HB 1410-FN - AS AMENDED BY THE SENATE
15Feb2024... 0534h
05/15/2024 1849s
05/23/2024 2177s
2024 SESSION
24-2690
09/05
HOUSE BILL 1410-FN
SPONSORS: Rep. Osborne, Rock. 2; Rep. T. Lekas, Hills. 38
COMMITTEE: Executive Departments and Administration
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AMENDED ANALYSIS
This bill eliminates the board of registration of medical technicians and transfers authority over the registration of medical technicians to the office of professional licensure and certification. This bill further makes changes to the nurse practice act.
This bill further makes various amendments to the regulation of optometry, including changing the board's name to the board of optometry, definitional changes to include what constitutes the "practice of optometry", repealing the joint credentialing committee, modifying the rulemaking authority of the board, and modifying the prescribing authority of optometrists.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
15Feb2024... 0534h
05/15/2024 1849s
05/23/2024 2177s 24-2690
09/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Nurse Practice Act; Board of Nursing. Amend RSA 326-B:3, II to read as follows:
II. Each APRN or RN member shall be a resident of this state, licensed in good standing under the provisions of this chapter, and currently engaged in the practice of nursing as an RN and shall have no fewer than 5 years of experience as an RN, at least 3 of which shall have immediately preceded appointment. RN members of the board shall represent the various areas of nursing practice including education, administration, and clinical practice.
2 Nurse Practice Act; Powers and Duties of the Board. Amend RSA 326-B:4 to read as follows:
326-B:4 Powers and Duties of the Board. The board may:
I. Establish reasonable and uniform standards for nursing practice consistent with the criteria identified by the National Council of State Boards of Nursing.
[II. Provide consultation regarding nursing practice for institutions and agencies.]
[III. Examine, license, and renew the licenses of duly qualified individuals.]
II. Establish eligibility criteria for licensure and renewal of licensure, including examination requirements and continuing education requirements. The board shall select an appropriate nationally approved licensing examination.
[IV. Gather and report to the public statistical information regarding, but not limited to, the education and licensure of registered and practical nurses.
V. [Repealed.]
VI. [Repealed.]]
[VII.] III. Determine and enforce appropriate disciplinary action against all individuals found guilty of violating this chapter or the rules adopted under this chapter.
[VIII.] IV. Deny or withdraw approval of nursing and nursing assistant educational programs that do not meet the minimum requirements of this chapter.
[IX. Maintain records of proceedings as required by the laws of New Hampshire.
X. Conduct conferences, forums, studies, and research on nursing practice and education.
XI. [Repealed.]
XII. [Repealed.]
XIII. Establish and collect fees, under rules adopted by the board under RSA 541-A, relative to applicants seeking any type of license issued by the board under this chapter, including fees for applications for temporary licenses, reinstatement of inactive licenses, licenses by examination, and renewal of licenses, as well as fees for verifying license status, program graduation, or computerized lists, and fees for site visits associated with nursing education programs under RSA 326-B:32.]
[XIV.] V. In accordance with state due process laws, limit the multistate licensure privilege of any registered nurse or licensed practical nurse to practice in New Hampshire and may take any other actions under applicable state laws necessary to protect the health and safety of New Hampshire citizens. If the board does take such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such action taken by the state of New Hampshire.
[XV.] VI. Establish a liaison committee, a practice and education committee, and such additional subcommittees as may be appropriate to assist the board in the performance of its duties.
3 Nurse Practice Act; Rulemaking Authority. Amend RSA 326-B:9 to read as follows:
326-B:9 Rulemaking Authority. The board shall adopt rules, in accordance with RSA 541-A, relative to the following:
I. Eligibility requirements for the issuance of all initial, temporary, and renewal licenses, specialty licenses, and certificates issued [by the board] under this chapter, including the issuance of such licenses to applicants holding a currently valid license or other authorization to practice in another jurisdiction.
II. Eligibility requirements for the reinstatement of licenses after lapse and after disciplinary action.
III. Recognition of national certifying bodies issuing specialty certifications required for licensure as an APRN which shall also be recognized by the National Council of State Boards of Nursing.
IV. The standards to be met by, and the process for approval of, education programs designed to prepare applicants to qualify for licensure or certification in any of the disciplines regulated by the board under RSA 326-B:32, including the time period within which noncompliance must be corrected before such approval is withdrawn.
V. The standards to be met by, and the process for approval of, education programs designed to prepare LPNs in intravenous therapy and by programs designed to prepare LNAs to perform tasks not addressed in the basic curriculum required for licensure.
VI. The determination of disciplinary sanctions authorized by this chapter, including the determination of administrative fines.
VII. The administration of examinations authorized by this chapter, and the manner in which information regarding the contents of any licensing examinations may be disclosed, solicited, or compiled.
VIII. Ethical standards for the practice of nursing and nursing-related activities.
IX. Continuing competence requirements.
X. Designations that may be used by persons regulated by the board and retired persons regulated by the board.
XI. The implementation and coordination of the nurse licensure compact adopted in RSA 326-B:46. The board shall use model rules developed for the nurse licensure compact by the National Council of State Boards of Nursing as the basis for adopting rules which shall be modified as necessary to comply with state statutes.
XII. Prescribing controlled drugs pursuant to RSA 318-B:41.
XIII. A process for registering practitioners who have been granted a special registration to prescribe controlled substances via telemedicine pursuant to 21 U.S.C. section 831(h).
XIV. The implementation of strategies and procedures necessary to increase the acceptance of military training and experience towards licensure for military veterans seeking to be licensed as a nurse. For the purposes of this subparagraph, "veterans" means veterans as defined in 38 U.S.C. section 101(2).
XV. Implementation of the nursing assistant registry pursuant to 42 C.F.R. section 483.156, including placement of qualified individuals on the nursing assistant registry.
XVI. The requirements for approval of a nurse aide training and competency evaluation program pursuant to 42 C.F.R. sections 483.151-152 and nurse aide competency evaluations pursuant to 42 C.F.R. section 483.154.
4 Nurse Practice Act; Criminal History Record Checks. Amend RSA 326-B:15, I to read as follows:
I. Every applicant for initial licensure shall submit to the [board] office a criminal history record release form, as provided by the New Hampshire division of state police, department of safety, which authorizes the release of his or her criminal history record, if any, to the [board] office.
5 Nurse Practice Act; Licensure; All Applicants. Amend RSA 326-B:16, I to read as follows:
I. Submit a completed application and fees [as established by the board].
6 Nurse Practice Act; Modified License; Registered Nurse or Licensed Practical Nurse. Amend RSA 326-B:25 to read as follows:
326-B:25 Modified License; Registered Nurse or Licensed Practical Nurse. The [board] office may issue a modified license to an individual who has met licensure requirements and who is able to practice without compromising public safety within a modified scope of practice or with accommodations or both as specified by the board.
7 Nurse Practice Act; Certificate of Medication Administration for Licensed Nursing Assistants. Amend RSA 326-B:27, I to read as follows:
I. The [board] office may issue a certificate of medication administration to a current LNA who:
(a) Has participated in and completed a board-approved medication administration education program;
(b) Has passed an examination approved by the board; and
(c) Has paid the certification fee.
8 Registration of Medical Technicians. Amend the chapter name of RSA 328-I to read as follows:
[BOARD OF] REGISTRATION OF MEDICAL TECHNICIANS
9 Registration of Medical Technicians, Definitions. Amend RSA 328-I:1, I to read as follows:
I. ["Board" means the board of registration of medical technicians.] “Executive Director” means the executive director of the office of professional licensure and certification.
10 Registration of Medical Technicians; Powers and Duties of the Executive Director. RSA 328-I:3 is repealed and reenacted to read as follows:
328-I:3 Powers and Duties of the Executive Director.
The powers and duties of the executive director under this chapter shall include:
I. Accepting applications for registration pursuant to RSA 310:4.
II. Conducting disciplinary proceedings in accordance with RSA 310:10.
III. Adopting rules pursuant to RSA 328-I:4.
IV. Other duties necessary to carry out the purposes of this chapter in accordance with RSA 310.
11 Registration of Medical Technicians; Rulemaking. RSA 328-I:4 is repealed and reenacted to read as follows:
328-I:4 Rulemaking.
The executive director shall adopt rules, pursuant to RSA 541-A, relative to:
I. Registration eligibility requirements for initial, renewal, and reinstatement of registration.
II. Adopting such rules as are necessary to carry out the purposes of this chapter in accordance with RSA 310:6.
III. Procedures for sharing information with other in-state boards, the office inspector general, department of health and human services, out-of-state boards, and law enforcement entities.
12 Registration of Medical Technicians; Registration of Medical Technicians Required. Amend RSA 328-I:5, III-V to read as follows:
III. The [board] executive director, after hearing and upon making an affirmative finding under paragraph II, that the person is engaged in unlawful practice, may take action in any one or more of the following ways:
(a) A cease and desist order in accordance with paragraph IV.
(b) The imposition of an administrative fine not to exceed $50,000.
(c) The imposition of an administrative fine for continuation of unlawful practice in the amount of $1,000 for each day the activity continues after notice from the [board] executive director that the activity shall cease.
(d) The denial or conditional denial of a license application, application for renewal, or application for reinstatement.
(e) The imposition of other sanctions permitted by RSA 310:12.
IV. The [board] executive director is authorized to issue a cease and desist order against any person or entity engaged in unlawful practice. The cease and desist order shall be enforceable in superior court.
V. The attorney general, the [board] executive director, or the prosecuting attorney of any county or municipality where the act of unlawful practice takes place may maintain an action to enjoin any person or entity from continuing to do acts of unlawful practice. The action to enjoin shall not replace any other civil, criminal, or regulatory remedy. An injunction without bond is available to the [board] executive director.
13 Registration of Medical Technicians; Initial Registration; Application, Fees. Amend RSA 328-I:6 to read as follows:
328-I:6 Initial Registration; Application, Fees.
I. The [board] executive director may register any person who submits a completed application and pays the established fee.
II. Completed applications shall include:
(a) Payment of the non-refundable registration fee;
(b) Reports of any pending criminal charges, criminal convictions, plea agreements in lieu of convictions, or complaints made to or dispositions made by licensing, certification, or registration boards, or other appropriate licensing authorities.
(c) A complete set of fingerprints and a criminal history record release form pursuant to RSA 328-I:7.
(d) The applicant's work history over the last 10 years.
III. All applications shall include at a minimum, the applicant's name, social security number, place and date of birth, place of employment in New Hampshire and the home address and shall be duly signed and verified. Applications shall be available for public inspection.
IV. Upon approval of the application [by the board], the applicant shall be registered as a medical technician for 2 years in accordance with RSA 310:8. [Such registration shall take effect within 90 days after the filing of such completed application.]
V. Any medical technician who changes his or her name, place or status of employment in New Hampshire, or residence shall notify the [board] executive director in writing within 30 days. For failure to report such a change within 30 days of such event, the [board] executive director may suspend the medical technician's registration.
VI. Once an application has been approved [by the board], a temporary registration may be issued, pending receipt of the criminal records check and fingerprint information.
14 Registration of Medical Technicians; Criminal History Record Checks. Amend RSA 328-I:7 to read as follows:
328-I:7 Criminal History Record Checks.
I. Every applicant for initial registration or reinstatement shall submit [to the board] a criminal history record release form, as provided by the New Hampshire division of state police, which authorizes the release of his or her criminal history record, if any, to the [board] executive director.
II. The applicant shall submit with the release form a complete set of fingerprints taken by a qualified law enforcement agency or an authorized employee of the department of safety. In the event that the first set of fingerprints is invalid due to insufficient pattern, a second set of fingerprints shall be necessary in order to complete the criminal history records check. If, after 2 attempts, a set of fingerprints is invalid due to insufficient pattern, the [board] executive director may, in lieu of the criminal history records check, accept police clearances from every city, town, or county where the person has lived during the past 5 years.
III. The [board] executive director shall submit the criminal history records release form and fingerprint form to the division of state police which shall conduct a criminal history records check through its records and through the Federal Bureau of Investigation. Upon completion of the records check, the division of state police shall release copies of the criminal history records to the [board] executive director.
IV. The [board] executive director shall review the criminal record information prior to making a registration decision and shall maintain the confidentiality of all criminal history records received pursuant to this section.
V. The applicant shall bear the cost of a criminal history record check.
15 Registration of Medical Technicians; Renewal of Registration. Amend RSA 328-I:8 to read as follows:
328-I:8 Renewal of Registration. Certificates of registration issued under this chapter shall be subject to renewal every 2 years in accordance with RSA 310:8 and shall expire unless renewed in the manner prescribed by the [board] executive director. Certificates of registration for medical technician shall be renewed upon the payment of the renewal fee.
16 Registration of Medical Technicians; Refusal to Issue or Renew Certificate. Amend RSA 328-I:9 to read as follows:
328-I:9 Refusal to Issue or Renew Certificate[; Return of Certificate].
[I.] The [board] executive director may deny the application for registration or refuse to issue a renewal thereof if it is determined after hearing that such applicant or registrant:
[(a)] I. Has made a material false statement or concealed or omitted a material fact in connection with his or her application for registration;
[(b)] II. Had a registration issued under this chapter suspended previously;
[(c)] III. Has been convicted of a felony under the laws of the United States or any state or any offense involving moral turpitude;
[(d)] IV. Has willfully or repeatedly failed to comply with any other provision of this chapter or any rules adopted by the [board] executive director; or
[(e)] V. Is a habitual user of drugs or intoxicants.
[II. Upon the suspension or revocation of a certificate of registration by the board and the issuance of a notice thereof, the registrant shall within 5 days, not including Sundays and holidays, deliver to the board the certificate of registration. If surrendered by mail, the certificate of registration shall be sent by registered or certified mail, postmarked no later than 3 days, not including Sundays and holidays, following notice of suspension or revocation. Failure to return a certificate of registration which has been revoked or suspended hereunder within the prescribed time shall constitute a misdemeanor.]
17 Registration of Medical Technicians; Disciplinary Action; Remedial Proceedings. RSA 328-I:10 is repealed and reenacted to read as follows:
328-I:10 Disciplinary Action; Remedial Proceedings.
I. The executive director is authorized to undertake investigations and disciplinary proceedings upon:
(a) The executive director’s initiative.
(b) A written complaint made by any person complaining that a registrant has committed an act of misconduct and specifying the nature of the misconduct.
(c) A written complaint made by any person that a person is engaged in unauthorized practice.
(d) Notification by a licensing or certifying agency of this state that a registrant has been disciplined by that agency.
(e) Notification by the regulatory authority of another domestic or foreign jurisdiction that a registrant has been disciplined in that jurisdiction.
(f) A report made pursuant to the obligation to report imposed by this chapter.
II. Every facility administrator, or designee, for any licensed hospital, health clinic, ambulatory surgical center, or other health care facility within the state shall report to the executive director any disciplinary or action related to disruptive conduct, professional incompetence, or violation of an organizational rule or procedure involving controlled substances, or any adverse action which results in the termination of an employment relationship, within 30 days after such action is taken, including situations in which allegations of misconduct are settled by voluntary resignation without adverse action, against a person registered as a medical technician. Disciplinary or adverse action shall include the requirement that a registrant undergo counseling or be subject to any policy with regard to disruptive behavior.
III. The executive director, after hearing, may take disciplinary action against any person registered by the executive director upon finding that the person:
(a) Has knowingly provided false information during any application for registration or employment, whether by making any affirmative statement which was false at the time it was made or by failing to disclose any fact material to the application.
(b) Is a habitual user of drugs or intoxicants.
(c) Has engaged in dishonest or unprofessional conduct, or has negligently or intentionally injured a patient while practicing as a medical technician or performing such ancillary activities.
(d) Has willfully or repeatedly violated any provision of this chapter or any substantive rule of the executive director.
(e) Has been convicted of a felony under the laws of the United States or any state.
IV. The executive director may take non-disciplinary remedial action against any person registered by the executive director upon finding that the person is afflicted with a physical or mental disability, disease, disorder, or condition deemed dangerous to the public health. Upon making an affirmative finding, the executive director, may take non-disciplinary remedial action:
(a) By suspension, limitation, or restriction of a registration for a period of time as determined reasonable by the executive director.
(b) By revocation of registration.
(c) By requiring the person to submit to the care, treatment, or observation of a physician, counseling service, health care facility, professional assistance program, or any combination thereof which is acceptable to the executive director.
(d) By requiring the person to practice under the direction of a physician in a public institution, public or private health care program, or private practice for a period of time specified by the executive director.
(e) By imposition of any sanction permitted pursuant to RSA 310:12.
18 Registration of Medical Technicians; Telemedicine. Amend RSA 328-I:16 to read as follows:
328-I:16 Telemedicine. Medical technicians registered by the [board] executive director shall be permitted to provide services through the use of telemedicine. "Telemedicine" means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment.
19 Residential Care and Health Facility Licensing; Verification of Medical Technician Registration. Amend RSA 151:3-d to read as follows:
151:3-d Verification of Medical Technician Registration. Every facility administrator, or designee, for any health care facility licensed under this chapter shall verify with the executive director of the office of professional licensure and certification [board of registration of medical technicians established under RSA 328-I:2,] prior to employing a medical technician, as defined in RSA 328-I:1, VI, that such medical technician is registered [with the board].
20 Office of Professional Licensure and Certification; Definitions; Establishment. Amend RSA 310:2, II(jj) to read as follows:
(jj) [Board of] Registration of medical technicians under RSA 328-I.
21 Repeal. The following are repealed:
I. RSA 326-B:3, IX-XI, relative to the board of nursing.
II. RSA 326-B:6, relative to collection and expenditure of funds.
III. RSA 326-B:8, relative to fees and charges.
IV. RSA 326-B:21, relative to licensure by endorsement for licensed nursing assistants.
V. RSA 326-B:22, relative to license renewal.
VI. RSA 326-B:23, relative to license reinstatement.
VII. RSA 328-I:2, relative to the board of registration of medical technicians.
22 Providing Controlled Drug Prescription Health and Safety Information. Amend RSA 126-A:93, I(b)(2) to read as follows:
(2) The board of dentistry, the board of medicine, the board of nursing, the board of [registration in] optometry, the board of podiatry, the board of veterinary medicine, and the pharmacy board; provided, however, that the request is pursuant to the boards' official duties and responsibilities and the disclosures to each board relate only to its licensees and only with respect to those licensees whose prescribing or dispensing activities indicate possible fraudulent conduct.
23 Office of Professional Licensure and Certification; Definitions; Establishment. Amend RSA 310:2, II(ii) to read as follows:
(ii) Board of [registration in] optometry under RSA 327.
24 Administration of the Office of Professional Licensure and Certification; Funding. Amend RSA 310:5, III to read as follows:
III. There is hereby established a dedicated, nonlapsing fund to be known as the New Hampshire health professionals' program administration fund for the administration of the professionals' health program, including the professionals' health program in RSA 329:13-b, the alternative recovery monitoring program in RSA 326-B:36-a, and the impaired pharmacist program set forth in RSA 318:29-a, with a fee charged to licensees at the time of initial licensure, renewal licensure, or reinstatement of licensure, for the board of medicine, board of dental examiners, pharmacy board, board of nursing, board of veterinary medicine, board of psychologists, board of chiropractic examiners, board of mental health practice, midwifery council, board of [registration in] optometry, board of podiatry, board of licensed dietitians, and board of licensing for alcohol and other drug use professionals, not to exceed 125 percent of the actual cost of providing the services. Other health and technical professions boards may be added to the program at the same annual fee per licensee. The moneys in this fund shall be continually appropriated to the office.
25 Pharmacy Board; Inspectional Services. Amend RSA 318:9-a to read as follows:
318:9-a Inspectional Services. The office of professional licensure and certification shall provide inspectional services under this chapter and RSA 318-B:25 to the board of medicine, the board of veterinary medicine, the board of podiatry, the board of [registration in] optometry, the board of dental examiners, the board of nursing, and the naturopathic board of examiners. Pharmacy board inspections shall be provided by pharmacists or pharmacy technicians licensed by the New Hampshire board of pharmacy who have training and experience regarding pharmacy statutes and rules.
26 Controlled Drug Prescription Health and Safety Program; Rulemaking for Prescribing Controlled Drugs. Amend RSA 318-B:41, I(a)(4) to read as follows:
(4) The board of [registration in] optometry, concerning optometrists.
27 Optometry; Definitions. Amend RSA 327:1 to read as follows:
327:1 Definitions. In this chapter:
I. "Board" means the board of [registration in] optometry.
II. "Dispensing pharmaceutical agents" means that a licensed optometrist authorized to use pharmaceutical agents may dispense a pharmaceutical agent to a patient if no charge is imposed for the pharmaceutical agent and the amount dispensed does not exceed a 24-hour supply, except that if the minimum available quantity for dispensing is greater than a 24-hour supply, the optometrist may dispense the minimum available quantity. Nothing in this paragraph shall prohibit a licensed optometrist authorized to use pharmaceutical agents pursuant to RSA 327:6-a from dispensing therapeutic contact lenses for a fee.
III. "Pharmaceutical agent" means the following pharmaceutical products:
(a) Non-legend, over the counter, agents.
(b) Mydriatic and cycloplegic agents [which are topically applied].
(c) Miotic agents approved pursuant to RSA 327:6-a, VI.
(d) Antibiotics, [sulfonomides] sulfonamides, and combinations thereof[, which are topically applied or orally administered] to treat or alleviate the effects of disease or abnormal conditions of the human eye, adnexa, and eyelids, [or] excluding structures posterior to the iris, approved pursuant to RSA 327:6-a, VI.
(e) Anti-allergy medications, including but not limited to antihistamines, decongestants, and mast-cell stabilizers [which are topically applied].
(f) Anesthetics and dyes [which are topically applied].
(g) Ocular lubricants and ocular hypertonic agents [which are topically applied].
(h) Orally administered analgesic agents used for the purpose of alleviating pain caused by a disease or abnormal condition of the human eye or eyelid, [or] excluding structures posterior to the iris. This may include class III and IV controlled substances approved pursuant to RSA 327:6-a, VI, or hydrocodone in combination with analgesics when limited to 72 hours with no refills and included in the formulary.
(i) Other pharmaceutical agents, any solely diagnostic agents, and diagnostic agents combined with pharmaceutical agents as defined in this paragraph and as approved pursuant to RSA 327:6-a, VI.
(j) Non-steroidal anti-inflammatory agents approved pursuant to RSA 327:6-a, VI.
(k) Anti-glaucoma agents provided that an optometrist may dispense or prescribe such agents if the optometrist has met the requirements of RSA 327:6-c.
(l) Corticosteroids [which are topically applied,] as approved by the board.
(m) Antivirals which are approved pursuant to RSA 327:6-a, VI.
[(n) Corticosteroids or antivirals, provided that optometrists with patients on corticosteroids or antivirals who demonstrate no improvement in 10 days shall be referred to an ophthalmologist.]
[(o)] (n) Influenza, COVID-19, and shingles vaccines which have been approved by the Food and Drug Administration to adults.
IV. "Practice of optometry":
(a) Means the employment of any methods or means, other than surgery, for the:
[(a)] (1) Diagnosis and treatment of any optical defect, deficiency, deformity, or disease of the human eye, adnexa and eyelids.
[(b)] (2) Diagnosis and treatment of any visual or muscular anomaly of the visual system.
[(c)] (3) Adaptation or prescribing of spectacle lenses, contact lenses, prisms or ocular exercises for the correction, relief or aid of the visual functions.
[(d)] (4) Prescribing, administering or dispensing of pharmaceutical agents.
[(e)] (5) Application, prescribing, or removal of Food and Drug Administration approved medical devices, as approved by the board and consistent with the practice of optometry as set forth in this chapter, including, but not limited to, contact lenses, plano lenses, and punctal plugs. The term "plano lenses" means contact lenses with no refractive power.
[(f) Diagnosis of acute angle closure glaucoma. Upon such diagnosis, an optometrist may administer emergency care and shall immediately refer the patient to an ophthalmologist. Oral pharmaceutical agents may be used for the emergency treatment of acute angle closure glaucoma.]
(b) Notwithstanding RSA 327:1, VI, the following ophthalmic procedures shall be permitted only upon authorization to perform ophthalmic procedures pursuant to RSA 327:6-d:
(1) Laser capsulotomy.
(2) Laser trabeculoplasty.
(3) Laser peripheral iridotomy.
(4) Injection of corticosteroid into a chalazion.
V. "Prescription of pharmaceutical agents" means a written or oral direction to dispense a pharmaceutical agent, including inscription, subscription, transcription, and renewal.
VI. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical means. Surgical procedures shall include the use of lasers for therapeutic and photorefractive purposes, ionizing radiation, therapeutic ultrasound, or medication administered by injection, provided that the removal of [superficial] non-perforating foreign bodies from the eye, adnexa or eyelid shall not be considered a surgical procedure prohibited by this chapter. [With respect to a foreign body, any part of which is situated within 3 millimeters of the visual axis, "superficial foreign body" means that which has not penetrated deeper than the corneal epithelium.]
VI-a. "Telemedicine" means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment.
VII. "Therapeutic contact lenses" means contact lenses which contain one or more medications and which deliver such medication to the eye.
28 Optometry; Examining Board; Board. Amend RSA 327:2, I to read as follows:
I. There shall be a board of [registration in] optometry consisting of 5 members; including 4 optometrists and one public member, each to be appointed by the governor, with the approval of the council, to a term of 5 years. No member shall be appointed to more than 2 consecutive terms.
29 Optometry; Examinations and Licenses; Authorization for Pharmaceutical Agents. Amend RSA 327:6-a, II to read as follows:
II. An optometrist licensed to practice optometry prior to January 1, 1993, shall complete a post-graduate course of study approved by the board covering the subjects of ocular pharmacology and the treatment and management of eye diseases and shall pass an examination administered by the National Board of Examiners in Optometry or its successor and approved by the board. Every optometrist licensed to practice optometry after January 1, 1993, shall pass an examination administered by the National Board of Examiners in Optometry or its successor and approved by the board. To meet the requirements of this section, an approved course shall be given by an accredited school or college of optometry in the United States and shall consist of a minimum of 105 hours, of which a minimum of 25 hours shall be in direct clinical training. The board shall adopt rules, under RSA 541-A, to carry out the provisions of this section and to [insure] ensure the safety of the public.
30 Optometry; Examinations and Licenses; Authorization for Pharmaceutical Agents. Amend RSA 327:6-a, IV to read as follows:
IV. Nothing in this section shall be construed to permit an optometrist to [administer any pharmaceutical product by injection; or to] administer, prescribe or dispense any pharmaceutical product designated as a schedule I or schedule II controlled substance under RSA 318-B:1-a, except hydrocodone in combination with analgesics when limited to 72 hours with no refills; or to administer, prescribe or dispense any pharmaceutical product except for the diagnosis or treatment of disease or conditions of the human eye, adnexa or eyelids.
31 Optometry; Examinations and Licenses; Treatment of Glaucoma. Amend RSA 327:6-c to read as follows:
327:6-c Treatment of Glaucoma.
I.(a) Optometrists seeking authorization to treat glaucoma shall complete at least 40 hours of classroom education, approved by the board, incorporating: epidemiology of the glaucomas; genetics of the glaucomas; anatomy, physiology, and mechanics of aqueous inflow and aqueous outflow; optic nerve anatomy and pathophysiology; neurotoxicity and neuroprotectants; receptor biology; pharmacology, clinical use and toxic effects of alpha and beta adrenergic agents, carbonic anhydrase inhibitors, and cholinergic agents.
(b) Optometrists shall pass an examination approved by the board that covers the educational components listed in subparagraph (a). Upon passage of such exam, an optometrist shall have prescriptive authority during the clinical management period pursuant to RSA 327:6-a.
(c) The board shall waive the requirements of this paragraph and of paragraph II for optometrists who have either graduated after 2002 or who have proof of 12 months of credentialed privileges to treat glaucoma by the United States Department of Defense or Department of Veteran Affairs or the national Indian Health Service, or who are certified by the American Board of Optometry, verified by the board.
II.(a) To be authorized to initiate treatment of glaucoma for patients 18 years of age or older, a therapeutic pharmaceutical agent certified optometrist shall complete the educational requirements in paragraph I and provide evidence of written referrals and consultations with an ophthalmologist. For purposes of this section, "ophthalmologist"; means a physician licensed under RSA 329 with a specialty in ophthalmology. The [joint credentialing committee] board shall review evidence of glaucoma co-management submitted pursuant to subparagraph (b).
(b) Except as provided in subparagraph I(c) or paragraph III, therapeutic pharmaceutical agent certified optometrists are required to provide evidence of successful collaborative treatment and co-management of 25 glaucoma patients, up to 5 of which may be established patients, during a period of not less than 18 months for each patient, to ophthalmologists according to the following criteria:
(1) A new or existing glaucoma patient is examined and diagnosed by the optometrist;
(2) The optometrist develops a proposed treatment plan and forwards the plan with examination documentation to an ophthalmologist for consultation;
(3) The ophthalmologist reviews the optometrist's examination documentation and proposed treatment plan;
(4) The ophthalmologist, optometrist, and patient mutually agree to and document a treatment plan;
(5) The optometrist shall consult with the co-managing ophthalmologist when any of the following occurs: the patient's target pressure is not reached within 90 days; the patient is experiencing documented progression of optic nerve damage; the patient develops documented and repeated progression of visual field loss; or the patient develops angle-closure; and
(6) For each successfully co-managed glaucoma patient the optometrist and co-managing ophthalmologist shall complete a glaucoma credentialing reporting form and submit the form to the [joint credentialing committee] board upon completion of the 18 months of treatment.
III. The [joint credentialing committee] board may waive or reduce the requirements of RSA 327:6-c, I and II for the following categories of optometrists:
(a) Optometrists with a license and proof of practice for 12 months treating glaucoma patients in another state that currently authorizes the treatment of glaucoma by optometrists; or
(b) Optometrists who have proof of successful completion of a 12-month accredited optometric residency program or its equivalent.
IV. [Upon certification] An optometrist certified to treat glaucoma but not having certification to perform ophthalmic procedures for the treatment of glaucoma shall refer the patient to the appropriate certified eye care provider [patients an optometrist shall consult with an ophthalmologist] within 30 days when any of the following occurs:
(a) The patient is experiencing documented progression of optic nerve damage or the patient develops documented and repeated progression of visual field loss on maximum tolerated topical medical therapy; or
(b) The patient develops angle-closure.
32 New Section; Optometry; Examinations and Licenses; Authorization to Perform Ophthalmic Procedures. Amend RSA 327 by inserting after section 6-c the following new section:
327:6-d Authorization to Perform Ophthalmic Procedures.
I. The board of optometry shall adopt rules under RSA 541-A establishing the certification which shall be fulfilled before a person may be certified to perform ophthalmic procedures for the practice of optometry, including:
(a) Identification and categorization of ophthalmic procedures for the practice of optometry;
(b) Establishment of criteria to perform such procedures with proficiency;
(c) Establishment of minimum education, training, and live experience requirements for a person to perform such procedures with proficiency;
(d) Criteria for requiring proctoring and criteria for proctors; and
(e) Outcome reporting requirements for such procedures performed by certificate holders.
II. No optometrist shall practice under this section unless the optometrist has submitted evidence of satisfactory completion of all requirements for specific procedures and the office has certified the optometrist as qualified.
33 Optometry; License Renewal; Disciplinary Action. Amend RSA 327:20, II(i) to read as follows:
(i) The use of any pharmaceutical agent by an optometrist not authorized under RSA 327:6-a or the use of any pharmaceutical agent other than those agents described in RSA 327:1 or those previously approved by the [joint credentialing committee] board.
34 Optometry; Regulations and Penalties; Contact Lens Prescriptions to be Provided to Patient. Amend RSA 327:25-a, IV to read as follows:
IV.(a) No person shall conduct or operate a business outside of the state for the sale at retail of contact lenses to individuals within the state unless such business is registered with a permit issued by the board of pharmacy if the out-of-state business is a pharmacy, or by the board of [registration in] optometry if the out-of-state business is not a pharmacy.
(b) The board of pharmacy or the board of [registration in] optometry shall issue a permit to such out-of-state business if the business discloses and provides proof:
(1) That the business is in compliance with all applicable laws and rules in the state in which the business is located;
(2) Of the operating locations and the names and titles of all principal corporate officers;
(3) That the business complies with all lawful directions and requests for information from the board of pharmacy and the board of [registration in] optometry of all states in which it conducts business;
(4) That the business agrees in writing to comply with all New Hampshire laws and rules relating to the sale or dispensing of contact lenses; and
(5) That the business has paid the established fee.
35 Optometry; Regulation and Penalties; Rulemaking Authority. Amend RSA 327:31, I to read as follows:
I. The qualifications of applicants in addition to those requirements set by RSA 327:6, [and] RSA 327:6-a, RSA 327:6-c, and RSA 327:6-d;
36 Optometry; Regulations and Penalties; Continuing Education Courses Required for Pharmaceutical and Glaucoma Certification. Amend RSA 327:33-a to read as follows:
327:33-a Continuing Education Courses Required for Pharmaceutical and Glaucoma Certification.
I. An optometrist certified to use pharmaceutical agents in the practice of optometry shall complete a minimum of [50 hours of continuing education every year in order to maintain pharmaceutical certification. A minimum of] 20 hours of continuing education every year [shall be] by participation in formal synchronous courses [and the remainder by independent study]. Each optometrist shall report continuing education hours to the board in accordance with rules adopted by the board for the implementation of this section. Such continuing education courses and activities shall satisfy the requirements of RSA 327:33.
II. An optometrist certified to treat glaucoma shall complete a minimum of 10 of the required hours in ocular pathology or pharmacology [glaucoma] specific education. [A minimum of 7 hours shall be by participation in formal courses and 3 hours may be by independent study.]
37 Repeal. RSA 327:6-b, relative to the optometry joint credentialing committee, is repealed.
38 Effective Date. This act shall take effect 60 days after its passage.
24-2690
Amended 6/6/24
HB 1410-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2024-2177s)
FISCAL IMPACT: [ ] State [ ] County [ ] Local [ X ] None
METHODOLOGY:
The Office of Legislative Budget Assistant states this bill, as amended by the Senate, has no fiscal impact on state, county and local expenditures or revenue.
AGENCIES CONTACTED:
Office of Professional Licensure and Certification
| Date | Amendment |
|---|---|
| Feb. 8, 2024 | 2024-0534h |
| May 8, 2024 | 2024-1849s |
| May 23, 2024 | 2024-2177s |
| Date | Body | Type |
|---|---|---|
| Jan. 17, 2024 | House | Hearing |
| Feb. 7, 2024 | House | Exec Session |
| Feb. 7, 2024 | House | Exec Session |
| Feb. 7, 2024 | House | Floor Vote |
| March 5, 2024 | House | Hearing |
| March 6, 2024 | House | Exec Session |
| March 6, 2024 | House | Exec Session |
| March 6, 2024 | House | Floor Vote |
| April 17, 2024 | Senate | Hearing |
| May 16, 2024 | Senate | Floor Vote |
| May 23, 2024 | Senate | Floor Vote |
| May 22, 2024 | Senate | Floor Vote |
| May 23, 2024 | Senate | Floor Vote |
| May 23, 2024 | Senate | Floor Vote |
Oct. 10, 2024: Died on Table, Session ended 10/10/2024 HJ 17
May 30, 2024: Lay HB1410 on Table (Rep. Nagel): MA DV 192-170 05/30/2024 HJ 15 P. 16
May 23, 2024: Ought to Pass with Amendment 2024-2177s, MA, VV; OT3rdg; 05/23/2024; SJ 15
May 23, 2024: Sen. Pearl Floor Amendment # 2024-2177s, AA, VV; 05/23/2024; SJ 15
May 23, 2024: Special Order to after HB 1394, Without Objection, MA; 05/23/2024; SJ 15
May 23, 2024: Special Order to after HB 1568, Without Objection, MA; 05/23/2024; SJ 14
May 22, 2024: Special Order to 05/23/2024, Without Objection, MA; 05/22/2024 SJ 14
May 21, 2024: Committee Report: Ought to Pass, 05/22/2024, Vote 6-1; SC 20A
May 13, 2024: Ought to Pass with Amendment 2024-1849s, MA, VV; Refer to Finance Rule 4-5; 05/15/2024; SJ 12
May 13, 2024: Committee Amendment # 2024-1849s, AA, VV; 05/15/2024; SJ 12
May 9, 2024: Committee Report: Ought to Pass with Amendment #2024-1849s, 05/16/2024; Vote 5-0; CC; SC 19
April 3, 2024: Hearing: 04/17/2024, Room 103, SH, 09:15 am; SC 14
March 26, 2024: Introduced 03/21/2024 and Referred to Executive Departments and Administration; SJ 8
March 21, 2024: Ought to Pass: MA VV 03/21/2024 HJ 9 P. 18
March 15, 2024: Committee Report: Ought to Pass 03/06/2024 (Vote 20-0; CC)
Feb. 28, 2024: Executive Session: 03/06/2024 01:30 pm LOB 202-204
Feb. 28, 2024: Executive Session: 03/06/2024 01:30 pm LOB 202-204
Feb. 28, 2024: Full Committee Work Session: 03/06/2024 09:30 am LOB 202-204
Feb. 28, 2024: Public Hearing: 03/05/2024 10:00 am LOB 202-204
Feb. 15, 2024: Referred to Ways and Means 02/15/2024 HJ 5 P. 11
Feb. 15, 2024: Ought to Pass with Amendment 2024-0534h: MA VV 02/15/2024 HJ 5 P. 8
Feb. 15, 2024: Amendment # 2024-0534h: AA VV 02/15/2024 HJ 5 P. 8
Feb. 8, 2024: Committee Report: Ought to Pass with Amendment # 2024-0534h 02/07/2024 (Vote 19-0; CC) HC 6 P. 5
Jan. 31, 2024: Executive Session: 02/07/2024 10:30 am LOB 306-308
Feb. 5, 2024: Subcommittee Work Session: 02/07/2024 09:00 am LOB 306-308
Jan. 31, 2024: Executive Session: 02/07/2024 10:30 am LOB 306-308
Jan. 29, 2024: Subcommittee Work Session: 02/02/2024 10:30 am LOB 306-308
Jan. 19, 2024: Subcommittee Work Session: 01/26/2024 01:00 pm LOB 306-308
Jan. 5, 2024: Public Hearing: 01/17/2024 11:30 am LOB 306-308
Dec. 6, 2023: Introduced 01/03/2024 and referred to Executive Departments and Administration HJ 1 P. 19