Bill Text: CA SB323 | 2015-2016 | Regular Session | Amended


Bill Title: Nurse practitioners: scope of practice.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed) 2015-05-07 - In Assembly. Read first time. Held at Desk. [SB323 Detail]

Download: California-2015-SB323-Amended.html
BILL NUMBER: SB 323	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 22, 2015
	AMENDED IN SENATE  MARCH 26, 2015

INTRODUCED BY   Senator Hernandez
   (Principal coauthor: Assembly Member Eggman)

                        FEBRUARY 23, 2015

   An act to amend  and renumber  Section  2835.7 of
  2837 of, and to add Section 2837 to,  the
Business and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 323, as amended, Hernandez. Nurse  practitioners.
  practitioners: scope of practice. 
   The Nursing Practice Act provides for the licensure and regulation
of nurse practitioners by the Board of Registered Nursing. The act
authorizes the implementation of standardized procedures that
authorize a nurse practitioner to perform certain acts, including
ordering durable medical equipment in accordance with standardized
procedures, certifying disability for purposes of unemployment
insurance after physical examination and collaboration with a
physician and surgeon, and, for an individual receiving home health
services or personal care services, approving, signing, modifying, or
adding to a plan of treatment or plan of care after consultation
with a physician and surgeon. A violation of those provisions is a
crime.
   This bill would authorize a nurse practitioner who holds a
national certification from a national certifying body recognized by
the board to practice without the supervision of a physician and
surgeon, if the nurse practitioner meets existing requirements for
nurse practitioners and practices in one of certain specified
settings. The bill would authorize  such  a nurse
practitioner, in addition to any other practice authorized in statute
or regulation, to perform specified acts, including the acts
described above, without reference to standardized procedures or the
specific need for the supervision of a physician and surgeon. The
bill, instead, would require a nurse practitioner to refer a patient
to a physician and surgeon or other licensed health care provider if
a situation or condition of the patient is beyond the scope of the
nurse practitioner's education and training. The bill would require a
nurse practitioner practicing under these provisions to maintain
professional liability insurance appropriate for the practice
setting. By imposing new requirements on nurse practitioners, the
violation of which 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 1.  The Legislature finds and declares all of the
following:
   (a) Nurse practitioners are a longstanding, vital, safe,
effective, and important part of the state's health care delivery
system. They are especially important given California's shortage of
physicians, with just 16 of 58 counties having the federally
recommended ratio of physicians to residents.
   (b) Nurse practitioners will play an especially important part in
the implementation of the federal Patient Protection and Affordable
Care Act (Public Law 111-148), which will bring an estimated five
million more Californians into the health care delivery system,
because they will provide for greater access to primary care services
in all areas of the state. This is particularly true for patients in
medically underserved urban and rural communities.
   (c) Due to the excellent safety and efficacy record that nurse
practitioners have earned, the Institute of Medicine of the National
Academies has recommended full practice authority for nurse
practitioners. Currently, 20 states allow nurse practitioners to
practice to the full extent of their training and education.
   (d) Furthermore, nurse practitioners will assist in addressing the
primary care provider shortage by removing delays in the provision
of care that are created when dated regulations require a physician's
signature or protocol before a patient can initiate treatment or
obtain diagnostic tests that are ordered by a nurse practitioner.

  SEC. 2.    Section 2835.7 of the Business and
Professions Code is amended to read:
   2835.7.  (a) Notwithstanding any other law, a nurse practitioner
who holds a national certification from a national certifying body
recognized by the board may practice under this section without
supervision of a physician and surgeon, if the nurse practitioner
meets all the requirements of this article and practices in one of
the following:
   (1) A clinic as described in Chapter 1 (commencing with Section
1200) of Division 2 of the Health and Safety Code.
   (2) A facility as described in Chapter 2 (commencing with Section
1250) of Division 2 of the Health and Safety Code.
   (3) A facility as described in Chapter 2.5 (commencing with
Section 1440) of Division 2 of the Health and Safety Code.
   (4) An accountable care organization, as defined in Section 3022
of the federal Patient Protection and Affordable Care Act (Public Law
111-148).
   (5) A group practice, including a professional medical
corporation, another form of corporation controlled by physicians and
surgeons, a medical partnership, a medical foundation exempt from
licensure, or another lawfully organized group of physicians that
delivers, furnishes, or otherwise arranges for or provides health
care services.
   (6) A medical group, independent practice association, or any
similar association.
   (b) Notwithstanding any other law, in addition to any other
practice authorized in statute or regulation, a nurse practitioner
may do any of the following:
   (1) Order durable medical equipment. Notwithstanding that
authority, nothing in this paragraph shall operate to limit the
ability of a third-party payer to require prior approval.
   (2) After performance of a physical examination by the nurse
practitioner and collaboration, if necessary, with a physician and
surgeon, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.
   (3) For individuals receiving home health services or personal
care services, after consultation, if necessary, with the treating
physician and surgeon, approve, sign, modify, or add to a plan of
treatment or plan of care.
   (4) Assess patients, synthesize and analyze data, and apply
principles of health care.
   (5) Manage the physical and psychosocial health status of
patients.
   (6) Analyze multiple sources of data, identify a differential
diagnosis, and select, implement, and evaluate appropriate treatment.

   (7) Establish a diagnosis by client history, physical examination,
and other criteria, consistent with this section, for a plan of
care.
   (8) Order, furnish, prescribe, or procure drugs or devices.
   (9) Delegate tasks to a medical assistant pursuant to standardized
procedures and protocols developed by the nurse practitioner and
medical assistant, that are within the medical assistant's scope of
practice.
   (10) Order hospice care, as appropriate.
   (11) Order and interpret diagnostic procedures.
   (12) Perform additional acts that require education and training
and that are recognized by the nursing profession as appropriate to
be performed by a nurse practitioner.
   (c) A nurse practitioner shall refer a patient to a physician and
surgeon or other licensed health care provider if a situation or
condition of the patient is beyond the scope of the education and
training of the nurse practitioner.
   (d) A nurse practitioner practicing under this section shall
maintain professional liability insurance appropriate for the
practice setting. 
   SEC. 2.    Section 2837 of the  Business and
Professions Code   is amended and renumbered to read: 

    2837.   2837.5.   Nothing in this
article shall be construed to limit the current scope of practice of
a registered nurse authorized pursuant to this chapter.
   SEC. 3.    Section 2837 is added to the  
Business and Professions Code   , to read:  
   2837.  (a) Notwithstanding any other law, a nurse practitioner who
holds a national certification from a national certifying body
recognized by the board may practice under this section without
supervision of a physician and surgeon, if the nurse practitioner
meets all the requirements of this article and practices in one of
the following:
   (1) A clinic as described in Chapter 1 (commencing with Section
1200) of Division 2 of the Health and Safety Code.
   (2) A facility as described in Chapter 2 (commencing with Section
1250) of Division 2 of the Health and Safety Code.
   (3) A facility as described in Chapter 2.5 (commencing with
Section 1440) of Division 2 of the Health and Safety Code.
   (4) An accountable care organization, as defined in Section 3022
of the federal Patient Protection and Affordable Care Act (Public Law
111-148).
   (5) A group practice, including a professional medical
corporation, another form of corporation controlled by physicians and
surgeons, a medical partnership, a medical foundation exempt from
licensure, or another lawfully organized group of physicians that
delivers, furnishes, or otherwise arranges for or provides health
care services.
   (6) A medical group, independent practice association, or any
similar association.
   (b) Notwithstanding any other law, in addition to any other
practice authorized in statute or regulation, a nurse practitioner
who meets the qualifications of subdivision (a) may do any of the
following without physician and surgeon supervision:
   (1) Order durable medical equipment. Notwithstanding that
authority, this paragraph shall not operate to limit the ability of a
third-party payer to require prior approval.
   (2) After performance of a physical examination by the nurse
practitioner and collaboration, if necessary, with a physician and
surgeon, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.
   (3) For individuals receiving home health services or personal
care services, after consultation, if necessary, with the treating
physician and surgeon, approve, sign, modify, or add to a plan of
treatment or plan of care.
   (4) Assess patients, synthesize and analyze data, and apply
principles of health care.
   (5) Manage the physical and psychosocial health status of
patients.
   (6) Analyze multiple sources of data, identify a differential
diagnosis, and select, implement, and evaluate appropriate treatment.

   (7) Establish a diagnosis by client history, physical examination,
and other criteria, consistent with this section, for a plan of
care.
   (8) Order, furnish, prescribe, or procure drugs or devices.
   (9) Delegate tasks to a medical assistant pursuant to standardized
procedures and protocols, developed by the nurse practitioner and
medical assistant, that are within the medical assistant's scope of
practice.
   (10) Order hospice care, as appropriate.
   (11) Order and interpret diagnostic procedures.
   (12) Perform additional acts that require education and training
and that are recognized by the nursing profession as appropriate to
be performed by a nurse practitioner.
   (c) A nurse practitioner shall refer a patient to a physician and
surgeon or other licensed health care provider if a situation or
condition of the patient is beyond the scope of the education and
training of the nurse practitioner.
   (d) A nurse practitioner practicing under this section shall
maintain professional liability insurance appropriate for the
practice setting. 
  SEC. 3.   SEC. 4.   No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.               
feedback