Request By:
Honorable Marvin R. O'Koon
General Counsel
Department for Human Resources
Frankfort, Kentucky 40601
Opinion
Opinion By: Robert F. Stephens, Attorney General; By: Martin Glazer, Assistant Attorney General
You want to know the status of "nurse practitioner" and "physician assistants" under Kentucky law. Such inquiry is made at the request of Mr. Richard L. Morris, Regional Medicaid Director, U.S. Department of Health, Education and Welfare. You point out that recent federal regulations permit the certification of rural health clinics employing nurse practitioners and physician assistants under the state medicaid program unless there is an explicit prohibition of this practice in state law.
The nursing law of Kentucky was amended in 1978 (effective June 17) to define "advanced registered nurse practitioner" and "advanced nursing practice".
KRS 314.011 (6) defines "advanced registered nurse practitioner" as:
". . . one who is certified to engage in advanced registered nursing practice including but not limited to the nurse anesthetist, nurse midwife and nurse practitioner. "
Subsection (7) defines "advanced registered nursing practice" as"
". . . the performance of additional acts by registered nurses who have gained added knowledge and skills through an organized post-basic program of study and clinical experience approved by the organization or agency which has the authority to certify the advanced registered nurse practitioner. In the performance of those procedures which are normally construed as the practice of medicine, the nurses will conform to the standards of the medical practice act and established medical protocol."
KRS 314.131 (1) authorizes the Board of Nursing (among other things) to "register and designate those persons qualified to engage in advanced nursing practice."
A nurse practice council is created to advise the Board of Nursing as to standards requiring additional education which is recognized jointly by the nursing and medical professions.
"The board of nursing may authorize the performance of such additional acts by its regulations, after seeking all available information from the group to be regulated. Such regulation should not be inconsistent with statutory law." (KRS 314.193 (2)).
The Board of Nursing has promulgated Regulation 201 KAR 20:055E dealing with nurse practitioners, defining them and setting out their qualifications.
So, it is clear that Kentucky does (since June 17, 1978) recognize and authorize nurse practitioners if they are registered with the Board of Nursing and meet that body's requirements for registration.
On the other hand, Kentucky law does not define, license, or register "physician assistants".
KRS Chapter 311 deals with the practice of medicine and subsection (8) of KRS 311.550 defines the practice of medicine or osteopathy. Subsection (9) excludes from that definition the other recognized healing arts such as dentistry, nursing, emergency medical technicians, pharmacists, to name a few. So, considering subsections (8) and (9) of KRS 311.550, there is no statutory definition (or recognition) of "physician assistants", and Kentucky does not recognize that type of medical health provider.
You also ask whether the Kentucky Department for Human Resources can pay rural health clinics certified by adjoining states that legally use physician assistants in their clinics for services rendered to Kentucky medicaid recipients.
As long as such physician assistants are legally recognized in the state wherein they practice and their services are rendered in such states, we see no legal impediment to the Department for Human Resources' paying the medical bill for the Department's recipients receiving such services in those states. At most, the question is one of policy, not law.
We trust that this has answered your questions.