Progress is the hallmark of the APRN legislation. A very active category each legislative year, this year proves no exception. ANA is tracking 43 bills in 20 states in this subject area. Typically the bills fall into one of 2 major categories: (1) establishing APNs as a recognized nurse class including definitions/scopes of practice, or (2) broadening exiting statutes to include prescriptive authority, hospital privileges or reimbursements.

The first category of legislation is shrinking as a majority of states have come to officially recognized APRNs and the various specialty areas. Two bills passed in HI will provide recognition of APN provided the nurse has a similar designation in other states; the other would allow APNs to practice psychotherapy. IL has a bill pending that would add CRNAs to the APN category. KY would add clinical nurse specialists to APN definitons and increase members of the BON by 1. OH is considering CNM title protection. NE approved legislation to change all references of RNP to APRN and require proof of continued clinical competency 5 years after APRN program completion. NY is looking at providing definition and title authority to nurse anesthetists. RI would like to license CRNPs. Finally, PA is considering defining APRN, CRNA, CNP, CNS, and CNM and setting their scopes of practice. MO proposals to establish title protection for APRNs died.

 Broadening scopes of practice marks the majority of the remaining legislation. CO provided for collaboration between physicians and CNMs; HI will allow APN to practice psychotherapy but along with GA allowed prescriptive authority bills to die; while IN and OH approved such authority for APNs. MD now has a law prohibiting insurers from limiting direct access to ob/gyn services from a CNM. APN prescriptive authority for Schedule III to VI drugs became law in VA and II through V is now law in WA. Dispensing of drug samples in IA died as did dispensing of nonscheduled legend drugs in KY.

A new law passed this session in KY will allow APNs to complete initial exams for persons admitted to mental hospitals; NY has legislation pending permitting NPs to be medical inspectors in schools and for bus drivers, do certain laboratory testing and authorize home health services. SD will permit APNs to form limited liability companies. TN is looking to add APNs to the services eligible for reimbursement by MCOs. A reimbursement bid in NM and ME failed. MD tried for CNM staff privileges and pending in NY, APNs could not be denied staff privileges without a written explanation. Finally, two omnibus bills, one in OH, would establish new fees and application and renewal process for APNs and in PA would include APNs in their "Health Care Provider Joint Negotiating Act," are still pending.