SB 491, as amended, Hernandez. Nurse practitioners.
Existing law, the Nursing Practice Act, provides for the licensure and regulation of nurse practitioners by the Board of Registered Nursing. Existing law authorizes the implementation of standardized procedures that authorize a nurse practitioner to perform certain acts, including, among others, ordering durable medical equipment, and, in consultation with a physician and surgeon, approving, signing, modifying, or adding to a plan of treatment or plan for an individual receiving home health services or personal care services. A violation of those provisions is a crime.
This bill would authorize a nurse practitioner to perform those acts and certain additional acts without physician supervision if the nurse practitioner meets specified experience and certification requirementsbegin insert
and is practicing in a clinic, health facility, county medical facility, accountable care organization, or group practiceend insert. The bill would require a nurse practitioner to refer a patient to a physician and surgeon or other licensed health care provider under certain circumstancesbegin delete, and would require specified nurse practitioners to maintain a current list of licensed health care providers most often used for the purposes of obtaining information or adviceend delete. The bill would also require a nurse practitioner practicing under these provisions to maintain professional liability insurance, as specified. The bill would also specify that a nurse practitioner practicing under the provisions of the bill shall not supplant a physician and surgeon employed by specified health care facilities. Because a violation of those provisions would be a crime, this bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 2835.3 is added to the Business and
2Professions Code, to read:
(a) Notwithstanding any other provision of this chapter,
4a nurse practitioner who holds a certification as a nurse practitioner
5from a national certifying body may practice under this section
6without physician supervision if the nurse practitionerbegin delete meets the
7requirements of this article and one of the following is met:end delete
8begin delete(1)end deletebegin delete end deletebegin deleteHe or sheend delete has practiced under the supervision of a physician
9for
at least 4160 hours and is practicing in one of the following:
10(A)
end delete11begin insert(1)end insert A clinic, health facility, or county medical facility.
12(B)
end delete
13begin insert(2)end insert An accountable care organization, as defined in Section
143022 of the federal Patient Protection and Affordable Care Act
15(Public Law 111-148).
16(C)
end delete
P3 1begin insert(3)end insert A group practice, including a professional medical
2corporation, another form of corporation controlled by physicians
3and surgeons, a medical partnership, a medical foundation exempt
4from licensure, or another lawfully organized group of physicians
5that delivers, furnishes, or otherwise arranges for or provides health
6care services.
7(2) He or she has practiced under the supervision of a physician
8for at least
6240 hours.
9(b) Notwithstanding any other law, in addition to any other
10practices authorized in statute or regulation, a nurse practitioner
11practicing under this section may do any of the following:
12(1) Order durable medical equipment. Notwithstanding that
13authority, nothing in this paragraph shall operate to limit the ability
14of a third-party payer to require prior approval.
15(2) After performance of a physical examination by the nurse
16practitioner, certify disability pursuant to Section 2708 of the
17Unemployment Insurance Code.
18(3) For individuals receiving home health services or personal
19care services, approve, sign, modify, or add to a plan of
treatment
20or plan of care.
21(4) Assess patients, synthesize and analyze data, and apply
22principles of health care.
23(5) Manage the physical and psychosocial health status of
24patients.
25(6) Analyze multiple sources of data, including patient history,
26general behavior, and signs and symptoms of illness, identify
27alternative possibilities as to the nature of a health care problem,
28and select, implement, and evaluate appropriate treatment.
29(7) Establish a diagnosis by client history, physical examination,
30and other criteria, consistent with this section.
31(8) Order, furnish, or prescribe drugs or devices.
32(9) Refer patients to physicians or other licensed health care
33providers as provided in subdivision (c).
34(10) Delegate tasks to a medical assistant that are within the
35medical assistant’s scope of practice.
36(11) Perform additional acts that require education and training
37and that are recognized by the board as proper to be performed by
38a nurse practitioner.
39(12) Order hospice care as appropriate.
P4 1(13) Perform procedures that are necessary and consistent with
2the nurse practitioner’s education and training.
3(c) A nurse practitioner
shall refer a patient to a physician and
4surgeon or another licensed health care provider if a situation or
5condition of the patient is beyond the nurse practitioner’s education
6or training.
7(d) A nurse practitioner described in paragraph (2) of subdivision
8(a) shall maintain a current list of licensed health care providers
9most often used for the purposes of obtaining information or
10advice.
11(e)
end delete
12begin insert(end insertbegin insertd)end insert A nurse practitioner practicing under this section shall
13maintain professional liability insurance that is appropriate for his
14or her practice setting.
15(f)
end delete16begin insert(e)end insert Nothing in this section shall do either of the following:
17(1) Limit a nurse practitioner’s authority to practice nursing.
18(2) Limit the scope of practice of a registered nurse authorized
19pursuant to this chapter.
20(g)
end delete
21begin insert(f)end insert The board shall adopt regulations by July 1, 2015,
22establishing the means of documenting completion of the
23requirements of this section.
24(h)
end delete
25begin insert(g)end insert A nurse practitioner practicing pursuant to this section shall
26not supplant a physician and surgeon employed by a health care
27facility specified inbegin delete subparagraph (A) ofend delete paragraph (1) of
28subdivision
(a).
No reimbursement is required by this act pursuant to
30Section 6 of Article XIII B of the California Constitution because
31the only costs that may be incurred by a local agency or school
32district will be incurred because this act creates a new crime or
33infraction, eliminates a crime or infraction, or changes the penalty
34for a crime or infraction, within the meaning of Section 17556 of
35the Government Code, or changes the definition of a crime within
36the meaning of Section 6 of Article XIII B of the California
37Constitution.
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