BILL ANALYSIS Ó ----------------------------------------------------------------------- |Hearing Date:June 17, 2013 |Bill No:AB | | |1028 | ----------------------------------------------------------------------- SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT Senator Ted W. Lieu, Chair Bill No: AB 1028Author:Patterson As Amended:June 10, 2013 Fiscal: Yes SUBJECT: Vocational nursing: interim permits. SUMMARY: Permits an applicant for a vocational nursing license to submit an application for an interim permit (IP) at the same time they submit an application for the required licensing examination and requires the California Board of Vocational Nursing and Psychiatric Technicians (BVNPT) to decide whether to issue the permit and, if the BVNPT deems to, issue the IP within 60 days of receiving the application. Existing law: 1) Provides for the licensure and regulation of Licensed Vocational Nurses (LVNs) and psychiatric technicians by the BVNPT. (Business and Professions Code (BPC) § 2849 et seq.) 2) Defines the scope of practice for LVNs and states they may: (California Code of Regulations § 2518.5) a) Use and practice basic assessment (data collection); b) Participate in planning; c) Execute interventions in accordance with the care plan or treatment plan; d) Contribute to evaluation of individualized interventions related to the care plan or treatment plan; e) Perform basic nursing services as specified; AB 1028 Page 2 f) Administer medications; g) Apply communication skills for the purpose of patient/client care and education; and h) Contribute to the development and implementation of a teaching plan related to self-care for the patient/client. 3) Outlines the requirements that an applicant for a license as a vocational nurse must meet in order to be granted an IP by the BVNPT. (BPC § 2872.2 et seq.) 4) Specifies that if the BVNPT receives an application for licensure as a vocational nurse, no later than four months after completion of a the BVNPT approved nursing program, the BVNPT may issue an IP authorizing the applicant to practice vocational nursing pending the results of the first licensing examination, or for a period of nine months, whichever occurs first. (BPC § 2872.2) 5) Specifies that the fee to be paid for an IP shall be in an amount no less than forty dollars ($40) and may be fixed by the BVNPT at an amount no more than fifty dollars ($50). (BPC § 2895(g)) This bill: 1) Specifies that an applicant may submit an application for an IP at the same time the applicant submits their application for the licensing examination. 2) Indicates that the BVNPT shall make a decision whether to issue the IP, and if the BVNPT decides to issue the IP, they will issue the IP within 60 days of receiving the completed application. FISCAL EFFECT: This bill has been keyed "fiscal" by Legislative Counsel. According to the Assembly Appropriations Committee analysis dated May 1, 2013, if half of the licensure applicants seek an IP, costs for increased workload to the BVNPT are estimated at $42,000 in 2013-2014 and $76,000 ongoing. These costs should be offset by the BVNPT's $40.00 IP fee, which would increase revenue by approximately $86,040 in the first year and $172,080 ongoing. COMMENTS: 1. Purpose. This bill is sponsored by the Author. According to the Author, vocational nursing applicants are currently experiencing AB 1028 Page 3 extraordinary delays with application processing times. The current wait time [for an interim permit] is actually 8 to12 weeks?The BVNPT states that there would then be an additional 4-5 weeks processing time before the interim permit could be issued. As a result of this lengthy process, the BVNPT has also stated that they have not actually issued any of these interim permits in over 2 years. AB 1028 aims to ensure that these critical health care providers can begin working in a timely manner once they have finished schooling and have entered the licensing process with the BVNPT by speeding up the process by which they can apply for and receive an interim permit while they complete all board exams. 2. Background. Current Processes for Issuing Interim Permits. Presently, a vocational nursing student who has completed their training program may apply to take the licensing examination. Provided that the application for licensure is received by the BVNPT no later than four months after completion of a board-approved nursing program and clearance from the Department of Justice, the BVNPT may issue an IP authorizing the applicant to practice vocational nursing, pending the results of the licensing examination, or for a period of nine months, whichever occurs first. If the applicant passes the examination, the interim permit shall remain in effect until the license is issued by the BVNPT or for a maximum period of six months after passing the examination, whichever occurs first. If the applicant fails the examination, the interim permit shall terminate upon notice by certified mail, return receipt requested, or if the applicant fails to receive the notice, upon the date specified in the interim permit, whichever occurs first. An interim permittee shall not use any title or designation other than "vocational nurse interim permittee." Supervision. A permittee shall function under the supervision of a LVN or a registered nurse (RN), who shall be present and available on the premises during the time the permittee is rendering professional services. The LVN or RN may delegate to the permittee any function taught in the permittee's basic nursing program. Delays in Issuing Interim Permits . According to the BVNPT website, it takes approximately 3-4 weeks to process an IP. However, the BVNPT acknowledges that it currently takes 8-12 weeks. This is due primarily to staffing shortages. 3. Will This Measure Increase IP Applicants? The BVNPT has not received an application for an IP in over two years. However, the Author believes that this measure will result in an increase in IP AB 1028 Page 4 applications. The Author states that many applicants do not apply for IPs because the BVNPT does not advertise IPs on its Web site. Since raising this issue, the BVNPT has agreed to begin listing information about IPs on its Web site. However, the Author believes that the additional provisions in this measure will also help to ensure that individuals apply for IPs. For example, currently the BVNPT only alerts applicants about the option for applying for an IP after the applicant's licensure application has been submitted to and processed by the BVNPT. This measure would allow an applicant to apply for the IP at the same time they apply for licensure. Additionally, it is the Author's belief that the time it takes the BVNPT to process the IP is a deterrent to applicants. This is because by the time the IP application is processed, the applicant's licensure application may be close to completion thus making the IP useless. By decreasing the BVNPTs 90 day IP application processing time to 60 days, the Author hopes that applicants will be more inclined to apply for an IP while they wait for their licensure application to be processed. 4. Arguments in Support. The California Association for Health Services at Home , the California Hospital Association and the Hospital Corporation of America all support the bill. In their letter they write, "The Affordable Care Act?emphasizes allowing all providers to function at the top of their education and training, and delivering care in teams. The ability for vocational nurses to work under an interim permit could enhance this access." They also add, "While the supply of registered nurses is presently stable, 50 percent of California's RN's with active licensees are over the age of 50 and are predicted to retire or reduce hours as the economy improves?Therefore, introducing vocational nurse into the workforce as interim permittees to maximize their availability and increase their significance in the care of Californians is crucial." The Association of California Healthcare Districts (ACHD) states in their letter, "The majority of California's Healthcare Districts are located in rural areas, and many have a difficult time recruiting qualified individuals into their workforce. By increasing the prospective workforce, Healthcare Districts will be able to offer their communities increased patient care. As ACHD supports long-term solutions to increase the potential workforce for healthcare professionals within all areas of California to ease workforce shortages, we strongly urge your support of this important measure." AB 1028 Page 5 SUPPORT AND OPPOSITION: Support: Association of California Healthcare Districts California Association for Health Services at Home California Hospital Association Hospital Corporation of America Opposition: None on file as of June 12, 2013. Consultant:Le Ondra Clark, Ph.D.