BILL ANALYSIS Ó
AB 154
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Date of Hearing: May 15, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 154 (Atkins) - As Amended: April 30, 2013
Policy Committee: Business,
Professions and Consumer Protection Vote: 9-4
Health 13-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill authorizes a nurse practitioner (NP), certified nurse
midwife (CNM), and physician assistant (PA) to perform abortion
by medication or aspiration techniques in the first trimester of
pregnancy upon completion of training, as specified.
FISCAL EFFECT
Unknown costs or savings, potentially in excess of 150,000. For
example, if the number of Medi-Cal first trimester procedures
increases by 350 per year, Medi-Cal costs would increase by
approximately $152,000. On the other hand, a similar reduction
in second trimester procedures would result in savings of
approximately $212,000, based on data from 2009.
COMMENTS
1)Rationale . This bill intends to address the current shortage
of health care professionals able to provide early abortion
care in California. It will authorize trained Nurse
Practitioners (NPs), Certified Nurse Midwives (CNMs) and
Physician Assistants (PAs) to provide comprehensive first
trimester abortion care, within the scope of their licenses.
According to the Guttmacher Institute, 52% of California
counties lack an abortion provider. Lack of access causes
women to delay termination into the second, or even third,
trimesters. It also forces rural women to travel long
distances, in the case of some rural areas, up to five hours;
women have to raise money to cover these travel costs, further
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delaying care. Even women in urban areas face long wait-times
to receive first trimester abortion care.
This bill helps to ensure women receive safe, early care and
will help provide comprehensive and better coordinated
reproductive health care in areas such as miscarriage
management, post-abortion follow-up, and contraception.
2)Background: UCSF study . The Office of Statewide Health
Planning and Development (OSHPD) permits temporary legal
waivers of certain practice restrictions or educational
requirements to test expanded roles and accelerated training
programs for health care professionals. A multi-year study
conducted by The University of California's San Francisco's
(UCSF) Bixby Center for Global Reproductive Health, under an
OSHPD waiver evaluated the providers affected by this bill
(described collectively as advance practice clinicians (APCs))
in providing aspiration abortion. Over the five years of the
study, almost 8,000 patients were provided care by an APC and
over 6,000 patients were provided care by a physician. The
results of the study show comparable levels of complications
and found APCs to be safe and qualified.
The OSHPD waiver includes numerous requirements to ensure
safety. For example, physician trainers are required to have
performed at least 200 procedures, have an excellent safety
record, and, have received formal "train-the-trainer"
instruction prior to training APCs. To participate in the
project, NPs, CNMs, and PAs must have at least 12 months
successful clinical experience in a health care facility and
be licensed to practice in California, demonstrate maintenance
of Professional Certification or equivalent credentialing,
have at least three months experience in the provision of
early medication abortion or equivalent experience,
demonstrate maintenance of certification of Basic Life
Support, and have a desire to work in the area of women's
reproductive health, including provision of early abortion
care.
3)Related legislation . SB 491 (Ed Hernandez) authorizes NPs to
perform some tasks independently, rather than with physician
supervision, including examination of patients and
establishing a medical diagnosis. SB 491 also requires NPs,
after July 1, 2016, to be certified by a national certifying
body in order to practice. The bill is pending in Senate
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Appropriations Committee.
4)Previous legislation . SB 623 (Kehoe), Chapter 450, Statutes
of 2012, extends, until January 1, 2014, the OSHPD waiver to
evaluate NPs, CNMs, and PAs in providing aspiration abortions.
SB 1338 (Kehoe) of 2012 would have allowed NPs, CNMs, and PAs
who have completed training in under the OSHPD waiver to
continue to perform abortions by aspiration techniques. SB
1338 died in Senate Business, Professions and Economic
Development Committee.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081