RULES AND REGULATIONS
STATE BOARD OF NURSING
[49 PA. CODE CH. 21]
Fees for Approval of Nursing Education Programs
[36 Pa.B. 2673]
[Saturday, June 3, 2006]The State Board of Nursing (Board) amends §§ 21.5, 21.147 and 21.253 (relating to fees).
Notice of proposed rulemaking was published at 35 Pa.B. 5522 (October 8, 2005). Publication was followed by a 30-day public comment period during which the Board did not receive any comments from the public. On November 22, 2005, the House Professional Licensure Committee (HPLC) submitted one comment. The Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) made no comments. On December 7, 2005, the Independent Regulatory Review Commission (IRRC) issued a letter stating that it had no objections, comments or recommendations to offer on the proposed rulemaking and noted that if the final-form rulemaking was submitted without revisions and the SCP/PLC and the HPLC did not take action, it would be deemed approved.
Comment and Response
The HPLC requested detailed information regarding the process for approving new education programs and the fiscal process used for determining the new fees.
As noted in the Board's proposed rulemaking, the Board reviews nursing educational programs with the assistance of its nursing education advisors, who are individuals with a minimum of a master's degree in nursing under section 2.1(i) of the Professional Nursing Law (RN Act) (63 P. S. § 212.1(i)). The procedure for reviewing an application for approval of a new nursing education program requires that the Board staff conduct an in-depth review and analysis of the application, including review of the budget, curriculum, faculty and clinical experiences.
Representatives of controlling institutions proposing development of a new nursing education program are required to submit a feasibility study addressing their intent. The feasibility study may be submitted in one or two phases. Most institutions choose to submit the study in two phases. The program must gather data to prepare Phase I of the feasibility study and submit the data in an organized format to the Board staff.
Board staff reviews the study to determine compliance with the Board's regulations. This review is extensive and requires Board staff to determine if the program is in compliance with the controlling institution's policies and procedures, if any other regulatory or accrediting bodies (such as the Department of Education, financial aid providers and institutional and programmatic accrediting bodies) have standards and whether the proposal meets these standards.
Board staff reviews the study to determine if the program has provided compelling regional labor statistics regarding the need for the type of licensee in the projected geographic area and potential local and regional employment opportunities for graduates.
Board staff reviews the study to determine whether the proposal has adequately addressed the potential impact on other nursing education programs within the geographic area (generally considered a 50-mile radius from the proposed program). This determination involves assessment of the locale, region, state or states from which the proposed and existing programs draw students to determine whether there are waiting lists or more applicants than the existing programs can admit annually. In addition, Board staff must consider whether the existing programs utilize the clinical sites the proposed program is proposing to use, and if so, analyze the possible effects on clinical experiences for the students of both the existing and proposed programs.
Board staff also review the projected student enrollment for the first and subsequent classes, the number of classes to be admitted annually and the projected time frame for planning and initiating the program, including the submission of the Phase II feasibility study, hiring of the program administrator and faculty and so forth.
Board staff reviews the controlling institution's accreditation status and date of next scheduled review. In addition, Board staff reviews the education mission of the controlling institution and the types of programs and degrees offered. Board staff considers whether the controlling institution operates satellite programs where the presence of this technologic capability impacts the proposed new nursing education program. Board staff reviews the organizational chart to determine whether the relationship of the proposed new program to the controlling institution complies with Board regulations.
Board staff reviews the job descriptions and suggested teaching/administrative hours of proposed faculty and staff for compliance with Board regulations. If faculty/staff have already been hired, Board staff determines whether the faculty/staff qualifications are consistent with the Board's regulations.
Board staff reviews the new program's philosophy and mission statement to determine congruence with that of the controlling institution. Board staff reviews the suggested curriculum and course descriptions. For practical nursing programs, Board staff reviews the hours required for program completion.
Board staff reviews the proposed physical location to be committed to the program, including staff and faculty office space, classrooms, laboratory, library and storage areas. Board staff determines if the proposed physical location is adequate to support the number of students the program has anticipated. Board staff reviews any submitted environmental or safety compliance documents submitted. Finally, Board staff carefully reviews the Agency Data Forms that must be submitted for each clinical site the program intends to use to determine whether sufficient and meaningful clinical experiences will be available for the proposed and existing programs.
Board staff also reviews the submitted budget to determine whether it is consistent with other nursing education programs of the same type operating in a similar geographic area within this Commonwealth.
Board staff offers feedback to the program within 3 to 4 weeks of receipt of the Phase I feasibility study. The program then responds to the feedback and may need to submit a revised proposal. The program may also request additional feedback or assistance from the Board staff. When the Phase I study is ready for submission to the Board, Board staff provides the Board with a written review of the proposal's strengths and weaknesses, impact on existing programs and recommendation to accept the proposal or request additional information.
Once the Board has reviewed the Phase I study and the staff's report, the Board discusses the proposal at a Board meeting and votes on the acceptance of the study. This vote authorizes the program to prepare and submit the Phase II feasibility study. Board staff provides written verification of the Board' action to the program.
The program then prepares its Phase II study and submits it to Board staff for review. Board staff again reviews the Phase II study on behalf of the Board. The Phase II study is more focused. Staff reviews the qualifications of the proposed director and nursing faculty and academic policies. In addition, staff reviews the master plan of the curriculum proposed, including detailed course descriptions and sample of the student clinical evaluation tool. This review includes a determination of whether the program evidences an adequate number of suitably scheduled core courses that prepare the students to enter the practice of nursing at the level proposed.
Board staff reviews the construction or renovation of the proposed physical facilities and the list of educational resources, equipment, supplies and library resources that have been purchased or will be purchased for the program. Board staff conducts a site survey and reviews the physical facilities, such as classroom space, library holdings and nursing equipment.
Board staff reviews the admission policies and criteria to determine congruence with the controlling institution. Board staff reviews the proposed progression and graduation criteria, grading policies and advanced placement policies. Recordkeeping is also examined to ensure compliance with Board regulations.
Board staff offers feedback to the program within 3 to 4 weeks of receipt of the Phase II feasibility study. The program then responds to the feedback and may need to submit a revised proposal. The program may also request additional feedback or assistance from the Board staff. When the Phase II study is ready for submission to the Board, Board staff provides the Board with a written review of the proposal's strengths and weaknesses, impact on existing programs and recommendation to accept the proposal or request additional information.
Once the Board has reviewed the Phase II study and the staff's report, the Board discusses the proposal at a Board meeting and votes on the acceptance of the study. This vote authorizes the program to admit students and begin operation of the new nursing education program.
The HPLC also requested a more detailed description of the fiscal process used to arrive at the new fees. Fees that are based on services provided are calculated to offset the identifiable costs incurred by the Board and to defray a portion of the Board's administrative overhead. The Department of State Revenue Office identified the following cost categories for provision of the service of approving a nursing education program: staff time to review and prepare the application, Board administrator time to prepare the application for the Board, Board counsel time to review the application for legal issues, Board meeting time for the Board to review and discuss the application, nursing education advisor time to evaluate the application and draft a proposal to the Board, executive secretary time per application and a portion of administrative overhead. When the fee is related to time spent by an individual or individuals, the fee is based on the average wage of the individual performing the task, with an added 31% to account for nonwage benefits.
For each of the three types of nursing education programs, staff time to review and prepare the application was estimated at 15 minutes, or $4.27. Staff at this level would open the package sent by the program seeking approval, ensure that the proper number of copies had been provided, make any additional copies needed and forward the application through interoffice mail to other appropriate staff. The staff is also responsible for date stamping the application and logging its submission.
The time estimated for the Board's nursing education advisor to review the application is 21 hours for registered nurse (RN) and licensed practical nurse (LPN) programs and 15 hours for certified registered nurse practitioner (CRNP) programs, or $695.31 and $496.65, respectively. The review process was outlined in response to the HPLC's first comment. The review time varies widely depending on the knowledge and skill of the individuals preparing the application. The Board's nursing education advisors have spent over 100 hours on a single application. Other applications take less than 21 hours to review. CRNP program applications are more polished and are always prepared by professional-level university staff. Therefore, the average time to review these applications is less than the average time to review applications for RN and LPN programs.
For each of the three types of nursing education programs, Board counsel time to review legal issues was estimated at 30 minutes, or $18.90. The Board's counsel works with the Board's nursing education advisors to review compliance with the Board's regulations. Because the Board counsel's review is limited to legal issues, the time involved is substantially less that the time required by the nursing education advisor.
For each of the three types of nursing education programs, the Board meeting time is estimated at 30 minutes, or $196.14. Board meeting costs are calculated by adding per diem and travel expenses for Board members and dividing the result by the total hours the Board meets within a fiscal year to calculate an hourly cost. The figure for this final-form rulemaking was based on 12 Board members being compensated at the statutorily authorized rate of $60 per diem, or $720. In 2005, the Board met 18 days, so the total per diem paid to Board members was $720 times 18, or $12,960. Board meeting costs also include the annual expense for Board members to travel to Board meetings. The estimated travel expenses for the year, submitted for budget approval, are $40,000. The total cost, $12,960 + $40,000, is $52,960. The total cost is then divided by the number of hours (7 1/2 hours per day times 18 meeting days, or 135 hours), to obtain a per hour cost of $392.29. Because the Board meeting time is estimated at 30 minutes, the fee for this part of the service was estimated at $196.14.
For each of the three types of nursing education programs, Board administrator time to prepare the application was estimated at 4.8 minutes, or $2.03. The Board administrator is responsible for drafting the formal correspondence to the program when the program has been approved.
For each of the three types of nursing education programs, an administrative overhead charge of $11.50 was estimated.
Statutory Authority
The final-form rulemaking is authorized under section 11.2 of the RN Act (63 P. S. § 221.2) and section 17.5 of the Practical Nurse Law (PN Act) (63 P. S. § 667.5).
Fiscal Impact and Paperwork Requirements
The final-form rulemaking will increase the fee for approval of professional and practical nursing education programs by $460. From 1993 to 2004, the Board has approved approximately 13 new professional nursing programs and 12 new practical nursing programs. If the numbers are consistent for the next 11-year time period, the overall increase will be $11,500 or $1,045 per year. The final-form rulemaking increases the fee for CRNP nursing education programs by $260. The Board has approved 30 CRNP nursing education programs since 1993 and anticipates only a handful of new CRNP programs over the next 11 years. The Board will realize savings to its general operating budget by having the fee for the service of approving nursing education programs accurately reflect the cost of the service provided. There is no fiscal impact on the Commonwealth from the final-form rulemaking.
The final-form rulemaking will not create or reduce paperwork requirements for nursing education programs seeking approval or for the Board. There are no paperwork requirements on the Commonwealth regarding the approval of nursing education programs.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on September 26, 2005, the Board submitted a copy of the notice of proposed rulemaking, published at 35 Pa.B. 5522, to IRRC and the Chairpersons of the HPLC and the SCP/PLC for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the HPLC and the SCP/PLC and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on April 4, 2006, the final-form rulemaking was approved by the HPLC and was deemed approved by the SCP/PLC on April 18, 2006. Under section 5(g) of the Regulatory Review Act, the final-form rulemaking was deemed approved, effective April 18, 2006.
Additional Information
Additional information may be obtained by writing to Ann Steffanic, Board Administrator, State Board of Nursing, P. O. Box 2649, Harrisburg, PA 17105-2649.
Findings
The Board finds that:
(1) Public notice of intention to adopt these amendments has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and no comments were received.
(3) This final-form rulemaking is necessary and appropriate for the administration of the RN Act and the PN Act.
Order
The Board therefore orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 21, are amended by amending §§ 21.5, 21.147 and 21.253 to read as set forth at 35 Pa.B. 5522.
(b) The Board shall submit a copy of this order and 35 Pa.B. 5522 to the Office of the Attorney General and the Office of General Counsel for approval as required by law.
(c) The Board shall certify this order and 35 Pa.B. 5522 and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect immediately upon publication in the Pennsylvania Bulletin.
JOANNE L. SORENSEN, RN, MS,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 36 Pa.B. 2251 (May 6, 2006).)
Fiscal Note: Fiscal Note 16A-5127 remains valid for the final adoption of the subject regulations.
[Pa.B. Doc. No. 06-974. Filed for public inspection June 2, 2006, 9:00 a.m.]
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