LRB-0429/1
MED&TJD:emw&kjf
2019 - 2020 LEGISLATURE
June 7, 2019 - Introduced by Representatives Rohrkaste, Subeck, Magnafici,
Anderson, Bowen, Brandtjen, Brostoff, Duchow, Emerson, Gundrum,
Hutton, Kitchens, Kuglitsch, Kulp, Kurtz, L. Myers, Mursau, Neubauer,
Novak, Ott, Petersen, Quinn, Riemer, Sinicki, Skowronski, Spiros, Steffen,
Tusler, Vruwink and Wichgers, cosponsored by Senators LeMahieu,
Ringhand, Testin, Carpenter, Hansen, Kooyenga, Marklein, Olsen, Risser,
Schachtner, Wanggaard and Wirch. Referred to Committee on Health.
AB267,2,18 1An Act to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 3.,
2252.01 (1c), 440.03 (13) (b) 42., 440.08 (2) (a) 50., 441.11 (title), 441.11 (1), 441.11
3(3), 441.15, 441.16, 441.19, 448.035 (1) (a) and 450.01 (1m); to renumber and
4amend
253.13 (1), 255.06 (1) (d), 441.06 (7) and 441.11 (2); to amend 14.87
5(title), 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd)
62. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 29.193 (3) (a), 45.40 (1g) (a), 46.03 (44),
750.08 (2), 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k), 50.49
8(1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8) (intro.), 77.54 (14) (f) 4., 97.59, 102.13
9(1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4., 102.13 (1) (d) 1., 2., 3. and 4., 102.13
10(2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and 2., 102.29 (3), 102.42 (2) (a), 106.30
11(1), 118.15 (3) (a), 118.25 (1) (a), 118.29 (1) (e), 118.2925 (3), 118.2925 (4) (c),
12118.2925 (5), 146.343 (1) (c), 146.82 (3) (a), 146.89 (1) (r) 1., 146.89 (1) (r) 8.,
13146.89 (6), 252.07 (8) (a) 2., 252.07 (9) (c), 252.10 (7), 252.11 (2), (4), (5), (7) and
14(10), 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m)

1(intro.) and (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d),
2253.115 (4), 253.115 (7) (a) (intro.), 253.15 (2), 255.06 (2) (d), 255.07 (1) (d),
3257.01 (5) (a) and (b), 341.14 (1a), (1e) (a), (1m) and (1q), 343.16 (5) (a), 343.51
4(1), 343.62 (4) (a) 4., 440.03 (13) (b) 3., 440.08 (2) (a) 4m., 440.981 (1), 440.982
5(1), 440.987 (2), 441.01 (3), 441.01 (4), 441.01 (7) (a) (intro.), 441.01 (7) (b),
6441.06 (3), 441.06 (4), 441.07 (1g) (intro.), (a), (c) and (e), 441.10 (7), 441.18 (2)
7(a) (intro.), 441.18 (2) (b), 441.18 (3), subchapter II (title) of chapter 441
8[precedes 441.51], 441.51 (title), 448.03 (2) (a), 448.035 (2), (3) and (4), 448.56
9(1) and (1m) (b), 448.62 (2m), 448.67 (2), 448.956 (1m), 450.01 (16) (h) 2., 450.01
10(16) (hr) 2., 450.03 (1) (e), 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b),
11450.11 (8) (e), 450.13 (5) (b), 450.135 (7) (b), 462.04, 655.001 (7t), 655.001 (9),
12655.005 (2) (a), 961.01 (19) (a) and 961.395; to repeal and recreate 441.06
13(title); and to create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em), 255.06 (1)
14(f) 2., 440.03 (13) (b) 39m., 440.08 (2) (a) 47., 441.001 (1c), 441.001 (1m), 441.001
15(5), 441.01 (7) (c) and 441.09 of the statutes; relating to: advanced practice
16registered nurses, extending the time limit for emergency rule procedures,
17providing an exemption from emergency rule procedures, and granting
18rule-making authority.
Analysis by the Legislative Reference Bureau
Nursing practice and licensure
This bill makes various changes to practice, licensure, and certification
requirements for nurses, which are administered by the Board of Nursing.
Licensure of advanced practice registered nurses
Under current law, a person who wishes to practice professional nursing must
be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
additional system of licensure for advanced practice registered nurses (APRNs), to
be administered by the board. Under the bill, in order to apply for an APRN license,
a person must 1) hold, or concurrently apply for, an RN license; 2) have completed

an accredited graduate-level or postgraduate-level education program preparing
the person to practice as an APRN in one of four recognized roles and hold a current
national certification approved by the board; 3) possess malpractice liability
insurance in an amount determined as provided in the bill; 4) pay a fee determined
by the Department of Safety and Professional Services; and 5) satisfy certain other
criteria specified in the bill. The bill also allows a person who has not completed an
accredited education program described above to receive an APRN license if the
person 1) on January 1, 2017, was both licensed as an RN in Wisconsin and practicing
in one of the four recognized roles; and 2) satisfies additional practice or education
criteria established by the board. The four recognized roles, as defined in the bill,
are 1) certified nurse-midwife; 2) certified registered nurse anesthetist; 3) clinical
nurse specialist; and 4) nurse practitioner. The bill also requires the board, upon
granting a person an APRN license, to also grant the person one or more specialty
designations corresponding to the recognized role or roles for which the person
qualifies.
The holder of an APRN license may append the title “A.P.R.N." to his or her
name, as well as a title corresponding to whichever specialty designations that the
person possesses. The bill prohibits any person from using the title “A.P.R.N.," and
from otherwise indicating that he or she is an APRN, unless the person is licensed
by the board as an APRN. The bill also prohibits the use of titles and abbreviations
corresponding to a recognized role unless the person has a specialty designation for
that role. However, the bill allows an APRN to delegate a task or order to another
clinically trained health care worker if the task or order is within the scope of the
APRN's practice, the APRN is competent to perform the task or issue the order, and
the APRN has reasonable evidence that the health care worker is minimally
competent to perform the task or issue the order under the circumstances. The bill
requires an APRN to adhere to professional standards when managing situations
that are beyond the advanced practice nurse's expertise.
Under the bill, when an APRN renews his or her APRN license, the board must
grant the person the renewal of both the person's RN license and the person's APRN
license. The bill requires all APRNs to complete continuing education requirements
each biennium in clinical pharmacology or therapeutics relevant to the APRN's area
of practice and to satisfy certain other requirements when renewing a license.
Practice of nurse-midwifery
This bill repeals licensure and practice requirements specific to
nurse-midwives and the practice of nurse-midwifery, including specific
requirements to practice with an obstetrician. Under the bill, “certified
nurse-midwife" is one of the four recognized roles for APRNs, and a person who
practices nurse-midwifery under current law who satisfies the APRN licensure
requirements may apply for and receive an APRN license and a certified
nurse-midwife specialty designation, except that the bill also requires that a person
applying for a certified nurse-midwife specialty designation be certified by a
national certifying body approved by the board.

Advanced practice registered nurse prescribers
Under current law, a person licensed as an RN may apply to the board for a
certificate to issue prescription orders if the person meets certain requirements
established by the board. An RN holding a certificate is subject to various practice
requirements and limitations established by the board and must possess malpractice
liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and replaces them
with permits to issue prescription orders. The bill allows the holder of an APRN
license to apply for a permit or for an applicant for an APRN license to apply for a
permit concurrently with his or her APRN license application. The bill requires the
board to establish the appropriate education, training, or experience requirements
that a registered nurse must satisfy to be granted a permit to issue prescription
orders. As under current law, an APRN holding a permit is subject to various practice
requirements and limitations established by the board.
The bill repeals a provision concerning the ability of advanced practice nurses
who are certified to issue prescription orders and who are required to work in
collaboration with or under the supervision of a physician to obtain and practice
under a federal waiver to dispense narcotic drugs to individuals for addiction
treatment.
Other changes
The bill makes numerous other changes throughout the statutes relating to
APRNs and APRN prescribers, including various terminology changes and technical
changes relating to the Nurse Licensure Compact.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB267,1 1Section 1. 14.87 (title) of the statutes is amended to read:
AB267,4,2 214.87 (title) Enhanced nurse Nurse licensure compact.
AB267,2 3Section 2. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
AB267,4,84 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
5or both arms or one or both hands and fails to meet the minimum standards of any
6one of the following standard tests, administered under the direction of a licensed
7physician, a licensed physician assistant, a licensed chiropractor, or a certified
8licensed advanced practice registered nurse prescriber:
AB267,3
1Section 3. 29.193 (2) (b) 2. of the statutes is amended to read:
AB267,5,72 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
3and furnished by the department, which shall include a written statement or report
4prepared and signed by a licensed physician, a licensed physician assistant, a
5licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
6registered nurse prescriber prepared no more than 6 months preceding the
7application and verifying that the applicant is physically disabled.
AB267,4 8Section 4. 29.193 (2) (c) 3. of the statutes is amended to read:
AB267,5,209 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
10who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
11subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
12applicant and the recommendation of a licensed physician, a licensed physician
13assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed
14advanced practice registered nurse prescriber selected by the applicant from a list
15of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
16podiatrists, and certified licensed advanced practice nurse prescribers registered
17nurses
compiled by the department, the department finds that issuance of a permit
18complies with the intent of this subsection. The use of this review procedure is
19discretionary with the department and all costs of the review procedure shall be paid
20by the applicant.
AB267,5 21Section 5. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
AB267,6,222 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
23in one or both arms and fails to meet the minimum standards of the standard upper
24extremity pinch test, the standard grip test, or the standard nine-hole peg test,
25administered under the direction of a licensed physician, a licensed physician

1assistant, a licensed chiropractor, or a certified licensed advanced practice registered
2nurse prescriber.
AB267,6 3Section 6. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
AB267,6,84 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
5one or both shoulders and fails to meet the minimum standards of the standard
6shoulder strength test, administered under the direction of a licensed physician, a
7licensed physician assistant, a licensed chiropractor, or a certified licensed advanced
8practice registered nurse prescriber.
AB267,7 9Section 7. 29.193 (2) (e) of the statutes is amended to read:
AB267,6,1910 29.193 (2) (e) Review of decisions. An applicant denied a permit under this
11subsection, except a permit under par. (c) 3., may obtain a review of that decision by
12a licensed physician, a licensed physician assistant, a licensed chiropractor, a
13licensed podiatrist, or a certified licensed advanced practice registered nurse
14prescriber designated by the department and with an office located in the
15department district in which the applicant resides. The department shall pay for the
16cost of a review under this paragraph unless the denied application on its face fails
17to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
18the only method of review of a decision to deny a permit under this subsection and
19is not subject to further review under ch. 227.
AB267,8 20Section 8. 29.193 (3) (a) of the statutes is amended to read:
AB267,6,2421 29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
22physician assistant, a licensed optometrist, or a certified licensed advanced practice
23registered nurse prescriber stating that his or her sight is impaired to the degree that
24he or she cannot read ordinary newspaper print with or without corrective glasses.
AB267,9 25Section 9. 45.40 (1g) (a) of the statutes is amended to read:
AB267,7,5
145.40 (1g) (a) “Health care provider" means an advanced practice registered
2nurse prescriber certified who holds a permit to issue prescription orders under s.
3441.16 441.09 (2), an audiologist licensed under ch. 459, a dentist licensed under ch.
4447, an optometrist licensed under ch. 449, a physician licensed under s. 448.02, or
5a podiatrist licensed under s. 448.63.
AB267,10 6Section 10. 46.03 (44) of the statutes is amended to read:
AB267,7,157 46.03 (44) Sexually transmitted disease treatment information. Prepare and
8keep current an information sheet to be distributed to a patient by a physician, a
9physician assistant, or certified an advanced practice registered nurse prescriber
10who holds a permit to issue prescription orders under s. 441.09 (2) providing
11expedited partner therapy to that patient under s. 448.035. The information sheet
12shall include information about sexually transmitted diseases and their treatment
13and about the risk of drug allergies. The information sheet shall also include a
14statement advising a person with questions about the information to contact his or
15her physician, pharmacist, or local health department, as defined in s. 250.01 (4).
AB267,11 16Section 11. 50.01 (1b) of the statutes is repealed.
AB267,12 17Section 12. 50.08 (2) of the statutes is amended to read:
AB267,7,2318 50.08 (2) A physician, an advanced practice registered nurse prescriber
19certified who holds a permit to issue prescription orders under s. 441.16 441.09 (2),
20or a physician assistant licensed under ch. 448, who prescribes a psychotropic
21medication to a nursing home resident who has degenerative brain disorder shall
22notify the nursing home if the prescribed medication has a boxed warning under 21
23CFR 201.57
.
AB267,13 24Section 13. 50.09 (1) (a) (intro.) of the statutes is amended to read:
AB267,8,8
150.09 (1) (a) (intro.) Private and unrestricted communications with the
2resident's family, physician, physician assistant, advanced practice registered nurse
3prescriber, attorney, and any other person, unless medically contraindicated as
4documented by the resident's physician, physician assistant, or advanced practice
5registered nurse prescriber in the resident's medical record, except that
6communications with public officials or with the resident's attorney shall not be
7restricted in any event. The right to private and unrestricted communications shall
8include, but is not limited to, the right to:
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