BILL ANALYSIS Ó AB 154 Page 1 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 AB 154 Page 2 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 AB 154 Page 3 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