STAND. COM. REP. NO.  217

Honolulu, Hawaii

                , 2009

RE:   H.B. No. 1378

      H.D. 1

Honorable Calvin K.Y. Say

Speaker, House of Representatives

Twenty-Fifth State Legislature

Regular Session of 2009

State of Hawaii

Sir:

     Your Committee on Health, to which was referred H.B. No. 1378 entitled:

"A BILL FOR AN ACT RELATING TO ADVANCED PRACTICE REGISTERED NURSES,"

begs leave to report as follows:

     The purpose of this bill is to improve access to health care by, among other things:

(1)  Allowing advance practice registered nurses (APRN) to serve as primary health providers:

(2)  Requiring insurers, mutual and fraternal benefit societies, and health maintenance organizations to recognize APRNs as primary care providers; and

(3)  Granting APRNs increased signature authority and prescriptive rights.

     The Hawaii Health Systems Corporation, University of Hawaii at Manoa School of Nursing and Dental Hygiene, Hawaii State Center for Nursing, Hawaii Primary Care Association, Lanai Women's Center, Hawaii Association of Professional Nurses, AARP Hawaii, and several concerned individuals supported this bill.  The Hawaii Government Employees Association supported the intent of this measure.  The Hawaii Medical Association, Kaiser Permanente Hawaii, and American Osteopathic Association opposed this bill.  The Board of Nursing (BON), Disability and Communication Access Board, and Hawaii Medical Service Association submitted comments.

     Your Committee has amended this bill by:

(1)  Excluding certificates of disability used to obtain parking for disabled persons from the documents APRNs are authorized to certify;

(2)  Providing that a person seeking the title of APRN shall have:

(A)  Completed an accredited graduate-level education program leading to a degree or certification as a certified registered nurse anesthetist, a certified nurse midwife, a clinical nurse specialist, or a certified nurse practitioner; or

(B)  Has passed a qualified national certification and various other certification, education, and skill level requirements;

(3)  Reinstituting requirements that the:

(A)  BON establish requirements for advanced nursing practice including education, experience, and national certification; and

(B)  Hawaii Medical Board submit an annual report on changes made to the exclusionary formulary of drugs certain APRNs are authorized to prescribe;

(4)  Changing the effective date to July 1, 2020, to encourage further discussion; and

(5)  Making technical, nonsubstantive changes for clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1378, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1378, H.D. 1, and be referred to the Committee on Consumer Protection & Commerce.

Respectfully submitted on behalf of the members of the Committee on Health,

____________________________

RYAN I. YAMANE, Chair