HOUSE 3rd Reading Unamended March 19, 2007 HOUSE Amended 2nd Reading March 16, 2007First Regular Session Sixty-sixth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 07-0081.01 Kristen Forrestal HOUSE BILL 07-1023 HOUSE SPONSORSHIP Stafford, Frangas, Lundberg, and Todd SENATE SPONSORSHIP Tochtrop, and Sandoval House Committees Senate Committees Health and Human Services Appropriations A BILL FOR AN ACT Concerning measures to enhance advanced practice nursing. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Health Care Task Force. Prohibits carriers from discriminating between a physician and an advanced practice nurse when establishing reimbursement rates for covered services that could be provided by a physician or an advanced practice nurse. States that a law or rule that requires a signature, certification, stamp, verification, affidavit, or endorsement by a physician shall be deemed to allow a signature, certification, stamp, verification, affidavit, or endorsement by an advanced practice nurse as long as it fits within the scope of practice of an advanced practice nurse. Allows an advanced practice nurse to sign a death certificate. Requires reimbursement for services provided by an advanced practice nurse pursuant to the Colorado medical assistance act to be made directly to the advanced practice nurse upon request, except when the services are provided within the scope of employment as a salaried employee of a public or private institution or a physician. Allows an advanced practice nurse to authorize a parking placard for a person with a disability. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. 10-16-125, Colorado Revised Statutes, is amended to read: 10-16-125. Reimbursement to nurses. (1) In counties of the state that are neither part of a metropolitan statistical area nor a primary statistical area, a carrier offering a health benefit plan shall not discriminate between a physician and an advance advanced practice nurse not practicing under the direction of a physician when establishing reimbursement rates for covered services that could be provided by an advance advanced practice nurse or a physician. (2) In order to improve access to primary care and choices of providers, a carrier providing a health benefit plan shall evaluate an application for status as a participating provider from an advanced practice nurse utilizing objective criteria and take into account the provider to covered person ratio for the covered benefits that appropriately may be provided by the advanced practice nurse. In the event of a denial of the application, the carrier shall respond promptly to the advanced practice nurse with the reason for the denial. SECTION 2. 25.5-4-409 (2), Colorado Revised Statutes, is amended to read: 25.5-4-409. Authorization of services - nurse anesthetists - advanced practice nurses. (2) When services by a certified pediatric nurse practitioner or a certified family nurse practitioner an advanced practice nurse are provided in accordance with this article, articles 5 and 6 of this title, and section 12-38-103 (10), C.R.S., or section 12-38-111.5, C.R.S., the executive director of the state department shall authorize reimbursement for said services. Payment for such services shall be made directly to the nurse practitioner advanced practice nurse, if requested by the nurse practitioner advanced practice nurse; except that this section shall not apply to nurse practitioners advanced practice nurses when acting within the scope of their employment as salaried employees of public or private institutions or physicians. SECTION 3. 42-3-204 (1) (b) (II), (2) (b), (2) (c), and (3), Colorado Revised Statutes, are amended to read: 42-3-204. Parking privileges for persons with disabilities - applicability. (1) As used in this section: (b) "Person with a disability" means either of the following: (II) A person who has a physical impairment that substantially limits the person's ability to move from place to place, which impairment is verified, in writing, by the director of the division of rehabilitation (administratively created by the department of human services), or a physician licensed to practice medicine or practicing medicine pursuant to section 12-36-106 (3) (i), C.R.S., or a podiatrist licensed under article 32 of title 12, C.R.S., or an advanced practice nurse registered pursuant to section 12-38-111.5, C.R.S. To be valid, such verification by the director, physician, or podiatrist, or advanced practice nurse shall certify to the department of revenue that the person meets the standards established by the executive director of the department, in consultation with the director of the division of rehabilitation. (2) (b) Notwithstanding the verification requirements of subparagraphs (I), (II), and (III) of paragraph (a) of this subsection (2), if a renewal applicant has a permanent disability that was verified in writing by a physician licensed to practice medicine in this state or practicing medicine pursuant to section 12-36-106 (3) (i), C.R.S., or an advanced practice nurse registered pursuant to section 12-38-111.5, C.R.S., and provided to the department with the original application for a license plate or placard under this section, such applicant shall not be required to meet such verification requirement to renew such license plate or placard. If a person renews such license plate or placard of and on behalf of a person with a permanent disability, the person renewing such license plate or placard shall sign an affidavit, under the penalty of perjury, attesting to the fact that the person with a permanent disability is still in need of the license plate or placard and stating that such license plate or placard shall be surrendered to the department upon the death of the person with a permanent disability. (c) Such license plate or placard shall be issued to such person upon presentation to the department of a written statement, verified by a physician licensed to practice medicine in this state or practicing medicine pursuant to section 12-36-106 (3) (i), C.R.S., or an advanced practice nurse registered pursuant to section 12-38-111.5, C.R.S., that such person is a person with a disability. The application for such a license plate or placard shall be sent to the department each year; except that a person who has been issued a disabled veteran special license plate shall not send an application to the department every year. The application for a disabled special license plate that qualifies for parking privileges pursuant to this section shall be sent to the department upon transfer of such plate to another vehicle. (3) The department shall issue temporary distinguishing license permits and a temporary identifying placard to a person who is temporarily disabled upon presentation of a written statement, verified by a physician licensed to practice medicine or practicing medicine pursuant to section 12-36-106 (3) (i), C.R.S., or a podiatric physician licensed under article 32 of title 12, C.R.S., or an advanced practice nurse registered pursuant to section 12-38-111.5, C.R.S., that such person temporarily meets the definition of a person with a disability. The department shall issue such permits and placards to a qualifying person who is a resident of another state and who becomes disabled while in this state. Such permits and placard shall be valid for a period of ninety days after the date of issuance and may continually be renewed for additional ninety-day periods during the term of such disability upon resubmission of such written and verified statements. The provisions of this section concerning the privileges granted to persons with disabilities shall apply to temporary license permits and temporary placards issued under this subsection (3). Further, the requirement that the placard include a printed identification number as set forth in subparagraph (II) of paragraph (a) of subsection (2) of this section shall apply to both temporary license permits and temporary placards issued under this subsection (3). The verification by a physician licensed to practice medicine or practicing medicine pursuant to section 12-36-106 (3) (i), C.R.S., or a podiatrist licensed under article 32 of title 12, C.R.S., or an advanced practice nurse registered pursuant to section 12-38-111.5, C.R.S., shall be carried in the vehicle transporting the person or persons with a disability to whom the temporary license permit or placard has been issued and shall be presented to any law enforcement officer upon request. Temporary license permits and temporary placards issued by states other than Colorado shall be valid so long as they are currently valid in the state of issuance and valid pursuant to 23 CFR part 1235. SECTION 4. Effective date. (1) This act shall take effect January 1, 2008. (2) However, if a referendum petition is filed against this act or an item, section, or part of this act during the 90-day period after final adjournment of the general assembly that is allowed for submitting a referendum petition pursuant to article V, section 1 (3) of the state constitution, then the act, item, section, or part, shall not take effect unless approved by the people at a biennial regular general election and shall take effect on the date specified in subsection (1) or on the date of the official declaration of the vote thereon by proclamation of the governor, whichever is later.