INTRODUCED BY   Senator Negrete McLeod

                        FEBRUARY 25, 2009

   An act to add Section 2835.7 to the Business and Professions Code,
relating to nurse practitioners.


   SB 294, as introduced, Negrete McLeod. Nurse practitioners.
   Existing law, the Nursing Practice Act, provides for the
certification and regulation of nurse practitioners and
nurse-midwives by the Board of Registered Nursing and specifies
requirements for qualification or certification as a nurse
practitioner. Under the act, the practice of nursing is defined, in
part, as providing direct and indirect patient care services, as
specified, including the dispensing of drugs or devices under
specified circumstances. The practice of nursing is also described as
the implementation, based on observed abnormalities, of standardized
procedures, defined as policies and protocols developed by specified
facilities in collaboration with administrators and health
professionals, including physicians and surgeons and nurses.
   This bill would authorize the implementation of standardized
procedures that would expand the duties of a nurse practitioner in
the scope of his or her practice, as enumerated. The bill would make
specified findings and declarations in that regard.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


  SECTION 1.  The Legislature finds and declares all of the
   (a) Nurse practitioners play a vital and cost-effective role in
the delivery of health care services both independently and in
collaboration with physicians and surgeons and other health care
providers. Nurse practitioners are involved in almost every setting
in which health care services are delivered, and, in collaboration
with physicians and surgeons, directly provide a wide range of
services and care.
   (b) Under current law, nurse practitioners have the same statutory
authority to provide services and care as do registered nurses.
However, the law allows those registered nurses that meet the
education requirements for certification as nurse practitioners to
provide care and services beyond those specified in statute for
registered nurses pursuant to standardized procedures and protocols
adopted by each entity delivering health care services in which a
nurse practitioner practices.
   (c) The Legislature reiterates its intention to allow each health
care setting in which a nurse practitioner practices to select and
control the services nurse practitioners may perform and provide
pursuant to Section 2725 of the Business and Professions Code, and
that it is not the intention of the Legislature to grant nurse
practitioners the authority to independently perform services beyond
the level set forth in statute for registered nurses outside of the
standardized procedures.
   (d) Notwithstanding the foregoing, the Legislature finds that
there is ambiguity in current law regarding what services and
functions to be performed by nurse practitioners may be included in
standardized procedures and protocols. This ambiguity results in
disruptions and delays in care, disputes over billings, and
duplication of services.
   (e) Therefore, it is the intent of the Legislature to provide
clarification that standardized procedures and protocols may include
the specified services and functions set forth in this act so that
health care entities may allow nurse practitioners to engage in those
activities if the entities choose to do so, and that third-party
payors understand that those services and functions can be performed
by nurse practitioners if they are included in an entity's
standardized procedures and protocols.
  SEC. 2.  Section 2835.7 is added to the Business and Professions
Code, to read:
   2835.7.  (a) Notwithstanding any other provision of law, in
addition to any other practices that meet the general criteria set
forth in statute or regulation for inclusion in standardized
procedures developed through collaboration among administrators and
health professionals, including physicians and surgeons and nurses,
standardized procedures may be implemented that authorize a nurse
practitioner to do any of the following:
   (1) Admit patients to a hospital, provided all admissions policies
are followed by the nurse practitioner.
   (2) Order durable medical equipment, subject to any limitations
set forth in the standardized procedures. Notwithstanding that
authority, nothing in this paragraph shall operate to limit the
ability of a third-party payor to require prior approval.
   (3) After performance of a physical examination by the nurse
practitioner and collaboration with a physician and surgeon, certify
disability pursuant to Section 2708 of the Unemployment Insurance
   (4) Permit a nurse practitioner to be designated by the nurse
practitioner's supervising physician and surgeon as the primary care
provider of record for an individual enrolled in a health care
service plan. Notwithstanding that authority, nothing in this
paragraph shall be construed to allow a nurse practitioner to operate
independently of a standardized procedure.
   (5) For individuals receiving home health services under Medicare
or Medi-Cal, or personal care services, approve, sign, modify, or add
to a plan of treatment or plan of care.
   (b)  Nothing in this section shall be construed to affect the
validity of any standardized procedures in effect prior to the
enactment of this section or those adopted subsequent to enactment.