BILL ANALYSIS                                                                                                                                                                                                    

                                                                  SB 294
                                                                  Page  1

          Date of Hearing:   July 15, 2009 

                                Kevin De Leon, Chair

                 SB 294 (Negrete McLeod) - As Amended:  July 1, 2009 

          Policy Committee:                              Business &  
          Professions  Vote:                            10-0

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              


          This bill clarifies standardized procedures and protocols  
          governing nurse practitioner (NP) scope of practice by adding  
          procedures to the Nursing Practice Act. Specifically, this bill  
          authorizes NP to: 

          1)Order durable medical equipment. 

          2)Certify disability for unemployment insurance eligibility  

          3)Sign, modify, or add to a plan of treatment or plan of care  
            for home health or personal care services after consultation  
            with a treating physician or surgeon. 

           FISCAL EFFECT 

          Absorbable workload to the Board of Registered Nursing (BRN) to  
          continue oversight of the NP scope of practice. 


           1)Rationale  . This bill is sponsored by the California  
            Association of Nurse Practitioners to reduce ambiguity about  
            what services may be authorized and provided by NP under  
            current law standardized procedures. NP are required to work  
            in collaboration with a supervising physician and follow  
            standardized written procedures. Within the parameters set by  
            these procedures they may order tests, diagnose patients, or  
            order medication. California limits the number of NP an  
            individual physician may supervise to four if the NP are  


                                                                  SB 294
                                                                 Page  2

            furnishing medications. The clarifications made in this bill  
            will ensure payment for these specific activities will be  
            reimbursed by third party payers. 

           2)Background  . The Nursing Practice Act licenses and regulates  
            nurse practitioners under the jurisdiction of BRN. The NP  
            scope of practice was created 50 years ago to address an  
            increasing physician shortage nationally. NP provide primary  
            care in many patient care settings. There are 145,000 NP  
            nationally and 14,300 practicing in California. Under current  
            law, a registered nurse who wants to be licensed as a NP must  
            submit education, work experience, and other credentials to  
            the BRN to receive the NP certification. Nurse practitioners  
            are registered nurses with additional graduate training with  
            at least a Master's in Nursing. 

           3)Related Legislation  . AB 1436 (Hernandez) in 2008 and SB 809  
            (Ashburn) in 2007 defined the NP scope of practice. Neither  
            bill passed policy committees in their respective houses of  
           Analysis Prepared by :    Mary Ader / APPR. / (916) 319-2081