Amended in Senate April 22, 2015

Amended in Senate March 26, 2015

Senate Bill No. 323

Introduced by Senator Hernandez

(Principal coauthor: Assembly Member Eggman)

February 23, 2015

An act to amend begin insert and renumber end insert Section begin delete 2835.7 of end delete begin insert 2837 of, and to add Section 2837 to, end insert the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL’S DIGEST

SB 323, as amended, Hernandez. Nurse begin delete practitioners. end delete begin insert practitioners: scope of practice. end insert

The Nursing Practice Act provides for the licensure and regulation of nurse practitioners by the Board of Registered Nursing. The act authorizes the implementation of standardized procedures that authorize a nurse practitioner to perform certain acts, including ordering durable medical equipment in accordance with standardized procedures, certifying disability for purposes of unemployment insurance after physical examination and collaboration with a physician and surgeon, and, for an individual receiving home health services or personal care services, approving, signing, modifying, or adding to a plan of treatment or plan of care after consultation with a physician and surgeon. A violation of those provisions is a crime.

This bill would authorize a nurse practitioner who holds a national certification from a national certifying body recognized by the board to practice without the supervision of a physician and surgeon, if the nurse practitioner meets existing requirements for nurse practitioners and practices in one of certain specified settings. The bill would authorize begin insert such end insert a nurse practitioner, in addition to any other practice authorized in statute or regulation, to perform specified acts, including the acts described above, without reference to standardized procedures or the specific need for the supervision of a physician and surgeon. The bill, instead, would require a nurse practitioner to refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of the patient is beyond the scope of the nurse practitioner’s education and training. The bill would require a nurse practitioner practicing under these provisions to maintain professional liability insurance appropriate for the practice setting. By imposing new requirements on nurse practitioners, the violation of which 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.  

The Legislature finds and declares all of the
following:

(a) Nurse practitioners are a longstanding, vital, safe, effective,
and important part of the state’s health care delivery system. They
are especially important given California’s shortage of physicians,
with just 16 of 58 counties having the federally recommended ratio
of physicians to residents.

(b) Nurse practitioners will play an especially important part in
the implementation of the federal Patient Protection and Affordable
Care Act (Public Law 111-148), which will bring an estimated
five million more Californians into the health care delivery system,
because they will provide for greater access to primary care
services in all areas of the state. This is particularly true for patients
in medically underserved urban and rural communities.

(c) Due to the excellent safety and efficacy record that nurse
practitioners have earned, the Institute of Medicine of the National
Academies has recommended full practice authority for nurse
practitioners. Currently, 20 states allow nurse practitioners to
practice to the full extent of their training and education.

(d) Furthermore, nurse practitioners will assist in addressing
the primary care provider shortage by removing delays in the
provision of care that are created when dated regulations require
a physician’s signature or protocol before a patient can initiate
treatment or obtain diagnostic tests that are ordered by a nurse
practitioner.

begin delete

SEC. 2.  

Section 2835.7 of the Business and Professions Code
is amended to read:

2835.7.  

(a) Notwithstanding any other law, a nurse practitioner
who holds a national certification from a national certifying body
recognized by the board may practice under this section without
supervision of a physician and surgeon, if the nurse practitioner
meets all the requirements of this article and practices in one of
the following:

(1) A clinic as described in Chapter 1 (commencing with Section
1200) of Division 2 of the Health and Safety Code.

(2) A facility as described in Chapter 2 (commencing with
Section 1250) of Division 2 of the Health and Safety Code.

(3) A facility as described in Chapter 2.5 (commencing with
Section 1440) of Division 2 of the Health and Safety Code.

(4) An accountable care organization, as defined in Section
3022 of the federal Patient Protection and Affordable Care Act
(Public Law 111-148).

(5) 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.

(6) A medical group, independent practice association, or any
similar association.

(b) Notwithstanding any other law, in addition to any other
practice authorized in statute or regulation, a nurse practitioner
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 and collaboration, if necessary, with a physician and
surgeon, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.

(3) For individuals receiving home health services or personal
care services, after consultation, if necessary, with the treating
physician and surgeon, 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, identify a differential
diagnosis, and select, implement, and evaluate appropriate
treatment.

(7) Establish a diagnosis by client history, physical examination,
and other criteria, consistent with this section, for a plan of care.

(8) Order, furnish, prescribe, or procure drugs or devices.

(9) Delegate tasks to a medical assistant pursuant to standardized
procedures and protocols developed by the nurse practitioner and
medical assistant, that are within the medical assistant’s scope of
practice.

(10) Order hospice care, as appropriate.

(11) Order and interpret diagnostic procedures.

(12) Perform additional acts that require education and training
and that are recognized by the nursing profession as appropriate
to be performed by a nurse practitioner.

(c) A nurse practitioner shall refer a patient to a physician and
surgeon or other licensed health care provider if a situation or
condition of the patient is beyond the scope of the education and
training of the nurse practitioner.

(d) A nurse practitioner practicing under this section shall
maintain professional liability insurance appropriate for the practice
setting.

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 2837 of the end insert begin insert Business and Professions Code end insert begin insert is
amended and renumbered to read: end insert

begin delete 2837. end delete
begin insert 2837.5. end insert   

Nothing in this article shall be construed to limit the
current scope of practice of a registered nurse authorized pursuant
to this chapter.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 2837 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2837. end insert   

(a) Notwithstanding any other law, a nurse practitioner
who holds a national certification from a national certifying body
recognized by the board may practice under this section without
supervision of a physician and surgeon, if the nurse practitioner
meets all the requirements of this article and practices in one of
the following:

(1) A clinic as described in Chapter 1 (commencing with Section
1200) of Division 2 of the Health and Safety Code.

(2) A facility as described in Chapter 2 (commencing with
Section 1250) of Division 2 of the Health and Safety Code.

(3) A facility as described in Chapter 2.5 (commencing with
Section 1440) of Division 2 of the Health and Safety Code.

(4) An accountable care organization, as defined in Section
3022 of the federal Patient Protection and Affordable Care Act
(Public Law 111-148).

(5) 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.

(6) A medical group, independent practice association, or any
similar association.

(b) Notwithstanding any other law, in addition to any other
practice authorized in statute or regulation, a nurse practitioner
who meets the qualifications of subdivision (a) may do any of the
following without physician and surgeon supervision:

(1) Order durable medical equipment. Notwithstanding that
authority, this paragraph shall not 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 and collaboration, if necessary, with a physician and
surgeon, certify disability pursuant to Section 2708 of the
Unemployment Insurance Code.

(3) For individuals receiving home health services or personal
care services, after consultation, if necessary, with the treating
physician and surgeon, 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, identify a differential
diagnosis, and select, implement, and evaluate appropriate
treatment.

(7) Establish a diagnosis by client history, physical examination,
and other criteria, consistent with this section, for a plan of care.

(8) Order, furnish, prescribe, or procure drugs or devices.

(9) Delegate tasks to a medical assistant pursuant to
standardized procedures and protocols, developed by the nurse
practitioner and medical assistant, that are within the medical
assistant’s scope of practice.

(10) Order hospice care, as appropriate.

(11) Order and interpret diagnostic procedures.

(12) Perform additional acts that require education and training
and that are recognized by the nursing profession as appropriate
to be performed by a nurse practitioner.

(c) A nurse practitioner shall refer a patient to a physician and
surgeon or other licensed health care provider if a situation or
condition of the patient is beyond the scope of the education and
training of the nurse practitioner.

(d) A nurse practitioner practicing under this section shall
maintain professional liability insurance appropriate for the
practice setting.

end insert

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

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.