State Lawmakers Release Bipartisan WHA-Priority Legislation to Further Team-Based Care

Legislation recognizes Advanced Practice Providers in state Power of Attorney and Living Will laws

May 21, 2019

Last week, a bipartisan group of four state lawmakers circulated a bill to address barriers experienced by hospitals and advanced practice providers looking to act upon the wishes of a patient documented through their Power of Attorney or Living Will. These barriers impact all hospitals, but can have a more significant impact on those facilities in rural areas and other areas that heavily rely on advanced practice providers.

While Advanced Practice Registered Nurses’ (APRNs) and Physician Assistants’ (PAs) education and training has evolved, Wisconsin law has not always kept up with these changes. The legislation, crafted alongside WHA, was circulated as LRB 1737 and recognizes APRNs and PAs professions in key provisions of Wisconsin’s Living Will and Power of Attorney statutes:
  • Activation of an individual’s wishes under the individual’s Living Will. Under current law, an individual’s treatment wishes under a Living Will can only be acted upon following a determination by two physicians that the individual has a terminal condition or is in a persistent vegetative state. The bill modifies current law to require that the determination be made by one physician plus one physician, PA, or APRN.
  • Activation of an individual’s health care Power of Attorney. Under current law, an individual may create a health care Power of Attorney instrument that authorizes an agent to make health care decisions for the individual should he/she become incapacitated. Also, under current law, the agent’s authority is only activated under the Power of Attorney document when two physicians or one physician and one psychologist examine the individual and determine that the individual is incapacitated. The bill modifies current law to require that the exam and determination be made by one physician plus one physician, psychologist, nurse practitioner, or PA.
  • Do-not-resuscitate orders. Under current law and subject to several conditions, a patient can request that his/her attending physician issue a do-not-resuscitate order should the patient have a terminal condition or be in a persistent vegetative state. The bill changes “attending physician” to include PAs and APRNs serving as the “attending health care professional.”

Reps. Pat Snyder (R-Wausau) and Steve Doyle (D-Onalaska), and Sens. Howard Marklein (R-Spring Green) and Janis Ringhand (D-Evansville) are lead authors of the legislation.

To contact your state legislator and ask them to co-sponsor this bill, please visit the WHA HEAT Action Center. The deadline for legislators to sign on to the bill is Thursday, May 23.

LRB 1737, a priority piece of legislation for WHA, is one of several team-based care proposals initiated by WHA that have advanced in the Legislature in recent years. Previous proactive legislation from WHA has included changes to Wisconsin’s hospital regulations that allow an advanced practice nurse or physician assistant to admit a patient into a hospital. Last session, WHA worked with a group of lawmakers to clarify under Wisconsin’s Medicaid statutes that an order from an advanced practice provider, like a physician order, is a valid order for a Medicaid beneficiary as long as the order is for a covered service and within the provider’s scope of practice.

See the following resources for LRB 1737:

This story originally appeared in the May 21, 2019 edition of WHA Newsletter