SB 491, as amended, Hernandez. Nurse practitioners.
Existing law, the Nursing Practice Act, provides for the licensure and regulation of nurse practitioners by the Board of Registered Nursing. Existing law authorizes the implementation of standardized procedures that authorize a nurse practitioner to perform certain acts, including, among others, ordering durable medical equipment, and, in consultation with a physician and surgeon, approving, signing, modifying, or adding to a plan of treatment or plan for an individual receiving home health services or personal care services. A violation of those provisions is a crime.
This bill would authorize a nurse practitioner to perform those acts and certain additional acts without physician supervision if the nurse practitioner meets specified experience and certification requirements. The bill would require a nurse practitioner to refer a patient to a physician and surgeon or other licensed health care provider under certain circumstances, and would require specified nurse practitioners to maintain a current list of licensed health care providers most often used for the purposes of obtaining information or advice. The bill would also require a nurse practitioner practicing under these provisions to maintain professional liability insurance, as specified.begin insert The bill would also specify that a nurse practitioner practicing under the provisions of the bill shall not supplant a physician and surgeon employed by specified health care facilities.end insert Because a violation of those provisions would be a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 2835.3 is added to the Business and
2Professions Code, to read:
(a) Notwithstanding any other provision of this chapter,
4a nurse practitioner who holds a certification as a nurse practitioner
5from a national certifying body may practice under this section
6without physician supervision if the nurse practitioner meets the
7requirements of this article and one of the following is met:
8(1) He or she has practiced under the supervision of a physician
9forbegin delete two years orend deletebegin insert at leastend insert 4160 hours and is practicing in one of the
10following:
11(A) A clinic, health facility, or county medical facility.
12(B) An accountable care organization, as defined in Section
133022 of the federal Patient Protection and Affordable Care Act
14(Public Law 111-148).
15(C) A group practice, including a professional medical
16corporation, another form of corporation controlled by physicians
17and surgeons, a medical partnership, a medical foundation exempt
18from licensure, or another lawfully organized group of physicians
P3 1that delivers, furnishes, or otherwise arranges for or provides health
2care services.
3(2) He or she has practiced under the supervision of a physician
4for at leastbegin delete three years orend delete
6240 hours.
5(b) Notwithstanding any other law, in addition to any other
6practices authorized in statute or regulation, a nurse practitioner
7practicing under this section may do any of the following:
8(1) Order durable medical equipment. Notwithstanding that
9authority, nothing in this paragraph shall operate to limit the ability
10of a third-party payer to require prior approval.
11(2) After performance of a physical examination by the nurse
12practitioner, certify disability pursuant to Section 2708 of the
13Unemployment Insurance Code.
14(3) For individuals receiving home health services or personal
15care services, approve, sign, modify, or add to a plan of
treatment
16or plan of care.
17(4) Assess patients, synthesize and analyze data, and apply
18principles of health care.
19(5) Manage the physical and psychosocial health status of
20patients.
21(6) Analyze multiple sources of data, including patient history,
22general behavior, and signs and symptoms of illness, identify
23alternative possibilities as to the nature of a health care problem,
24and select, implement, and evaluate appropriate treatment.
25(7) Establish a diagnosis by client history, physical examination,
26and other criteria, consistent with this section.
27(8) Order, furnish, or prescribe drugs or devices.
28(9) Refer patients to physicians or other licensed health care
29providers as provided in subdivision (c).
30(10) Delegate tasks to a medical assistant that are within the
31medical assistant’s scope of practice.
32(11) Perform additional acts that require education and training
33and that are recognized by thebegin delete nursing professionend deletebegin insert boardend insert as proper
34to be performed by a nurse practitioner.
35(12) Order hospice care as appropriate.
36(13) Perform procedures that are necessary and consistent with
37the nurse practitioner’s education and training.
38(c) A nurse practitioner shall refer a patient to a physician and
39surgeon or another licensed health care provider if a situation or
P4 1condition of the patient is beyond the nurse practitioner’s education
2or training.
3(d) A nurse practitioner described in paragraph (2) of subdivision
4(a) shall maintain a current list of licensed health care providers
5most often used for the purposes of obtaining information or
6advice.
7(e) A nurse practitioner practicing under this section shall
8maintain professional liability insurance that is appropriate for
his
9or her practice setting.
10(f) Nothing in this section shall do either of the following:
11(1) Limit a nurse practitioner’s authority to practice nursing.
12(2) Limit the scope of practice of a registered nurse authorized
13pursuant to this chapter.
14(g) The board shall adopt regulations bybegin delete September 1, 2014end deletebegin insert July
151, 2015end insert, establishing the means of documenting completion of the
16requirements of this section.
17(h) A nurse practitioner practicing pursuant to this section shall
18not supplant a physician and surgeon employed by a health care
19facility specified in subparagraph (A) of paragraph (1) of
20subdivision (a).
No reimbursement is required by this act pursuant to
22Section 6 of Article XIII B of the California Constitution because
23the only costs that may be incurred by a local agency or school
24district will be incurred because this act creates a new crime or
25infraction, eliminates a crime or infraction, or changes the penalty
26for a crime or infraction, within the meaning of Section 17556 of
27the Government Code, or changes the definition of a crime within
28the meaning of Section 6 of Article XIII B of the California
29Constitution.
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