August 27, 2021
Joint State Government Commission
General Assembly of the Commonwealth of Pennsylvania
Harrisburg, PA 17120
To Whom It May Concern,
On behalf of the Pennsylvania State Nurses Association (PSNA), the professional association representing the interests of the 229,000 registered nurses (RNs) in the Commonwealth, I am writing to recommend that the General Assembly act to ensure the continuity of several waivers and suspensions that are set to expire on September 30, 2021. The waivers and suspensions outlined in this letter have helped nurses and the nursing profession respond to the ongoing COVID-19 pandemic and have ensured access to care for Pennsylvanians.
Virtual State Board of Nursing (SBON) Meetings
The Governor’s initial disaster declaration suspended 63 P.S. § 212.1 (c), which states that members of the SBON must be physically present at Board meetings to be counted as part of a quorum or vote on any issue. Temporarily suspending this requirement permitted the Board to conduct remote meetings. This suspension increased stakeholder participation in Board meetings and improved communication between the Board and licensees. In addition, more stakeholders remain abreast of the issues affecting the Commonwealth’s largest professional licensure board.
After September 30th, SBON meetings will be statutorily required to be held in-person, which will potentially prevent Board members and stakeholders from participating. PSNA recommends that the General Assembly amend 63 P.S. § 212.1 (c) to permit Board members to participate in virtual meetings. Ideally, meetings should be “hybrid” – in-person meetings with the option to participate or view a virtual meeting. It is critical that stakeholders continue to have opportunities to weigh in during meetings.
Certified Registered Nurse Practitioners (CRNPs)
Remaining waivers relating to CRNPs expire on September 30th, which will create a crisis for healthcare management as COVID enters a new phase. Senate Bill 25, which modernizes regulations for CRNPs, is a solution to this crisis.
To provide healthcare systems with the flexibility needed to address healthcare during the pandemic, the Pennsylvania Department of State issued waivers that suspended a range of regulations relating to licensed healthcare practitioners. The most significant waivers relating to CRNPs authorized CRNPs to practice to the fullest extent of their education by suspending the restrictions requiring a CRNP to practice within a specific clinical specialty and by waiving the requirement that a CRNP maintain two collaborative agreements. A collaborative agreement is a regulated contract between a physician and CRNP that must be submitted to the SBON for approval. A sudden influx of new collaborative agreements is expected when the waivers expire on September 30th. This will create a significant backlog and lengthy processing period, leading to CRNPs being unable to work during the expected surge of COVID cases this fall.
Senate Bill 25 would solve this crisis, both in the long- and short-term, by eliminating the requirement for collaborative agreements. States with the provisions in SB 25 in law prior to the pandemic have been more nimble in repositioning the NP workforce to address the challenges presented by COVID. Moreover, this legislation would more closely align Pennsylvania with the CRNP licensure and practice laws of 24 states, including Delaware and Maryland.
COVID-19 waivers provided Pennsylvania with an 18-month trial, which demonstrated the need to retire outdated restrictions and proved that CRNPs provide safe, quality care. SB 25 is a ready solution to solve this emergency, as it has already passed committee in the Senate and has the support needed to pass both chambers. PSNA urges the General Assembly to pass this legislation without delay.
Telemedicine
On March 18, 2020, the Pennsylvania Department of State issued guidance that authorized licensed healthcare professionals to provide services via telemedicine during the COVID emergency. Under this guidance, licensed practitioners in other states are permitted to provide services to Pennsylvanians via telemedicine, without obtaining a Pennsylvania license, for the duration of the emergency.
Telemedicine allows patients access to care in a timely and efficient manner. PSNA recommends that telemedicine services continue permanently, including the ability for patients to be seen by an out-of-state provider if the provider is appropriately credentialed and vetted through the National Practitioner Data Bank. This initiative has been in place since the guidance was issued in March 2020; it will expire on September 30, 2021.
Buprenorphine via Telemedicine
In an effort to combat the opioid epidemic in Pennsylvania, which was exacerbated by the pandemic, measures were put in place to ensure that individuals with opioid use disorder could access buprenorphine treatment via telemedicine.
Federal law requires that before a patient receive an in-person physical evaluation before they can be admitted to an opioid treatment program and treated with buprenorphine. However, the pandemic curtailed many in-person examinations. To fix this, consistent with federal guidance from the Substance Abuse and Mental Health Services Administration, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) suspended the requirement that licensed Narcotic Treatment Programs (NTPs) make a face-to-face determination before admission to receive buprenorphine treatment.
PSNA recommends that buprenorphine treatment via telemedicine should continue permanently. This will ensure that those who need treatment for opioid use disorder are not denied access to said treatment.
COVID-19 Vaccinations
Vaccinations are a critical piece in mitigating the COVID-19 pandemic. All licensees under the SBON have played an important role in getting shots into arms across the Commonwealth. Nursing students, retired nurses, and out-of-state nurses have delivered nearly 12 million vaccine doses to Pennsylvanians. However, there is still work to be done.
Prior to the vaccine roll-out, Pennsylvania nursing students were permitted to administer vaccines as part of their clinical placements through their respective education programs if the students were under the direct supervision of RNs and were properly trained. On December 24, 2020, Governor Wolf approved a waiver allowing supervised nursing students to administer influenza and COVID-19 vaccines. This decision increased the number of qualified providers administering vaccines during the vaccine roll-out. It also provided more experience for student nurses, many of whom now have less clinical experience due to pandemic restrictions.
The Wolf Administration also issued several suspensions in early February 2021, increasing the number of qualified providers administering vaccines. Under the temporary suspension issued February 9th, out-of-state healthcare providers were permitted to administer vaccines in Pennsylvania if they held an unencumbered license in their home jurisdiction. Two similar waivers were issued on February 5th. One allowed Pennsylvania nurses whose license lapsed, expired, or became inactive within the last five years to administer COVID-19 vaccines without reactivating or renewing their license. Another allowed “licensed volunteers,” (former licensees whose licenses expired more than five years ago) to administer vaccines in settings that fall outside the definition of “approved clinic.” Again, these waivers increased the pool of qualified personnel administering vaccine doses.
To date, millions of Pennsylvanians remain unvaccinated. Furthermore, the CDC is recommending booster shots eight months after receiving your second dose. This is not the time to decrease the number of available skilled practitioners qualified to administer COVID-19 vaccinations. Nursing students, out-of-state nurses, and retired nurses play a critical role in ensuring that Pennsylvania reaches herd immunity.
Vaccine-related waivers are set to expire on September 30th, at which point nursing students, out-of-state practitioners, recently retired nurses, and licensed volunteers will be prevented from aiding in the statewide vaccination effort. The General Assembly must ensure that vaccine doses remain accessible to the general public and that there are sufficient skilled personnel to administer them. PSNA recommends that the General Assembly immediately enact legislation to make permanent the aforementioned waivers and suspensions:
- Allowing supervised and educated nursing students to administer influenza and COVID-19 vaccinations outside of their clinical placements
- Allowing out-of-state RNs with licenses in good standing in their home state to administer COVID-19 vaccinations
- Allowing RNs whose Pennsylvania licenses lapsed, expired, or became inactive within the last five years to administer COVID-19 vaccinations
- Allowing licensed volunteers under the SBON to administer COVID-19 vaccinations in settings that fall outside the definition of “approved clinic”
PSNA is willing and able to discuss the above recommendations in greater detail with you and members of your staff. Do not hesitate to reach out to Noah Logan, PSNA Government Relations Specialist.