STATEMENTS OF POLICY
Title 55—PUBLIC WELFARE
[ 55 PA. CODE CHS. 1153, 2380, 5200, 5210, 6400 AND 6500 ]
Medication Prescribing Practices of CRNPs in Mental Health Programs and Mental Retardation Programs
[40 Pa.B. 1644]
[Saturday, March 27, 2010]Scope
This statement of policy applies to the following:
1) Administrative Entity Directors or Administrators
2) Behavioral Health Managed Care Organizations
3) County Mental Health/Mental Retardation Administrators
4) Directors or Administrators of facilities licensed under the following 55 Pa. Code Chapters:
• Chapter 1153 (relating to outpatient psychiatric services)• Chapter 2380 (relating to adult training facilities)• Chapter 5200 (relating to psychiatric outpatient clinics)• Chapter 5210 (relating to partial hospitalization)• Chapter 6400 (relating to community homes for individuals with mental retardation)• Chapter 6500 (relating to family living homes)Purpose
The purpose of this statement of policy is to communicate that, subject to certain conditions, medications may be prescribed by a Certified Registered Nurse Practitioner (CRNP) for individuals who receive services in a facility licensed under 55 Pa. Code Chapters 2380, 5200, 5210, 6400 and 6500.
Discussion
Licensing regulations of the Department of Public Welfare (Department) limit authority to prescribe medication to a physician for an individual who receives services in a facility licensed under Chapters 2380, 5200, 5210, 6400 and 6500. In addition, Medical Assistance conditions of participation for outpatient psychiatric facilities require that medications be prescribed by a licensed physician. (55 Pa. Code § 1153.41(10) (relating to participation requirements)).
These Department regulations are more restrictive than other provisions of State law, which do not limit prescriptive authority to licensed physicians. Under current State law, a CRNP is permitted to prescribe certain medications if granted prescriptive authority by the State Board of Nursing and acting within the scope of a collaborative agreement with a physician. See Section 8.3 of The Professional Nursing Law (63 P. S. § 218.3) and 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
Guideline
The statement of policy is contained in Annex A.
Effective Date
This statement of policy is effective immediately upon publication in the Pennsylvania Bulletin.
Contact Person
For questions related to this statement of policy regarding facilities licensed under Chapters 5200 and 5210 (relating to psychiatric outpatient clinics; and partial hospitalization) by the Office of Mental Health and Substance Abuse Services (OMHSAS), contact OMHSAS at (717) 772-7322.
For questions related to this statement of policy regarding facilities licensed under Chapters 2380, 6400 or 6500 (relating to adult training facilities; community homes for individuals with mental retardation; and family living homes) by the Office of Developmental Programs (ODP), contact the appropriate regional licensing administrator in ODP.
HARRIET DICHTER,
Acting Secretary(Editor's Note: The regulations of the Department, 55 Pa. Code, are amended by adding §§ 1153.41a, 2380.122a, 2380.124a, 2380.126a, 5200.42a, 5210.58a, 6400.162a—6400.164a, 6400.166a, 6500.132a—6500.134a and 6500.136a to read as set forth in Annex A.)
Fiscal Note: 14-BUL-090. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 55. PUBLIC WELFARE
PART III. MEDICAL ASSISTANCE MANUAL
CHAPTER 1153. OUTPATIENT PSYCHIATRIC SERVICES
PROVIDER PARTICIPATION § 1153.41a. Medication prescription—statement of policy.
Medications may be prescribed by a certified registered nurse practitioner in outpatient psychiatric clinics and outpatient partial hospitalization facilities as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
PART IV. ADULT SERVICES MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 2380. ADULT TRAINING FACILITIES
MEDICATIONS § 2380.122a. Labeling of medications—statement of policy.
Prescriptions for medications may be written by a certified registered nurse practitioner as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners). The label on the original container must include the name of the prescribing practitioner.
§ 2380.124a. Medication log—statement of policy.
The medication log must identify the prescribing certified registered nurse practitioner (CRNP) when a medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
§ 2380.126a. Adverse reaction—statement of policy.
Notification of an adverse reaction to a medication may be made to the prescribing certified registered nurse practitioner (CRNP) when the medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
PART VII. MENTAL HEALTH MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 5200. PSYCHIATRIC OUTPATIENT CLINICS
MISCELLANEOUS PROVISIONS § 5200.42a. Medication prescription—statement of policy.
Prescriptions for medications may be written by and dispensed on the order of a certified registered nurse practitioner in outpatient psychiatric clinics as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
CHAPTER 5210. PARTIAL HOSPITALIZATION
MISCELLANEOUS PROVISIONS § 5210.58a. Medication prescription—statement of policy.
Prescriptions for medications may be written by and dispensed on the order of a certified registered nurse practitioner in partial hospitalization facilities as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
PART VIII. MENTAL RETARDATION MANUAL
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
ARTICLE I. LICENSING/APPROVAL
CHAPTER 6400. COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION
MEDICATIONS § 6400.162a. Labeling of medication—statement of policy.
Prescriptions for medications may be written by a certified registered nurse practitioner as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners). The label on the original container must include the name of the prescribing practitioner.
§ 6400.163a. Use of prescription medication—statement of policy.
The review of documentation, including the reason for prescribing the medication, the need to continue the medication and the necessary dosage, may be conducted by a certified registered nurse practitioner (CRNP) as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners) when the medication was prescribed by a CRNP.
§ 6400.164a. Medication log—statement of policy.
The medication log must identify the prescribing certified registered nurse practitioner (CRNP) when a medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
§ 6400.166a. Adverse reaction—statement of policy.
Notification of an adverse reaction to a medication may be made to the prescribing certified registered nurse practitioner (CRNP) when the medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
CHAPTER 6500. FAMILY LIVING HOMES
MEDICATIONS § 6500.132a. Labeling of medication—statement of policy.
Prescriptions for medications may be written by a certified registered nurse practitioner as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners). The label on the original container must include the name of the prescribing practitioner.
§ 6500.133a. Use of prescription medications—statement of policy.
The review of documentation, including the reason for prescribing the medication, the need to continue the medication and the necessary dosage, may be conducted by a certified registered nurse practitioner (CRNP) as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners) when the medication was prescribed by a CRNP.
§ 6500.134a. Medication log—statement of policy.
The medication log must identify the prescribing certified registered nurse practitioner (CRNP) when a medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
§ 6500.136a. Adverse reaction—statement of policy.
Notification of an adverse reaction to a medication may be made to the prescribing certified registered nurse practitioner (CRNP) when the medication was prescribed by a CRNP as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).
[Pa.B. Doc. No. 10-555. Filed for public inspection March 26, 2010, 9:00 a.m.]
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