hospitals and other facilities control the spread of COVID-19, largely thanks to emergency reforms implement by Kansas' Governor and state legislature.These temporary measured empowered APRNs to utilize the full extent of their education and training to deliver life-saving care to patients with COVID-19. This bill would permanently authorize APRNs to autonomously practice without working under a costly and burdensome supervisory agreement. (Attachment 9)
Questions were posed by committee members.
Written only proponent testimony was submitted by:
Eric Stafford, Vice President of Governmental Affairs, Kansas Chamber of Commerce (Attachment 10)
Dr. Ginger Breedlove, Founder & Principal Consultant, Grow Midwives LLC (Attachment 11)
Sharon Foster, CNM (Attachment 12)
Dr. Uyen Dinh, APRN (Attachment 13)
Dawna Huhman, APRN, FNCP, Advanced Mobile Healthcare & Community Clinic (Attachment 14)
Kristin Loyd, APRN, PhD, FNP, BC-ADM (Attachment 15)
Kyanna Kuntz, CNM, APRN (Attachment 16)
Rachel Cheek, CNM (Attachment 17)
Carmine Di Palo, Chrm & CEO, Revere Healthcare Solutions Inc. (Attachment 18)
Michael Moore, APRN, FNP-C, ENP-C, KS State Rep & Midwest Regional Dir AAENP (Attachment 19)
Merilyn Douglass, APRN (Attachment 20)
Dustin Baker, APRN (Attachment 21)
Tarena Sisk, APRN, Sunflower Birth & Family Wellness (Attachment 22)
Kesha Staley, APRN (Attachment 23)
Stacy Geil, APRN, Sunshine’s Nursing Horizons Inc (Attachment 24)
Abigail Koch, BSN, RN (Attachment 25)
Sophia L. Thomas (Attachment 26)
Carol Moreland, Executive Administrator, Kansas State Board of Nursing (Attachment 27)
Leslie Mack, APRN, Salina Regional Endocrinology (Attachment 28)
Kelly Sommers, State Director, KSNA (Attachment 29)
Ronda Eagleson, APRN (Attachment 30)
Samuel G. MacRoberts, Kansas Justice Institute (Attachment 31)
Doug Smith gave verbal, neutral testimony on SB174 stating that the over 1,300 Physician Assistants (PAs) licensed in Kansas have concern regarding unintended consequences should SB174 become law. They believe there will be a loss of job opportunities for PAs and that there may be a lack of clarity in professional roles resulting from an expanded scope of practice for APRNs. (Attachment 32)
Written only neutral testimony was submitted by:
Tucker Poling, Executive Director, Kansas Board of Healing Arts. (Attachment 33)
Rachelle Colombo testified as an opponent stating by removing the requirement for physician supervision/collaboration and expanding their scope of practice, SB174 grants nurses a scope of practice which is without any statutory limitations and equivalent to that of a physician, despite the APRN not having medical education and training. Also, under SB174, APRNs would be licensed and regulated by the board of nursing, despite the clear overlap into the practice of medicine and surgery. SB174 creates two different standards for the practice of medicine and patient care - one for physicians, and another for APRNs, though the law would allow them to practice interchangeably. (Attachment 34)
Dr. Jennifer Bucani-McKinney spoke as an opponent to SB174. The Kansas Academy of Family Physicians believes, and Kansas law reflects, that patients are best served by a team approach. They do not oppose nurses practicing to the highest level of their professional training, in nursing; however, that training is not equal to that of physicians. There is a distinct difference between the practice of medicine and the practice of nursing. (Attachment 35)
Dr. Kristie Clark stated in her opponent testimony that the amount of preparation between a primary care physician and an APRN, to treat patients is not comparable. APRNs came into existence as mid-level practitioners -- not to replace treatment by a physician but to enable a physician to care for more patients. Their roles are defined by their collaborative practice agreements with physicians. (Attachment 36)
Dr. Christine White, in her opponent testimony, stated that they believe optimal healthcare includes a team approach supervised by a physician leader. Non-physician clinicians, including nurse practitioners, provide valuable contributions in delivering optimal healthcare, but the independent practice of non-physician clinicians raises critical concerns. (Attachment 37)
Questions were asked by committee members.
Written only, opponent testimony was submitted by:
Vicki Whitaker, Executive Director, Kansas Association of Osteopathic Medicine (Attachment 38)
Dr. James Madara, CEO and Executive Vice President, American Medical Association (Attachment 39)
Dr. James W. Owen, Kansas Radiological Society (Attachment 40)
Chairman Hilderbrand closed the hearing on SB174 and adjourned the meeting at 9:25 a.m. The next scheduled meeting is February 19, 2021.
