RULES AND REGULATIONS
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF NURSING
[49 PA. CODE CH. 21]
Child Abuse Reporting Requirements
[52 Pa.B. 1916]
[Saturday, March 26, 2022]The State Board of Nursing (Board) amends §§ 21.28, 21.29, 21.131, 21.155, 21.156, 21.271, 21.331, 21.501—21.507, 21.603, 21.605, 21.721, 21.723, 21.724, 21.811, 21.812 and 21.822; and adds §§ 21.20, 21.150, 21.508 and 21.509 to read as set forth in Annex A.
Effective Date
This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
Statutory Authority
Section 2.1(k) of the Professional Nursing Law (63 P.S. § 222.1(k)) and section 17.6 of the Practical Nurse Law (63 P.S. § 667.6) set forth the Board's general rulemaking authority. Under 23 Pa.C.S. Chapter 63 (relating to Child Protective Services Law) (CPSL), specifically section 6383(b)(2) of the CPSL (relating to education and training), the Board is required to promulgate regulations to implement the mandatory reporting requirements for licensees of the Board.
Background and Purpose
Beginning in 2014, and continuing through 2019, the General Assembly has made numerous amendments to the CPSL, including the requirement imposed by the act of April 15, 2014 (P.L. 411, No. 31) (Act 31) on all health-related boards to require training in child abuse recognition and reporting. Section 2 of Act 31 provides that these training requirements apply to all persons applying for a license or certificate, or applying for renewal of a license or certificate, on or after January 1, 2015. The Board implemented the training requirements as mandated at the beginning of 2015 and subsequently proposed this rulemaking to update the Board's existing regulations on the subject of child abuse reporting to be consistent with the CPSL, as amended.
The proposed rulemaking was published at 51 Pa.B. 558 (January 30, 2021) for 30 days of public comment, but no public comments were received. The Independent Regulatory Review Commission (IRRC) submitted comments on March 31, 2021. The House Professional Licensure Committee (HPLC) and the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) did not submit comments. The following represents a summary of IRRC's comments and the Board's response, and a description of the amendments made to this final-form rulemaking.
Summary of IRRC's Comments and the Board's Response
Initially, IRRC points out that the proposed rulemaking did not amend the application and continuing education requirements in Subchapters C and H (relating to certified registered nurse practitioners; and clinical nurse specialists). IRRC acknowledged that these certifications are held by individuals who are licensed registered nurses and asks the Board to explain how the child abuse recognition and reporting training and continuing education requirements in 23 Pa.C.S. § 6383(b)(3(i) and (ii) are implemented for these certifications. Further, IRRC asked the Board to consider clarifying these subchapters by either adding the child abuse recognition and reporting requirements or cross-references to the applicable registered nurse regulations.
The mandatory training requirements under the CPSL are applicable to all licenses and certificates issued by the Board. So, if a licensed registered nurse subsequently applies for a certificate as a certified registered nurse practitioner or as a clinical nurse specialist, the registered nurse is required to have completed at least 3 hours of approved training in child abuse recognition and reporting as a condition of certification. If the registered nurse's education profile in the Pennsylvania Licensing System (PALS) contains evidence of at least 3 hours of approved training, as reported by approved course providers, the certificate would be issued. If not, the individual would need to complete the required training. Often, an applicant will apply for both credentials simultaneously, such as when the individual is already licensed as a registered nurse/certified as a certified registered nurse practitioner from another state. That individual would only need to complete 3 hours of approved training, not 6, which would be applied to both credentials. As for the continuing education that is required as a condition of biennial renewal, when a Board-regulated practitioner takes an approved course and that attendance/participation is reported by the approved provider, it is applied to all licenses and certificates held by the individual. Thus, if an individual holds both a registered nurse license and a certificate as a certified registered nurse practitioner, both of which expire on the same date under § 21.331(a) (relating to biennial renewal of certification), that individual would not need to take the course twice or apply for an exemption.
This would also apply across licensure Boards within the Bureau of Professional and Occupational Affairs (Bureau) that also require this training. For example, a registered nurse license issued by the Board is a prerequisite to obtaining a license as a nurse-midwife from the State Board of Medicine. When an individual holding both licenses takes an approved course, the report from the approved provider received by the Bureau is applied to both licenses. When the licensee applies for biennial renewal, the PALS system then ''looks back'' 24 months from the applicable expiration date of the license to determine whether the individual completed an approved course of at least 2 hours in child abuse recognition and reporting during the relevant biennial licensure cycle. If so, the license is renewed. Provided the course was completed within the 2-year biennial renewal cycle for each license/certificate held by the individual, there is no need to repeat the course or obtain an exemption from either board. However, because different boards have different biennial renewal cycles, it is incumbent upon the licensee to make sure that they complete the training at a time when the biennial renewal periods overlap, or risk having to take the course again.
In response to this inquiry by IRRC, the Board makes a number of amendments to this final-form rulemaking. First, the Board clarifies in § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirements) that if a licensee holds more than one license or certificate issued by the Board, or holds a license issued by another licensing board within the Bureau that required mandatory training in child abuse recognition and reporting, credit for completion of an approved course will be applied to both credentials. In addition, the Board adds references to the mandatory training requirements for certified registered nurse practitioners and clinical nurse specialists in Subchapters C and H, as suggested by IRRC. Specifically, the Board adds to §§ 21.171, 21.811 and 21.812 (relating to certification requirements; qualifications for initial certification; and qualifications for certification by endorsement; additional certification) the requirement that an applicant for initial certification shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a); and adds to §§ 21.331 and 21.822 (relating to biennial renewal of certification) the requirement to have completed at least 2 hours of approved training as a condition of biennial renewal in accordance with § 21.508(b).
Next, IRRC points out that §§ 21.20, 21.28(f), 21.131(d) and (e), 21.150, 21.155(f) and 21.723(b)(3) require an applicant or licensee to ''submit proof of completion'' of the required training, while it is the approved course provider that reports participation/attendance electronically to the Bureau. IRRC asked the Board to revise these sections to clarify that the approved course provider electronically reports proof of attendance/completion. In response, the Board amends each of these sections to aid clarity. Each section is amended in this final-form rulemaking to require the applicants to ''complete'' the required training or ''cause to be submitted'' the proof of completion of the mandated reporter training. In addition, the Board amends § 21.508(a) to clarify that the Board will not issue a license or certificate unless the Bureau has received a report from an approved course provider documenting the attendance/participation by the applicant, or the applicant has obtained an exemption from the Board.
Pertaining to § 21.501 (relating to definitions), IRRC offered two comments. First, IRRC commented that subparagraphs (i)(D) and (ii)(D) of the definition of ''perpetrator'' would be clearer if the specifically-defined term ''person responsible for the child's welfare'' were used. In response, the Board amends these subparagraphs to use the defined term. IRRC's second comment noted that the definition of ''serious physical neglect'' does not include the phrase ''when committed by a perpetrator'' as specified in the definition of this term in 23 Pa.C.S. § 6303 (relating to definitions). IRRC asked the Board to revise the definition to include the omitted language. Initially, the Board had omitted the language because the Board did not want to dissuade individuals from making a report of suspected child abuse if they did not know who was responsible for the ''serious physical neglect'' or imply that they had a duty to determine whether that individual would be considered ''a perpetrator'' under the CPSL. However, the Board adds the omitted language as requested by IRRC. In addition, amendments made in response to IRRC's next comment provide additional clarity that a mandated reporter is not required to identify the person responsible for the child abuse to make a report.
Next, IRRC notes that § 21.502(a) (relating to suspected child abuse—mandated reporting requirements) requires a Board-regulated practitioner to report suspected child abuse when there is reasonable cause to suspect that a child is a victim of child abuse under a set of circumstances derived from 23 Pa.C.S. § 6311(b)(1) (relating to persons required to report suspected child abuse), but that the provisions of 23 Pa.C.S. § 6311(b)(2) and (3) have been omitted. These provisions provide that the responsibility to report suspected child abuse exists even when certain information is unknown. Specifically, they provide that:
''(2) Nothing in this subsection shall require a child to come before the mandated reporter to make a report of suspected child abuse.
(3) Nothing in this subsection shall require the mandated reporter to identify the person responsible for the child abuse to make a report of suspected child abuse.''
The Board agrees that the omitted language does clarify the scope of the duty to report and has been added to § 21.502, which necessitated some re-numbering of the section.
With regard to § 21.503 (relating to photographs, medical tests and X-rays of child subject to report), IRRC noted that under 23 Pa.C.S. § 6314 (relating to photographs, medical tests and X-rays of child subject to report), these types of materials ''shall be made available to law enforcement officials in the course of investigating cases.'' However, this requirement was not included in the proposed rulemaking. For consistency, IRRC suggested that the Board should add the statutory requirement to make these materials available to law enforcement officials. The Board agrees and adds the omitted language to this final-form rulemaking.
Next, IRRC offered a number of comments pertaining to § 21.508. First, IRRC notes that subsection (a), which requires an individual applying for initial licensure to complete at least 3 hours of training in child abuse recognition and reporting requirements, does not address the documentation and reporting of completion of training as required under 23 Pa.C.S. § 6383(b)(3)(i). IRRC asked the Board to revise this subsection to include the implementation procedures for submission of proof of training by an approved course provider. The Board amends this section to clarify that applicants for an initial license or certificate shall have completed the required training, which has been approved by the Department of Human Services and the Bureau. Further, the Board adds the requirement that the applicant shall certify on the application that the training has been completed, and that the Board will not issue a license or certificate unless the Bureau has received an electronic report from an approved course provider documenting the attendance/participation by the applicant or the applicant has obtained an exemption from the Board.
IRRC also noted that subsection (b) indicates that the Board will not renew a license unless the Bureau has received an electronic report from an approved course provider documenting the attendance/participation by the licensee in an approved course or the licensee has obtained an exemption under subsection (c). However, IRRC pointed out that § 21.131(b) (relating to continuing education) provides that a registered nurse ''will not be required to meet the continuing education requirement on the first renewal immediately following licensure.'' IRRC asked the Board to explain how it will implement the child abuse recognition and reporting continuing education requirements for registered nurse's who are exempt from continuing education following initial licensure.
There is no exception provided by the CPSL that would excuse a registered nurse from complying with the mandated reporter training requirements the first time they renew. However, as a practical matter, the PALS system was programmed to ''look back'' 24 months to determine if a licensee applying for renewal has completed an approved course of at least 2 hours. If so, the license would be renewed. If not, the licensee would receive a discrepancy notice. Since an applicant is required to complete at least 3 hours of training as a condition of licensure, if the subsequent renewal occurs within 2 years of the date of completion of that course, the PALS system would renew the registered nurse's license without requiring an additional 2 hours of approved training. However, it would depend on when the initial training was completed as compared to the expiration date of the individual's license. If the first renewal would fall beyond the 24-month look-back period from the date the licensee completed the initial training, then the licensee would need to complete the additional 2 hours. The Board believes this comports with the statutory intent that a licensee be required to complete at least 2 hours of training in child abuse recognition and reporting during each biennial licensure cycle. In response to IRRC's comment, the Board amends § 21.131(b) to clarify that the exception does not apply to the mandatory continuing education in child abuse recognition and reporting. The Board also notes that licensed practical nurses currently have no continuing education requirements at all, but are required to complete the mandatory training in child abuse recognition and reporting as a condition of renewal and would likewise not be exempt during their first renewal after initial licensure.
With regard to § 21.508(c), which provides for circumstances in which the Board may grant an exemption from the mandatory training requirements, IRRC raised three concerns. First, the standards for documentation and evaluation are vague. Second, this subsection does not specify if the exemption is limited to one biennial renewal period. Third, the process for notification of approval or denial is not stated. IRRC asked the Board to explain the standards for sufficient documentation and the evaluation process for reviewing a request for exemption, including if there is a time frame for completion of training prior to applying for an exemption. IRRC also asked the Board to consider clarifying this subsection to state the time period of the exemption and the process for notifying applicants and licensees.
In response to IRRC's comments, the Board makes a number of amendments to subsection (c). First, the Board clarifies that for purposes of licensure renewal, comparable training in child abuse recognition and reporting completed as required either under the Public School Code of 1949 (24 P.S. §§ 1-101—27-2702) or under 23 Pa.C.S. § 6383(c) for individuals subject to regulation by the Department of Human Services must have been completed during the relevant biennial renewal period. Next, the Board amends paragraph (3) to clarify the standards for review of other exemption requests. It is difficult to specify what documentation might be ''acceptable to the Board,'' because it would depend on the reason for the exemption request. For example, it may include documentation that the licensee is an approved trainer in the area of child abuse recognition and reporting. Another example might be a licensee who volunteers as a Court-appointed Special Advocate for children who are victims of abuse or neglect. These individuals are required to complete at least 30 hours of pre-service training and 12 hours of annual in-service training. See 37 Pa. Code § 200.221 (relating to training). In this case acceptable documentation may consist of proof of having completed the annual in-service training. Generally, the Board evaluates these requests to determine whether training in the area of child abuse recognition and reporting would be duplicative of other training the individual has completed or is unnecessary under the circumstances. In addition, the Board would not find it sufficient for an applicant or licensee to simply state that they do not include children in their practice, due to the expanded scope of the duty to report set forth in section 6311(b) of the CPSL which no longer requires the mandated reporter to come into contact with the child in the course of their employment, occupation or practice of a profession.
The Board adds new subsection (d) to clarify that exemptions granted under subsection (c) are only applicable for the biennial renewal period for which the exemption is requested. This, too, the Board believes is consistent with the statutory intent that a mandated reporter be required to complete at least 2 hours of approved training every 2 years or obtain an exemption from the Board. The Board explains the process for notifying applicants/licensees of the grant or denial of an exemption request in subsection (d). If an exemption is granted, the license or certificate will be issued or renewed. If an exemption is denied, the applicant or licensee will receive a discrepancy notice by e-mail notifying them of the need to complete an approved course, or to submit additional documentation in support of their request for an exemption.
With regard to § 21.721 (relating to qualifications for licensure), IRRC pointed out that because the approved course providers electronically report participation/attendance to the Bureau, subsection (c) should be revised to delete the word ''submit.'' The Board agrees and makes this correction. In addition, IRRC pointed out a number of miscellaneous clarity issues resulting from typographical and other errors in §§ 21.501, 21.502, 21.507(b)(4), 21.603(b) and 21.605, as well as in the Regulatory Analysis Form. These are corrected in this final-form rulemaking.
Description of the Amendments to this Final-Form Rulemaking
The following is a description of the amendments made to this final-form rulemaking.
§§ 21.20 and 21.150 Licensure by examination
In response to comments from IRRC, the Board amends these sections to eliminate the requirement that an applicant for licensure ''submit proof of completion of'' the mandatory training in recognition of the fact that it is the approved course provider that actually submits the report to the Bureau. Instead, these sections will simply require an applicant to complete the required training.
§§ 21.28 and 21.155 Licensure by endorsement
A similar revision was made to these sections to clarify that an applicant for licensure by endorsement shall complete at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a), which now makes it clear that the Board will not issue the license unless the approved course provider has submitted the required report to the Bureau.
§ 21.131 Continuing education
In response to IRRC's comments, subsection (b) is amended to make it clear that there is no exception to the mandatory continuing education in child abuse recognition and reporting for licensees who are renewing for the first time. In addition, subsections (d) and (e) are amended to clarify that a registered nurse seeking reinstatement or reactivation of a lapsed, inactive or suspended license would be required to submit, or cause to be submitted, documentation demonstrating the completion of 30 hours of continuing education, including at least 2 hours in approved training in child abuse recognition and reporting.
§ 21.156 Renewal of license
The Board amends subsection (b.1) to be consistent with other provisions by adding the term ''approved'' to make it clear that the 2 hours of training in child abuse recognition and reporting must be approved by the Department of Human Services and the Bureau.
§ 21.271 Certification requirements
In response to IRRC's comments, the Board adds a cross-reference in subsections (a) and (b) to the mandatory training requirements in § 21.508(a) to make it clear that applicants for certification as a certified registered nurse practitioner must have completed at least 3 hours of approved training in child abuse recognition and reporting as a condition of certification.
§ 21.331 Biennial renewal of certification
Likewise, the Board amends this section to add a cross-reference to the requirement that a certified registered nurse practitioner complete at least 2 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(b) as a condition of renewal.
§ 21.501 Definitions
The Board amends the definition of the term ''mandated reporter'' to refer to this ''subchapter'' rather than ''chapter.'' The definition of ''perpetrator'' is amended to incorporate the specifically-defined term ''person responsible for the child's welfare,'' and to correct a typographical error to refer to ''birth or adoption to the child.'' A typographical error is corrected in the definition of ''recent act or failure to act'' correcting the word ''of'' to read ''or.'' The Board adds the omitted phrase ''when committed by a perpetrator'' to the definition of ''serious physical neglect.''
§ 21.502 Suspected child abuse—mandated reporting requirements
The Board amends subsection (a) to incorporate the provisions of 23 Pa.C.S. § 6311(b)(2) and (3) to clarify that ''nothing in this subsection shall require a child to come before the mandated reporter'' and that ''nothing in this subsection shall require the mandated reporter to identify the person responsible for the child abuse'' for the mandated reporter to make a report of suspected child abuse. In addition, the term ''subparagraph'' is corrected to read ''paragraph'' in subsection (c)(1).
§ 21.503 Photographs, medical tests and X-rays of child subject to report
As suggested by IRRC, the Board adds language clarifying that medical summaries or reports of the photographs, X-rays and relevant medical tests shall be made available to law enforcement officials in the course of investigating cases under 23 Pa.C.S. § 6490(a)(9) or (10) (relating to release of information in confidential reports).
§ 21.507 Noncompliance
The citation to the relevant section of the CPSL is corrected to read ''23 Pa.C.S. § 6319'' in paragraph (4).
§ 21.508 Child abuse recognition and reporting—mandatory training requirement
In response to IRRC's comments, the Board makes substantial edits to this section. First, subsection (a), pertaining to the mandator training in child abuse recognition and reporting required for initial licensure or certification, the Board amends the language to clarify that an applicant shall have completed at least 3 hours of training which has been approved by the Department of Human Services and the Bureau, as set forth in § 21.509 (relating to child abuse recognition and reporting course approval process). In addition, the Board includes a requirement that the applicant shall certify on the application that the training has been completed or that the applicant has received an exemption from the Board. Finally, the Board adds a notice that the Board will not issue a license or certificate unless the Bureau has received an electronic report from an approved course provider documenting the attendance/participation by the applicant or the applicant has obtained an exemption under subsection (c).
Additionally, the Board amends subsection (b) to make it clear that licensees seeking renewal of a license or certificate issued by the Board are required to complete at least 2 hours of approved continuing education in child abuse recognition and reporting as a condition of renewal, and that the training must have been completed within the applicable biennial renewal period. The Board clarifies that if a licensee holds more than one license or certificate issued by the Board, or holds a license issued by another licensing board within the Bureau that requires mandatory training in child abuse recognition and reporting, credit for completion of an approved course will be applied to both credentials.
The Board amends subsection (c)(1) and (2) to clarify that, for purposes of licensure renewal, an exemption may be granted to individuals who have completed comparable training provided that the training must have been completed during the relevant biennial renewal period. Paragraph (3) is amended to provide that the Board may otherwise grant an exemption of the applicant or licensee submit documentation acceptable to the Board indicating that the completion of the mandated reporter training is duplicative or unnecessary under the circumstances, and that it is not enough that the applicant or licensee state that they do not include children in their practice.
Finally, the Board adds subsection (d) to provide that exemptions granted under subsection (c) are applicable only for the biennial renewal period for which the exemption is requested and to set for the process by which the Board will notify applicants and licensees of the grant or denial of an exemption request.
§ 21.603 Applications
The Board corrects a typographical error in subsection (b) where the term ''licensee'' should have read ''license.'' In addition, for the sake of consistency, the Board clarifies that the training in child abuse recognition and reporting must be ''approved.''
§ 21.605 Biennial renewal
The Board corrects the citation to section 6(c) of the Volunteer Health Services Act.
§§ 21.272 and 21.723 Qualifications for licensure; and license renewal
Both of these sections, pertaining to licensed dietitian-nutritionists, are amended to clarify the fact that the applicant/licensee shall complete the training or ''cause to be submitted'' proof to the Board of completion of the required training, in recognition of the fact that it is the approved course provider that submits the report of the applicant's/licensee's completion of the required training.
§§ 21.811 and 21.812 Qualifications for initial certification; and qualifications for certification by endorsement; additional certification
In response to IRRC's comments, the Board adds a cross-reference to the mandatory training requirements in § 21.508(a) to make it clear that applicants for certification as a clinical nurse specialist must have completed at least 3 hours of approved training in child abuse recognition and reporting as a condition of certification.
§ 21.822 Biennial renewal of certification
Likewise, the Board amends this section to add a cross-reference to the requirement that a clinical nurse specialist complete at least 2 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(b) as a condition of renewal.
Fiscal Impact and Paperwork Requirements
The Board does not anticipate any significant fiscal impact or paperwork requirements relating to these amendments. Registered nurses, dietitian-nutritionists, clinical nurse specialists, certified registered nurse practitioners and volunteer license holders are already required to complete mandatory continuing education, and as these 2 hours are incorporated in the existing requirement, there would be no increased burden. Only applicants for licensure/certification and licensed practical nurses would incur an additional requirement. Because there are many low-cost and free options available to complete the training, the Board anticipates this impact to also be minimal. Because all approved Act 31 training providers are required to report attendance/participation electronically, there are no additional paperwork requirements imposed on licensees. In addition, the implementation of an electronic reporting system for mandatory reporters of child abuse under the CPSL by the Department of Human Services has decreased the paperwork requirements related to the mandatory reporting requirements.
Sunset Date
The Board continuously monitors the effectiveness of its regulations on a fiscal year and biennial basis. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) and (f) of the Regulatory Review Act (71 P.S. § 745.5(a) and (f)), on January 15, 2021, the Board submitted a copy of the notice of proposed rulemaking, published at 51 Pa.B. 558, to IRRC and the Legislative Reference Bureau. The Board subsequently submitted the notice of proposed rulemaking to the Chairpersons of the HPLC and the SCP/PLC for review and comment on February 19, 2021, as required under section 5(f) of the Regulatory Review Act.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received on the regulation, as well as other documents when requested. In preparing this final-form rulemaking, the Board has considered all comments received from IRRC. No public comments were received. The Board also received no comments from the HPLC or the SCP/PLC.
Under section 5.1(a) of the Regulatory Review Act (71 P.S. § 745.5a(a)), on November 30, 2021, the Board delivered this final-form rulemaking to IRRC, the HPLC and the SCP/PLC. Under section 5.1(j.2) of the Regulation Review Act, the final-form rulemaking was deemed approved by the HPLC and the SCP/PLC on January 25, 2022. Under section 5.1(e) of the Regulatory Review Act, IRRC met on January 26, 2022, and approved the final-form rulemaking.
Additional Information
Additional information may be obtained by writing to Cynthia Miller, Board Administrator, State Board of Nursing, P.O. Box 2649, Harrisburg, PA 17105-2649, ST-NURSE@PA.GOV.
Findings
The Board finds that:
(1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P.L. 769, No. 240) (45 P.S. §§ 1201 and 1202), referred to as the Commonwealth Documents Law and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2 (relating to notice of proposed rulemaking required; and adoption of regulations).
(2) A public comment period was provided as required by law, but no comments were received.
(3) The amendments to this final-form rulemaking do not enlarge the original purpose of the proposed rulemaking published at 51 Pa.B. 558.
(4) This final-form rulemaking is necessary and appropriate for the administration of the CPSL (23 Pa.C.S. §§ 6301—6388).
Order
The Board, therefore, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 21 are amended by amending §§ 21.28, 21.29, 21.131, 21.155, 21.156, 21.271, 21.331, 21.501—21.507, 21.603, 21.605, 21.721, 21.723, 21.724, 21.811, 21.812 and 21.822, and adding §§ 21.20, 21.150, 21.508 and 21.509 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Board shall submit this final-form rulemaking to the Office of Attorney General and the Office of General Counsel for approval as required by law.
(c) The Board shall submit this final-form rulemaking to IRRC, the HPLC and the SCP/PLC as required by law.
(d) The Board shall certify this final-form rulemaking and deposit it with the Legislative Reference Bureau as required by law.
(e) This final-form rulemaking shall take effect upon publication in the Pennsylvania Bulletin.
KRISTIN MALADY, BSN, RN,
Chairperson(Editor's Note: See 52 Pa.B. 1079 (February 12, 2022) for IRRC's approval order.)
Fiscal Note: Fiscal Note 16A-5140 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 21. STATE BOARD OF NURSING
Subchapter A. REGISTERED NURSES
LICENSES § 21.20. Licensure by examination.
An applicant for licensure by examination shall comply with the requirements of § 21.23 (relating to application for examination), pass the examination and complete at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.28. Licensure by endorsement.
* * * * * (e) An applicant for licensure by endorsement shall demonstrate proficiency in English by submitting proof that the applicant's nursing education program was conducted in English or that the applicant received a passing score on a Board-approved English proficiency examination unless the applicant has met this requirement in satisfaction of § 21.7(b)(2) (relating to temporary practice permits). The Board will make available a list of Board-approved English proficiency examinations on its web site.
(f) An applicant for licensure by endorsement shall complete at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.29. Expiration and renewal of license.
* * * * * (c) The applicant for license renewal may complete and submit an application online or may mail a completed application form to the Board's administrative office. When applying for licensure renewal, a registered nurse shall:
(1) Complete and submit the renewal application, including disclosing any license to practice nursing or any allied health profession in any other state, territory, possession or country.
(2) Pay the biennial renewal of licensure fee in § 21.5 (relating to fees).
(3) Verify that the registered nurse has complied with the continuing education requirements mandated by section 12.1 of the act (63 P.S. § 222) during the biennial period immediately preceding the application for renewal in accordance with §§ 21.131—21.134 (relating to continuing education). School nurses, who as certified education specialists are required to obtain continuing professional education under the Public School Code of 1949 (24 P.S. §§ 1-101—27-2702), shall verify by signed statement that the school nurse has complied with the continuing education requirements for certification by the Department of Education.
(3.1) Ensure that the registered nurse has completed at least 2 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(4) Disclose any discipline imposed by a state licensing board on any nursing or allied health profession license or certificate in the previous biennial period and any criminal charges pending or criminal conviction, plea of guilty or nolo contendere, or admission into a probation without verdict or accelerated rehabilitative disposition during the previous biennial period unless prior notification has been made under § 21.29a (relating to reporting of crimes and disciplinary action).
(d) When communicating with the Board, licensees shall identify themselves by full name, current address and license number.
CONTINUING EDUCATION § 21.131. Continuing education.
(a) Requirement of continuing education. A registered nurse seeking licensure renewal shall complete 30 hours of continuing education approved by the Board during the biennial period immediately preceding the application for renewal in accordance with section 12.1 of the act (63 P.S. § 222) and this subchapter. At least 2 of the 30 hours shall be completed in approved continuing education in child abuse recognition and reporting requirements in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement). The Board will not renew a license of a registered nurse who fails to verify compliance with the continuing education requirement. A registered nurse whose license is not renewed by the expiration of the biennial period may not engage in the practice of professional nursing until the continuing education requirements are satisfied and the license has been renewed, reinstated or reactivated.
(b) Exception. An applicant applying for initial licensure in this Commonwealth will not be required to meet the continuing education requirement on the first renewal immediately following licensure, except for the mandatory continuing education in child abuse recognition and reporting required under § 21.508(b).
* * * * * (d) Reinstatement of lapsed license or reactivation of inactive license. A registered nurse seeking to reinstate a lapsed license or reactivate an inactive license shall file an application for reinstatement or reactivation and submit, or cause to be submitted, documentation to demonstrate that the licensee completed 30 hours of continuing education, including at least 2 hours in approved child abuse recognition and reporting in accordance with § 21.508(b), within the biennial period immediately preceding application.
(e) Reinstatement of suspended license. A registered nurse seeking to reinstate a suspended license shall submit, or cause to be submitted, documentation to demonstrate that the registered nurse completed 30 hours of continuing education, including at least 2 hours in approved child abuse recognition and reporting in accordance with § 21.508(b), within the biennial period immediately preceding application for reinstatement.
* * * * *
Subchapter B. PRACTICAL NURSES
LICENSURE § 21.150. Licensure by examination.
An applicant for licensure by examination shall comply with the requirements of § 21.151 (relating to application for examination), pass the examination and complete at least 3 hours of training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.155. Licensure by endorsement.
* * * * * (e) An applicant for licensure by endorsement shall demonstrate proficiency in English by submitting proof that the applicant's nursing education program was conducted in English or that the applicant has received a passing score on a Board-approved English proficiency examination unless the applicant has previously met this requirement in satisfaction of § 21.149(b)(2) (relating to temporary practice permits). The Board will make available a list of Board-approved English proficiency examination on its web site.
(f) An applicant for licensure by endorsement shall complete at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.156. Renewal of license.
* * * * * (b) When applying for licensure renewal, a licensed practical nurse shall:
(1) Submit the renewal application, including disclosing a license to practice nursing or an allied health profession in any other state, territory, possession or country.
(2) Pay the biennial renewal of license fee in § 21.147(b) (relating to fees).
(3) Disclose discipline imposed by a state licensing board in the previous biennial period and criminal charges pending or criminal conviction, plea of guilty or nolo contendere, or admission into a probation without verdict or accelerated rehabilitative disposition during the previous biennial period, unless prior notification has been made under § 21.156b (relating to reporting of crimes and disciplinary actions).
(b.1) Licensed practical nurses applying for renewal shall complete at least 2 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(c) When communicating with the Board, licensed practical nurses shall identify themselves by their full name, current address and license number.
Subchapter C. CERTIFIED REGISTERED
NURSE PRACTITIONERS
CERTIFICATION REQUIREMENTS § 21.271. Certification requirements.
(a) Initial certification. An applicant for initial certification shall meet the following requirements:
(1) Registered nurse license. An applicant for certification shall hold a current, unrestricted license as a professional nurse in this Commonwealth.
(2) Education. An applicant for certification shall have completed an accredited, Board-approved master's or postmaster's nurse practitioner program or other Board-approved program that awarded an advanced degree or a course of study considered by the Board to be equivalent to that required for certification in this Commonwealth at the time the course was completed.
(3) National certification. An applicant for initial certification after February 7, 2005, shall hold current National certification in the specialty in which the professional nurse is seeking certification.
(4) Mandatory training in child abuse recognition and reporting. An applicant for initial certification shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement) as a condition of certification.
(b) Certification by endorsement. An applicant for certification who holds a current, unrestricted license or certificate as a nurse practitioner from another state, territory or possession of the United States or a foreign country, shall meet the certification requirements that were effective at the time the applicant was licensed or certified as a nurse practitioner by the other jurisdiction. Applicants who were initially licensed or certified by another state, territory or possession of the United States or a foreign country after February 7, 2005, shall hold current National certification in the specialty in which the nurse is seeking certification. Nurse practitioners applying for certification from a jurisdiction that does not designate the nurse practitioner's specialty will be required to present evidence satisfactory to the Board to demonstrate the nurse practitioner's specialty. An applicant for initial certification by endorsement shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement) as a condition of certification.
(c) Addition of a specialty. A CRNP who holds an unrestricted certification to practice may apply for certification in an additional specialty. To be granted certification in an additional specialty, the CRNP shall meet the educational and National certification requirements for the specialty in which the CRNP is applying for certification.
MAINTENANCE OF CERTIFICATION § 21.331. Biennial renewal of certification.
* * * * * (c) As a condition of biennial renewal, a CRNP shall:
(1) Renew the CRNP's registered nurse license.
(2) Verify completion of a minimum of 30 hours of Board-approved continuing education in the 2 years prior to renewal, including at least 2 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement). As a condition of biennial renewal of prescriptive authority approval, a CRNP shall complete a minimum of 16 of the 30 hours of Board-approved continuing education in pharmacology in the 2 years prior to renewal.
(3) Demonstrate current National certification, if the CRNP was certified by the Board after February 7, 2005.
(4) Pay the required biennial renewal fee set forth in § 21.253 (relating to fees).
(5) Verify compliance with section 8.7 of the act (63 P.S. § 218.7) regarding liability coverage.
(d) Any written communication with the Board must be typed or printed and include the CRNP's full name, including former names, the current address and certification number.
Subchapter E. CHILD ABUSE REPORTING REQUIREMENTS § 21.501. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Acts—The Professional Nursing Law (63 P.S. §§ 211—225); and the Practical Nurse Law (63 P.S. §§ 651—667).
Board-regulated practitioner—A registered nurse (RN), licensed practical nurse (LPN), certified registered nurse practitioner (CRNP), clinical nurse specialist (CNS) or licensed dietitian-nutritionist (LDN).
Bodily injury—Impairment of physical condition or substantial pain.
Bureau—Bureau of Professional and Occupational Affairs within the Department of State of the Commonwealth.
Child—An individual under 18 years of age.
Child abuse—
Intentionally, knowingly or recklessly doing any of the following:
(i) Causing bodily injury to a child through any recent act or failure to act.
(ii) Fabricating, feigning or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act.
(iii) Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act.
(iv) Causing sexual abuse or exploitation of a child through any act or failure to act.
(v) Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act.
(vi) Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act.
(vii) Causing serious physical neglect of a child.
(viii) Engaging in any of the following recent acts:
(A) Kicking, biting, throwing, burning, stabbing or cutting a child in a manner that endangers the child.
(B) Unreasonably restraining or confining a child, based on consideration of the method, location or duration of the restraint or confinement.
(C) Forcefully shaking a child under 1 year of age.
(D) Forcefully slapping or otherwise striking a child under 1 year of age.
(E) Interfering with the breathing of a child.
(F) Causing a child to be present at a location while a violation of 18 Pa.C.S. § 7508.2 (relating to operation of methamphetamine laboratory) is occurring, provided that the violation is being investigated by law enforcement.
(G) Leaving a child unsupervised with an individual, other than the child's parent, who the actor knows or reasonably should have known:
(I) is required to register as a Tier II or Tier III sexual offender under 42 Pa.C.S. Chapter 97, Subchapter H (relating to registration of sexual offenders), where the victim of the sexual offense was under 18 years of age when the crime was committed;
(II) has been determined to be a sexually violent predator under 42 Pa.C.S. § 9799.24 (relating to assessments) or any of its predecessors;
(III) has been determined to be a sexually violent delinquent child as defined in 42 Pa.C.S. § 9799.12 (relating to definitions); or
(IV) has been determined to be a sexually violent predator under 42 Pa.C.S. § 9799.58 (relating to assessments) or has to register for life under 42 Pa.C.S. § 9799.55(b) (relating to registration).
(ix) Causing the death of the child through any act or failure to act.
(x) Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 (Division A of Pub.L. No. 106-386).
ChildLine—An organizational unit of the Department of Human Services, which operates a 24-hour a day Statewide toll-free telephone system for receiving reports of suspected child abuse, referring reports for investigation and maintaining the reports in the appropriate file.
Mandated reporter—A person who is required under 23 Pa.C.S. § 6311 (relating to persons required to report suspected child abuse) to make a report of suspected child abuse. For purposes of this subchapter, the term includes all Board-regulated practitioners.
Parent—A biological parent, adoptive parent or legal guardian.
Perpetrator—A person who has committed child abuse as defined in this section.
(i) This term includes only the following:
(A) A parent of the child.
(B) A spouse or former spouse of the child's parent.
(C) A paramour or former paramour of the child's parent.
(D) An individual 14 years of age or older who is a person responsible for the child's welfare or who has direct contact with children as an employee of child-care services, a school or through a program, activity or service.
(E) An individual 14 years of age or older who resides in the same home as the child.
(F) An individual 18 years of age or older who does not reside in the same home as the child but is related within the third degree of consanguinity or affinity by birth or adoption to the child.
(G) An individual 18 years of age or older who engages a child in severe forms of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 (Division A of Pub.L. No. 106—386).
(ii) Only the following may be considered a perpetrator for failing to act, as provided in this section:
(A) A parent of the child.
(B) A spouse or former spouse of the child's parent.
(C) A paramour or former paramour of the child's parent.
(D) A person responsible for the child's welfare who is 18 years of age or older.
(E) An individual 18 years of age or older who resides in the same home as the child.
Person responsible for the child's welfare—A person who provides permanent or temporary care, supervision, mental health diagnosis or treatment, training or control of a child in lieu of parental care, supervision and control.
Program, activity or service Any of the following in which children participate and which is sponsored by a school or a public or private organization:
(i) A youth camp or program.
(ii) A recreational camp or program.
(iii) A sports or athletic program.
(iv) A community or social outreach program.
(v) An enrichment or educational program.
(vi) A troop, club or similar organization.
Recent act or failure to act—An act or failure to act committed within 2 years of the date of the report to the Department of Human Services or county agency.
Serious mental injury—A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that does one or more of the following:
(i) Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child's life or safety is threatened.
(ii) Seriously interferes with a child's ability to accomplish age-appropriate developmental and social tasks.
Serious physical neglect—Any of the following when committed by a perpetrator that endangers a child's life or health, threatens a child's well-being, causes bodily injury or impairs a child's health, development or functioning:
(i) A repeated, prolonged or egregious failure to supervise a child in a manner that is appropriate considering the child's developmental age and abilities.
(ii) The failure to provide a child with adequate essentials of life, including food, shelter or medical care.
Sexual abuse or exploitation—Any of the following:
(i) The employment, use, persuasion, inducement, enticement or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes the following:
(A) Looking at sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any individual.
(B) Participating in sexually explicit conversation either in person, by telephone, by computer or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual.
(C) Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual.
(D) Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting or filming.
(ii) Any of the following offenses committed against a child:
(A) Rape as defined in 18 Pa.C.S. § 3121 (relating to rape).
(B) Statutory sexual assault as defined in 18 Pa.C.S. § 3122.1 (relating to statutory sexual assault).
(C) Involuntary deviate sexual intercourse as defined in 18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse).
(D) Sexual assault as defined in 18 Pa.C.S. § 3124.1 (relating to sexual assault).
(E) Institutional sexual assault as defined in 18 Pa.C.S. 3124.2 (relating to institutional sexual assault).
(F) Aggravated indecent assault as defined in 18 Pa.C.S. § 3125 (relating to aggravated indecent assault).
(G) Indecent assault as defined in 18 Pa.C.S. § 3126 (relating to indecent assault).
(H) Indecent exposure as defined in 18 Pa.C.S. § 3127 (relating to indecent exposure).
(I) Incest as defined in 18 Pa.C.S. § 4302 (relating to incest).
(J) Prostitution as defined in 18 Pa.C.S. § 5902 (relating to prostitution and related offenses).
(K) Sexual abuse as defined in 18 Pa.C.S. § 6312 (relating to sexual abuse of children).
(L) Unlawful contact with a minor as defined in 18 Pa.C.S. § 6318 (relating to unlawful contact with minor).
(M) Sexual exploitation as defined in 18 Pa.C.S. § 6320 (relating to sexual exploitation of children).
(iii) For the purposes of subparagraph (i), the term does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within 4 years of the child's age.
§ 21.502. Suspected child abuse—mandated reporting requirements.
(a) General rule.
(1) Under 23 Pa.C.S. § 6311 (relating to persons required to report suspected child abuse), all Board-regulated practitioners are considered mandated reporters. A mandated reporter shall make a report of suspected child abuse in accordance with this section if the mandated reporter has reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:
(i) The mandated reporter comes into contact with the child in the course of employment, occupation and practice of the profession or through a regularly scheduled program, activity or service.
(ii) The mandated reporter is directly responsible for the care, supervision, guidance or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization or other entity that is directly responsible for the care, supervision, guidance or training of the child.
(iii) A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse.
(iv) An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse.
(2) Nothing in this subsection shall require a child to come before the mandated reporter to make a report of suspected child abuse.
(3) Nothing in this subsection shall require the mandated reporter to identify the person responsible for the child abuse to make a report of suspected child abuse.
(b) Staff members of public or private agencies, institutions and facilities. Whenever a Board-regulated practitioner is required to make a report under subsection (a) in the capacity as a member of the staff of a medical or other public or private institution, school, facility or agency, that Board-regulated practitioner shall report immediately in accordance with subsection (c) and shall immediately thereafter notify the person in charge of the institution, school, facility or agency or the designated agent of the person in charge.
(c) Reporting procedure.
A mandated reporter shall immediately make a report of suspected child abuse to the Department of Human Services by either:
(1) Making an oral report of suspected child abuse by telephone to ChildLine at (800) 932-0313, followed by a written report within 48 hours to the Department of Human Services or the county agency assigned to the case in a manner and format prescribed by the Department of Human Services. The written report submitted under this paragraph may be submitted electronically.
(2) Making an electronic report of suspected child abuse in accordance with 23 Pa.C.S. § 6305 (relating to electronic reporting) through the Department of Human Service's Child Welfare Information Solution self-service portal at www.compass.state.pa.us/cwis. A confirmation by the Department of Human Services of the receipt of a report of suspected child abuse submitted electronically relieves the mandated reporter of the duty to make an additional oral or written report.
(d) Written or electronic reports. A written or electronic report of suspected child abuse, shall include the following information, if known:
(1) The names and addresses of the child, the child's parents and any other person responsible for the child's welfare.
(2) Where the suspected child abuse occurred.
(3) The age and sex of each subject of the report.
(4) The nature and extent of the suspected child abuse, including any evidence of prior abuse to the child or any sibling of the child.
(5) The name and relationship of each individual responsible for causing the suspected abuse and any evidence of prior abuse by each individual.
(6) Family composition.
(7) The source of the report.
(8) The name, telephone number and e-mail address of the person making the report.
(9) The actions taken by the person making the report, including actions taken under 23 Pa.C.S. §§ 6314—6317.
(9.1) Other information required by Federal law or regulation.
(10) Other information which the Department of Human Services may require by regulation.
§ 21.503. Photographs, medical tests and X-rays of child subject to report.
A Board-regulated practitioner may take or cause to be taken photographs of the child who is subject to a report and, if clinically indicated, cause to be performed a radiological examination and other medical tests on the child. Medical summaries or reports of the photographs, X-rays and relevant medical tests taken shall be sent to the county children and youth social service agency at the time the written report is sent, or within 48 hours after an electronic report is made under § 21.502(c)(2) (relating to suspected child abuse—mandated reporting requirements), or as soon thereafter as possible. The county children and youth social service agency shall have access to actual photographs or duplicates and X-rays and may obtain them or duplicates of them upon request. Medical summaries or reports of the photographs, X-rays and relevant medical tests shall be made available to law enforcement officials in the course of investigating cases under 23 Pa.C.S. § 6490(a)(9) or (10) (relating to release of information in confidential reports).
§ 21.504. Suspected death as a result of child abuse—mandated reporting requirement.
A Board-regulated practitioner who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the coroner or medical examiner of the county where death occurred or, in the case where the child is transported to another county for medical treatment, to the coroner or medical examiner of the county where the injuries were sustained.
§ 21.505. Immunity from liability.
Under 23 Pa.C.S. § 6318 (relating to immunity from liability), a Board-regulated practitioner who participates in good faith in the making of a report of suspected child abuse, making a referral for general protective services, cooperating or consulting with an investigation including providing information to a child fatality or near fatality review team, testifying in a proceeding arising out of an instance of suspected child abuse or general protective services or engaging in any action authorized under 23 Pa.C.S. §§ 6314—6317, shall have immunity from civil and criminal liability that might otherwise result by reason of the Board-regulated practitioner's actions. For the purpose of any civil or criminal proceeding, the good faith of the Board-regulated practitioner shall be presumed. The Board will uphold the same good faith presumption in any disciplinary proceeding that might result by reason of a Board-regulated practitioner's actions under §§ 21.502—21.504 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement).
§ 21.506. Confidentiality—waived.
To protect children from abuse, the reporting requirements of §§ 25.502—25.504 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) take precedence over provisions of any client confidentiality, ethical principle or professional standard that might otherwise apply. In accordance with 23 Pa.C.S. § 6311.1 (relating to privileged communications), privileged communications between a mandated reporter and a patient does not apply to a situation involving child abuse and does not relieve the mandated reporter of the duty to make a report of suspected child abuse. Additionally, under 23 Pa.C.S. § 6313(e) (relating to reporting procedure), notwithstanding any other provision of law to the contrary, a mandated reporter who makes a report of suspected child abuse does not violate the Mental Health Procedures Act (50 P.S. §§ 7101—7503), by releasing information necessary to complete the report.
§ 21.507. Noncompliance.
(a) Disciplinary action. A Board-regulated practitioner who willfully fails to comply with the reporting requirements in §§ 25.502—25.504 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) will be subject to disciplinary action under section 14 of the Professional Nursing Law (63 P.S. § 224) and section 16 of the Practical Nurse Law (63 P.S. § 666).
(b) Criminal penalties. Under 23 Pa.C.S. § 6319 (relating to penalties), a Board-regulated practitioner who is required to report a case of suspected child abuse or to make a referral to the appropriate authorities and who willfully fails to do so commits a criminal offense, as follows:
(1) An offense not otherwise specified in paragraphs (2), (3) or (4) is a misdemeanor of the second degree.
(2) An offense is a felony of the third degree if all of the following apply:
(i) The mandated reporter willfully fails to report.
(ii) The child abuse constitutes a felony of the first degree or higher.
(iii) The mandated reporter has direct knowledge of the nature of the abuse.
(3) If the willful failure to report continues while the mandated reporter knows or has reasonable cause to suspect a child is being subjected to child abuse by the same individual, or while the mandated reporter knows or has reasonable cause to suspect that the same individual continues to have direct contact with children through the individual's employment, program, activity or service, the mandated reporter commits a felony of the third degree, except that if the child abuse constitutes a felony of the first degree or higher, the mandated reporter commits a felony of the second degree.
(4) A mandated reporter who, at the time of sentencing for an offense under 23 Pa.C.S. § 6319, has been convicted of a prior offense under 23 Pa.C.S. § 6319, commits a felony of the third degree, except that if the child abuse constitutes a felony of the first degree or higher, the penalty for the second or subsequent offense is a felony of the second degree.
§ 21.508. Child abuse recognition and reporting—mandatory training requirement.
(a) Except as provided in subsection (c), individuals applying to the Board for an initial license or certificate shall have completed at least 3 hours of training in child abuse recognition and reporting requirements which has been approved by the Department of Human Services and the Bureau, as set forth in § 21.509 (relating to child abuse recognition and reporting course approval process). The applicant shall certify on the application that the applicant has either completed the required training or has been granted an exemption under subsection (c). The Board will not issue a license or certificate unless the Bureau has received an electronic report from an approved course provider documenting the attendance/participation by the applicant or the applicant has obtained an exemption under subsection (c).
(b) Except as provided in subsection (c), licensees seeking renewal of a license or certificate issued by the Board shall complete, as a condition of biennial renewal, at least 2 hours of approved continuing education in child abuse recognition and reporting requirements, as a portion of the total continuing education required for biennial renewal. For credit to be granted, the continuing education course or program must be approved by the Bureau, in consultation with the Department of Human Services, as set forth in § 21.509 (relating to child abuse recognition and reporting course approval process). The Board will not renew a license or certificate unless the Bureau has received an electronic report from an approved course provider documenting the attendance/participation by the licensee in an approved course within the applicable 2-year biennial licensure cycle or the licensee has obtained an exemption under subsection (c). If a licensee holds more than one license or certificate issued by the Board, or holds a license issued by another licensing board within the Bureau that requires mandatory training in child abuse recognition and reporting, credit for completion of an approved course will be applied to both credentials.
(c) An applicant or licensee may apply in writing for an exemption from the training/continuing education requirements set forth in subsections (a) and (b) provided the applicant or licensee meets one of the following:
(1) The applicant or licensee submits documentation demonstrating all of the following:
(i) The applicant or licensee has already completed child abuse recognition training as required by section 1205.6 of the Public School Code of 1949 (24 P.S. § 12-1205.6).
(ii) The training was approved by the Department of Education in consultation with the Department of Human Services.
(iii) The amount of training received equals or exceeds the amount of training or continuing education required under subsection (a) or (b), as applicable.
(iv) For purposes of licensure renewal, the training must have been completed during the relevant biennial renewal period.
(2) The applicant or licensee submits documentation demonstrating all of the following:
(i) The applicant or licensee has already completed child abuse recognition training required under 23 Pa.C.S. § 6383(c) (relating to education and training).
(ii) The training was approved by the Department of Human Services.
(iii) The amount of training received equals or exceeds the amount of training or continuing education required under subsection (a) or (b), as applicable.
(iv) For purposes of licensure renewal, the training must have been completed during the relevant biennial renewal period.
(3) The applicant or licensee submits documentation acceptable to the Board demonstrating why the applicant or licensee should not be subject to the training or continuing education requirement. The Board will not grant an exemption based solely upon proof that children are not part of the applicant's or licensee's practice. Each request for an exemption under this paragraph will be considered on a case-by-case basis. The Board may grant the exemption if it finds that completion of the training or continuing education requirement is duplicative or unnecessary under the circumstances.
(d) Exemptions granted under subsection (c) are applicable only for the biennial renewal period for which the exemption is requested. If an exemption is granted, the Board will issue or renew the license/certificate, as applicable. If an exemption is denied, the Board will e-mail the applicant or licensee a discrepancy notice notifying them of the need to either complete an approved course or, if warranted, to submit additional documentation in support of their request for an exemption.
§ 21.509. Child abuse recognition and reporting course approval process.
(a) An individual, entity or organization may apply for approval to provide mandated reporter training as required under 23 Pa.C.S. § 6383(b) (relating to education and training) by submitting the course materials set forth in subsection (b) simultaneously to the Department of Human Services, Office of Children, Youth and Families, and to the Bureau at the following addresses:
(1) Department of Human Services, Office of Children, Youth and Families, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120; or electronically at RA-PWOCYFCPSL@pa.gov.
(2) Bureau of Professional and Occupational Affairs, 2601 North Third Street, P.O. Box 2649, Harrisburg, PA 17105-2649; or electronically at RA-stcpsl_course_app@ pa.gov.
(b) Submissions must include all of the following:
(1) Contact information (mailing address, e-mail address and telephone number) for the agency/course administrator.
(2) General description of the training and course delivery method.
(3) Title of the course.
(4) Timed agenda and estimated hours of training.
(5) Learning objectives.
(6) Intended audience.
(7) Course related materials, including as applicable:
(i) Handouts.
(ii) Narrated script or talking points.
(iii) Interactive activities or exercises.
(iv) Videos and audio/visual content.
(v) Knowledge checks, quizzes or other means of assessing participant's understanding of the material.
(vi) For online courses, a transcript of audio training.
(8) Citation of sources, including written permission to use copyrighted material, if applicable.
(9) Anticipated credentials or experience of the presenter, or biography of presenter, if known.
(10) Printed materials used to market the training.
(11) Evaluation used to assess participants' satisfaction with the training.
(12) Sample certificate of attendance/participation, which shall include:
(i) Name of participant.
(ii) Title of training.
(iii) Date of training.
(iv) Length of training (2 or 3 hours).
(v) Name and signature of the authorized representative of the provider. The signature may be an electronic signature.
(vi) Statement affirming the participant attended the entire course.
(13) Verification of ability to report participation/attendance electronically to the Bureau in a format prescribed by the Bureau.
(c) The Bureau will notify the individual, entity or organization in writing upon approval of the course and will post a list of approved courses on the Bureau's web site and the Board's web site.
Subchapter F. VOLUNTEER LICENSES § 21.603. Applications.
(a) An applicant for a volunteer license shall complete an application obtained from the Board. In addition to providing information requested by the Board, the applicant shall provide:
(1) An executed verification on forms provided by the Board certifying that the applicant intends to practice nursing exclusively:
(i) Without personal remuneration for professional services.
(ii) In an approved clinic.
(2) A letter signed by the director or chief operating officer of an approved clinic that the applicant has been authorized to provide volunteer services in the named clinic by the governing body or responsible officer of the clinic.
(b) An applicant for a volunteer license shall complete at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement) as a condition of issuance of a volunteer license.
§ 21.605. Biennial renewal.
A volunteer license shall be renewed biennially on forms provided by the Board. In accordance with section 6(c) of the Volunteer Health Services Act (35 P.S. § 449.46(c)), a volunteer license holder shall comply with the applicable continuing education requirements imposed by the Board, including at least 2 hours of training in approved child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement). The applicant shall be exempt from payment of the biennial renewal fee of § 21.5, § 21.147 or § 21.253 (relating to fees), as applicable.
Subchapter G. DIETITITIAN-NUTRITIONISTS
LICENSURE REQUIREMENTS § 21.721. Qualifications for licensure.
(a) An individual may apply for licensure as a dietitian-nutritionist by submitting a written application on forms provided by the Board and remitting the application fee set forth in § 21.705 (relating to fees).
(b) To obtain licensure, an applicant must meet the qualifications set forth in section 6(b)(1)—(4) of the act (63 P.S. § 216(b)(1)—(4)), which include:
(1) Evidencing good moral character.
(2) Receipt of a baccalaureate or higher degree from a Board-approved program or equivalent program as set forth in section 5(b) and (c) of the act (63 P.S. § 215(b) and (c)).
(3) Completion of a planned continuous preprofessional experience of at least 900 hours under appropriate supervision.
(4) Successful completion of one of the examinations specified in § 21.722 (relating to education and examination of applicants).
(c) To obtain licensure, an applicant shall complete at least 3 hours of training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.723. License renewal.
(a) A license issued under section 5(e) of the act (63 P.S. § 215(e)) or under this subchapter will be valid from the date of issuance through September 30, 2006, following the issuance of the license. Each subsequent license renewal will be valid for 2 years from October 1 through September 30.
(b) When applying for renewal of licensure, an LDN shall:
(1) Complete the renewal application, including disclosing a license to practice dietetics-nutrition in any other state, territory, possession or country.
(2) Pay the required fee as set forth in § 21.705 (relating to fees).
(3) Submit, or cause to be submitted, proof to the Board that the LDN has satisfactorily completed a minimum of 30 hours of CPE approved by the Board in accordance with § 21.724 (relating to continuing education) during the 2 calendar years immediately preceding the application for renewal. At least 2 of the required 30 hours shall be completed in approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(4) Disclose any discipline imposed by a state licensing board in the previous biennial period or any criminal charges pending or criminal conviction, plea of guilty or nolo contendere, or admission into a probation without verdict or accelerated rehabilitative disposition program during the previous biennial period unless prior notification has been made under § 21.723a (relating to reporting of crimes and disciplinary action).
§ 21.724. Continuing education.
(a) Prior to renewal. One hour of CPE credit will be given for each 50-minute clock hour of CPE activity. Each LDN shall complete 30 CPE credits during the 2 calendar years immediately preceding the application for license renewal. At least 2 of the 30 hours shall be completed in approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement). If any activity overlaps two renewal periods, the date of completion of the activity determines the date in which the activity can be reported.
* * * * *
Subchapter H. CLINICAL NURSE SPECIALISTS
CERTIFICATION REQUIREMENTS § 21.811. Qualifications for initial certification.
The Board may certify an applicant for initial certification who files an application on a form provided by the Board and pays the application fee in § 21.805 (relating to fees), in accordance with the following:
(1) RN license. The Board may certify an applicant who has a current, unrestricted license to practice professional nursing in this Commonwealth.
(2) Education. The Board may certify an applicant who has a master's degree, doctoral degree or post-master's degree or certificate in nursing from an educational program that meets the requirements of section 6.2(c)(1) of the act (63 P.S. § 216.2(c)(1)).
(3) Alternative education. An applicant for initial certification who completed an educational program in a related discipline previously recognized for National certification as a CNS may be granted certification from the Board in the area of the applicant's current National certification from the American Nurses Association or the American Nurses Credentialing Center.
(4) National certification or equivalence.
(i) The Board may grant initial certification in a Board-designated specialty or other pertinent specialty to an applicant who demonstrates current National certification by examination.
(ii) The Board may grant initial certification without specialty to applicants who demonstrate that their educational program does not make them eligible to take a National certification examination and who demonstrate equivalence. For purposes of this section, the Board will determine equivalence on a case-by-case basis after considering the information submitted by the applicant that may include an official transcript, course descriptions, current curriculum vitae, work history in the CNS role, professional recommendations and additional advanced nursing education and certification examinations.
(5) Mandatory training in child abuse recognition and reporting. An applicant for initial certification shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
§ 21.812. Qualifications for certification by endorsement; additional certification.
(a) Certification by endorsement. An applicant for certification by the Board who holds an unrestricted license, certificate or authorization to practice as a CNS from another state, territory or possession of the United States or a foreign country, who met initial certification requirements equivalent to the Board's certification requirements and a current RN license in this Commonwealth may be granted certification by endorsement. An applicant for initial certification by endorsement shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
(b) Additional certification. A CNS who is already certified by the Board may apply for an additional certification. To be granted an additional certification, the CNS shall meet the educational and National certification requirements for the additional certification.
MAINTENANCE OF CERTIFICATION § 21.822. Biennial renewal of certification.
(a) The certification of a CNS will expire at the same time as the CNS's professional nursing license as provided in § 21.29 (relating to expiration and renewal of license).
(b) Notice of application for renewal will be forwarded biennially to each active CNS at the CNS's address of record with the Board prior to the expiration date of the current biennial period.
(c) As a condition of biennial renewal, a CNS shall hold a valid, unexpired and unrestricted professional nursing license.
(d) As a condition of biennial renewal, a CNS shall complete a minimum of 30 hours of Board-approved continuing education, in the 2 years prior to renewal as required under section 8.5(c)(2) of the act (63 P.S. § 218.5(c)(2)), unless the requirement is waived by the Board under § 21.823(b) (relating to CNS-level continuing education; waiver; sanctions) or the CNS's certification is on inactive status. At least 2 of the required 30 hours must be completed in approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(e) The applicant shall remit the required renewal fee in § 21.805 (relating to fees) with the applicant's renewal application forms. Upon approval of the renewal application, the CNS will receive a certification for the current renewal period.
[Pa.B. Doc. No. 22-487. Filed for public inspection March 25, 2022, 9:00 a.m.]
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