HB 1490 — An Act amending the act of May 22, 1951 (P.L.317, No.69), known as The Professional Nursing Law, providing for Certified Registered Nurse Practitioner Pilot Program.

PRINTER'S NO.   1744

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1490
                                                Session of
                                                  2025

     INTRODUCED BY VENKAT, KOSIEROWSKI, KUZMA, MULLINS, BOROWSKI,
        PROBST, GIRAL, HILL-EVANS, MADDEN, SANCHEZ, CERRATO, WAXMAN,
        DONAHUE, MALAGARI, HOWARD, JAMES, CIRESI AND WARREN,
        MAY 19, 2025

     REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, MAY 21, 2025


                                     AN ACT
 1   Amending the act of May 22, 1951 (P.L.317, No.69), entitled "An
 2      act relating to the practice of professional nursing;
 3      providing for the licensing of nurses and for the revocation
 4      and suspension of such licenses, subject to appeal, and for
 5      their reinstatement; providing for the renewal of such
 6      licenses; regulating nursing in general; prescribing
 7      penalties and repealing certain laws," providing for
 8      Certified Registered Nurse Practitioner Pilot Program.
 9      The General Assembly of the Commonwealth of Pennsylvania
10   hereby enacts as follows:
11      Section 1.     The act of May 22, 1951 (P.L.317, No.69), known
12   as The Professional Nursing Law, is amended by adding a section
13   to read:
14      Section 8.10.     Certified Registered Nurse Practitioner Pilot
15   Program.--(a)    The board shall establish the Certified
16   Registered Nurse Practitioner Pilot Program to allow an eligible
17   certified registered nurse practitioner to receive an additional
18   certification to practice as an independent practitioner in a
19   health professional shortage area.
20      (b)     A certified registered nurse practitioner shall be
 1   eligible to participate in the program if the certified
 2   registered nurse practitioner meets all of the following
 3   criteria:
 4      (1)   The certified registered nurse practitioner holds a
 5   current license to practice in this Commonwealth.
 6      (2)   The certified registered nurse practitioner received no
 7   disciplinary action or has no pending disciplinary action within
 8   the five (5) years immediately preceding the date of the
 9   certified registered nurse practitioner's application under
10   paragraph (4).
11      (3)   The certified registered nurse practitioner engaged in
12   the practice of professional nursing in collaboration with a
13   physician for a period of not less than three (3) years and not
14   less than three thousand six hundred (3,600) hours in accordance
15   with a collaborative or written agreement with a physician and
16   the practice occurred in a primary care setting within the five
17   (5) years immediately preceding the date of the certified
18   registered nurse practitioner's application under paragraph (4).
19      (4)   The certified registered nurse practitioner submits an
20   application with the board on a form prescribed by the board and
21   pays a fee established by the board. The application shall
22   attest that the certified registered nurse practitioner meets
23   the criteria to participate in the program under paragraph (3)
24   and shall be signed by a current or former collaborating
25   physician under paragraph (3). If the certified registered nurse
26   practitioner is unable to obtain the signature required under
27   this paragraph, the board may accept any other documentation
28   attesting that the certified registered nurse practitioner meets
29   the criteria to participate in the program under paragraph (3).
30      (c)   While practicing in a health professional shortage area

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 1   under the program, a certified registered nurse practitioner
 2   may:
 3      (1)   practice in accordance with section 8.2 without a
 4   collaborative agreement; and
 5      (2)   prescribe medical therapeutic or corrective measures in
 6   accordance with section 8.3 without a collaborative agreement.
 7      (d)   In order to continue to participate in the program, a
 8   certified registered nurse practitioner shall be subject to
 9   biennial renewal and shall submit a renewal application on a
10   form prescribed by the board, pay a fee established by the board
11   and complete ten (10) hours of continuing education approved by
12   the board in patient safety and risk management. The renewal
13   application under this subsection shall attest that the
14   certified registered nurse practitioner completed the continuing
15   education required under this subsection. The continuing
16   education required under this subsection shall be in addition to
17   the continuing education required under section 8.1(c).
18      (e)   While practicing in a health professional shortage area
19   under the program, the clinical practice of a certified
20   registered nurse practitioner shall be limited to primary care,
21   including family practice, internal medicine, gynecology or
22   pediatrics. A certified registered nurse practitioner shall
23   immediately notify the board in writing if the certified
24   registered nurse practitioner changes practice settings or
25   provides care in an area that is not a health professional
26   shortage area. A certified registered nurse practitioner who
27   fails to provide the notice required under this subsection or
28   who is found to be practicing outside of the practice settings
29   or health professional shortage area specified in the notice
30   shall not be authorized to continue participation in the program

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 1   and disciplinary actions may be taken on the certified
 2   registered nurse practitioner's license as deemed necessary by
 3   the board.
 4      (f)   While participating in the program in a health
 5   professional shortage area, a certified registered nurse
 6   practitioner shall be accountable to the board, nursing
 7   profession and patients and shall have the following duties:
 8      (1)   The certified registered nurse practitioner shall comply
 9   with the requirements of this act and the standard of care of
10   advanced nursing care rendered.
11      (2)   The certified registered nurse practitioner shall
12   recognize the certified registered nurse practitioner's
13   limitation regarding knowledge and experience.
14      (3)   The certified registered nurse practitioner shall wear a
15   name identification badge stating the individual's professional
16   title and shall inform new patients in writing about the
17   certified registered nurse practitioner's qualifications,
18   including a disclosure that the certified registered nurse
19   practitioner is not a physician, and the nature of the certified
20   registered nurse practitioner's autonomous practice before or
21   during the initial patient encounter.
22      (4)   The certified registered nurse practitioner shall plan
23   for the management of situations beyond the certified registered
24   nurse practitioner's expertise.
25      (5)   The certified registered nurse practitioner shall
26   consult with and refer patients to other health care providers,
27   as appropriate.
28      (g)   (1)   The board shall be responsible for administering
29   the program. Within sixty (60) days of the effective date of
30   this subsection, the board shall establish a subcommittee to

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 1   assist the board in administering the program. The subcommittee
 2   shall consist of the following members:
 3      (i)    The Secretary of Health or a designee from the
 4   Department of Health, Bureau of Health Planning, that has
 5   experience and expertise in health professional shortage areas,
 6   who shall serve as chair of the subcommittee.
 7      (ii)    Two certified registered nurse practitioners who are
 8   actively engaged in primary care clinical practice. The
 9   certified registered nurse practitioners shall be selected by a
10   Statewide professional organization representing certified
11   registered nurse practitioners engaged in primary care clinical
12   practice. The Statewide professional organization shall submit
13   the names of the certified registered nurse practitioners
14   selected under this subparagraph to the board for appointment on
15   the subcommittee.
16      (iii)    Two licensed physicians, one of whom shall be an
17   allopathic physician and one of whom shall be an osteopathic
18   physician, who are actively engaged in primary care clinical
19   practice. The licensed physicians shall be selected by Statewide
20   professional organizations representing family medicine,
21   internal medicine or pediatrics. The Statewide professional
22   organizations shall submit the names of the licensed physicians
23   selected under this subparagraph to the board for appointment on
24   the subcommittee. At the time of appointment under this
25   subparagraph, the licensed physicians shall meet all of the
26   following criteria:
27      (A)    The licensed physicians shall be collaborating with a
28   certified registered nurse practitioner or shall have
29   collaborated with a certified registered nurse practitioner
30   within the preceding three (3) years.

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 1      (B)     The licensed physicians shall be nationally board
 2   certified in family medicine, internal medicine or pediatrics.
 3      (2)     The subcommittee shall have the following duties:
 4      (i)     Provide guidance to certified registered nurse
 5   practitioners regarding the qualifications to participate in the
 6   program.
 7      (ii)     Approve the temporary regulations promulgated under
 8   subsection (m).
 9      (iii)     Review applications for certification to participate
10   in the program.
11      (iv)     Collaborate with the board to approve, issue, track and
12   revoke the certification of certified registered nurse
13   practitioners to participate in the program.
14      (v)     Conduct a preliminary review of a certified registered
15   nurse practitioner's application to participate in the program.
16   If the subcommittee determines that the certified registered
17   nurse practitioner meets the criteria to participate in the
18   program under subsection (b), the subcommittee shall submit a
19   notice of preapproval to the board. The board may not issue a
20   certification to participate in the program to a certified
21   registered nurse practitioner if the certified registered nurse
22   practitioner's application has not been preapproved by the
23   subcommittee under this subparagraph.
24      (h)     While participating in the program in a health
25   professional shortage area, a certified registered nurse
26   practitioner shall be recognized as a primary care provider.
27      (i)     A certified registered nurse practitioner who
28   participates in the program shall be deemed to be a
29   participating health care provider as defined in section 702 of
30   the act of March 20, 2002 (P.L.154, No.13), known as the Medical

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 1   Care Availability and Reduction of Error (Mcare) Act, shall meet
 2   the requirements under section 711 of the Medical Care
 3   Availability and Reduction of Error (Mcare) Act, and shall be
 4   assessed under section 712 of the Medical Care Availability and
 5   Reduction of Error (Mcare) Act. Upon receiving an assessment
 6   under section 712 of the Medical Care Availability and Reduction
 7   of Error (Mcare) Act, the certified registered nurse
 8   practitioner who participates in the program shall be eligible
 9   to receive money from claims paid by the Medical Care
10   Availability and Reduction of Error Fund. For purposes of the
11   program, the board shall be considered a licensure authority as
12   defined in section 702 of the Medical Care Availability and
13   Reduction of Error (Mcare) Act.
14      (j)   If a certified registered nurse practitioner intends to
15   practice simultaneously under the program, and pursuant to a
16   collaboration agreement with a physician who is external to the
17   program, the collaborating physician shall have no legal
18   responsibility for acts or omissions of the certified registered
19   nurse practitioner practicing under the program.
20      (k)   (1)   Five (5) years after the effective date of this
21   subsection, the Joint State Government Commission shall conduct
22   a study on the program and, within six (6) months of commencing
23   the study, submit the study to the Consumer Protection and
24   Professional Licensure Committee of the Senate and the
25   Professional Licensure Committee of the House of Representatives
26   for the purpose of evaluating the program. The study shall
27   include, but not be limited to, all of the following
28   information:
29      (i)   The number of certified registered nurse practitioners
30   who participated in the program and the health professional

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 1   shortage areas where they participated.
 2      (ii)    The number of certified registered nurse practitioners
 3   who were rejected from participating in the program and the
 4   reason why they were rejected.
 5      (iii)    The number of certified registered nurse practitioners
 6   that left the program and the reason why they left the program.
 7      (iv)    The access to patient care, patient outcomes and
 8   emergency room use in the health professional shortage areas
 9   covered under the program as compared to the access to patient
10   care, patient outcomes and emergency room use in the areas not
11   covered by the program.
12      (v)    The number of referrals by certified registered nurse
13   practitioners to emergency hospitals, the severity of illness
14   experienced by each referred patient and the number of repeat
15   visits by patients to emergency hospitals.
16      (vi)    A comparison of the use of advanced diagnostic tests
17   and imaging by certified registered nurse practitioners
18   participating in the program and the use of advanced diagnostic
19   tests and imaging by primary care physicians in the same health
20   professional shortage area.
21      (vii)    The number of complaints filed with the board, the
22   nature of the complaints and the disciplinary actions that were
23   taken.
24      (viii)    The number of referrals by certified registered nurse
25   practitioners to physician specialists as compared to primary
26   care physicians in the same health professional shortage areas
27   covered under the program, including the types of specialists
28   referred to by certified registered nurse practitioners, the
29   reasons for the referrals and the number of visits with each
30   certified registered nurse practitioner before the referrals.

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 1      (ix)     The number of certified registered nurse practitioners
 2   that are employed while participating in the program versus the
 3   number of certified registered nurse practitioners that are
 4   working in private practice under the program.
 5      (x)    Any other relevant information to evaluate the program.
 6      (2)    The Joint State Government Commission shall obtain
 7   deidentified data from health insurance company claims on
 8   patients receiving care from a certified registered nurse
 9   practitioner participating in the program for the purpose of
10   collecting data to complete the study under paragraph (1).
11      (3)    The board shall provide the Joint State Government
12   Commission, upon request, with all information necessary to
13   complete the study under paragraph (1).
14      (l)    The department shall notify the board and subcommittee
15   immediately upon receiving notification of an alleged violation
16   of this section. The board shall maintain current records of all
17   reports of alleged violations and periodically review the
18   records for the purpose of determining that each alleged
19   violation has been resolved in a timely manner, and if
20   necessary, forward the reports to the State Board of Medicine or
21   the State Board of Osteopathic Medicine for informational
22   purposes.
23      (m)    The board shall promulgate regulations necessary to
24   implement the program as approved by the subcommittee
25   established under subsection (g)(1) and with the consideration
26   of any recommendations made by the Consumer Protection and
27   Professional Licensure Committee of the Senate and the
28   Professional Licensure Committee of the House of Representatives
29   for the purpose of evaluating the program. In order to
30   facilitate the prompt implementation of the program, regulations

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 1   promulgated by the board shall be deemed temporary regulations
 2   which shall not expire for a period of six (6) years following
 3   publication. Temporary regulations promulgated under this
 4   subsection shall not be subject to:
 5      (1)   Section 612 of the act of April 9, 1929 (P.L.177,
 6   No.175), known as The Administrative Code of 1929.
 7      (2)   Sections 204(b) and 301(10) of the act of October 15,
 8   1980 (P.L.950, No.164), known as the Commonwealth Attorneys Act.
 9      (3)   Sections 201, 202, 203, 204 and 205 of the act of July
10   31, 1968 (P.L.769, No.240), referred to as the Commonwealth
11   Documents Law.
12      (4)   The act of June 25, 1982 (P.L.633, No.181), known as the
13   Regulatory Review Act.
14      (n)   Nothing in this section shall be construed to:
15      (1)   permit a certified registered nurse practitioner to
16   practice under the act of December 20, 1985 (P.L.457, No.112),
17   known as the Medical Practice Act of 1985, or the act of October
18   5, 1978 (P.L.1109, No.261), known as the Osteopathic Medical
19   Practice Act; or
20      (2)   prohibit a certified registered nurse practitioner
21   certified under the program from consulting with or seeking
22   information related to patient care from a physician. For the
23   purpose of this section, no physician-patient relationship shall
24   be established between a patient and a physician with whom the
25   certified registered nurse practitioner consults or from whom
26   clinical information or guidance is sought.
27      (o)   The program shall expire six (6) years after the
28   effective date of this subsection. Upon the expiration of the
29   program, the following shall apply:
30      (1)   A certified registered nurse practitioner shall be

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 1   deemed to have retired as a health care practitioner for the
 2   purposes of the Medical Care Availability and Reduction of Error
 3   (Mcare) Act.
 4      (2)   A certified registered nurse practitioner may not
 5   practice under the program.
 6      (p)   As used in this section, the following words and phrases
 7   shall have the meanings given to them in this subsection:
 8      "Health professional shortage area" shall mean a geographic
 9   or population area in this Commonwealth designated by the United
10   States Department of Health and Human Services that indicates a
11   health care professional shortage in primary care.
12      "Program" shall mean the Certified Registered Nurse Pilot
13   Program established under subsection (a).
14      Section 2.    This act shall take effect as follows:
15            (1)   Section 8.10(g) and (m) of the act shall take effect
16      immediately.
17            (2)   This section shall take effect immediately.
18            (3)   The remainder of this act shall take effect in 180
19      days.




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