NJ REGULATIONS SPECIFICALLY INCLUDING APNS: ORGANIZED BY  NJ GOVERNMENT ADMINISTRATIVE DEPARTMENT OR DIVISION:

SECTION I: DEPARTMENT OF LAW AND PUBLIC SAFETY/DIVISION OF CONSUMER AFFAIRS

1. BOARD OF NURSING REGULATIONS: Subchapter 7: Certification Of Advanced Practice Nurses N.J.A.C. 13:37-7.1-11, re-adopted with amendments, 6/16/08; implements the APN statute (see Addendum A for full citation).

2.  BOARD OF NURSING: 13:37-8.1 STANDARDS FOR JOINT PROTOCOLS BETWEEN ADVANCED PRACTICE NURSES AND COLLABORATING PHYSICIANS: re-adopted 11/10/10; 6.3 re-codified as 8.1: detail the content required to be in the JP (see Addendum A for full citation).

3. BOARD OF MEDICAL EXAMINERS, SURGICAL AND ANESTHESIA STANDARDS IN PHYSICIANS OFFICE, adopted 12/16/02, include APNs among providers who can perform minor conduction blocks (at 13:35–4A.11).

4. ALCOHOL AND DRUG COUNSELOR COMMITTEE RULES, N.J.A.C. 13:14C, adopted with amendments 10/5/09, authorize APNs who meet the requirements of the rule to act as clinical supervisors.

Section II: DEPARTMENT OF HEALTH AND SENIOR SERVICES:

1. HOSPITAL LICENSING STANDARDS:

1.     HOSPITAL  LICENSING STANDARDS: N.J.A.C. 8:43G-6.3 ANESTHESIA STAFF: qualifications for administering anesthesia, adopted 3/22/11; contain language re. administration of anesthesia by APNs/anesthesia (See Appendex B for relevant citation.)

2.     HOSPITAL LICENSING STANDARDS: N.J.A.C. 8:43G-6.3 Anesthesia staff: minor regional blocks, re-adopted with amendments regarding minor regional block on 4/4/11 because rules failed to include APNs who are not APNs/anesthesia in rule on adoption 2/22/11; at request of NJSNA, corrected the oversight; now reads at: “ j. minor regional blocks may be administered by 3. APNs in accordance with a .joint protocol established in accordance, with N .J.A.C. 13:37-6.3 (now 8.1) which joint protocol shall require sections governing: i. The availability of an anesthesiologist to consult with the APN on site, on-call or by electronic means.”

3.     HOSPITAL LICENSING STANDARDS: 8:43G-7A.4 PRIMARY STROKE CENTER STAFF QUALIFICATIONS, adopted 2/5/07 and contain language re. NPs acting as member of stroke team, as follows:

(b) At a minimum, an acute care stroke team shall consist of:

1. A neurologist or emergency physician who is board-certified or board-eligible in neurology or emergency medicine with special competence in caring for acute stroke patients; and

2. A registered nurse, physician assistant or nurse practitioner who has demonstrated competency, as determined by the physician director described in (a) above, in caring for acute stroke patients

4.     HOSPITAL LICENSING STANDARDS: 8:43G–4.1 Patient rights, adopted 9/6/05, added definition of “clinical practitioner,” to describe providers who can obtain informed consent, which includes nurse practitioners:

<<+“Clinical practitioner” means a physician, dentist, podiatrist, certified nurse midwife, physician assistant, or nurse practitioner operating within his or her scope of practice.+>>

6.To receive from the patient's physician(s) <<+or clinical practitioner(s)+>> undefinedin terms that the patient understandsundefinedan explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives. If this information would be detrimental to the patient's health, or if the patient is not capable of understanding the information, the explanation shall be provided to his or her next of kin or guardian and documented in the patient's medical record;

7. To give informed, written consent prior to the start of specified nonemergency procedures or treatments only after a physician <<+or clinical practitioner+>> has explainedundefinedin terms that the patient understandsundefinedspecific details about the recommended procedure or treatment, the risks involved, the possible duration of incapacitation, and any reasonable medical alternatives for care and treatment. The procedures requiring informed, written consent shall be specified in the hospital's policies and procedures. If the patient is incapable of giving informed, written consent, consent shall be sought from the patient's next of kin or guardian or through an advance directive, to the extent authorized by law. If the patient does not given written consent, a physician <<+or clinical practitioner+>> shall enter an explanation in the patient's medical record;

5.  HOSPITAL LICENSING STANDARDS: 8:43G-16.6 Medical staff patient services, includes APNs among providers who can perform histories and physicals related to admission; amended on adoption 2/22/11:

(a) (No change.)

(b) Each patient admitted to the hospital shall have a medical history and physical examination that includes a provisional diagnosis performed by a clinical practitioner within 30 days before a hospital or outpatient surgery admission or within 48 hours after admission.

1. If the history and physical were performed earlier than seven days before admission, the patient's medical history and physical examination record completed pursuant to (b) above shall be included in the medical record together with the following, subject to the timeline established in (b)2 below with respect to outpatient surgery patients:

i. A written assessment performed by the attending physician, advanced practice nurse or physician assistant no earlier than seven days before and no later than 48 hours after the patient's admission that includes a physical examination of the patient to update any components of the patient's medical status that may have changed since the prior history and physical, to address any areas as to which more current data are needed and to confirm that the necessity of the procedure or care for which the patient was admitted is still present and the history and physical are still current; and

ii. Regardless of whether there were any changes in the patient's status noted in the assessment performed pursuant to (b)li above, an update note written by the attending physician, advanced practice nurse or physician assistant no earlier than seven days before and no later than 48 hours after the patient's admission addressing the patient's current status and any changes thereto, which note shall be on or attached to the history and physical performed pursuant to (b) above; and

iii.The history and physical, and all updates and assessments, shall be included in the patient's medical record, except in emergency situations, within 48 hours after a hospital admission or, for an outpatient, prior to surgery.

6.DHSS: HOSPITAL LICENSING STANDARDS, PRIMARY STROKE CENTER CONTINUOUS QUALITY IMPROVEMENT, N.J.A.C. 8:43G-7A.6 readopted 8/17/09, includes nurse practitioners with physicians and physician assistants, in requirement to complete form indicating why IV thrombolytic not administered.

7. HOSPITAL LICENSING STANDARDS: EMERGENCY DEPARTMENT RULES AT: 8:43G–12.6 Definitions, adopted 12/20/99, define Qualified Medical Personnel (QMP) to include APNs:

 “Qualified medical personnel” means a physician who meets the requirements at N.J.A.C. 8:43G–12.3, or <<+an advanced practice+>> nurse certified by the New Jersey State Board of Nursing, or a physician assistant licensed by the New Jersey State Board of Medical Examiners. The <<+advanced practice+>> nurse <<- specialist->> or licensed physician assistant shall have training and experience in emergency care.

Note: These definitions also define an “emergency medical condition” which must include evaluation by a physician when the patient comes to the ER. Conditions that don’t meet this definition can be treated by QMPs including APNs, without a physician’s evaluation.

“Emergency medical condition” means:

1. A medical condition manifesting itself by acute symptoms or sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that absence of immediate attention could reasonably be expected to result in:

i. Placing the health of the individual (or, with respect to a pregnant woman the health of the woman or her unborn child) in serious jeopardy;

ii. Serious impairment to bodily functions; or

iii. Serious dysfunction of a bodily organ or part; or

2. With respect to a pregnant woman who is having contractions:

i. That there is inadequate time to effect a safe transfer to another hospital before delivery; or

ii. That transfer may pose a threat to the health or safety of the woman or the unborn child.

Hospital Licensing Standard: 8:43G–12.7 Emergency department patient services

(a) When an individual comes to the emergency department requesting examination or treatment for a medical condition, or if a request is made on the individual's behalf, clinical priority for treatment shall be assigned by a registered professional nurse or qualified medical personnel.

(b) (No change.)

(c) If an individual comes to the emergency department requesting examination or treatment for a medical condition, or if a request is made on the individual's behalf, the hospital shall provide for an appropriate medical screening examination performed by qualified medical personnel. Medical screening may be provided in the emergency department or urgent care clinic or area accessible to the emergency department and on hospital grounds.

(d) If it is determined that an emergency medical condition exists, the patient must be <<-admitted to the emergency department or inpatient service->> <<+evaluated by a physician+>> and provided with such medical treatment as is necessary to assure that the condition has been stabilized, except as provided in (e) below.

(e) If a patient has an emergency medical condition which has not been stabilized, the hospital shall not transfer the patient unless:

1. The patient (or a legally responsible person acting on the patient's behalf), after being informed of the hospital's obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility; or

2. A physician has signed a certification that, based upon the information available at the time of transfer, the medical benefits <<- reasonable->> <<+reasonably+>> expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the patient and, in the case of labor, to the unborn child, from effecting the transfer. This certification shall include a summary of the risks and benefits upon which the certification is based.

(f) If it is determined that an emergency medical condition does not exist, the patient <<-may be->> <<+shall either be+>> treated <<+in the emergency department+>> or <<+shall be+>> referred to an appropriate health care facility or provider<<+; and the patient shall be discharged in accordance with (n) below+>>.

(g) No patient<<+who comes to+>> the emergency department<< shall be discharged to home or another facility without being seen and evaluated by qualified medical personnel. This evaluation shall occur within four hours of the patient's coming to the emergency department.

(h) The hospital shall implement a protocol for meeting the needs of patients in a timely manner, such as augmenting staff and notifying or diverting ambulances when a specified volume of patients in the emergency department is reached, or patient waiting time before initial evaluation by qualified medical personnel+>> exceeds four hours.

(i)-(k) (No change in text.)

(l) No <<-admitted->> patient <<+for whom inpatient admission is required+>> shall be held under clinical observation in the emergency department for more than eight hours if a bed is available in an inpatient unit that has the correct monitoring equipment or can meet the needs of the patient.

(m) A registry of all individuals who come to the emergency department shall be maintained that includes the patient name and a least:

2. Date and time arrived. After <<-(one year after the effective date of these rules)->> <<+December 20, 2000+>>, the names of the ambulance provider and mobile intensive care unit provider, if applicable, shall be entered in the registry;

4. The name(s) of qualified medical personnel who provided the emergency medical screening examination;

5. The name(s) of treating qualified medical personnel;

II. DEPARTMENT OF HEALTH AND SENIOR SERVICES (DHSS)

• B.    DHSS:  LONG TERM CARE REGULATIONS: N.J.A.C. 8:39: Standards for Licensure of Long Term Care Facilities when readopted 8/21/01,, included APNs throughout the rule wherever the language had previously used only the word physician; among other tasks, this authorizes the APN to make both the first and subsequent required visits to patients in LT Care.

COMMENT: The New Jersey State Nurses Association (NJSNA) expresses appreciation for the Department's sensitivity to nursing input during the development of these standards. However, NJSNA recommends the addition of “or advanced practice nurse” in many more areas of the regulations, directly after the use of the word “physician.” NJSNA specifically requests the use of this term at N.J.A.C. 8:39–4.1(a) 1, 2, 6, 17, 19, 21, 22, 23, 25, 28 and 31; 8:39–5.3(b); 8:39–9.6, 24.2 and 29.3; 8:39–33.1(b); and 8:39 Appendix B (IV, B and VI).

RESPONSE: Advanced practice nurses, pursuant to the amended, governing statute (Section 8 or 9 of P.L. 1991, c.377; amended 1999, c. 85, § (6)), are permitted to assume many responsibilities that were previously required to be performed only by physicians. The Department acknowledges this change and agrees to add the language “or advanced practice nurse” to all areas of the rules listed in the New Jersey State Nurses Association's comments above.

3. DHSS: STANDARDS FOR LICENSURE OF AMBULATORY CARE FACILITIES, N.J.A.C.  8:43A, adopted 2003, include APNs (as nurse practitioners/clinical nurse specialists) in the definition of clinical practitioners who can obtain informed consent, under Subchapter 16, Patient Rights. These regs, in Chapter 12, Surgical and Anesthesia Services, still utilize the now retired phrase “CRNA” to describe (now) APNs/anesthesia, relative to delivery of anesthesia and will have to be amended in near future.

4. DHSS: HOSPICE LICENSING STANDARD: N.J.A.C. 8:42C, as adopted 6/21/10, added APNs throughout the chapter as a provider whom the resident can choose as a PCP and recognizes them as providers who may be directing the patient’s care. DHSS cites federal law in making this change: . CMS conditions of participation for hospice services (42 CFR Part 418) has recognized the use of nurse practitioners to function as attending physicians if the patient identifies the nurse practitioner as such. The commenter's recommendation is consistent with both CMS policy and the Department's intent in proposing the inclusion of advanced practice nurse in the proposed amendments to the chapter. This substantive change is appropriate on adoption because it will not increase a burden on the regulated community or decrease a protection to the public. On adoption, the Department will change N.J.A.C. 8:42C-5.1(b) 9 to include a hospice patient's right to select either an attending physician or an “APN.”

5. DHSS: DIVISION OF AGING AND SENIOR SERVICES: N.J.A.C. 8:43 F and J: ADULT AND PEDIATRIC DAY HEALTH SERVICE, rules  re-adopted  11/16, 09, recognize APNs throughout the rule as  primary care providers who may make comprehensive assessments of patients and order specific treatments.

6. DHSS: DIVISION OF HIV/AIDS SERVICES: N.J.A.C. 8:61-4: procedures for testing pregnant women and newborns for HIV(adopted 7/6/2010): recognizes APNs throughout rule as one of the “clinical practitioners” who can order testing and provide care as a PCP

7. DHSS: STANDARDS FOR ASSISTED LIVING RESIDENCES, COMPREHENSIVE PERSONAL CARE HOMES AND ASSISTED LIVING PROGRAMS, N.J.A.C. 8:36, adopted 2/5/07, include APNs as a primary care provider of choice as well as throughout the rule.

8. DHSS: BIRTH DEFECTS REGISTRY, N.J.A.C. re-adopted 11/15/10, names APNs among those professionals who may diagnose or confirm and are required to report children with birth defects to the Department.

9. DHSS: PUBLIC HEALTH SERVICES BRANCH, COMMUNICABLE DISEASES: N.J.A.C. 8:57, readopted with amendments 8/6/09, includes Advanced Practice Nurses among defined “health care providers” throughout the rule.

10. DHSS: DIVISION OF FAMILY HEALTH SERVICES, EARLY INTERVENTION SYSTEM, N.J.A.C. 8:17, amended the rules on adoption 10/6/08 to include Advanced Practice Nurses in responding to (NJSNA) comments: “This change would authorize APNs, in addition to physicians and psychologists[,] to sign the statement or report related to a ‘diagnosed physical or mental condition likely to result in developmental delay’ [and to] issue a proposal for the ‘types and amounts of services' that are appropriate for a child or his or her family through the early intervention system. These [changes would ensure] that families of children seeking or receiving [early intervention] services continue to have access to APNs as providers involved in their care.”

RESPONSE: The Department accepts the commenter's representation that the functions allocated to physicians at proposed new N.J.A.C. 8:17-7.1(e) and (e) 1 are within the licensed scope of practice of advanced practice nurses pursuant to N.J.S.A. 45:11-23 through 52. The Department regrets its oversight in failing to recognize this practice authority in the proposed new rules and will make a change on adoption at proposed new N.J.A.C. 8:17-7.1(e) and (e) 1 to refer to “advanced practice nurses” equivalently with “physicians.”

11. DHSS: COLLECTION, PROCESSING AND DISTRIBUTION OF BLOOD: N.J.A.C. 8.8, adopted 10/3/05, retains RNs as emergency personnel at permanent blood collection sites and permits APNs to order blood and blood products in accordance with a joint protocol with a collaborating physician

12. DHSS: BUREAU OF VITAL STATISTICS AND REGISTRATION, BIRTH CERTIFICATES, N.J.A.C. 8:2, readopted with amendments, 7/5/05, includes APNs and RNs among definition of licensed health care professionals.

13. DHSS: COMMUNICABLE DISEASE SERVICE, VACCINE PREVENTABLE DISEASE PROGRAM,  IMMUNIZATION OF PUPILS IN SCHOOL, N.J.A.C. 8:57, adopted 1/7/08, include APNs with physicians as providers who can at 8:57–4.5 Provisional admission, document that children have had at least one dose of each required age-appropriate vaccine or antigen and are in the process of receiving the remaining immunizations required for school admission (preschool, school or child care center).

14. DHSS: DIVISION OF AGING AND COMMUNITY SERVICE, STATEWIDE RESPITE CARE PROGRAM, N.J.A.C. 8:82, adopted 7/6/04, adds APNs to providers who can certify than an individual is “functionally impaired” and physically dependent upon others for care.

15. DHSS: DIVISION OF LONG TERM CARE SYSTEMS, STANDARDS FOR LICENSURE OF RESIDENTIAL HEALTH CARE FACILITIES, N.J.A.C. 8:43, adopted 2/22/05, add APNs as providers (along with attending physicians) residents can choose for care.

16. DHSS: LICENSING STANDARDS PEDIATRIC COMMUNITY TRANSITION HOMES, N.J.A.C. 8:43D, adopted 12/1/03, added APNs to primary care providers who provide initial and continuing care to residents

• Q.   DHSS: CHILDHOOD LEAD POISONING N.J.A.C. 8:51, adopted 7/19/10 recognizes RN/PHNs as providers who  screen and manage children related to lead poisoning and added APNs as recognized PCPs of children with lead poisoning.
• R.    DHSS: OMBUDSMAN FOR THE INSTITUTIONALIZED ELDERLY, N.J.A.C. 8:90, adopted 2003, added APNs to rule, authorizing them to initiate DNR and DNH orders (in consultation with a physician) in NJ facilities providing care to the elderly; these facilities “… include but are not limited to, nursing homes, skilled nursing homes, intermediate care facilities, extended care facilities, convalescent homes, rehabilitation centers, assisted living facilities, residences, and programs, residential healthcare facilities, comprehensive personal care homes, class “C” and “D” boarding homes, special hospitals, veterans' hospitals, chronic disease hospitals, psychiatric hospitals, mental hospitals, mental retardation centers or facilities, day care facilities for the elderly, and medical day care centers.

SECTION III. DEPARTMENT OF HUMAN SERVICES (DHS):

• A. DHS: DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, ADVANCED PRACTICE NURSE SERVICES, N.J.A.C. 10:58A adopted 4/18/11, describe the reimbursement process for APNs (in full) who provide care for Medicaid fee-for-service and NJ FamilyCare recipients.
• B.    DHS: DIVISION OF MEDICAL ASSISTANCE  AND HEALTHSERVICES ADMINISTRATION MANUAL: N.J.A.C. 10:49: Adopted, 8/4/08. NJSNA noted that at N.J.A.C. 10:49-9.1(c) 1ii. Advanced Practice Nurses (APN) should be added to the list of specialists and other practitioners eligible to receive co-payments to beneficiaries as indicated on their HMO card. APNs may work in practices where they are providing either specialist care or primary care and therefore should be included. The Dept. agreed and added APNs.

3. DHS: DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES,PROSTHETIC AND ORTHOTIC SERVICES: N.J.A.C. 10:55, re-adopted with amendments 1/27/11, added APNs to the providers who can order these devices with the following language: Department will revise N.J.A.C. 10:55-1.6(b) 2 and 4 upon adoption to indicate the applicability of the rule to advanced practice nurses since they are recognized as primary care providers by the New Jersey Medicaid and NJ FamilyCare programs (when licensed/certified in accordance with N.J.A.C. 13:37-7 and enrolled as New Jersey Medicaid and NJ FamilyCare providers in accordance with N.J.A.C. 10:49 and 10:58A) and therefore may, within the scope of their practice, prescribe medically necessary custom made prosthetic or orthotic devices.

• D.   DHS: MANAGED CARE SERVICES FOR NJ MEDICAID AND NJ FAMILYCARE BENEFICIARIES: N.J.A.C. 10: 74 re-proposed  2/7/11, changes the phrase NP/CNS to Advanced Practice Nurses and recognizes APNs among other providers who may be PCPs for these beneficiaries, with the following language: “Primary care provider (PCP)” means a licensed medical doctor (MD) or doctor of osteopathy (DO) or certain other licensed medical practitioner who, within the scope of practice and in accordance with State certification/licensure requirements, standards and practices, is responsible for providing all required primary care services to enrollees, including periodic examinations, preventive health care and counseling, immunizations, diagnosis and treatment of illness or injury, coordination of overall medical care, record maintenance, <<-and->> initiation of referrals to specialty providers described in this chapter<<-,->> and for maintaining the continuity of patient care. This definition includes general/family practitioners, pediatricians, internists and may include specialist physicians, physician assistants, CNMs or advanced practice nurses (APNs), provided that the practitioner is able and willing to carry out all PCP responsibilities in accordance with this chapter and with applicable licensure requirements.
• E.    DHS: HOSPITAL SERVICES MANUAL: N.J.A.C. 10:52, readopted with amendments, 11/24/10, names a psychiatric APN along with a psychiatrist as the provider who must complete a PASRR II screen on an individual with serious mental illness prior to placement in a nursing facility. (An amendment to the law allows physicians to complete the assessment in the absence of a psychiatrist of psychiatric APN).
• F.    DHS: STANDARDS FOR COMMUNITY RESIDENCES FOR PERSONS WITH HEAD INJURIES: N.J.A.C. 10:44C, re-proposed 3/2/09, includes APNs as a recognized provider along with physicians

7. DHS: DIVISION OF ADDICTION SERVICES, LICENSURE OF OUTPATIENT SUBSTANCE ABUSE TREATMENT FACILITIES, N.J.A.C. 10: 161B, adopted 6/1/09, added APNs to parts of the rule and allows them to be director of substance abuse counseling if they are certified clinical supervisors (CCS) or LCADCs (Licensed Clinical Alcohol and Drug Counselors). The Division declined to add APNs to the definition of “practitioner” in the rule claiming that statutory language at N.J.S.A. 45-9:22-4 “limits the definition of practitioner to physicians, podiatrists and chiropractors.” The Division also declined to require that an RN who is the director of substance abuse counseling have a masters degree as a psychiatric APN because they claim the degree isn’t germane to the issue of substance abuse.

8. DHS: OFFICE OF LICENSING, STANDARDS FOR COMMUNITY RESIDENCES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES: N.J.A.C. 10:44A-1.3, proposed with amendments 6/1/09, added APNs (to physicians) as a “health care provider.”

9. DHS: DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, ADULT MENTAL HEALTH REHABILITATION SERVICES PROVIDED IN/BY COMMUNITY RESIDENCE PROGRAMS, N.J.A.C. 10:77A, re-proposed with amendments 3/2/09, include definitions of both Registered Professional Nurse and APN in the rule.

• J.     DHS: DIVISION OF MENTAL HEALTH SERVICES, SHORT TERM CARE FACILITIES STANDARDS, RE-ADOPTED WITH AMENDMENTS,  N.J.A.C. 8:37G, adopted, 1/22/08. According to the definition of these rules, “Licensed independent practitioner” means an individual permitted by law to provide mental health care services without direct supervision, within the scope of the individual's license to practice in the State of New Jersey pursuant to N.J.S.A. 45:1-1 et seq., and may include physicians, advanced practice nurses, licensed clinical social workers, and psychologists.
• K.   DHS: DIVISION OF MENTAL HEALTH SERVICES, ADVANCED DIRECTIVES FOR MENTAL HEALTH CARE STANDARDS, N.J.A.C., adopted 6/18/07, state: “Licensed independent practitioner” means an individual permitted by law to provide mental health care services without direct supervision, within the scope of the individual's license to practice in the State of New Jersey pursuant to N.J.S.A. 45:1-1 et seq., and may include physicians, advanced practice nurses, licensed clinical social workers, and psychologists. Furthermore, the rule says that: “ For purposes of determining whether a patient, who has executed an advance directive for mental health care, has or does not have the capacity to make a particular mental health treatment decision, a physician<<+advanced+>> practice nurse, or psychologist on the declarant's treatment team may function as a responsible mental health care professional, but for all other purposes, each member of the State hospital treatment team assigned to the declarant may be considered a “responsible mental health care professional.”
• L.    DHS, DIVISION OF MENTAL HEALTH SERVICES, BASIS OF PAYMENT OUTPATIENT HOSPITAL SERVICES, PROGRAM REQUIREMENTS, N.J.A.C. 10:51A (new rules) and amendments (10:51-1.2 and 4.3), adopted 2/5/07, include APNs with psychiatrist as providers of psychiatric treatment.

13. DHS: STANDARDS FOR PRIVATE LICENSED FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES: N.J.A.C. 10:57, adopted 3/5/07, added APNs along with physicians throughout the rule as a primary care provider option for individual residents.

14. DHS: DIVISION OF MENTAL HEALTH SERVICES, PARTIAL CARE SERVICES STANDARDS, N.J.A.C. 10: 37, re-adopted with amendments 5/6/06, includes APNs, along with psychiatrists among providers of mental health services who are part of the interdisciplinary team and authorized to sign the patients Individualized Recovery Plan.

• O.   DHS: DIVISION OF YOUTH AND FAMILY SERVICES, MANUAL OF REQUIREMENTS FOR FAMILY DAY REGISTRATION, N.J.A.C. 10:126, proposed 2/17/04, added an inclusive definition of health care provider to include health care professionals other than physicians, including APNs.

16. DHS: DIVISION OF YOUTH AND FAMILY SERVICES, MANUAL OF REQUIREMENTS FOR CHILD CARE REGISTRATION, N.J.A.C. 10:122, adopted 11/18/02, include APNs among defined “health care providers.”

17. DHS: DIVISION OF MEDICAL AND HEALTH SERVICES, HEARING AID SERVICES, N.J.A.C. 10:64, adopted 8/24/06, added APNs (to physicians) as providers authorized to perform hearing screening tests necessary to determine a need for further audiological examination in Medicaid beneficiaries.

SECTION III. DEPARTMENT OF CORRECTIONS:

• A.   DEPARTMENT OF CORRECTIONS, MEDICAL AND HEALTH SERVICES, N.J.A.C. 10A: 16, readopted 4/19/10, with amendments, recognizes APNs among health care providers who may be on call 24/7 (but declines to allow them to be mental health supervisors because they “cannot direct” physicians).

2. DEPARTMENT OF CORRECTIONS, STRIP AND BODY CAVITY SEARCHES: N.J.A.C. 10:31, adopted 7/6/10, with amendments, includes RNs and APNs among those “licensed medical professionals” authorized to performs these searches.

SECTION IV: DEPARTMENT OF CHILDREN AND FAMILIES

1. IN-COMMUNITY MENTAL HEALTH REHABILITATIVE SERVICES FOR CHILDREN, YOUTH AND YOUNG ADULTS, N.J.A.C.10:200, rules proposed 11/19/07, recognize APNs along with psychiatrists, psychologists as licensed mental health care providers authorized to provide mental health services.

• B.    DEPARTMENT OF CHILDREN AND FAMILIES, PSYCHIATRIC COMMUNITY RESIDENCES FOR YOUTH, N.J.A.C. 10:128, re-adopted with amendments, 6/21/10, includes psychiatric APNs among the providers who may be supervising care of a resident.
• C.    PSYCHIATRIC COMMUNITY RESIDENCES FOR YOUTH: Adopted Amendments: N.J.A.C. 10:128-1, 2.1, 3.2, 3.3, 3.6, 3.7, 3.8, 5.2, 5.3, 5.4, 6.1, 6.5, 6.8 and 7.4; Adopted New Rule: N.J.A.C. 10:128-3.10, Adopted May 16, 2010

The child's treatment may be under the supervision of an Advanced Practice Nurse (APN) as specified in N.J.S.A. 45:11-45 et seq., certified in the category of psychiatric/mental health and as supported by a collaborative agreement with the facility psychiatrist and joint protocol document as specified in N.J.A.C. 13:37-6.3

SECTION VI:  DEPARTMENT OF BANKING AND INSURANCE:

1. HMO Rules which Implement the Health Care Quality Act: N.J.A. C. 8:38 and 8:38A:

Relevant language:

(f) Those providers qualified to function as PCPs include:

1. A licensed physician who has successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association in family practice, internal medicine, general practice, obstetrics and gynecology or pediatrics;

2. A licensed physician who does not meet the standards of (e)1 above, but who has been evaluated by the carrier's committee charged with setting standards for and reviewing provider credentialing under the direction of the carrier's medical director, and is found by that committee to demonstrate through training, education and experience, equivalent expertise in primary care;

3. Nurse practitioners/clinical nurse specialists certified by the State Board of Nursing in accordance with N.J.S.A. 45:11–45 et seq. in advance practice categories comparable to family practice, internal medicine, general practice, obstetrics and gynecology or pediatrics, and in hospitals or other facilities;

4. Physician assistants licensed by the New Jersey Board of Medical Examiners;

5. Certified nurse midwives registered by the New Jersey Board of Medical Examiners; and

6. At the discretion of the carrier, appropriate, licensed medical specialists for specified individual covered persons or patient groups who, due to health status or chronic illness, would benefit from medical care management by such a medical specialist.

• B.    DEPARTMENT OF BANKING AND INSURANCE (DOBI): N.J.A.C. 11:22-5.5 (a) Minimum Standards for Health Benefits Plans, Prescription Drug Plans and Dental Plans, adopted 9/8/09, changed the phrase primary care physician to primary care provider to assure that the rule is consistent with the Health Care Quality Act (P.L. 1997, c.192), which allows health maintenance organizations to recognize APNs as PCPs.

SECTION VII: DEPARTMENT OF EDUCATION:

1. DEPARTMENT OF EDUCATION, PROGRAMS TO SUPPORT STUDENT DEVELOPMENT, N.J.A.C. 6A: 16, re-adopted 1016/06, authorize APNs to perform the “medical examinations” necessary for student participation in school athletic programs.

SECTION VIII. DEPARTMENT OF LABOR

A.    DEPARTMENT OF LABOR, WORK FIRST NJ PROGRAM, N.J.A.C. 10:90, readopted 9/21/09, includes APNs (along with physicians and psychologists) among providers who can complete the WFNJ/Med-1 report attesting to an individual’s permanent disability.

B.    DEPARTMENT OF LABOR, DIVISION OF TEMPORARY DISABILITY INSURANCE, TEMPORARY DISABILITY BENEFITS, N.J.A.C. 12:18, proposed for re-adoption 6/2/08 with a single amendment: adds Advanced Practice Nurses to list of “licensed medical practitioners” who can make assessment of and sign temporary disability papers (mandated by P.L. 2004, c.168).

SECTION IX: DEPARTMENT OF HIGHER EDUCATION:

1. HIGHER EDUCATION: PRIMARY CARE PHYSICIAN AND DENTIST LOAN REDEMPTION PROGRAM: N.J.A.C. 9A:16, adopted 2/7/11: primary care definition includes the practice of a nurse practitioner as per the following language in the rule:

• “Primary care” means the practice of family medicine, general internal medicine, general pediatrics, general obstetrics, gynecology, pediatric dentistry, general dentistry, public health dentistry, and any other areas of medicine or dentistry defined as such by the Commissioner of Health and Senior Services. Primary care also includes the practice of a nurse-practitioner, certified nurse-midwife, and physician assistant as defined by the U.S. Department of Health and Human Services regulations at 42 CFR Part 62.

SECTION X: DEPARTMENT OF ENVIRONMENTAL PROTECTION:

1. DEPARTMENT OF ENVIRONMENTAL PROTECTION, RADIATION PROTECTION PROGRAMS, RADIOLOGIC TECHNOLOGY, N.J.A.C.7:28-19, adopted 8/18/08: While declining to add Advanced Practice Nurses as a “licensed practitioner” along with physicians, podiatrists and chiropractors, DOE does acknowledge that APNs by virtue of statutory and regulatory law have the authority to order diagnostic tests which may involve radiologic examinations, and that these rules do not limit that authority

SECTION XI: DEPARTMENT OF LAW AND PUBLIC SAFETY (LPS):

           

1. LPS: JUVENILE JUSTICE COMMISSION, UNDER N.J.A.C. 13:95–16.7 Special psychological/psychiatric assessment required of juvenile on special observation status prior to discipline, includes psychiatric APNs among mental health professionals authorized to complete an assessment and the Form JJC CO-6 Disciplinary Report.

2. LPS: JUVENILE JUSTICE COMMISSION, SECURE FACILITIES: N.J.A.C. 13:95, includes psychiatric APNs among those mental health professionals who can assess a resident for recommendation to a Behavioral Accountability Unit and nurse practitioners as authorized health care personnel under Medical Staff.