Connecticut Governor Ned Lamont recently signed into law Public Act No. 19-98 “An Act Concerning The Scope Of Practice Of Advanced Practice Registered Nurses” (PA 19-98), which generally expands the scope of practice for Connecticut-licensed advanced practice registered nurses (APRNs). Among other things, PA 19-98 addresses matters related to medical records, emergency treatment, insurance coverage, and workers’ compensation, as further described below. PA 19-98 becomes effective October 1, 2019.
Currently, physicians may provide, without consent, emergency treatment for a child hospitalized for psychiatric disabilities if parental consent is withheld or immediately unavailable and the physician determines that treatment is necessary to prevent serious harm. PA 19-98 expands existing law to allow an APRN who is certified by the American Nurses Credentialing Center (ANCC) as a psychiatric mental health provider to also provide such emergency treatment in the absence of parental consent.
Confidentiality of Psychiatric Records
Under current law, communications and records related to mental health may be disclosed without patient consent only in limited circumstances. The existing law applies to mental health records or communications with a “psychiatrist,” which was previously limited to individuals licensed to practice medicine and who devoted a substantial portion of their time to the practice of psychiatry. PA 19-98 expands the current law by replacing the term “psychiatrist” with “psychiatric mental health provider,” which includes (1) Connecticut-licensed physicians specializing in psychiatry; (2) Connecticut-licensed advanced practice registered nurses who are board certified by the ANCC as psychiatric mental health providers; (3) a person licensed to practice medicine who devotes a substantial portion of his or her time to the practice of psychiatry; and (4) persons the patient reasonably believes to be a qualified psychiatric mental health provider.
Currently, Connecticut prohibits managed care companies or other organizations or insurers from requiring contractual indemnification by a medical provider – including physicians, podiatrists, dentists, optometrists, and psychologists – in the event a claim or liability results from that managed care company’s, organization’s or insurer’s determination of medical necessity or appropriateness of care, as long as the medical provider gave information that was accurate and appropriate at the time it was given. PA 19-98 expands the definition of “medical provider” to include all nurses.
APRNs’ Scope of Practice is Further Expanded in the Following Areas
Collaborative Drug Therapy Management Agreements. Under existing law, pharmacists may enter into written protocol-based collaborative drug therapy management agreements with physicians to manage drug therapy provided to patients. PA 19-98 permits pharmacists to enter into such agreements with APRNs as well.
- Workers’ Compensation. Under PA 19-98, APRNs may treat injured employees involved in workers’ compensation cases, and the Workers’ Compensation Commission Chairman may list APRNs as approved providers. Current law allows only physicians or surgeons to treat injured employees involved in workers’ compensation cases.
- Medical Records.Under existing law, when an institutionlicensed by the Department of Public Health (DPH), such as a hospital, makes a patient’s medical record available at the request of the patient, his or her attorney, or his or her authorized representative, and such records include tissue samples or laboratory slides, the patient’s health care provider may examine the tissue sample(s) and laboratory slide(s). Current law defines “health care provider” as an institution, laboratory or physician. PA 19-98 expands the definition of health care provider to include APRNs.
- DPH-Controlled Laboratory Testing. Under PA 19-98, APRNs may apply for testing and laboratory services to be performed at DPH-controlled state laboratories. Existing law allows physicians, laboratories, dentists, podiatrists and certain other qualified individuals to request the DPH laboratories to perform services.
- Clarification to Statute of Limitations. PA 19-98 adds APRNs as a class of providers subject to Connecticut’s statute of limitations for personal injury and property damage claims made against physicians, surgeons, dentists and certain other providers.