Delaware Register of INFORMATION ABOUT THE DELAWARE REGISTER OF REGULATIONS DELAWARE REGISTER OF REGULATIONS The Delaware Register of Regulations is an official State publication established by authority of 69 Del. Laws, c. 107 and is published on the first of each month throughout the year. The Delaware Register will publish any regulations that are proposed to be adopted, amended or repealed and any emergency regulations promulgated. The Register will also publish some or all of the following information: • Governor’s Executive Orders • Governor’s Appointments • Attorney General’s Opinions in full text • Agency Hearing and Meeting Notices • Other documents considered to be in the public interest. CITATION TO THE DELAWARE REGISTER The Delaware Register of Regulations is cited by volume, issue, page number and date. An example would be: 6 DE Reg. 1541-1542 (06/01/03) Refers to Volume 6, pages 1541-1542 of the Delaware Register issued on June 1, 2003. SUBSCRIPTION INFORMATION The cost of a yearly subscription (12 issues) for the Delaware Register of Regulations is $135.00. Single copies are available at a cost of $12.00 per issue, including postage. For more information contact the Division of Research at 302-744-4114 or 1-800-282-8545 in Delaware. CITIZEN PARTICIPATION IN THE REGULATORY PROCESS Delaware citizens and other interested parties may participate in the process by which administrative regulations are adopted, amended or repealed, and may initiate the process by which the validity and applicability of regulations is determined. Under 29 Del.C. §10115 whenever an agency proposes to formulate, adopt, amend or repeal a regulation, it shall file notice and full text of such proposals, together with copies of the existing regulation being adopted, amended or repealed, with the Registrar for publication in the Register of Regulations pursuant to §1134 of this title. The notice shall describe the nature of the proceedings including a brief synopsis of the subject, substance, issues, possible terms of the agency action, a reference to the legal authority of the agency to act, and reference to any other regulations that may be impacted or affected by the proposal, and shall state the manner in which persons may present their views; if in writing, of the place to which and the final date by which such views may be submitted; or if at a public hearing, the date, time and place of the hearing. If a public hearing is to be held, such public hearing shall not be scheduled less than 20 days following publication of notice of the proposal in the Register of Regulations. If a public hearing will be held on the proposal, notice of the time, date, place and a summary of the nature of the proposal shall also be published in at least 2 Delaware newspapers of general circulation. The notice shall also be mailed to all persons who have made timely written requests of the agency for advance notice of its regulation-making proceedings. The opportunity for public comment shall be held open for a minimum of 30 days after the proposal is published in the Register of Regulations. At the conclusion of all hearings and after receipt, within the time allowed, of all written materials, upon all the testimonial and written INFORMATION ABOUT THE DELAWARE REGISTER OF REGULATIONS evidence and information submitted, together with summaries of the evidence and information by subordinates, the agency shall determine whether a regulation should be adopted, amended or repealed and shall issue its conclusion in an order which shall include: (1) A brief summary of the evidence and information submitted; (2) A brief summary of its findings of fact with respect to the evidence and information, except where a rule of procedure is being adopted or amended; (3) A decision to adopt, amend or repeal a regulation or to take no action and the decision shall be supported by its findings on the evidence and information received; (4) The exact text and citation of such regulation adopted, amended or repealed; (5) The effective date of the order; (6) Any other findings or conclusions required by the law under which the agency has authority to act; and (7) The signature of at least a quorum of the agency members. The effective date of an order which adopts, amends or repeals a regulation shall be not less than 10 days from the date the order adopting, amending or repealing a regulation has been published in its final form in the Register of Regulations, unless such adoption, amendment or repeal qualifies as an emergency under §10119. Any person aggrieved by and claiming the unlawfulness of any regulation may bring an action in the Court for declaratory relief. No action of an agency with respect to the making or consideration of a proposed adoption, amendment or repeal of a regulation shall be subject to review until final agency action on the proposal has been taken. When any regulation is the subject of an enforcement action in the Court, the lawfulness of such regulation may be reviewed by the Court as a defense in the action. Except as provided in the preceding section, no judicial review of a regulation is available unless a complaint therefor is filed in the Court within 30 days of the day the agency order with respect to the regulation was published in the Register of Regulations. CLOSING DATES AND ISSUE DATES FOR THE DELAWARE REGISTER OF REGULATIONS ISSUE CLOSING CLOSING DATE DATE TIME OCTOBER 1 SEPTEMBER 15 4:30 P.M. NOVEMBER 1OCTOBER 15 4:30 P.M. DECEMBER 1NOVEMBER 15 4:30 P.M. JANUARY 1 DECEMBER 15 4:30 P.M. FEBRUARY 1JANUARY 17 4:30 P.M. DIVISION OF RESEARCH STAFF: Deborah A. Porter, Interim Supervisor; Sandra F. Clark, Administrative Specialist II; Kathleen Morris, Unit Operations Support Specialist; Jeffrey W. Hague, Registrar of Regulations; Steve Engebretsen, Assistant Registrar; Victoria Schultes, Administrative Specialist II; Rochelle Yerkes, Administrative Specialist II; Rhonda McGuigan, Administrative Specialist I; Ruth Ann Melson, Legislative Librarian; Lisa Schieffert, Research Analyst; Judi Abbott, Administrative Specialist I; Alice W. Stark, Legislative Attorney; Ted Segletes, Paralegal; Deborah J. Messina, Print Shop Supervisor; Marvin L. Stayton, Printer; Don Sellers, Printer. DELAWARE REGISTER OF REGULATIONS, VOL. 8, ISSUE 3, WEDNESDAY, SEPTEMBER 1, 2004 TABLE OF CONTENTS Cumulative Tables................................................. ....... 371 EMERGENCY DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF FISH & WILDLIFE Non-Tidal Finfish: 3308 (Formerly NT-7) Fish Stocking Practices.................................................. ....... 374 ERRATA DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF SOCIAL SERVICES 5311 Notification of Time and Place of Hearing.. ....... 376 PROPOSED DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 1900 Board of Nursing.......................................... ....... 377 5300 Board of Massage and Bodywork................ ....... 390 DEPARTMENT OF EDUCATION 705 Training Camp and Special Duty in the National Guard and/or Reserves.................... ....... 396 706 Credit for Experience for Full Time Service in the Armed Forces....................................... ....... 397 718 Health Examinations for School District Employees...................................................... ....... 399 805 The School Health Tuberculosis (TB) Control Program............................................. ....... 400 925 Children With Disabilities.............................. ....... 402 PROFESSIONAL STANDARDS BOARD 1554 Standard Certificate Reading Specialist....... ....... 405 DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF SOCIAL SERVICES Child Care Subsidy Program: 11002.9 Definitions and Explanation Of Terms; 11004.4.1 Explanation of Certificates; 11006.4.2 Fee Paying Clients............................................................ ...... 407 DEPARTMENT OF INSURANCE 504 (Formerly Reg. No. 47) Education for Insurance Agents, Brokers, Surplus Lines Brokers and Consultants................................. ...... 409 FINAL DELAWARE STATE FIRE PREVENTION COMMISSION State Fire Prevention Regulations.......................... ...... 416 DEPARTMENT OF EDUCATION 101 Delaware Student Testing Program................ ...... 425 106 Teacher Appraisal Process Delaware Performance Appraisal System (DPAS II)..... ...... 431 107 Specialist Appraisal Process Delaware Performance Appraisal System (DPAS II)..... ...... 431 108 Administrator Appraisal Process Delaware Performance Appraisal System (DPAS II)..... ...... 431 501 State Content Standards.................................. ...... 445 PROFESSIONAL STANDARDS BOARD 1509 Meritorious New Teacher Candidate Designation..................................................... ...... 446 1577 (Formerly Reg. 368) Standard Certificate-School Psychologist........................................ ...... 448 DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF PUBLIC HEALTH 463 Licensing and Registration of Operators of Public Water Supply Systems.................................... ...... 453 TABLE OF CONTENTS DEPARTMENT OF INSURANCE 607 (Formerly Reg. No. 37) Defensive Driving Course Discount (Automobiles & Motorcycles).................................................. ....... 460 1501 (Formerly Reg. No. 41) Medicare Supplement Insurance Minimum Standards.. ....... 465 DEPARTMENT OF LABOR COUNCIL ON APPRENTICESHIP & TRAINING Section 106.5, Standards of Apprenticeship......... ....... 468 DEPARTMENT OF STATE OFFICE OF THE STATE BANKING COMMISSIONER 708 Establishment of a Branch Office by a Bank or Trust Company.......................................... ....... 472 714 Establishment of a Mobile Branch Office by a Bank or Trust Company......................... ....... 473 1113 Election by a Subsidiary Corporation of a Banking Organization or Trust Company to be Taxed in Accordance with Chapter 19 of Title 30....................................................... ....... 474 GOVERNOR Executive Order No. 58, Relating to the Reestablishment of the Juvenile Justice Advisory Group.............................................. ....... 477 Appointments........................................................ ....... 479 GENERAL NOTICES DEPARTMENT OF EDUCATION Interagency Agreements between the Department of Education and other agencies.................... ....... 482 DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF SOIL & WATER CONSERVATION Delaware Coastal Management Program Policy Update ........................................................... ....... 497 CALENDAR OF EVENTS/HEARING NOTICES Dept. Of Administrative Services, Div. of Professional Regulation, Board of Nursing, Notice of Public Hearing................................ ...... 499 Board of Massage and Bodywork, Notice of Public Hearing ........................................... ...... 499 State Board of Education Monthly Meeting Notice .... 499 Dept. of Health and Social Services, Div. of Social Services, Child Care Subsidy Program, Notice of Public Comment Period.................. ...... 499 Dept. of Insurance, Notice of Public Hearing........ ...... 500 Delaware River Basin Commission, Notice of Public Hearing................................................ ...... 500 CUMULATIVE TABLES The table printed below lists the regulations that have been proposed, adopted, amended or repealed in the preceding issues of the current volume of the Delaware Register of Regulations. The regulations are listed alphabetically by the promulgating agency, followed by a citation to that issue of the Register in which the regulation was published. Proposed regulations are designated with (Prop.); Final regulations are designated with (Final); Emergency regulations are designated with (Emer.); and regulations that have been repealed are designated with (Rep.). DELAWARE STATE FIRE PREVENTION COMMISSION State Fire Prevention Regulations.......................................................................................... .......... 8 DE Reg. 6 (Prop.) DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION (TITLE 24 DELAWARE ADMINISTRATIVE CODE) 2100 Board of Examiners in Optometry......................................................................... 8 DE Reg. 16 (Prop.) 3900 Board of Clinical Social Work Examiners.................................................................... 8 DE Reg. 218 (Prop.) DEPARTMENT OF AGRICULTURE Rule 8.3.3.5, Erythropietin............................................................................................................. 8 DE Reg. 329 (Final) Standardbred Breeder’s Fund Regulations..................................................................................... 8 DE Reg. 336 (Final) DEPARTMENT OF EDUCATION (TITLE 14 DELAWARE ADMINISTRATIVE CODE) 101 Delaware Student Testing Program................................................................................. 8 DE Reg. 17 (Prop.) 106 Teacher Appraisal Process Delaware Performance Appraisal System (DPAS II).......... 8 DE Reg. 23 (Prop.) 107 Specialist Appraisal Process Delaware Performance Appraisal System (DPAS II)...... 8 DE Reg. 23 (Prop.) 108 Administrator Appraisal Process Delaware Performance Appraisal System (DPAS II) 8 DE Reg. 23 (Prop.) 260 General Appeal Procedure for the Child and Adult Care Food Program of the United States Department of Agriculture CACFP/USDA .................................................... 8 DE Reg. 221 (Prop.) 501 State Content Standards.......................................................................................................... 8 DE Reg. 36 (Prop.) 618 (Formerly Reg. 879) School Safety Audit.............................................................................. 8 DE Reg. 344 (Final) 620 (Formerly Reg. 880) School Crisis Response Plans............................................................... 8 DE Reg. 344 (Final) 718 Health Examinations for School District Employees..................................................... 8 DE Reg. 37 (Prop.) 805 The School Health Tuberculosis (TB) Control Program................................................ 8 DE Reg. 38 (Prop.) 852 Child Nutrition........................................................................................................................ 8 DE Reg. 224 (Prop.) 885 Safe Management and Disposal of Surplus Chemicals in the Delaware Public School System ................................................................................................................................. 8 DE Reg. 345 (Final) 925 Children with Disabilities....................................................................................................... 8 DE Reg. 225 (Prop.) 1105 School Transportation................................................................................................... 8 DE Reg. 237 (Final) PROFESSIONAL STANDARDS BOARD 323 Certification Computer Science Teacher................................................................................ 8 DE Reg. 247 (Prop.) 331 Certification Family and Consumer Sciences Teacher........................................................... 8 DE Reg. 248 (Prop.) 368 Certification School Psychologist................................................................................... 8 DE Reg. 41 (Prop.) 1501 Knowledge, Skills And Responsibility Based Supplements For Educators................. 8 DE Reg. 73 (Final) 1502 Educator Mentoring.............................................................................................................. 8 DE Reg. 347 (Final) 1505 Professional Growth Programs..................................................................................... 8 DE Reg. 78 (Final) 1528 Foreign Language Teacher Comprehensive.................................................................. 8 DE Reg. 80 (Final) 1529 Foreign Language Teacher Secondary.......................................................................... 8 DE Reg. 80 (Final) 1533 Foreign Language Teacher Elementary........................................................................ 8 DE Reg. 80 (Final) 1537 Bilingual Teacher (Spanish) Secondary........................................................................ 8 DE Reg. 80 (Final) 1558 Bilingual Teacher (Spanish) Primary Middle Level..................................................... 8 DE Reg. 80 (Final) CUMULATIVE TABLES DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF LONG TERM CARE RESIDENTS PROTECTION Assisted Living Facilities, Regulations for..................................................................... 8 DE Reg. 46 (Prop.) 8 DE Reg. 85 (Final) DIVISION OF PUBLIC HEALTH Regulations Pertaining to the Testing of Newborn Infants for Metabolic, Hematologic and Endocrinologic Disorders................................................................................. 8 DE Reg. 100 (Final) 203 Cancer Treatment Program...................................................................................... 8 DE Reg. 107 (Final) 463 Licensing and Registration of Operators of Public Water Supply Systems............. 8 DE Reg. 47 (Prop.) DIVISION OF SOCIAL SERVICES Division of Social Services Manual (DSSM) 5311 Notification of Time and Place of Hearing............................................................. 8 DE Reg. 351 (Final) 9068.1 Certification Period Length......................................................................... 8 DE Reg. 113 (Final) 20700.5-20700.5.8, Acquired Brain Injury Waiver Program.......................................... 8 DE Reg. 250 (Prop.) DEPARTMENT OF INSURANCE 301 Audited Financial Reports...................................................................................................... 8 DE Reg. 252 (Prop.) 606, (Formerly Reg. No. 31) Proof of Automobile Insurance............................................... 8 DE Reg. 55 (Prop.) 607, (Formerly Reg. No. 37) Defensive Driving Course Discount Automobiles and Motorcycles.............................................................................................................. 8 DE Reg. 59 (Prop.) 1404 Long-Term Care Insurance...................................................................................................8 DE Reg. 257 (Prop.) 1501, Medicare Supplement Insurance Minimum Standards................................................ 8 DE Reg. 62 (Prop.) DEPARTMENT OF LABOR COUNCIL ON APPRENTICESHIP & TRAINING Section 106.5, Standards of Apprenticeship................................................................... 8 DE Reg. 65 (Prop.) DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL Green Energy Fund Program Regulation............................................................................... 8 DE Reg. 114 (Final) DIVISION OF AIR AND WASTE MANAGEMENT-AIR QUALITY MANAGEMENT SECTION Hazardous Waste, Regulations Governing............................................................................. 8 DE Reg. 352 (Final) Reporting of a Discharge of a Pollutant or Air Contaminant......................................... 8 DE Reg. 126 (Final) Solid Waste, Regulations Governing...................................................................................... 8 DE Reg. 354 (Final) DIVISION OF FISH & WILDLIFE 4.0 Seasons & 7.0 Deer........................................................................................................... 8 DE Reg. 355 (Final) DIVISION OF WATER RESOURCES Design, Installation and Operation of On-Site Wastewater Treatment and Disposal Systems, Regulations Governing............................................................................................ 8 DE Reg. 283 (Prop.) Surface Water Quality Standards.................................................................................... 8 DE Reg. 154 (Final) DEPARTMENT OF SAFETY AND HOMELAND SECURITY Board of Examiners of Private Investigators and Private Security Agencies................................ 8 DE Reg. 325 (Final) DEPARTMENT OF STATE DIVISION OF HISTORICAL AND CULTURAL AFFAIRS Historic Preservation Tax Credit, Regulations Governing ............................................ 8 DE Reg. 194 (Final) OFFICE OF THE STATE BANKING COMMISSIONER 708 (Formerly Reg. No. 5.770.0009) Establishment of a Branch Office by a Bank or Trust Company........................................................................................................ 8 DE Reg. 68 (Prop.) 714 Establishment of a Mobile Branch Office by a Bank or Trust Company................ 8 DE Reg. 68 (Prop.) 1113 Election by a Subsidiary Corporation of a Banking Organization of Trust Company to be Taxed in Accordance with Chapter 19 of Title 30.......................................... 8 DE Reg. 68 (Prop.) CUMULATIVE TABLES GOVERNOR’S OFFICE Appointments ................................................................................................................................ 8 DE Reg. 361 (Final) Executive Order No. 56, Establishing The Infant Mortality Task Force....................................... 8 DE Reg. 199 (Final) Executive Order No .57, Declaring Friday, June 11, 2004 A Legal Holiday In Remembrance Of Former President Reagan.......................................................................... 8 DE Reg. 360 (Final) EMERGENCY REGULATIONS DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF FISH AND WILDLIFE Statutory Authority: 29 Delaware Code, Section 10119 (29 Del.C. §10119) Adoption of amendment to Non-Tidal Fishing Regulations Concerning Snakehead Fishes Order No. 2004-F-0044 Authority Pursuant to 29 Del.C. subsection 10119, The Department of Natural Resources and Environmental Control is adopting an amendment to Non-Tidal Fishing Regulation 3308 (Formerly Regulation NT-7). Fish Stocking Practices without prior notice or public hearing to prevent the introduction into Delaware waters of a potentially injurious exotic species of fish, the northern snakehead, Channa argus. This emergency regulation would add live northern snakehead fish to the list of species for which it is unlawful to transport, purchase, possess or sell in Delaware without the written permission of the Director of the Division of Fish and Wildlife. Reason For The Emergency Order: Many states have taken action to ban the possession, purchase, sale or stocking of live northern snakehead fish, Channa argus, within their boundaries. Two years ago the Maryland Department of Natural Resources attracted national news media attention because of its attempt to eradicate a breeding population of northern snakehead fishes from a pond in Crofton, MD. Since then more than a dozen northern snakeheads have been caught recently in the tidal Potomac River, indicating that this exotic species may already be reproducing in the wild in Maryland and Virginia waters. The northern snakehead is a exotic species native to Southeast Asia with the potential to displace native species and out compete them for food and space because it is an aggressive predator with high reproductive potential and the ability to move from one water body to another by wriggling along wet grass. Some species of snakeheads are known to reach four ft. in length and all are very aggressive predators. The northern snakehead and other snakehead species have been imported to the United States by the aquarium and/or food trade and apparently are regarded by the Asian community in the US as a food fish. The Pennsylvania Fish and Boat Commission issued a press release on July 23, 2004 that northern snakeheads were found in Meadow Lake within FDR Park near Philadelphia International Airport. According to Dan Tredinnick, the Press Secretary for the PA Fish and Boat Commission, the Commission has concluded that there is no practical method for eradicating snakeheads in this system of ponds, tidal sloughs and embayments that connect with the Schuylkill and Delaware Rivers. If the species becomes established in the lower Delaware River, it is very likely that it will take up residence in the Delaware portion of the Delaware River as well, where it then could enter the Christiana and Brandywine systems. It is against PA Fish and Boat Commission regulations to possess any variety of live snakeheads. The Maryland Department of Natural Resources recognizes 29 species of snakeheads of the Genera Channa and Parachanna. Regulations banning these 29 species are scheduled for implementation September 13, 2004. The US Fish and Wildlife Service added 28 species of the snakehead family Channidae to the list of injurious wildlife on October 4, 2002. By this federal action no snakehead fishes may be imported into or transported into or between states and territories in the US (Federal Register vol. 67, No. 193, p. 62193-62204). If the northern snakehead becomes established in Delaware waters it will have an unknown and possibly injurious impact on native and naturalized biota. By acting quickly, the Delaware Department of Natural Resources and Environmental Control may be able to head off any purposeful or inadvertent releases of northern snakehead fishes in Delaware waters now, that there are known populations living in the wild in the neighboring states of MD, VA and PA that could serve as reservoirs for anyone so inclined. Effective Date Of Order This Emergency Order shall take effect at 12:01 a.m. on July 28, 2004 and shall remain in effect for 120 days. Petition For Recommendations The Department will receive, consider and respond to petitions by any interested person for recommendations or revisions of this Order. Petitions should be presented to the Fisheries Section, Division of Fish and Wildlife, 89 Kings Highway, Dover, Delaware, 19901. ORDER It is hereby ordered, the 28th day of July, 2004 that the above referenced amendment to Non-Tidal Fishing Regulation 3308 (Formerly NT-7). Fishing Stocking Practices, copies of which are hereby attached, are adopted pursuant to 29 Del.C. subsection 10119 and supported by the EMERGENCY REGULATIONS evidence contained herein. John A. Hughes, Secretary Department of Natural Resources and Environmental Control 3308 (Formerly NT-7) Fish Stocking Practices (Penalty Section 7 Del.C. §1304) 1.0 Stocking Fish Practices. 1.1 It shall be unlawful for any person to stock any species of fish into the non-tidal public waters of this State without the written permission of the Director. This regulation does not prohibit the stocking of private impoundments. 2.0 Transportation, Possession and Sale. 2.1 It shall be unlawful for any person to transport, purchase, possess or sell walking catfish (Clarius batrachus) or the white amur or grass carp (Ctenopharyngodon idella) or live northern snakehead fish (Channa argus) without the written permission of the Director. 3 DE Reg. 289 (8/1/99) ERRATA DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF SOCIAL SERVICES Statutory Authority: 31 Delaware Code, Section 107 (31 Del.C. §107) PUBLIC NOTICE PLEASE NOTE: THE AUGUST 2004 ISSUE CONTAINED AN ERROR IN THE FIRST PARAGRAPH OF REGULATION 5311 (8 DE REG. 351). THE TEXT DID NOT REFLECT THE CHANGE FROM TEN (10) DAYS TO TWELVE (12) DAYS. THE CORRECT VERSION FOLLOWS: 5311 Notification of Time and Place of Hearing The time, date, and place of the hearing will be arranged so that the hearing is accessible to the appellant. At least ten (10) 12 days before the hearing, advance written notice will be provided by mailing the notice to all parties involved to permit adequate preparation of the case. An appellant may request less notice in order to expedite the scheduling of the hearing. Notices to appellants are sent by certified mail. The notice will: 1) Advise the appellant or representative of the name, address, and phone number of the person to notify in the event it is not possible for the appellant to attend the scheduled hearing; 2) Stipulate that the hearing request will be dismissed if the appellant or his/her representative fails to appear for the hearing without good cause (i.e., death in family, personal illness, unexpected emergency); 3) Include the hearing procedures and any other information that would provide the appellant with an understanding of the proceedings that would contribute to the effective presentation of the household's case and will include fair hearing summary and documents filed for the hearing; 4) Explain that the appellant has the right to bring an attorney or other representative to his/her hearing; 5) Explain that the appellant may present any information that (s)he desires at the hearing; 6) Explain that the appellant or representative may examine the record prior to the hearing. 8 DE Reg. 351 (8/1/04) PROPOSED REGULATIONS Symbol Key Roman type indicates the text existing prior to the regulation being promulgated. Underlined text indicates new text. Language which is stricken through indicates text being deleted. Proposed Regulations Under 29 Del.C. §10115 whenever an agency proposes to formulate, adopt, amend or repeal a regulation, it shall file notice and full text of such proposals, together with copies of the existing regulation being adopted, amended or repealed, with the Registrar for publication in the Register of Regulations pursuant to §1134 of this title. The notice shall describe the nature of the proceedings including a brief synopsis of the subject, substance, issues, possible terms of the agency action, a reference to the legal authority of the agency to act, and reference to any other regulations that may be impacted or affected by the proposal, and shall state the manner in which persons may present their views; if in writing, of the place to which and the final date by which such views may be submitted; or if at a public hearing, the date, time and place of the hearing. If a public hearing is to be held, such public hearing shall not be scheduled less than 20 days following publication of notice of the proposal in the Register of Regulations. If a public hearing will be held on the proposal, notice of the time, date, place and a summary of the nature of the proposal shall also be published in at least 2 Delaware newspapers of general circulation; The notice shall also be mailed to all persons who have made timely written requests of the agency for advance notice of its regulation-making proceedings. DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION BOARD OF NURSING 24 DE Admin. Code 1900 Statutory Authority: 24 Delaware Code, Section 1906(1) (24 Del.C. §1906(1)) PUBLIC NOTICE The Delaware Board of Nursing in accordance with 24 Del.C. §1906(1) has proposed to promulgate Rules and Regulations related to Intravascular Therapy by Licensed Nurses. These proposed rules and regulations which have been developed by the Board define intravascular therapy practices for licensed nurses. Peripheral and central line management, including special procedures such as chemotherapy and epidural catheter management are included. A public hearing will be held on Wednesday, October 13, 2004 at 9:00 a.m. in the second floor Conference Room A, Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware. Anyone desiring a copy of the proposed new section of the Rules and Regulations may obtain a copy from the Delaware Board of Nursing, 861 Silver Lake Boulevard, Cannon Building, Suite 203, Dover, DE 19904, (302) 7444515 or (302) 744-4516. Persons desiring to submit written comments on the revised rules and regulations may forward these comments to the above address. The final date to receive written comments will be October 13, 2004. The Delaware Board of Nursing proposes to add language regarding Intravascular Therapy to Section 7, Standards of Nursing Practice, within its Rules and Regulations. 7.0 Standards of Nursing Practice 7.1 Authority “Standards of nursing practice” means those standards of practice adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards of nursing practice shall not be used to directly or indirectly affect the employment practices and deployment of personnel by duly licensed or accredited hospitals and other duly licensed or accredited health care facilities and organizations. In addition, such standards shall not be assumed the only evidence in civil malpractice litigation, nor shall they be given a different weight than any other evidence. 7.2 Purpose The purpose of standards is to establish minimal acceptable levels of safe practice for the Registered and Licensed Practical Nurse, and to serve as a guide for the Board to evaluate safe and effective nursing care. 7.3 Standards of Practice for the Registered and Licensed Practical Nurse 7.3.1 Standards related to the Registered Nurse. 7.3.1.1 The Registered Nurse shall conduct and document nursing assessments of the health status of individuals and groups by: 7.3.1.1.1 Collecting objective and subjective data from observations, examinations, interviews PROPOSED REGULATIONS and written records in an accurate and timely manner. The data include but are not limited to: 7.3.1.1.1.1 Biophysical and emotional status and observed changes; 7.3.1.1.1.2 Growth and development; 7.3.1.1.1.3 Ethno-cultural, spiritual, socio-economic and ecological background; 7.3.1.1.1.4 Family health history; 7.3.1.1.1.5 Information collected by other health team members; 7.3.1.1.1.6 Ability to perform activities of daily living; 7.3.1.1.1.7 Consideration of client’s health goals; 7.3.1.1.1.8 Client knowledge and perception about health status and potential, or maintaining health status; 7.3.1.1.1.9 Available and accessible human and material resources; 7.3.1.1.1.10 Patterns of coping and interaction. 7.3.1.1.2 Sorting, selecting, reporting, and recording the data. 7.3.1.1.3 Analyzing data. 7.3.1.1.4 Validating, refining and modifying the data by using available resources including interactions with the client, family, significant others, and health team members. 7.3.1.1.5 Evaluating data. 7.3.1.2 Registered Nurses shall establish and document nursing diagnoses that serve as the basis for the strategy of care. 7.3.1.3 Registered Nurses shall develop strategies of care based on assessment and nursing diagnoses. This includes, but is not limited to: 7.3.1.3.1 Prescribing nursing intervention(s) based on the nursing diagnosis. 7.3.1.3.2 Initiating nursing interventions through 7.3.1.3.2.1 Giving care. 7.3.1.3.2.2 Assisting with care. 7.3.1.3.2.3 Delegating care. 7.3.1.3.3 Identifying to the identification of priorities in the strategies of care. 7.3.1.3.4 Setting realistic and measurable goals for implementation. 7.3.1.3.5 Identifying measures to maintain comfort, to support human functions and responses, to maintain an environment conducive to well being, and to provide health teaching and counseling. 7.3.1.3.6 Supervising the caregiver to whom care is delegated. 7.3.1.4 Registered Nurses shall participate in the implementation of the strategy of care by: 7.3.1.4.1 Providing care for clients whose conditions are stabilized or predictable. 7.3.1.4.2 Providing care for clients whose conditions are critical and/or fluctuating, under the direction and supervision of a recognized authority. 7.3.1.4.3 Providing an environment conducive to safety and health. 7.3.1.4.4 Documenting nursing interventions and client outcomes. 7.3.1.4.5 Communicating nursing interventions and client outcomes to health team members. 7.3.1.5 Registered Nurses shall evaluate outcomes, which shall include the client, family, significant others and health team members. 7.3.1.5.1 Evaluation data shall be appropriately documented; and 7.3.1.5.1.1 Be communicated to the client, family, significant others and appropriate members of the health care team; and 7.3.1.5.1.2 Used as a basis for modifying outcomes by reassessing client health status, modifying nursing diagnoses, revising strategies of care or prescribing changes in nursing interventions. 7.4 Standards of Practice for the Licensed Practical Nurse 7.4.1 Standards related to the Licensed Practical Nurse’s contributions to the nursing process. 7.4.1.1 The Licensed Practical Nurse shall contribute to and document nursing assessments of the health status of individuals and groups by: 7.4.1.1.1 Sorting, selecting, reporting, and recording the data. 7.4.1.1.2 Collecting objective and subjective data from observations, examinations, interview and written records in an accurate and timely manner. The data include but are not limited to: 7.4.1.1.2.1 Biophysical and emotional status and observed changes; 7.4.1.1.2.2 Growth and development; 7.4.1.1.2.3 Ethno-cultural, spiritual, socio-economic, and ecological background; 7.4.1.1.2.4 Family health history; 7.4.1.1.2.5 Information collected by other health team members; 7.4.1.1.2.6 Ability to perform activities of daily living; 7.4.1.1.2.7 Consideration of client’s health goals; 7.4.1.2 Licensed Practical Nurses shall participate in establishing and documenting nursing diagnoses that serve as the basis for the strategy of care. 7.4.1.3 Licensed Practical Nurses shall participate in developing strategies of care based on PROPOSED REGULATIONS assessment and nursing diagnoses. 7.4.1.3.1 Contributing to setting realistic and measurable goals for implementation. 7.4.1.3.2 Participating in identifying measures to maintain comfort, to support human functions and responses to maintain an environment conducive to well-being, and to provide health teaching and counseling. 7.4.1.3.3 Contributing to setting client priorities. 7.4.1.4 Licensed Practical Nurses shall participate in the implementation of the strategy of care by: 7.4.1.4.1 Providing care for clients whose conditions are stabilized or predictable. 7.4.1.4.2 Providing care for clients whose conditions are critical and/or fluctuating, under the directions and supervision of a recognized licensed authority. 7.4.1.4.3 Providing an environment conducive to safety and health. 7.4.1.4.4 Documenting nursing interventions and client outcomes. 7.4.1.4.5 Communicating nursing interventions and client outcomes to health team members. 7.4.1.5 Licensed Practical Nurses shall contribute to evaluating outcomes by appropriately documenting and communicating to the client, family, significant others and the health care team members. 7.5 Standards Related to the Registered and Licensed Practical Nurse’s Competencies and Responsibilities. 7.5.1 Registered and Licensed Practical Nurses shall: 7.5.1.1 Have knowledge of the statutes and regulations governing nursing and function within the legal boundaries of professional and practical nursing practice. 7.5.1.2 Accept responsibility for competent nursing practice. 7.5.1.3 Function as a member of the health team: 7.5.1.3.1 By collaborating with other members of the health team to provide optimum care, or 7.5.1.3.2 As an LPN under the direction and supervision of a recognized licensed authority. 7.5.1.4 Consult with nurses, other health team members and community agencies for continuity of care and seek guidance as necessary. 7.5.1.5 Obtain instruction and supervision as necessary when implementing nursing techniques. 7.5.1.6 Contribute to the formulation, interpreting, implementing and evaluating of the objectives and policies related to professional and practical nursing practice within the employment setting. 7.5.1.7 Participate in evaluating nurses through peer review. 7.5.1.8 Report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities. 7.5.1.9 Practice without discrimination as to age, race, religion, sex, sexual orientation, national origin, or disability. 7.5.1.10 Respect the dignity and rights of clients regardless of social or economic status, personal attributes or nature of health problems. 7.5.1.11 Respect the client’s right to privacy by protecting confidentiality unless obligated by law to disclose the information. 7.5.1.12 Respect the property of clients, their families and significant others. In addition to the proceeding, the Registered Nurse shall: 7.5.1.13 Delegate to others only those nursing interventions that those persons are prepared or qualified to perform. 7.5.1.14 Supervise others to whom nursing interventions are delegated. 7.5.1.15 Retain professional accountability for care when delegating. 7.5.1.16 Teach safe practice to other health care workers as appropriate. 7.6 Dispensing 7.6.1 Definitions 7.6.1.1 “Dispensing” means providing medication according to an order of a practitioner duly licensed to prescribe medication. The term shall include both the repackaging and labeling of medication from bulk to individual doses. 7.6.1.2 “Prescription label” - a label affixed to every prescription or drug order which contains the following information at a minimum. 7.6.1.2.1 A unique number for that specific drug order. 7.6.1.2.2 The date the drug was dispensed. 7.6.1.2.3 The patient’s full name. 7.6.1.2.4 The brand or established name and manufacturer and the strength of the drug to the extent it can be measured. 7.6.1.2.5 The practitioner’s directions as found on the prescription order. 7.6.1.2.6 The practitioner’s name. 7.6.1.2.7 The initials of the dispensing nurse. 7.6.1.2.8 The name and address of the facility or practitioner from which the drug is dispensed. 7.6.1.2.9 Expiration date. 7.6.1.3 “Standing order” - An order written by the practitioner which authorizes a designated registered nurse or nurses to dispense prescription drugs to his/her patients(s) according to the standards listed below. 7.6.2 Authority to Dispense 7.6.2.1 Registered Nurses may assume the PROPOSED REGULATIONS responsibility of dispensing as defined in the Nurse Practice Act. 7.6.2.2 Licensed Practice Nurses may assume the responsibility of dispensing as authorized by the Nurse Practice Act and defined in these Regulations, Section 7.6.2.2.1., 7.6.2.2.2, and 7.6.2.2.3 7.6.2.2.1 Licensed Practical Nurses may provide to a patient pre-packaged medications in accordance with the order of a practitioner duly licensed to prescribe medication where such medications have been prepackaged by a person with lawful authority to dispense drugs. 7.6.2.2.2 Licensed Practical Nurses, per written order of a physician, dentist, podiatrist, advanced practice nurse, or other practitioner duly licensed to prescribe medication, may add the name of the client to a preprinted label on a pre-packaged medication. 7.6.2.2.3 Licensed Practical Nurses in a licensed methadone clinic may apply a preprinted label to a pre-packaged medication. 7.6.3 Standards for Dispensing 7.6.3.1 All licensed nurses engaged in dispensing shall adhere to these standards. 7.6.3.1.1 The medication must be prepackaged by a pharmaceutical company or prepared by a registered pharmacist. 7.6.3.1.2 The nurse shall be responsible for proper drug storage of the medication prior to dispensing. 7.6.3.1.3 The practitioner who originated the prescription or drug order must be on the premises or he/she or their designated coverage shall be available by telephone during the act of dispensing. 7.6.3.1.4 Once a drug has been dispensed it shall not be returned for reuse by another or the same patient in an institutional setting. 7.6.3.1.5 The nurse may not delegate any part of the dispensing function to any other individual who is not licensed to dispense. 7.6.3.1.6 The dispensing nurse must assure compliance to the state generic substitution laws when selecting the product to be dispensed. 7.6.3.1.7 The nurse-dispensed prescription may not be refillable; it requires the authority of the prescriber with each dispensing. 7.6.3.1.8 A usage review process must be established for the medicines dispensed to assure proper patient usage. 7.6.3.1.9 All dispensed drugs must be labeled as defined above and dispensed in proper safety closure containers that meet the standards established by the United States Pharmacopoeia for stability. 7.6.3.1.10 Record keeping must include the maintenance of the original written prescription of drug order for at least three years, allow retrospective review of accountability, and provide an audit trail. All dispensing records must be maintained on site, and available for inspection by authorized agents of the Board of Health, Pharmacy, and Nursing. 7.6.3.1.11 The dispensing nurse shall assume the responsibility of patient counseling of drug effects, side-effects, desired outcome, precautions, proper storage, unique dosing criteria, drug interactions, and other pertinent data, and record evidence of patient education. 7.6.3.1.12 Conformance to paragraphs 6 through 11 are not necessary if the original prescription was dispensed by a pharmacist for that specific patient. 7.7 Delegation 7.7.1 Definitions 7.7.1.1 “Accountability” - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision. 7.7.1.2 “Delegation” -Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act. 7.7.1.3 “Supervision” - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action. 7.7.1.4 “Unlicensed Assistive Personnel” -Individuals not licensed to perform nursing tasks that are employed to assist in the delivery of client care. The term “unlicensed assistive personnel” does not include members of the client’s immediate family, guardians, or friends; these individuals may perform incidental care of the sick in private homes without specific authority from a licensed nurse (as established in 24 Del.C. §1921(a)(4) of the Nurse Practice Act). 7.7.2 Conditions 7.7.2.1 The following conditions are relevant to delegation: 7.7.2.1.1 Only RNs may delegate. 7.7.2.1.2 The RN must be knowledgeable regarding the unlicensed assistive personnel’s education and training and have opportunity to periodically verify the individual’s ability to perform the specific tasks. 7.7.2.1.3 The RN maintains accountability for determining the appropriateness of all delegated nursing duties and responsibility for the delivery of safe and competent care. Unlicensed assistive personnel may not reassign a delegated act. 7.7.3 Criteria PROPOSED REGULATIONS 7.7.3.1 The RN may delegate only tasks that are within the scope of sound professional nursing judgment to delegate. 7.7.3.2 Determination of appropriate factors include, but are not limited to: 7.7.3.2.1 stability of the client’s condition 7.7.3.2.2 educational background, skill level, or preparation of the individual 7.7.3.2.3 nature of the nursing act that meets the following: 7.7.3.2.3.1 task is performed frequently in the daily care of a client 7.7.3.2.3.2 task is performed according to an established sequence of steps 7.7.3.2.3.3 task may be performed with a predictable outcome 7.7.3.2.3.4 task does not involve ongoing assessment, interpretation or decision making that cannot be logically separated from the task itself. 7.7.3.3 The RN must be readily available in person or by telecommunication. 7.7.4 Exclusions 7.7.4.1 The following activities require nursing knowledge, judgment, and skill and may not be delegated by the RN to an unlicensed assistive person. These exclusions do not apply to Advanced Practice Nurses. 7.7.4.2 Physical, psychological, and social assessment which requires professional nursing judgment, intervention, referral, or follow-up; 7.7.4.3 Development of nursing diagnosis and care goals; 7.7.4.4 Formulation of the plan of nursing care and evaluation of the effectiveness of the nursing care provided; 7.7.4.5 Specific tasks involved in the implementation of the plan of care which require nursing judgment, skill, or intervention, that include, but are not limited to: performance of sterile invasive procedures involving a wound or anatomical site; nasogastric, newly established gastrostomy and jejunostomy tube feeding; nasogastric, jejunostomy and gastrostomy tube insertion or removal; suprapubic catheter insertion and removal; (phlebotomy is not considered a sterile, invasive procedure); 7.7.4.6 Administration of medications, including prescription topical medications; and 7.7.4.7 Receiving or transmitting verbal orders. 1 DE Reg. 1888 (6/1/98) 6 DE Reg. 1195 (3/1/03) 7.8 Intravascular Therapy By Licensed Nurses Intravascular therapy encompasses several components, some of which require primarily skill proficiency with a minimum of critical judgement. Other aspects of intravascular therapy require skill proficiency and more importantly a high degree of knowledge, critical judgement and decision making to perform the function safely. 7.8.1 Definition Of Terms 7.8.1.1 Vascular system - is composed of all peripheral and central veins and arteries. 7.8.1.2 Intravascular therapy (IV) - is the broad term including the administration of fluids and medications, blood and blood derivatives into an individual's vascular system. 7.8.1.3 Intravenous fluids - include solutions, vitamins, nutrient preparations, and commercial blood fractions designed to be administered into an individual's vascular system. Whole blood and blood components, which are administered in the same manner, are considered intravenous fluids in this definition. 7.8.1.4 Intravenous and intra-arterial medications - are drugs administered into an individual's vascular system by any one of the following methods: 7.8.1.4.1 By way of infusion diluted in solution or suspended in fluid and administered over a specified time at a specified rate. 7.8.1.4.2 Through an established intravascular needle or catheter (referred to as "IV push"). 7.8.1.4.3 By venipuncture carried out for the sole purpose of administering the medication. This method is referred to as direct medication injection (direct IV push). 7.8.1.5 Vascular access - Utilization of an established device or the introduction of a needle or catheter into an individual’s vascular system. 7.8.1.6 Venipuncture -Introduction of a needle or catheter into an individual's peripheral vein for the purpose(s) of withdrawing blood or establishing an infusion or administering medications. 7.8.1.7 Intravascular therapy maintenance -Monitoring of the therapy for changes in patient's condition, appropriate flow rate, equipment function, the hanging of additional fluid containers and the implementation of site care. 7.8.1.8 Termination of intravascular therapy - Cessation of the therapy either by withdrawing a needle or catheter from an individual’s vascular system or by discontinuing the infusion and maintaining the device as a reservoir. 7.8.1.9 Supervision - a registered nurse, licensed physician or dentist is physically present in the unit where the patient is being provided care, or within immediate electronic/telephone contact. 7.8.2 Conditions Of Performing Intravascular Therapy Procedures By Licensed Nurses 7.8.2.1 Intravascular therapy must be authorized by a written order from a state licensed and PROPOSED REGULATIONS authorized prescriber. 7.8.2.2 The performance of any procedures of intravascular therapy by a licensed practical nurse will be done under the supervision of a registered nurse, APN, or person licensed to practice medicine, surgery, or podiatry. 7.8.2.3 Admixed intravascular solutions documented and instituted by one licensed nurse and subsequently interrupted may be re-instituted by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.4 Admixed intravascular solutions documented and prepared by one licensed nurse may be initiated or continued by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.5 Intradermal or topical anesthetics may be used by the RN or LPN when initiating vascular access therapy in various situations or settings, provided there is an authorized prescriber’s order and organizational policy/ procedure to support use of these medications. All RNs and LPNs must have documented educational preparation according to the employing agency’s policies and procedures. Documented evidence must include both theoretical instruction including anatomy and physiology, pharmacology, nursing management and education of patients and demonstration of clinical proficiency in performance of the task. 7.8.3 Functional Scope Of Responsibility For Intravascular Therapy Procedures 7.8.3.1 Registered Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following: 7.8.3.1.1 Assessment of the patient and the prescribed intravascular therapy before, during and after the therapy is carried out. 7.8.3.1.2 Acceptance and confirmation of intravascular therapy order(s). 7.8.3.1.3 Calculation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.4 Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.5 Addition of prescribed medications in intravascular solution, labeling and documenting appropriately. 7.8.3.1.6 Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.1.7 Vascular access for establishing an infusion or administering medications. 7.8.3.1.8 Administration of medications by "IV push". 7.8.3.1.9 Intravascular therapy maintenance. 7.8.3.1.10 Termination of intravascular therapy, including the removal of subclavian and PICC lines. 7.8.3.1.11 Access the vascular system for the purpose of the withdrawal of blood and to monitor the patient's condition before, during, and after the withdrawal of blood. 7.8.3.2 Licensed Practical Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following for peripheral lines: 7.8.3.2.1 Acceptance of intravascular therapy order(s). 7.8.3.2.2 Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.2.3 Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.2.4 Addition of mediations in intravascular solutions, label and document appropriately. 7.8.3.2.5 Venipuncture with needle device to establish access to the peripheral vascular system. 7.8.3.2.6 Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.2.7 Intravascular therapy maintenance including the flushing of peripheral lines with Heparin and/or saline solution. 7.8.3.2.8 Termination of peripheral intravascular therapy. 7.8.3.2.9 Performance of venipuncture for the purpose of the withdrawal of blood and to monitor the patient's condition before, during and after the withdrawal of blood. 7.8.3.3 The Licensed Practical Nurse is permitted to perform the following procedures for central lines: 7.8.3.3.1 Acceptance of intravascular therapy order(s). 7.8.3.3.2 Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.3.3 Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.3.4 Addition of medications in intravascular solutions, label and document appropriately. 7.8.3.3.5 Intravascular therapy maintenance, including the flushing of central lines with Heparin and/or saline solution. 7.8.3.3.6 Dressing and tubing changes, including PICC lines. 7.8.3.3.7 Addition of replacement fluids to an existing infusion as prescribed. PROPOSED REGULATIONS 7.8.4. Special Intravascular Procedures By Registered Nurses 7.8.4.1 Chemotherapy - Only intravascular routes are addressed in these rules. Review of the Oncology Nursing Society’s current guidelines is recommended before the administration of anti-neoplastic agents. 7.8.4.1.1 Definition of Terms 7.8.4.1.1.1 Cancer Chemotherapy - is the broad term including the administration of antineoplastic agents into an individual's vascular system. 7.8.4.1.1.2 Anti-neoplastic agents -are those drugs which are administered with the intent to control neoplastic cell growth. 7.8.4.1.2 The Registered Nurse who administers cancer chemotherapy by the intravascular route must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.1.3 The Registered Nurse must have documented evidence of knowledge and skill in the following: • Pharmacology of antineoplastic agents • Principles of drug handling and preparation • Principles of administration • Vascular access • Side effects of chemotherapy on the nurse, patient, and family 7.8.4.2 Central Venous Access Via Peripheral Veins 7.8.4.2.1 Definition of Terms 7.8.4.2.1.1 Central venous access -is that entry into an individual's vascular system via the insertion of a catheter into a peripheral vein threaded through to the superior vena cava with placement confirmed by x-ray. 7.8.4.2.2 The Registered Nurse who performs central venous access via peripheral veins must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.2.3 Documented evidence must include, but is not limited to, evidence of both theoretical instruction and clinical proficiency in performance of the task. 7.8.4.2.3.1 Theoretical instruction must include, but is not limited to, anatomy and physiology, pharmacology, nursing management, and education of patients as they relate to central venous access via peripheral veins. 7.8.4.2.3.2 A preceptor must supervise the learning experience and must document the Registered Nurse's competency in the performance of the procedure. 7.8.4.3 Pain Management Via Epidural Catheter 7.8.4.3.1 It is within the scope of practice of a Registered Nurse to instill analgesics (opiates)/ low dose anesthetics at analgesic levels into an existing catheter under the following conditions/exceptions: 7.8.4.3.1.1 The epidural catheter is in place. 7.8.4.3.1.2 The position of the epidural catheter was verified as correct by a physician at the time of insertion. 7.8.4.3.1.3 Bolus doses and/or continuous infusions, as pre-mixed by anesthesiologists, C.R.N.A.s, or pharmacists, of epidural analgesics/low does anesthetics at analgesic levels can be administered by the Registered Nurse only after the initial dose has been administered. Changes in medication and/or dosage of the same medication are not defined as the initial dose. 7.8.4.3.1.4 Only analgesics (opiates)/low dose anesthetics at analgesic levels will be administered via this route for acute and chronic pain management. 7.8.4.3.1.5 The Registered Nurse must complete a course that includes, but is not limited to, a) anatomy, physiology, pharmacology, nursing management, assessment, and education of patients as they relate to epidural administration of opiates/low dose anesthetics at analgesic levels; b) a credentialed preceptor must supervise the learning experience and must document the Registered Nurse's clinical competency in the performance of the procedure. 7.8.4.3.1.6 The Registered Nurse may not insert or remove epidural catheters 8.0 Rules and Regulations Governing the Practice of Nursing as an Advanced Practice Nurse in the State of Delaware 8.1 Authority These rules and regulations are adopted by the Delaware Board of Nursing under the authority of the Delaware Nurse Practice Act, 24 Del.C. §§1902(d), 1906(1), 1906(7). 8.2 Purpose 8.2.1 The general purpose of these rules and regulations is to assist in protecting and safeguarding the public by regulating the practice of the Advanced Practice Nurse. 8.3 Scope 8.3.1 These rules and regulations govern the educational and experience requirements and standards of practice for the Advanced Practice Nurse. Prescribing medications and treatments independently is pursuant to the Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). The Advanced Practice Nurse is responsible and accountable for PROPOSED REGULATIONS her or his practice. Nothing herein is deemed to limit the scope of practice or prohibit a Registered Nurse from engaging in those activities that constitute the practice of professional nursing and/or professional nursing in a specialty area. 8.4 Definitions “Advanced Practice Nurse”as defined in 24 Del.C. §1902(d)(1). Such a nurse will be given the title Advanced Practice Nurse by state licensure, and may use the title Advanced Practice Nurse within his/her specific specialty area. “Audit” The verification of existence of a collaborative agreement for a minimum of 10% of the total number of licenses issued during a specified time period. “Board” The Delaware Board of Nursing “Certified Nurse Midwife (C.N.M.)” A Registered Nurse who is a provider for normal maternity, newborn and well-woman gynecological care. The CNM designation is received after completing an accredited post-basic nursing program in midwifery at schools of medicine, nursing or public health, and passing a certification examination administered by the ACNM Certification Council, Inc. or other nationally recognized, Board of Nursing approved certifying organization. “Certified Registered Nurse Anesthetist (C.R.N.A.)” A Registered Nurse who has graduated from a nurse anesthesia educational program accredited by the American Association of Nurse Anesthetists’ Council on Accreditation of Nurse Anesthesia Educational programs, and who is certified by the American Association of Nurse Anesthetists’ Council on Certification of Nurse Anesthetists or other nationally recognized, Board of Nursing approved certifying organization. “Clinical Nurse Specialist (C.N.S.)” A Registered Nurse with advanced nursing educational preparation who functions in primary, secondary, and tertiary settings with individuals, families, groups, or communities. The CNS designation is received after graduation from a Master’s degree program in a clinical nurse specialty or post Master’s certificate, such as gerontology, maternal-child, pediatrics, psych/mental health, etc. The CNS must have national certification in the area of specialization at the advanced level if such a certification exists or as specified in 8.9.4.1 of these Rules and Regulations. The certifying agency must meet the established criteria approved by the Delaware Board of Nursing. “Clinical Nursing Specialty” a delimited focus of advanced nursing practice. Specialty areas can be identified in terms of population, setting, disease/pathology, type of care or type of problem. Nursing administration does not qualify as a clinical nursing specialty. 3 DE Reg. 1373 (4/1/00) “Collaborative Agreement” Written verification of health care facility approved clinical privileges; or health care facility approved job description; or a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system. “Guidelines/ Protocols” Suggested pathways to be followed by an Advanced Practice Nurse for managing a particular medical problem. These guidelines/protocols may be developed collaboratively by an Advanced Practice Nurse and a licensed physician, dentist or a podiatrist, or licensed Delaware health care delivery system. “National Certification” That credential earned by a nurse who has met requirements of a Board approved certifying agency. The agencies so approved include but are not limited to: • American Academy of Nurse Practitioners • American Nurses Credentialing Center • American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists • American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists • National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties • National Certification Board of Pediatric Nurse Practitioners and Nurses. • ACNM Certification Council, Inc. “Nurse Practitioner (N.P.)” A Registered Nurse with advanced nursing educational preparation who is a provider of primary healthcare in a variety of settings with a focus on a specific area of practice. The NP designation is received after graduation from a Master’s program or from an accredited post-basic NP certificate program of at least one academic year in length in a nurse practitioner specialty such as acute care, adult, family, geriatric, pediatric, or women’s health, etc. The NP must have national certification in the area of specialization at the advanced level by a certifying agency which meets the established criteria approved by the Delaware Board of Nursing. “Post Basic Program” A combined didactic and clinical/preceptored program of at least one academic year of full time study in the area of advanced nursing practice with a minimum of 400 clinical/preceptored hours. The program must be one offered and administered by an approved health agency and/or institution of higher learning, Post basic means a program taken after licensure is achieved. PROPOSED REGULATIONS “Scope of Specialized Practice” That area of practice in which an Advanced Practice Nurse has a Master’s degree or a post-basic program certificate in a clinical nursing specialty with national certification. “Supervision” Direction given by a licensed physician or Advanced Practice Nurse to an Advanced Practice Nurse practicing pursuant to a temporary permit. The supervising physician or Advanced Practice Nurse must be periodically available at the site where care is provided, or available for immediate guidance. 8.5 Grandfathering Period 8.5.1 Any person holding a certificate of state licensure as an Advanced Practice Nurse that is valid on July 8, 1994 shall be eligible for renewal of such licensure under the conditions and standards prescribed herein for renewal of licensure. 8.6 Standards for the Advanced Practice Nurse 8.6.1 Advanced Practice Nurses view clients and their health concerns from an integrated multi-system perspective. 8.6.2 Standards provide the practitioner with a framework within which to operate and with the means to evaluate his/her practice. In meeting the standards of practice of nursing in the advanced role, each practitioner, including but not limited to those listed in 8.6.2 of these Rules and Regulations: 8.6.2.1 Performs comprehensive assessments using appropriate physical and psychosocial parameters; 8.6.2.2 Develops comprehensive nursing care plans based on current theories and advanced clinical knowledge and expertise; 8.6.2.3 Initiates and applies clinical treatments based on expert knowledge and technical competency to client populations with problems ranging from health promotion to complex illness and for whom the Advanced Practice Nurse assumes primary care responsibilities. These treatments include, but are not limited to psychotherapy, administration of anesthesia, and vaginal deliveries; 8.6.2.4 Functions under established guidelines/protocols and/or accepted standards of care; 8.6.2.5 Uses the results of scientifically sound empirical research as a basis for nursing practice decisions; 8.6.2.6 Uses appropriate teaching/learning strategies to diagnose learning impediments; 8.6.2.7 Evaluates the quality of individual client care in accordance with quality assurance and other standards; 8.6.2.8 Reviews and revises guidelines/ protocols, as necessary; 8.6.2.9 Maintains an accurate written account of the progress of clients for whom primary care responsibilities are assumed; 8.6.2.10 Collaborates with members of a multi-disciplinary team toward the accomplishment of mutually established goals; 8.6.2.11 Pursues strategies to enhance access to and use of adequate health care services; 8.6.2.12 Maintains optimal advanced practice based on a continual process of review and evaluation of scientific theory, research findings and current practice; 8.6.2.13 Performs consultative services for clients referred by other members of the multi-disciplinary team; and 8.6.2.14 Establishes a collaborative agreement with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system to facilitate consultation and/or referral as appropriate in the delivery of health care to clients. 8.6.3 In addition to these standards, each nurse certified in an area of specialization and recognized by the Board to practice as an Advanced Practice Nurse is responsible for practice at the level and scope defined for that specialty certification by the agency which certified the nurse. 8.7 Generic Functions of the Advanced Practice Nurse Within the Specialized Scope of Practice include but are not limited to: 8.7.1 Eliciting detailed health history(s) 8.7.2 Defining nursing problem(s) 8.7.3 Performing physical examination(s) 8.7.4 Collecting and performing laboratory tests 8.7.5 Interpreting laboratory data 8.7.6 Initiating requests for essential laboratory procedures 8.7.7 Initiating requests for essential x-rays 8.7.8 Screening patients to identify abnormal problems 8.7.9 Initiating referrals to appropriate resources and services as necessary 8.7.10 Initiating or modifying treatment and medications within established guidelines 8.7.11 Assessing and reporting changes in the health of individuals, families and communities 8.7.12 Providing health education through teaching and counseling 8.7.13 Planning and/or instituting health care programs in the community with other health care professionals and the public 8.7.14 Delegating tasks appropriately 8.7.15 Prescribing medications and treatments independently pursuant to Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). 8.7.16 Inserting and removing epidural catheters after specialized training. 8.8 Criteria for Approval of Certification Agencies 8.8.1 A national certifying body which meets PROPOSED REGULATIONS the following criteria shall be recognized by the Board to satisfy 24 Del.C. §1902(d)(1). 8.8.2 The national certifying body: 8.8.2.1 Is national in the scope of its credentialing. 8.8.2.2 Has no requirement for an applicant to be a member of any organization. 8.8.2.3 Has educational requirements which are consistent with the requirements of these rules. 8.8.2.4 Has an application process and credential review which includes documentation that the applicant’s education is in the advanced nursing practice category being certified, and that the applicant’s clinical practice is in the certification category. 8.8.2.5 Uses an examination as a basis for certification in the advanced nursing practice category which meets the following criteria: 8.8.2.5.1 The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community; 8.8.2.5.2 The examination represents the knowledge, skills and abilities essential for the delivery of safe and effective advanced nursing care to the clients; 8.8.2.5.3 The examination content and its distribution are specified in a test plan (blueprint), based on the job analysis study, that is available to examinees; 8.8.2.5.4 Examination items are reviewed for content validity, cultural sensitivity and correct scoring using an established mechanism, both before use and periodically; 8.8.2.5.5 Examinations are evaluated for psychometric performance; 8.8.2.5.6 The passing standard is established using acceptable psychometric methods, and is reevaluated periodically; and 8.8.2.5.7 Examination security is maintained through established procedures 8.8.2.6 Issues certification based upon passing the examination and meeting all other certification requirements. 8.8.2.7 Provides for periodic recertification which includes review of qualifications and continued competency. 8.8.2.8 Has mechanisms in place for communication to Boards of Nursing for timely verification of an individual’s certification status, changes in certification status, and changes in the certification program, including qualifications, test plan and scope of practice. 8.8.2.9 Has an evaluation process to provide quality assurance in its certification program. 8.9 Application for Licensure to Practice as an Advanced Practice Nurse 8.9.1 Application for licensure as a Registered Nurse shall be made on forms supplied by the Board. 8.9.2 In addition, an application for licensure to practice as an Advanced Practice Nurse shall be made on forms supplied by the Board. 8.9.2.1 The APN applicant shall be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists. 8.9.2.2 Notification of changes in the name of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system shall be forwarded to the Board office. 8.9.3 Each application shall be returned to the Board office together with appropriate documentation and non-refundable fees. 8.9.4 A Registered Nurse meeting the practice requirement as listed in 8.11 and all other requirements set forth in these Rules and Regulations may be issued a license as an Advanced Practice Nurse in the specific area of specialization in which the nurse has been nationally certified at the advanced level and/or has earned a Master’s degree in a clinical nursing specialty. 8.9.4.1 Clinical nurse specialists, whose subspecialty area can be categorized under a broad scope of nursing practice for which a Board-approved national certification examination exists, are required to pass this certification examination to qualify for permanent licensure as an Advanced Practice Nurse. This would include, but not be limited to medical-surgical and psychiatric-mental health nursing. If a more specific post-graduate level certification examination that has Board of Nursing approval is available within the clinical nursing specialist’s subspecialty area at the time of licensure application, the applicant may substitute this examination for the broad-based clinical nursing specialist certification examination. 8.9.4.2 Faculty members teaching in nursing education programs are not required to be licensed as Advanced Practice Nurses. Those faculty members teaching in graduate level clinical courses may apply for licensure as Advanced Practice Nurses and utilize graduate level clinical teaching hours to fulfill the practice requirement as stated in 8.11.2.1. 8.9.5 Renewal of licensure shall be on a date consistent with the current Registered Nurse renewal period. A renewal fee shall be paid. 8.9.6 The Board may refuse to issue, revoke, suspend or refuse to renew the license as an Advanced Practice Nurse or otherwise discipline an applicant or a practitioner who fails to meet the requirements for licensure as an Advanced Practice Nurse or as a registered nurse, or who commits any disciplinary offense under the Nurse Practice Act, 24 Del.C. Ch. 19, or the Rules and Regulations promulgated pursuant thereto. All decisions regarding independent practice and/or independent prescriptive authority are made by the Joint Practice Committee as PROPOSED REGULATIONS provided in 24 Del.C. §1906(20) - (22). 8.10 Temporary Permit for Advanced Practice Nurse Licensure 8.10.1 A temporary permit to practice, pending Board approval for permanent licensure, may be issued provided that: 8.10.1.1 The individual applying has also applied for licensure to practice as a Registered Nurse in Delaware, or 8.10.1.2 The individual applying holds a current license in Delaware, and 8.10.1.3 The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nursing program, and has passed the certification examination, or 8.10.1.4 The individual is a graduate of a Master’s program in a clinical nursing specialty for which there is no certifying examination, and can show evidence of at least 1000 hours of clinical nursing practice within the past 24 months. 8.10.1.5 Application(s) and fee(s) are on file in the Board office. 8.10.2 A temporary permit to practice, under supervision only, may be issued at the discretion of the Executive Director provided that: 8.10.2.1 The individual meets the requirements in 8.10.1.1 or 8.10.1.2, and 8.10.1.5 and; 8.10.2.2 The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nurse program, and; 8.10.2.3 The individual submits proof of admission into the approved certifying agency’s examination or is seeking a temporary permit to practice under supervision to accrue the practice hours required to sit for the certifying examination or has accrued the required practice hours and is scheduled to take the first advanced certifying examination upon eligibility or is accruing the practice hours referred to in 8.10.2.4; or, 8.10.2.4 The individual meets 8.10.2.1 and 8.10.2.2 hereinabove and is awaiting review by the certifying agency for eligibility to sit for the certifying examination. 8.10.3 If the certifying examination has been passed, the appropriate form must accompany the application. 8.10.4 A temporary permit may be issued: 8.10.4.1 For up to two years in three month periods. 8.10.4.2 At the discretion of the Executive Director. 8.10.5 A temporary permit will be withdrawn: 8.10.5.1 Upon failure to pass the first certifying examination 8.10.5.1.1 The applicant may petition the Board of Nursing to extend a temporary permit under supervision until results of the next available certification exam are available by furnishing the following information: 8.10.5.1.1.1 current employer reference, 8.10.5.1.1.2 supervision available, 8.10.5.1.1.3 job description, 8.10.5.1.1.4 letter outlining any extenuating circumstances, 8.10.5.1.1.5 any other information the Board of Nursing deems necessary. 8.10.5.2 For other reasons stipulated under temporary permits elsewhere in these Rules and Regulations. 3 DE Reg. 1373 (4/1/00) 8.10.6 A lapsed temporary permit for designation is equivalent to a lapsed license and the same rules apply. 8.10.7 Failure of the certifying examination does not impact on the retention of the basic professional Registered Nurse licensure. 8.10.8 Any person practicing or holding oneself out as an Advanced Practice Nurse in any category without a Board authorized license in such category shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of the Law regulating the Practice of Nursing in Delaware, (24 Del.C. Ch. 19). 8.10.9 Endorsement of Advanced Practice Nurse designation from another state is processed the same as for licensure by endorsement, provided that the applicant meets the criteria for an Advanced Practice Nurse license in Delaware. 8.11 Maintenance of Licensure Status: Reinstatement 8.11.1 To maintain licensure, the Advanced Practice Nurse must meet the requirements for recertification as established by the certifying agency. 8.11.2 The Advanced Practice Nurse must have practiced a minimum of 1500 hours in the past five years or no less than 600 hours in the past two years in the area of specialization in which licensure has been granted. 8.11.2.1 Faculty members teaching in graduate level clinical courses may count a maximum of 500 didactic course contact hours in the past five years or 200 in the past two years and all hours of direct on-site clinical supervision of students to meet the practice requirement. 8.11.2.2 An Advanced Practice Nurse who does not meet the practice requirement may be issued a temporary permit to practice under the supervision of a person licensed to practice medicine, surgery, dentistry, or advanced practice nursing, as determined on an individual basis by the Board. 8.11.3 The Advanced Practice Nurse will be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery PROPOSED REGULATIONS system with whom a current collaborative agreement exists. 8.11.4 Advanced Practice Nurses who fail to renew their licenses by February 28, May 31, or September 30 of the renewal period shall be considered to have lapsed licenses. After February 28, May 31, or September 30 of the current licensing period, any requests for reinstatement of a lapsed license shall be presented to the Board for action. 8.11.5 To reinstate licensure status as an Advanced Practice Nurse, the requirements for recertification and 1500 hours of practice in the past five years or no less than 600 hours in the past two years in the specialty area must be met or the process described in 8.11.4 followed. 8.11.6 An application for reinstatement of licensure must be filed and the appropriate fee paid. 8.12 Audit of Licensees 8.12.1 The Board may select licensees for audit two months prior to renewal in any biennium. The Board shall notify the licensees that they are to be audited for compliance of having a collaborative agreement. 8.12.1.1 Upon receipt of such notice, the licensee must submit a copy of a current collaborative agreement(s) within three weeks of receipt of the notice. 8.12.1.2 The Board shall notify the licensee of the results of the audit immediately following the Board meeting at which the audits are reviewed. 8.12.1.3 An unsatisfactory audit shall result in Board action. 8.12.1.4 Failure to notify the Board of a change in mailing address will not absolve the licensee from audit requirements. 8.12.2 The Board may select licensees for audit throughout the biennium. 8.13 Exceptions to the Requirements to Practice 8.13.1 The requirements set forth in 8.9 shall not apply to a Registered Nurse who is duly enrolled as a bona fide student in an approved educational program for Advanced Practice Nurses as long as the practice is confined to the educational requirements of the program and is under the direct supervision of a qualified instructor. 8.14 Definitions 8.14.1 Collaborative Agreement - Includes 8.14.1.1 A true collegial agreement between two parties where mutual goal setting, access, authority, and responsibility for actions belong to individual parties and there is a conviction to the belief that this collaborative agreement will continue to enhance patient outcomes and 8.14.1.2 a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a duly licensed Delaware physician, dentist, podiatrist or licensed Delaware health care delivery system. This document can include, but not be limited to, written verification of health care facility approved clinical privileges or a health care facility approved job description of the A.P.N. If the agreement is with a licensed Delaware health care delivery system, the individual will have to show that the system will supply appropriate medical back-up for purposes of consultation and referral. 8.14.2 National Certification - That credential earned by an Advanced Practice Nurse who has met requirements of a Boardof Nursing approved certifying agency. 8.14.3 Pharmacology/Pharmacotherapeutics -refers to any course, program, or offering that would include, butnot be limited to, the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success, their dosages, their side-effects and their interactions. It also encompasses clinical judgement skills and decision making. These skills may be based on thorough interviewing, history taking, physical assessment, test selection and interpretation, patho-physiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non-pharmacologic interventions. 8.14.4 Prescription Order -includes the prescription date, the name of the patient, the name, address, area of specialization and business telephone number of the advanced practice nurse prescriber, the name, strength, quantity, directions for use, and number of refills of the drug product or device prescribed, and must bear the name and prescriber ID number of the advanced practice nurse prescriber, and when applicable, prescriber’s D.E.A. number and signature. There must be lines provided to show whether the prescription must be dispensed as written or substitution is permitted. 8.15 Requirements for Initial Independent Practice/ prescriptive Authority An APN who has not had independent prescriptive authority within the past two years in Delaware or any other jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.15.1 Be an Advanced Practice Nurse (APN)holding a current permanent license issued by the Board of Nursing (BON). If the individual does not hold national certification, eligibility will be determined on a case by case basis. 8.15.2 Have completed a post basic advanced practice nursing program that meets the criteria as established in Section 4.7 of Article 7 of the Rules and Regulations of the Delaware Board of Nursing with documentation of academic courses in advanced health assessment, diagnosis and management of problems within the clinical specialty, advanced patho-physiology and advanced pharmacology/pharmacotherapeutics. In the absence of transcript verification of the aforementioned courses, applicants shall show evidence of content integration through course descriptions, course syllabi, or correspondence from school officials. If the applicant cannot PROPOSED REGULATIONS produce the required documentation, such applicant may petition the Joint Practice Committee for consideration of documented equivalent independent prescriptive authority experience. 8.15.3 Submit a copy of the current collaborative agreement to the Joint Practice Committee (JPC). The collaborative agreement(s) shall include arrangements for consultation, referral and/or hospitalization complementary to the area of the nurse's independent practice. 8.15.4 Show evidence of the equivalent of at least thirty hours of advanced pharmacology and pharmacotherapeutics related continuing education within the two years prior to application for independent practice and/or independent prescriptive authority. This may be continuing education programs or a three credit, semester long graduate level course. The thirty hours may also occur during the generic APN program as integrated content as long as this can be documented to the JPC. All offerings will be reviewed and approved by the JPC. 8.15.5 Demonstrate how submitted continuing education offerings relate to pharmacology and therapeutics within their area of specialty. This can be done by submitting the program titles to show content and dates attended. If the JPC questions the relevance of the offerings, the applicant must have available program descriptions, and/ or learner objectives, and/or program outlines for submission to the JPC for their review and approval. 8.16 Requirements for Independent Practice/ prescriptive Authority by Endorsement An APN who has had prescriptive authority in another jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.16.1 Show evidence of meeting 8.15.1 and 8.15.3. 8.16.2 Show evidence of having current prescriptive authority in another jurisdiction. 8.16.3 Have no encumbered APN designation(s) in any jurisdiction. 8.16.4 Show evidence of completion of a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure within the past two years. 8.17 Application 8.17.1 Names and credentials of qualified applicants will be forwarded to the Joint Practice Committee for approval and then forwarded to the Board of Medical Practice for review and final approval. 8.18 Prescriptive Authority 8.18.1 APNs may prescribe, administer, and dispense legend medications including Schedule II - V controlled substances, (as defined in the Controlled Substance Act and labeled in compliance with 24 Del.C. §2536(C), parenteral medications, medical therapeutics, devices and diagnostics. 8.18.2 APNs will be assigned a provider identifier number as outlined by the Division of Professional Regulation. 8.18.3 Controlled Substances registration will be as follows: 8.18.3.1 APNs must register with the Drug Enforcement Agency and use such DEA number for controlled substance prescriptions. 8.18.3.2 APNs must register biennially with the Office of Narcotics and Dangerous Drugs in accordance with 16 Del.C. §4732(a). 8.18.4 APNs may request and issue professional samples of legend, including schedule II-V controlled substances, and over-the-counter medications that must be labeled in compliance with 24 Del.C. §2536(C). 8.18.5 APNs may give verbal prescription orders. 8.19 Prescriptive Writing 8.19.1 All prescription orders will be written as defined by the Delaware Board of Pharmacy as defined in 8.14.4. 8.20 Renewal 8.20.1 Maintain current APN licensure. 8.20.2 Maintain competency through a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure per biennium. The pharmacology/ pharmacotherapeutics content may be a separate course or integrated within other offerings. 8.21 Disciplinary Proceedings 8.21.1 Pursuant to 24 Del.C. §1906(19)(c), the Joint Practice Committee is statutorily empowered, with the approval of the Board of Medical Practice, to grant independent practice and/or prescriptive authority to nurses who qualify for such authority. The Joint Practice Committee is also empowered to restrict, suspend or revoke such authority also with the approval of the Board of Medical Practice. 8.21.2 Independent practice or prescriptive authority may be restricted, suspended or revoked where the nurse has been found to have committed unprofessional conduct in his or her independent practice or prescriptive authority or if his or her mental or physical faculties have changed or deteriorated in such a manner as to create an inability to practice or prescribe with reasonable skill or safety to patients. 8.21.3 Unprofessional conduct, for purposes of restriction, suspension or revocation of independent practice or prescriptive authority shall include but not be limited to: 8.21.3.1 The use or attempted use of any false, fraudulent or forged statement or document or use of any fraudulent, deceitful, dishonest or immoral practice in connection with any acquisition or use of independent practice or prescriptive authority; PROPOSED REGULATIONS 8.21.3.2 Conviction of a felony; 8.21.3.3 Any dishonorable or unethical conduct likely to deceive, defraud or harm the public; 8.21.3.4 Use, distribution or prescription of any drugs or medical devices other than for therapeutic or diagnostic purposes; 8.21.3.5 Misconduct, incompetence, or gross negligence in connection with independent or prescriptive practice; 8.21.3.6 Unjustified failure upon request to divulge information relevant to authorization or competence to independently practice or exercise prescriptive authority to the Executive Director of the Board of Nursing or to anyone designated by him or her to request such information. 8.21.3.7 The violation of the Nurse Practice Act or of an Order or Regulation of the Board of Nursing or the Board of Medical Practice related to independent practice or prescriptive authority. 8.21.3.8 Restriction, suspension, or revocation of independent practice or prescriptive authority granted by another licensing authority in any state, territory or federal agency. 8.21.4 Complaints concerning the use or misuse of independent practice or prescriptive authority received by the Division of Professional Regulation or the Board of Nursing shall be investigated in accordance with the provisions of Title 29, Section 8807 governing investigations by the Division of Professional Regulation. As soon as convenience permits, the Board of Nursing shall assign an Investigating Board Member to assist with the investigation of the complaint. The Investigating Board Member shall, whenever practical, be a member of the Joint Practice Committee. 8.21.5 Upon receipt of a formal complaint from the Office of the Attorney General seeking the revocation, suspension or restriction of independent practice or prescriptive authority, the Committee Chairperson shall promptly arrange for not less than a quorum of the Committee to convene for an evidentiary hearing concerning such complaint upon due notice to the licensee against whom the complaint has been filed. Such notice shall comply with the provisions of the Administrative Procedures Act (29 Del. C. Ch. 101). 8.21.6 The hearing shall be conducted in accordance with the Administrative Procedures Act (29 Del.C. §101), and after the conclusion thereof, the Joint Practice Committee will promptly issue a written Decision and Order which shall be based upon the affirmative vote of a majority of the quorum hearing the case. 8.21.7 Any written Decision and Order of the Joint Practice Committee which imposes a restriction, suspension or revocation of independent practice or prescriptive authority shall not be effective prior to the approval of the Board of Medical Practice. 4 DE Reg. 296 (8/1/00) 5 DE Reg. 1606 (2/1/02) * PLEASE NOTE: AS THE REST OF THE SECTIONS WERE NOT AMENDED THEY ARE NOT BEING PUBLISHED. A COMPLETE SET OF THE BOARD OF NURSING RULES AND REGULATIONS ARE AVAILABLE AT: Board of Nursing DIVISION OF PROFESSIONAL REGULATION BOARD OF MASSAGE AND BODYWORK 24 DE Admin. Code 5300 Statutory Authority: 24 Delaware Code, Section 5306(1) (24 Del.C. §5306(1)) PUBLIC NOTICE PLEASE TAKE NOTICE, pursuant to 29 Del.C. Chapter 101 and 24 Del.C. Section 5306(1), the Delaware Board of Massage and Bodywork proposes to revise its rules and regulations. The proposed revisions implement changes to the rules necessary to conform to the statutory changes resulting from House Bill 208 as amended by House Amendment No. 1 and Senate Amendment No.1. The revisions clarify the requirements of the change from a 100 hour course to a 300 hour course for certification as a massage technician; the requirements for temporary massage technician certification; incorporate continuing education requirements for renewal of lapsed licenses; and outline the requirements for placing a license on inactive status. In addition, the Board is proposing to revise the rules on continuing education to require that all continuing education must be pre-approved by the Board. A public hearing will be held on the proposed Rules and Regulations on Thursday, October 7, 2004 at 2:00 p.m. in the Second Floor Conference Room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware, 19904. Any written comments should be submitted to the Board in care of Caitlin Mears, Administrative Specialist, Division of Professional Regulation, at the above address. The final date to submit written comments shall be at the scheduled public hearing. This notice will be published in two newspapers of general circulation not less than twenty (20) days prior to the date of the hearing. The proposed amendments are set forth below: 1.0 Definitions and General Definitions 1.1 The term "500 hours of supervised in-class study" as referenced in 24 Del.C. §5308(a)(1) shall mean that an PROPOSED REGULATIONS instructor has controlled and reviewed the applicant's education on the premises of a school or approved program of massage or bodywork therapy, and can document that the applicant has successfully completed a curriculum that is substantially the same as referenced in 24 Del.C. §5308(a)(1) and which includes hands-on technique and contraindications as they relate to massage and bodywork. More than one school or approved program of massage or bodywork therapy may be attended in order to accumulate the total 500 hour requirement. 1.2 The term a "100 300 - hour course of supervised in-class study of massage" as referenced in 24 Del.C. §5309(a)(1) shall mean that an instructor has controlled and reviewed the applicant's education on the premises of a school or approved program of massage or bodywork therapy, and can document that the applicant has successfully completed a 100 300 hour course which includes hands-on technique and theory, and anatomy, physiology, and contraindications as they relate to massage and bodywork no less than sixty hours of anatomy and physiology, one hundred-forty hours of theory and technique and one hundred hours of elective courses in the field of massage therapy as referenced in 24 Del.C. §5309(a)(1). 1.2.1 The 100 300 hour course must be a unified introductory training program in massage and bodywork, including training in the subjects set forth in Rule 1.2 1.4. The entire 100 300 hour course must be taken at one school or approved program. The Board may, upon request, waive the “single school” requirement for good cause or hardship, such as the closure of a school. 1.3 The term a “200 hour course of supervised in-class study of massage" as referenced in 24 Del.C. §5309(b) shall mean that an instructor has controlled and reviewed the applicant's education on the premises of a school or approved program of massage or bodywork therapy, and can document that the applicant has successfully completed a 200 hour course which includes no less than fifty hours of anatomy and physiology, one hundred-ten hours of theory and technique, twenty- five hours of ethics, law, and contraindications and fifteen hours of elective courses in the field of massage therapy as referenced in 24 Del.C. §5309(b). 1.3 4 The “practice of massage and bodywork” includes, but is not limited to, the following modalities: Acupressure Chair Massage Craniosacral Therapy Deep Tissue Massage Therapy Healing Touch Joint Mobilization Lymph Drainage Therapy Manual Lymphatic Drainage Massage Therapy Myofascial Release Therapy Neuromuscular Therapy Orthobionomy Process Acupressure Reflexology Rolfing Shiatsu Swedish Massage Therapy Trager Visceral Manipulation 1.4 5 The practice of the following modalities does not constitute the “practice of massage and bodywork”: Alexander Technique Aroma therapy Feldenkrais Hellerwork Polarity Therapy Reiki Shamanic Techniques Therapeutic Touch 3 DE Reg. 1516 (5/1/00) 4 DE Reg. 1245 (2/1/01) 2.0 Filing of Application for Licensure as Massage/ Bodywork Therapist 2.1 A person seeking licensure as a massage/bodywork therapist must submit a completed application on a form prescribed by the Board to the Board office at the Division of Professional Regulation, Dover, Delaware. Each application must be accompanied by (1) a copy of a current certificate from a State certified cardiopulmonary resuscitation program as required by 24 Del.C. §5308(3); and (2) payment of the application fee established by the Division of Professional Regulation pursuant to 24 Del.C. §5311. 2.2 In addition to the application and materials described in 2.1 of this Rule, an applicant for licensure as a massage/bodywork therapist shall have (1) each school or approved program of massage or bodywork where the applicant completed the hours of study required by 24 Del.C. §5308(a)(1) submit to the Board an official transcript or official documentation showing dates and total hours attended and a description of the curriculum completed; and (2) Assessment Systems, Incorporated or its predecessor, submit to the Board verification of the applicant's score on the written examination described in Rule 3.0 herein. 2.3 The Board shall not consider an application for licensure as a massage/bodywork therapist until all items specified in 2.1 and 2.2 of this Rule are submitted to the Board's office. 2.3.1 The Board may, in its discretion, approve applications contingent on receipt of necessary documentation. If the required documentation is not received within 120 days from the date when the application is first reviewed by the Board, the Board will propose to deny the application. PROPOSED REGULATIONS 2.3.2 If an application is complete in terms of required documents, but the candidate has not responded to a Board request for further information, explanation or clarification within 120 days of the Board’s request, the Board will vote on the application as it stands. 2.4 Renewal. Applicants for renewal of a massage/ bodywork therapist license shall submit a completed renewal form, renewal fee, proof of continuing education pursuant to Rule 6 7.0 and a copy of a current certificate from a State certified cardiopulmonary resuscitation program. License holders shall be required to maintain current CPR certification throughout the biennial licensure period. 4 DE Reg. 1245 (2/1/01) 3.0 Examination The Board designates the National Certification Examination administered by the National Certification Board for Therapeutic Massage and Bodywork ("NCBTMB") as the written examination to be taken by all persons applying for licensure as a massage/bodywork therapist. The Board will accept as a passing score on the exam the passing score established by the NCBTMB. 4.0 Application for Certification as Massage Technician 4.1 A person seeking certification as a massage technician must submit a completed application on a form prescribed by the Board to the Board office at the Division of Professional Regulation, Dover, Delaware. Each application must be accompanied by (1) a copy of current certificate from a State certified cardiopulmonary resuscitation program as required by 24 Del.C. §5309(a)(2); and (2) payment of the application fee established by the Division of Professional Regulation pursuant to 24 Del.C. §5311. 4.2 In addition to the application and materials described in 4.1 of this Rule, an applicant for certification as a massage technician shall have the school or approved program of massage or bodywork therapy where the applicant completed the hours or study required by 24 Del.C. §5309(a)(1) submit to the Board an official transcript or official documentation showing dates and total hours attended and a description of the curriculum completed. 4.2.1 An applicant for a temporary massage technician certification, in addition to the application and materials described in 4.1 of this Rule, shall have the school or approved program of massage or bodywork therapy where the applicant completed the hours or study required by 24 Del.C. §5309(b) submit to the Board an official transcript or official documentation showing dates and total hours attended and a description of the curriculum completed. 4.3 The Board shall not consider an application for certification as a massage technician until all items specified in 4.1 and 4.2 of this Rule are submitted to the Board's office. 4.3.1 The Board may, in its discretion, approve applications contingent on receipt of necessary documentation. If the required documentation is not received within 120 days from the date when the application is first reviewed by the Board, the Board will propose to deny the application. 4.3.2 If an application is complete in terms of required documents, but the candidate has not responded to a Board request for further information, explanation or clarification within 120 days of the Board’s request, the Board will vote on the application as it stands. 4.4 Renewal. Applicants for renewal of a massage technician certificate shall submit a completed renewal form, renewal fee, proof of continuing education pursuant to Rule 6.0 7.0 and a copy of a current certificate from a State certified cardiopulmonary resuscitation program. Certificate holders shall be required to maintain current CPR certification throughout the biennial licensure period. Temporary massage technician certificates are valid for no more than one (1) year and may not be renewed or reissued pursuant to the provision of 24 Del.C. §5309(b). 3 DE Reg. 1516 (5/1/00) 4 DE Reg. 1245 (2/1/01) 5.0 Expired License or Certificate An expired license as a massage/bodywork therapist or expired certificate as a massage technician, excluding temporary massage technician certificates, may be reinstated within one (1) year after expiration upon application and payment of the renewal fee plus a late fee as set by the Division of Professional Regulation, and submission of documentation demonstrating compliance with the continuing education requirements of Rule 7.0. 5 DE Reg. 827 (10/01/01) 6.0 Inactive Status 6.1 A licensee asking to have his or her license placed on inactive status must notify the Board of his/her intention to do so in writing prior to the expiration of his/her current license. Holders of temporary massage technician certificates are not eligible for inactive status. 6.2 A licensee on inactive status seeking to re-enter practice must notify the Board in writing of his/her intention, pay the appropriate fee, and provide the Board with documentation demonstrating compliance with the continuing education hours required by Rule 7.0. 6 7.0 Continuing Education 6 7.1 Hours required. For license or certification periods beginning September 1, 20004 and thereafter, each massage/bodywork therapist shall complete twenty-four (24) hours of acceptable Board approved continuing education during each biennial licensing period, except as otherwise provided in these Rules and Regulations. Each massage technician shall complete twelve (12) hours of acceptable PROPOSED REGULATIONS continuing education during each biennial licensing period, except as otherwise provided in these Rules and Regulations. Completion of the required continuing education is a condition of renewing a license or certificate. Hours earned in a biennial licensing period in excess of those required for renewal may not be credited towards the hours required for renewal in any other licensing period. 6 7.1.1 Calculation of Hours. For academic course work, correspondence courses or seminar/workshop instruction, one (1) hour of acceptable continuing education shall mean 50 minutes of actual instruction. One (1) academic semester hour shall be equivalent to fifteen (15) continuing education hours; one (1) academic quarter hour shall be equivalent to ten (10) continuing education hours. 6 7.1.2 If during a licensing period an individual certified by the Board as a massage technician is issued a license as a massage and bodywork therapist, the continuing education requirement for that licensing period is as follows: 6 7.1.2.1 If the license is issued more than twelve (12) months prior to the next renewal date, the licensee shall complete twenty-four (24) hours of acceptable continuing education during the licensing period. 6 7.1.2.2 If the license is issued less than twelve (12) months prior to the next renewal date, the licensee shall complete twelve (12) hours of acceptable continuing education during the licensing period. 6 7.2 Proration. Candidates for renewal who were first licensed or certified twelve (12) months or less before the date of renewal are exempt from the continuing education requirement for the period in which they were first licensed or certified. 6 7.3 Content. 6 7.3.1 Except as provided in Rule 67.3.2, continuing education hours must contribute to the professional competency of the massage/bodywork therapist or massage technician within modalities constituting the practice of massage and bodywork. Continuing education hours must maintain, improve or expand skills and knowledge obtained prior to licensure or certification, or develop new and relevant skills and knowledge. For each biennial licensing period, massage therapists must complete at least eighteen of the required twenty-four hours of continuing education hours in supervised in-class hands-on study of the “practice of massage and bodywork” as defined in Rule 1.34. For each biennial licensing period, massage technicians must complete at least nine of the required twelve hours of continuing education hours in supervised in-class hands-on study of the “practice of massage and bodywork” as defined in Rule 1.34. 6 7.3.2 For each biennial licensing period, massage therapists may complete (but are not required to complete) up to six hours of the required twenty-four hours of continuing education hours in any combination of the areas and methods listed in Rules 67.3.2.1 through 67.3.2.5. In each biennial licensing period, massage technicians may complete (but are not required to complete) up to three hours of the required twelve hours of continuing education hours in any combination of the areas and methods listed in Rules 6 7.3.2.1 through 6.3.2.5 7.3.2.6. 6 7.3.2.1 Courses in modalities such as are listed in Rule 1.45, which are modalities other than in the practice of massage and bodywork 6 7.3.2.2 Personal growth and self-improvement courses 6 7.3.2.3 Business Management Courses 6 7.3.2.4 Courses taught by correspondence or mail 6 7.3.2.5 Courses taught by video, teleconferencing, video conferencing or computer. 6 7.3.2.6 Courses in anatomy or physiology 6 7.4 Board approval. 6.4.1 “Acceptable continuing education” shall include any continuing education programs meeting the requirements of Rule 6.3 and offered or approved by the following organizations: 6 7.4.1.1 NCBTMB 6 7.4.1.2 American Massage Therapy Association 6 7.4.1.3 Association of Oriental Bodywork Therapists of America 6 7.4.1.4 Association of Bodywork and Massage Practitioners 6 7.4.1.5 Delaware Nurses Association 6.4.2 7.4.1 Other All continuing education must be pre-approved by the Board. cContinuing education programs or providers may must apply for pre-approval of continuing education hours by submitting a written request to the Board which includes the program agenda, syllabus and time spent on each topic, the names and resumes of the presenters and the number of hours for which approval is requested. The Board reserves the right to approve less than the number of hours requested. 6.4.3 7.4.2 Self-directed activity: The Board may, upon request, review and approve credit for self-directed activities, including, but not limited to, teaching, research, preparation and/or presentation of professional papers and articles. A licensee must obtain pre-approval of the Board prior to undertaking the self-directed activity in order to assure continuing education credit for the activity. Any self-directed activity submitted for approval must include a written proposal outlining the scope of the activity, the number of continuing education hours requested, the anticipated completion date(s), the role of the licensee in the case of multiple participants (e.g. research) and whether any part of the self-directed activity has ever been previously approved or submitted for credit by the same licensee. 6.4.4 7.4.3 The Board may award additional PROPOSED REGULATIONS continuing education credits, on an hour for hour basis, to continuing education instructors for the first-time preparation and presentation of an approved continuing education course for other practitioners, to a maximum of 6 additional hours. (e.g. an instructor presenting a 8 hour course for the first time may receive up to 6 additional credit hours for preparation of the course). This provision remains subject to the limitations of Rule 6 7.3.2. 6 7.5 Reporting. 6 7.5.1 For license or certification periods beginning September 1, 20004 and thereafter, each candidate for renewal shall submit a summary of their continuing education hours, along with any supporting documentation requested by the Board, to the Board on or before May 31 of the year the license or certification expires. No license or certification shall be renewed until the Board has approved the required continuing education hours or granted an extension of time for reasons of hardship. The Board’s approval of a candidate’s continuing education hours in a particular modality does not constitute approval of the candidate’s competence in, or practice of, that modality. 6 7.5.2 If a continuing education program has already been approved by the Board, the candidate for renewal must demonstrate, at the Board’s request, the actual completion of the continuing education hours by giving the Board a letter, certificate or other acceptable proof of attendance provided by the program sponsor. 6 5.3 If a continuing education program has not already been approved by the Board, the candidate for renewal must give the Board, at the Board’s request, all of the materials required in Rule 67.4.2 and demonstrate the actual completion of the continuing education hours by giving the Board a letter, certificate or other acceptable proof of attendance provided by the program sponsor. 6 7.6 Hardship. A candidate for renewal may be granted an extension of time in which to complete continuing education hours upon a showing of unusual hardship. “Hardship” may include, but is not limited to, disability, illness, extended absence from the jurisdiction and exceptional family responsibilities. Requests for hardship consideration must be submitted to the Board in writing prior to the end of the licensing or certification period for which it is made. If the Board does not have sufficient time to consider and approve a request for hardship extension prior to the expiration of the license, the license will lapse upon the expiration date and be reinstated upon completion of continuing education pursuant to the hardship exception. The licensee may not practice until reinstatement of the license. 7.7 Continuing Education Requirements for Reinstatement of a Lapsed License. Unless extended by the Board for hardship as defined in Rule 7.6, and subject to the one (1) year limitation set forth in Rule 5.0, a massage therapist applying for reinstatement of a lapsed license must provide to the Board adequate proof of the satisfactory completion of twenty-four (24) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of application for reinstatement. A massage technician applying for reinstatement of a lapsed license must provide to the Board adequate proof of the satisfactory completion of twelve (12) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of application for reinstatement. Continuing education hours required for reinstatement of a lapsed license may not be credited towards the hours required for renewal in any other licensing period. 7.7.1 A massage therapist who has let his/her license lapse for more than one (1) year and is ineligible for reinstatement and therefore required to submit a new application shall not be permitted to circumvent continuing educations requirements. The massage therapist must provide to the Board adequate proof of the satisfactory completion of twenty-four (24) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of the new application. A massage technician who has let his/her license lapse for more than one (1) year and is ineligible for reinstatement and therefore required to submit a new application shall not be permitted to circumvent continuing education requirements. The massage technician must provide to the Board adequate proof of the satisfactory completion of twelve (12) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of the new application. Continuing education hours required to be filed with a new application may not be credited towards the hours required for renewal in any other licensing period. 7.8 Continuing Education Requirements for Licensees Returning from Inactive Status. Unless extended by the Board for hardship as defined in Rule 7.6, a massage therapist returning from inactive status must provide notice to the Board as set forth in Rule 6.2 and must provide to the Board adequate proof of the satisfactory completion of twenty-four (24) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of the notice to return to active. A massage technician returning from inactive status must provide notice to the Board as set forth in Rule 6.2 and must provide to the Board adequate proof of the satisfactory completion of twelve (12) hours of Board approved continuing education within the immediately preceding two (2) year period prior to the date of the notice to return to active status. Continuing education hours required to return to active status may not be credited towards the hours required for renewal in any other licensing period. 3 DE Reg. 1516 (5/1/00) 4 DE Reg. 1245 (2/1/01) PROPOSED REGULATIONS 4 DE Reg. 1944 (6/1/01) 5 DE Reg. 1409 (1/1/02) 7 DE Reg. 40 (7/1/03) 7 8.0 Scope of Practice Licensed massage/bodywork therapist and certified massage technicians shall perform only the massage and bodywork activities and techniques for which they have been trained as stated in their certificates, diplomas or transcripts from the school or program of massage therapy where trained. 8 9.0 Voluntary Treatment Option for Chemically Dependent or Impaired Professionals 8 9.1 If the report is received by the chairperson of the regulatory Board, that chairperson shall immediately notify the Director of Professional Regulation or his/her designate of the report. If the Director of Professional Regulation receives the report, he/she shall immediately notify the chairperson of the regulatory Board, or that chairperson's designate or designates. 8 9.2 The chairperson of the regulatory Board or that chairperson's designate or designates shall, within 7 days of receipt of the report, contact the individual in question and inform him/her in writing of the report, provide the individual written information describing the Voluntary Treatment Option, and give him/her the opportunity to enter the Voluntary Treatment Option. 8 9.3 In order for the individual to participate in the Voluntary Treatment Option, he/she shall agree to submit to a voluntary drug and alcohol screening and evaluation at a specified laboratory or health care facility. This initial evaluation and screen shall take place within 30 days following notification to the professional by the participating Board chairperson or that chairperson's designate(s). 8 9.4 A regulated professional with chemical dependency or impairment due to addiction to drugs or alcohol may enter into the Voluntary Treatment Option and continue to practice, subject to any limitations on practice the participating Board chairperson or that chairperson's designate or designates or the Director of the Division of Professional Regulation or his/her designate may, in consultation with the treating professional, deem necessary, only if such action will not endanger the public health, welfare or safety, and the regulated professional enters into an agreement with the Director of Professional Regulation or his/her designate and the chairperson of the participating Board or that chairperson's designate for a treatment plan and progresses satisfactorily in such treatment program and complies with all terms of that agreement. Treatment programs may be operated by professional Committees and Associations or other similar professional groups with the approval of the Director of Professional Regulation and the chairperson of the participating Board. 8 9.5 Failure to cooperate fully with the participating Board chairperson or that chairperson's designate or designates or the Director of the Division of Professional Regulation or his/her designate in regard to the Voluntary Treatment Option or to comply with their requests for evaluations and screens may disqualify the regulated professional from the provisions of the Voluntary Treatment Option, and the participating Board chairperson or that chairperson's designate or designates shall cause to be activated an immediate investigation and institution of disciplinary proceedings, if appropriate, as outlined in subsection (h) of this section. 8 9.6 The Voluntary Treatment Option may require a regulated professional to enter into an agreement which includes, but is not limited to, the following provisions: 8 9.6.1 Entry of the regulated professional into a treatment program approved by the participating Board. Board approval shall not require that the regulated professional be identified to the Board. Treatment and evaluation functions must be performed by separate agencies to assure an unbiased assessment of the regulated professional's progress. 8 9.6.2 Consent to the treating professional of the approved treatment program to report on the progress of the regulated professional to the chairperson of the participating Board or to that chairperson's designate or designates or to the Director of the Division of Professional Regulation or his/her designate at such intervals as required by the chairperson of the participating Board or that chairperson's designate or designates or the Director of the Division of Professional Regulation or his/her designate, and such person making such report will not be liable when such reports are made in good faith and without malice. 8 9.6.3 Consent of the regulated professional, in accordance with applicable law, to the release of any treatment information from anyone within the approved treatment program. 8 9.6.4 Agreement by the regulated professional to be personally responsible for all costs and charges associated with the Voluntary Treatment Option and treatment program(s). In addition, the Division of Professional Regulation may assess a fee to be paid by the regulated professional to cover administrative costs associated with the Voluntary Treatment Option. The amount of the fee imposed under this subparagraph shall approximate and reasonably reflect the costs necessary to defray the expenses of the participating Board, as well as the proportional expenses incurred by the Division of Professional Regulation in its services on behalf of the Board in addition to the administrative costs associated with the Voluntary Treatment Option. 8 9.6.5 Agreement by the regulated professional that failure to satisfactorily progress in such treatment program shall be reported to the participating Board's PROPOSED REGULATIONS chairperson or his/her designate or designates or to the Director of the Division of Professional Regulation or his/ her designate by the treating professional who shall be immune from any liability for such reporting made in good faith and without malice. 8 9.6.6 Compliance by the regulated professional with any terms or restrictions placed on professional practice as outlined in the agreement under the Voluntary Treatment Option. 8 9.7 The regulated professional's records of participation in the Voluntary Treatment Option will not reflect disciplinary action and shall not be considered public records open to public inspection. However, the participating Board may consider such records in setting a disciplinary sanction in any future matter in which the regulated professional's chemical dependency or impairment is an issue. 8 9.8 The participating Board's chairperson, his/her designate or designates or the Director of the Division of Professional Regulation or his/her designate may, in consultation with the treating professional at any time during the Voluntary Treatment Option, restrict the practice of a chemically dependent or impaired professional if such action is deemed necessary to protect the public health, welfare or safety. 8 9.9 If practice is restricted, the regulated professional may apply for unrestricted licensure upon completion of the program. 8 9.10 Failure to enter into such agreement or to comply with the terms and make satisfactory progress in the treatment program shall disqualify the regulated professional from the provisions of the Voluntary Treatment Option, and the participating Board shall be notified and cause to be activated an immediate investigation and disciplinary proceedings as appropriate. 8 9.11 Any person who reports pursuant to this section in good faith and without malice shall be immune from any civil, criminal or disciplinary liability arising from such reports, and shall have his/her confidentiality protected if the matter is handled in a nondisciplinary matter. 8 9.12 Any regulated professional who complies with all of the terms and completes the Voluntary Treatment Option shall have his/her confidentiality protected unless otherwise specified in a participating Board's rules and regulations. In such an instance, the written agreement with the regulated professional shall include the potential for disclosure and specify those to whom such information may be disclosed. DEPARTMENT OF EDUCATION 14 DE Admin. Code 705 Statutory Authority: 14 Delaware Code, Section 220 (14 Del.C. §220) 705 Training Camp and Special Duty in the National Guard and/or Reserves Education Impact Analysis Pursuant to 14 Del.C. §122(d) A. Type Of Regulatory Action Required Amendment to Existing Regulation B. Synopsis Of Subject Matter Of The Regulation The Secretary of Education intends to amend 14 DE Admin. Code 705 Training Camp and Special Duty in the National Guard and/or Reserves in order to improve the language and to better reflect the intent of the statute. C. Impact Criteria 1. Will the amended regulation help improve student achievement as measured against state achievement standards? The amended regulation addresses time off for school employees for service in the National Guard and Reserves not student achievement. 2. Will the amended regulation help ensure that all students receive an equitable education? The amended regulation addresses time off for school employees for service in the National Guard and Reserves not equity issues. 3. Will the amended regulation help to ensure that all students’ health and safety are adequately protected? The amended regulation addresses time off for school employees for service in the National Guard and Reserves not health and safety issues. 4. Will the amended regulation help to ensure that all students’ legal rights are respected? The amended regulation addresses time off for school employees for service in the National Guard and Reserves not students’ legal rights. 5. Will the amended regulation preserve the necessary authority and flexibility of decision making at the local board and school level? The amended regulation will preserve the necessary authority and flexibility of decision making at the local board and school level. 6. Will the amended regulation place unnecessary reporting or administrative requirements or mandates upon decision makers at the local board and school levels? The amended regulation will not place any unnecessary reporting or administrative requirements or mandates upon decision makers at the local board and school levels. 7. Will the decision making authority and accountability for addressing the subject to be regulated be PROPOSED REGULATIONS placed in the same entity? The decision making authority and accountability for addressing the subject to be regulated will remain in the same entity. 8. Will the amended regulation be consistent with and not an impediment to the implementation of other state educational policies, in particular to state educational policies addressing achievement in the core academic subjects of mathematics, science, language arts and social studies? The amended regulation will be consistent with and not an impediment to the implementation of other state educational policies, in particular to state educational policies addressing achievement in the core academic subjects of mathematics, science, language arts and social studies. 9. Is there a less burdensome method for addressing the purpose of the regulation? There is no less burdensome method for addressing the purpose of the regulation. 10. What is the cost to the State and to the local school boards of compliance with the regulation? There may be the additional cost of hiring a substitute for the person while on duty. 705 Training Camp and Special Duty in the National Guard and/or R