BILL NUMBER: SB 491 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 8, 2013
AMENDED IN ASSEMBLY AUGUST 5, 2013
AMENDED IN SENATE MAY 21, 2013
AMENDED IN SENATE MAY 1, 2013
AMENDED IN SENATE APRIL 16, 2013
AMENDED IN SENATE APRIL 1, 2013
INTRODUCED BY Senator Hernandez
FEBRUARY 21, 2013
An act to add Section 2835.3 to the Business and Professions Code,
relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
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. 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. 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 1. Section 2835.3 is added to the Business and Professions
Code, to read:
2835.3. (a) Notwithstanding any other provision of this chapter,
a nurse practitioner who holds a certification as a nurse
practitioner from a national certifying body may practice under this
section without physician supervision if the nurse practitioner meets
the requirements of this article and one of the following is met:
(1) He or she has practiced under the supervision of a physician
for two years or at least 4160 hours
and is practicing in one of the following:
(A) A clinic, health facility, or county medical facility.
(B) An accountable care organization, as defined in Section 3022
of the federal Patient Protection and Affordable Care Act (Public Law
111-148).
(C) A group practice, including a professional medical
corporation, another form of corporation controlled by physicians and
surgeons, a medical partnership, a medical foundation exempt from
licensure, or another lawfully organized group of physicians that
delivers, furnishes, or otherwise arranges for or provides health
care services.
(2) He or she has practiced under the supervision of a physician
for at least three years or 6240 hours.
(b) Notwithstanding any other law, in addition to any other
practices authorized in statute or regulation, a nurse practitioner
practicing under this section may do any of the following:
(1) Order durable medical equipment. Notwithstanding that
authority, nothing in this paragraph shall operate to limit the
ability of a third-party payer to require prior approval.
(2) After performance of a physical examination by the nurse
practitioner, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.
(3) For individuals receiving home health services or personal
care services, approve, sign, modify, or add to a plan of treatment
or plan of care.
(4) Assess patients, synthesize and analyze data, and apply
principles of health care.
(5) Manage the physical and psychosocial health status of
patients.
(6) Analyze multiple sources of data, including patient history,
general behavior, and signs and symptoms of illness, identify
alternative possibilities as to the nature of a health care problem,
and select, implement, and evaluate appropriate treatment.
(7) Establish a diagnosis by client history, physical examination,
and other criteria, consistent with this section.
(8) Order, furnish, or prescribe drugs or devices.
(9) Refer patients to physicians or other licensed health care
providers as provided in subdivision (c).
(10) Delegate tasks to a medical assistant that are within the
medical assistant's scope of practice.
(11) Perform additional acts that require education and training
and that are recognized by the nursing profession
board as proper to be performed by a nurse practitioner.
(12) Order hospice care as appropriate.
(13) Perform procedures that are necessary and consistent with the
nurse practitioner's education and training.
(c) A nurse practitioner shall refer a patient to a physician and
surgeon or another licensed health care provider if a situation or
condition of the patient is beyond the nurse practitioner's education
or training.
(d) A nurse practitioner described in paragraph (2) of subdivision
(a) shall maintain a current list of licensed health care providers
most often used for the purposes of obtaining information or advice.
(e) A nurse practitioner practicing under this section shall
maintain professional liability insurance that is appropriate for his
or her practice setting.
(f) Nothing in this section shall do either of the following:
(1) Limit a nurse practitioner's authority to practice nursing.
(2) Limit the scope of practice of a registered nurse authorized
pursuant to this chapter.
(g) The board shall adopt regulations by September 1,
2014 July 1, 2015 , establishing the means of
documenting completion of the requirements of this section.
(h) A nurse practitioner practicing pursuant to this section shall
not supplant a physician and surgeon employed by a health care
facility specified in subparagraph (A) of paragraph (1) of
subdivision (a).
SEC. 2. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.