Independent Practice Q&A
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With the passing of HB 607 (Independent Practice) on March 11, 2020 there have been numerous questions sent in for clarification.  We know everyone has questions so we hope this page will provide some of the answers.  If you have a question that is not answered here, please feel free to email us at contact@flanp.org

 

September 18, 2020 Update: Per the Board of Nursing (BON), it is expected that the application for Independent Practice will be available mid to late October.  The application (registration form as termed by the BON) will include the following:

  1. Have you completed 3,000 hours of supervised practice in the past 5 years? (Check Yes/No)
  2. Have you had any disciplinary action in the past 5 years? (Check Yes/No)
  3. Have you submitted documentation for proof of completion for the 2 graduate level courses (3-credits each) or the equivalent 45 credit hours for pharmacology and differential diagnosis? (Check Yes/No) (There will be instructions to submit such proof by the the BON)

Applications/Registrations WILL BE authorized BEFORE standards of practice are available as the statute does not state otherwise.  This means that autonomous APRNs will be subject to FUTURE RULES on their practice and MUST REMAIN up to date with developments that govern their practice.

There will be a rules workshop on October 9th during the BON meeting (tentatively at 11am) to discuss the definition of primary care.  We will post more information on how to join prior to the workshop.

The October 8th & 9th BON meeting will discuss the definition of primary care and the rule will be advanced for the course equivalency for pharmacology and differential diagnosis.  The specific definitions for what constitutes pharmacology and differential diagnosis CE will be detailed and released later this month.  We will update here as soon as that information is out.

August 30, 2020 Update: The APRN Council meeting was held on Friday, August 28th.  Click here to read our full summary from the meeting, or listen to the complete audio recording here.  Here are a few key points:

  • Sovereign immunity is a consideration for the upcoming legislative session
  • The definition of primary care has not emerged from the rulemaking process yet, therefor much of the agenda was impacted and standards of practice could not be developed
  • Further discussion of what would qualify for CE replacement of the graduate level courses was tabled as it will be addressed further by the full Board of Nursing at their next meeting in October
  • Legal counsel, Christopher R. Dierlam, the Assistant Attorney General, was present and tasked with drafting a first pass at standards of practice
  • The application/registration for the IP license was confirmed to be potentially available in mid to late October at the earliest.  This however would serve more as a queue as no licenses will be issued until a clearly defined standard of practice is adopted
  • The next full Board of Nursing (BON) meeting is October 8-9, 2020 with a second meeting of the IP Council to occur within the 2-3 weeks after the full BON meeting

  

August 17, 2020 Update: The Board of Nursing has started the rulemaking process.  Review the Notice of Development of Rulemaking and the Notice of Proposed Rule.  Again, we encourage you to review the rulemaking process here.

 

August 13, 2020 Update: We are waiting for the official Board of Nursing post regarding the meeting last week.  In the meantime, here is what was voted on during the meeting direct from the minutes:

1.  House Bill 607: Discussion of Equivalency to Required Graduate-level Semester Hours - A motion was made by McKeen to open rule making.  Motion passed unanimously.  A motion was made by McKeen to delegate board counsel, staff and Dr. Talmadge to draft proposed rule language to move forward.  The motion passed unanimously.

2. House Bill 607: Autonomous APRN Renewal - Additional 10 CE Hours Required.  After discussion, there was consensus that this would be 10 additional CE hours at renewal, perhaps related to practice area or certification specialty.  A motion was made by McKeen to delegate to board counsel, staff and Dr. Talmadge to draft proposed language for the October meeting.  Motion passed unanimously.

We encourage all APRNs to review the rulemaking process and know that we will keep you updated as the process moves through its steps.

July 15, 2020 REMINDER: Although the Independent Practice Law went into effect 7/1/2020, APRN's do NOT automatically assume autonomous practice.  APRN's are NOT authorized to sign death certificates until they are Registered for Autonomous APRN practice.  The application is PENDING the Board of Nursing's rulemaking & vote.

 

July 1, 2020 Update:  The Board of Nursing has posted this announcement with the appointments made to the Council on Advanced Practice Registered Nurse Autonomous Practice.

 

June 10, 2020 Update: The Florida Board of Nursing (BON) issued a statement today providing more details on the rulemaking process for HB 607.  Here are a few additional points made:

  • The Registration application for autonomous APRNs will be available after it has been adopted by rule, which is anticipated to take approximately 90 days.
  • The Board also voted to define “primary care practice” to include “health promotion, disease prevention, health maintenance, counselling, patient education, and diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings”. This definition will also move through the rule making adoption process prior to becoming effective.

To read the full statement by the Board of Nursing, click here.

 

The BON had their bi-monthly meeting this past Friday, June 5, 2020 to discuss among many agenda items, rulemaking and implementation of HB 607 as it relates to Autonomous Practice for APRNs (NP and CNM per HB 607). A bulleted summary of their rulemaking decisions is provided below.

  • An application which is termed a Registration form by the BON is not available yet. They ask that you DO NOT submit any attestations or CE reports before the application is available as there will be nobody tracking such information ahead of the approved Registration form. The Registration form will be free and made available by the BON on their website once approved through the rulemaking process.
  • Educational equivalency was discussed as it related to the 3 graduate credit hour courses in pharmacology and differential diagnosis. In accordance with the understanding that 1 graduate credit hour = 15 CE credits, an equivalency was voted that an APRN can submit evidence of 45 CE credits in pharmacology and 45 CE credits in differential Diagnosis completed within the last 5 years to fulfill the statutory requirement of the two 3 credit courses.
  • CE Providers for the 45/45 CE equivalency was discussed and voted upon too. Any CE provider that has been authorized by the BON previously to provide CE or national associations or organizations empowered to accredit nursing CE are approved. For nurse practitioners, this would mean that CE accredited by ANCC or AANP are authorized. 
  • Differential Diagnosis specification of CE was discussed in that many courses may not be entitled “Differential Diagnosis of X.” To satisfy that requirement when submitting the differential diagnosis CE is that course descriptions may be used to show that the differential diagnosis of conditions are met. For this reason, we recommended keeping a log of your CE or track your CE so as to have it readily available if applying for autonomous practice.
  • A One Time CE requirement is what the 3/3 graduate credit or the 45/45 CE stipulation is. This means that once it is satisfied it WILL NOT need to be completed with each subsequent license renewal, but these must have been completed in the last 5 years.
  • Malpractice / Liability Insurance limits were clarified in that an APRN who seeks autonomous practice must meet the limits specified in the statute and NOT IN ADDITION TO the BON’s current limit attestation.
  • Faculty Credit or credit for teaching nursing courses WILL NOT BE allowed in place of the education requirement for graduate / CE credit. This means that there will be no credit that can be supplemented by precepting or teaching a course even if that course is pharmacology or differential diagnosis / health assessment.

Your elected leadership will continue to track any and all developments as they occur and make that information available to you. If you have any questions, don’t hesitate to send them to contact@flanp.org.

Questions & Answers (Last updated 7/15/2020)

  • When can I complete the application?  Where do I find it?  The Registration Form IS NOT available yet; it will be available once it has went through the rulemaking process and has been voted on.  Once approved it will be posted on the Board of Nursing website and we will also post it here as soon as it is available.  APRNs DO NOT automatically assume independent practice when the law takes effect on July 1st.  The Board of Nursing asks that no one sends in any prior information as they can not predetermine if you are eligible for the independent practice license.  The Board of Nursing also asks us to remind APRN's that they are NOT authorized to sign death certificates until they are Registered for Autonomous APRN practice.
  • Are ALL nurse practitioners able to practice independently?  Unfortunately no.  Nurse Practitioners who are issued a licensed to practice autonomously/independently, must engage in such practice only in primary practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule.  Certified Nurse Midwives (CNM) are also able to practice independently.  
  • Why weren't other groups/specialties included?  They were included in the original version of HB 607.  As the legislative process moved forward the bill was amended and approved by both the House and the Senate. FLANP continuously advocated for the original version of the bill throughout the 2020 session.  The Board of Nursing will be clarifying further as to what is included in primary practice.
  • Can I apply now to practice independently?  Unfortunately no.  The Registration Form IS NOT available yet; it will be available once it has went through the rulemaking process and has been voted on.  Once approved it will be posted on the Board of Nursing website and we will also post it here as soon as it is available.  APRNs DO NOT automatically assume independent practice when the law takes effect on July 1st. 
  • With the passage of the Independent practice bill, are we now able to sign DNR's, terminal condition forms, etc.?  Once Registered for Autonomous APRN practice, the NP is granted signature authority which includes the Baker Act involuntary examination, signing death certificates, admitting/discharging patients from a facility and “provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician (except for medical cannabis)".  This means that until the Application is available and the APRN is Registered for Autonomous APRN practice, APRN's CAN NOT sign these.
  • I graduated over 5 years ago but the new law will be requiring a completion of 3 graduate-level semester hours in differential diagnosis and the completion of 3 graduate-level semester hours in pharmacology, do I have to go back to school? This was discussed at the Board Of Nursing Meeting on June 5th, in accordance with the understanding that 1 graduate credit hour = 15 CE credits, an equivalency was voted that an APRN can submit evidence of 45 CE credits in pharmacology and 45 CE credits in differential Diagnosis completed in last 5 years to fulfill the statutory requirement of the two 3 credit courses. 
  • What is your advice for obtaining the necessary 3 hours of CEU in differential diagnosis and pharmacology?  Do you think it will be offered online prior to July when the law becomes active?  CE Providers for the 45/45 CE equivalency was discussed and voted upon too. Any CE provider that has been authorized by the BON previously to provide CE or national associations or organizations empowered to accredit nursing CE are approved. For nurse practitioners, this would mean that CE accredited by ANCC or AANP are authorized. 
  • How will this impact our ability to be providers on health insurance plans without a collaborating physician?  This law doesn’t supersede CMS policies so we will get what we have been getting. It made it so insurance companies can’t force patients to see an NP over a physician and can’t discriminate against NPs ONLY BECAUSE they are NPs.
  • Since CMS is Federal- will we still need to get a physician signature on 485s and Home Health Care orders?  As of April 30th, CMS issued an interim final rule that permanently implements section 3708 of the CARES Act, retroactively effective on March 1, 2020.  Please visit our CARES Act page for more information.
  • Will we be able to sign home health certifications, and will we be able to prescribe schedule II drugs longer than 7 days at a time with independent practice?  These are 2 separate questions.  As of April 30th, CMS issued an interim final rule that permanently implements section 3708 of the CARES Act, retroactively effective March 1, 2020.  Visit our CARES Act page for more information. The DEA legislation is also enshrined in other statutes and that applies until otherwise changed. 

 

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  • Florida Association of Nurse Practitioners, Inc.
  • PO Box 602
    Lake Helen, FL 32744
  • 850.363.3627
  • contact@flanp.org

Vision Statement

Florida Association of Nurse Practitioners will be the leading Florida Nurse Practitioner professional organization advocating for patient centered health care. The organization will increase knowledge on healthcare policy pertaining to Nurse Practitioner practice and patient centered health care; and will remove barriers to Nurse Practitioner practice to gain access to quality health care for Floridians.