January 02, 2015
Health Care Alert
A new year means new regulations for experienced nurse practitioners with more than 3,600 hours of practice experience. In lieu of a written practice agreement and protocols with a designated collaborating physician, a nurse practitioner is now required to have a collaborative relationship with one or more physicians or a hospital. The new regulations provide relief to experienced nurse practitioners who may have had difficulty satisfying the previously existing requirements.
The New York State Board of Regents adopted final regulations at its December 2014 meeting providing that nurse practitioners with more than 3,600 hours of experience practicing as a licensed or certified nurse practitioner in New York or another state or for the Veterans Administration, the US Armed Forces or the US Public Health Service may choose to practice without a written practice agreement and written practice protocols with a designated collaborating physician as long as they have a “collaborative relationship” with a physician or hospital. The regulatory changes are in response to provisions included in the State Budget adopted in April 2014 and referred to as the “Nurse Practitioners Modernization Act.”
The most immediate impact of these changes will be in communities where experienced nurse practitioners have had difficulty satisfying the previously existing requirement for a written practice agreement with a collaborating physician due to physician relocation or retirement and the subsequent inability to recruit replacement physicians due to physician shortages. In light of the increased expectations of collaboration between and among health care providers across the care continuum, however, it remains to be seen just how significant these changes will be for nurse practitioners and their collaboration with physicians and other health care providers.
Pursuant to the new regulations, which became effective January 1, 2015, an experienced nurse practitioner is required to have a collaborative relationship with one or more physicians or a hospital in lieu of a written practice agreement and written practice protocols. A “collaborative relationship” is defined to mean that “the nurse practitioner communicates, in person, by telephone or through written means … with a physician who is qualified to collaborate in the specialty involved … for the purposes of exchanging information, as needed, in order to provide comprehensive patient care and to make referrals, as necessary.”
In addition, a nurse practitioner practicing without a written practice agreement is required to complete and submit a form to the State Education Department attesting to 1) having more than 3,600 hours of experience, 2) having collaborative relationships with one or more physicians, and 3) maintaining documentation evidencing his or her collaborative relationships. The draft attestation form developed by the Office of the Professions contains examples of documentation which would evidence a collaborative relationship including 1) an agreement or arrangement with a physician or hospital to transfer or refer patients for care, 2) written communications or records of consultations and communications for referral, 3) documentation of employment relationships with a physician practice, a hospital, a hospice program, a licensed home care agency or licensed mental health facility with a physician medical director or 4) documentation of a contractual relationship with a physician, physician practice or a hospital, pursuant to which the nurse practitioner provides professional services.
Unlike the current “Verification of Collaborative Agreement and Practice Protocol” form, which is required to be filed by nurse practitioners in New York, the “Collaborative Relationships Attestation” form does not require the nurse practitioner to identify a collaborating physician nor does it collect other information regarding approved practice protocols or the nurse practitioner’s practice locations(s).
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