Ala. Admin. Code r. 540-X-8-.08 - Requirements For Collaborative Practice By Physicians And Certified Registered Nurse Practitioners
(1)
The collaborating physician shall:
(a)
Provide professional medical oversight and direction to the certified
registered nurse practitioner.
(b)
Be readily available for direct communication or by radio, telephone or
telecommunications.
(c) Be readily
available for consultation or referrals of patients from the certified
registered nurse practitioner.
(d)
Be readily available at each remote practice site.
(2) In the event the collaborating physician
is not readily available, provisions shall be made for professional medical
oversight and direction by a covering physician who is readily available, who
is pre-approved by the Board of Medical Examiners, and who is familiar with
these rules. The collaborating physician shall certify to the Board of Medical
Examiners at least annually that any approved covering physician continues to
agree to serve in that capacity and shall inform the Board of Medical Examiners
of the termination of a covering physician within ten (10) days of the
termination.
(3) In the event of an
unanticipated, permanent absence of a collaborating physician, a previously
approved covering physician may be designated as a temporary collaborating
physician for a period of up to sixty (60) days. During the sixty (60) day time
period, a new "Notice of Commencement" designating a new collaborating
physician should be submitted for approval.
(4) The certified registered nurse
practitioner's scheduled hours in patient homes, facilities licensed by the
Alabama Department of Public Health, facilities certified by the Alabama
Department of Mental Health, and when practicing under specified limited
protocols, are not subject to the required minimum hours for physician
presence.
(5) The collaborating
physician shall:
(a) Have no additional
requirement for documentation of on-site collaboration when working in the same
facility with the Certified Registered Nurse Practitioner (CRNP).
(b) Be present for not less than ten percent
(10%) of the CRNP's scheduled hours in an approved practice site with a CRNP
who has less than two (2) years (4,000 hours) of collaborative practice
experience:
1. Since initial certification;
or
2. In the collaborating
physician's practice specialty.
(c) Maintain documentation of the CRNP's two
(2) years (4,000 hours) of collaborative practice experience for the duration
of the collaborative practice and for three (3) years following the termination
of the collaborative practice agreement.
(d) Visit remote practice sites no less than
twice annually.
(e) Meet no less
than quarterly with the CRNP who has more than two (2) years (4,000 hours) of
collaborative practice experience.
(f) Complete quarterly quality assurance with
each CRNP. Documentation of any quality assurance review required by this
chapter shall be maintained by the collaborating physician for the duration of
the collaborative practice and for three years following the termination of the
collaborative practice agreement.
(g) Allow a pre-approved covering physician
to be present in lieu of the collaborating physician.
(6) The collaborating physician shall provide
notice in writing to the State Board of Medical Examiners of the commencement
or termination of a collaborative practice agreement as required by Rule
540-X-8-.04.
(7) The Joint Committee may, at its
discretion, waive the requirements of written verification of physician
availability upon documentation of exceptional circumstances. Employees of
state and county health departments are exempt from the requirements of written
verification of physician availability.
(8) A written standard protocol specific to
the specialty practice area of the certified registered nurse practitioner and
the specialty practice area of the collaborating physician, approved and signed
by both the collaborating physician and the certified registered nurse
practitioner shall:
(a) Identify all sites
where the certified registered nurse practitioner will practice within the
collaboration protocol.
(b)
Identify the physician's principal practice site.
(c) Be maintained at each practice site and
be on file with the Board of Nursing and Board of Medical Examiners.
(d) Include a formulary of drugs, devices,
medical treatments, tests and procedures that may be prescribed, ordered, and
implemented by the certified registered nurse practitioner consistent with
these rules and which are appropriate for the collaborative practice
setting.
(e) Include a
pre-determined plan for emergency services.
(f) Specify the process by which the
certified registered nurse practitioner shall refer a patient to a physician
other than the collaborating physician.
(g) Specify a plan for quality assurance
management with defined quality outcome measures for evaluation of the clinical
practice of the certified registered nurse practitioner and include review of a
meaningful sample of medical records plus all adverse outcomes. The term
"medical records" includes, but is not limited to, electronic medical records.
Documentation of quality assurance review shall be readily retrievable,
identify records that were selected for review, include a summary of findings,
conclusions, and, if indicated, recommendations for change. Quality assurance
monitoring may be performed by designated personnel, with final results
presented to the physician and certified registered nurse practitioner for
review. The certified registered nurse practitioner shall maintain a copy of
the plan for quality assurance, in a form prescribed by the Board of Nursing,
on file with the Board of Nursing. The collaborating physician shall maintain
an updated copy of the plan for quality assurance on file with the Board of
Medical Examiners.
(9)
The physician shall maintain independent medical judgment related to the
practice of medicine at all times, irrespective of employment structure or
business model.
(10) Irrespective
of the location of the principal practice site and any remote site(s) of the
collaboration, all services provided to patients and actions incident to
services provided to patients of the collaborative practice shall be deemed to
have occurred in the state where the patient is located at the time of service
or action incident to the service. The collaborating physician, covering
physician, and certified registered nurse practitioner shall comply with all
applicable Alabama laws, rules, and regulations pertaining to services and
actions incident to services provided to Alabama patients of the collaborative
practice. Actions incident to services include, but are not limited to,
professional medical oversight and direction to the certified registered nurse
practitioner regarding Alabama patients, consultation, or referral of Alabama
patients from the certified registered nurse practitioner, quality assurance
review of the medical records of Alabama patients, and maintenance of
documentation pursuant to this chapter. The collaborating physician shall
maintain all documentation required pursuant to this chapter for the duration
of the collaborative practice and for three years following the termination of
the collaborative practice agreement.
Notes
Was previously Rule 540-X-8-.09, renumbered as per certification filed August 25, 2003; effective September 29, 2003.
Author: Alabama Board of Medical Examiners
Statutory Authority: Code of Ala. 1975, ยงยง 34-24-53, 34-21-85.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.