BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 323 (Hernandez) - Nurse practitioners: scope of practice ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 22, 2015 |Policy Vote: B., P. & E.D. 7 - | | | 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: Yes | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 4, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill does not meet the criteria for referral to the Suspense File. Bill Summary: SB 323 would authorize a nurse practitioner who holds a national certification to practice without physician supervision in specified settings. Fiscal Impact: One-time costs, likely about $75,000, to update existing regulations (Board of Registered Nursing Fund). Likely minor ongoing costs for enforcement (Board of Registered Nursing Fund). The Board of Registered Nursing indicates that there may be increased need for enforcement activity under the bill, but that those costs are not SB 323 (Hernandez) Page 1 of ? anticipated to be significant. Background: Under current law, nurse practitioners are licensed and regulated by the Board of Registered Nursing. Under current law, nurse practitioners must meet certain educational requirements. Current law authorizes nurse practitioners to provide certain services under supervision of a physician or surgeon or pursuant to standardized procedures created by a physician or surgeon. Current law allows nurse practitioners who are under the supervision of a physician to prescribe Schedule II - V drugs. A physician may supervise up to four prescribing nurse practitioners or an unlimited number of non-prescribing nurse practitioners. Proposed Law: SB 323 would authorize a nurse practitioner who holds a national certification to practice without physician supervision in specified settings. The bill would allow a nurse practitioner who has been certified by a national certification agency recognized by the Board of Registered Nursing to practice independent of physician supervision in specified settings, including clinics, health facilities, accountable care organizations, group practices, and medical groups. The bill would require a certified nurse practitioner who is practicing independently under the bill to maintain malpractice insurance. When practicing in the specified settings, the bill would authorize a certified nurse practitioner to: Order durable medical equipment; Certify disability claims; Make changes to a plan of treatment for certain home health patients; Assess patients, synthesize data, and apply the principals of health care; Mange patients' health status; Analyze data to identify the nature of a health problem and implement appropriate treatment; Examine a patient and establish a medical diagnosis; Order prescription drugs; Refer patients to other health care providers; SB 323 (Hernandez) Page 2 of ? Delegate duties to medical assistants; Order hospice care; Related Legislation: SB 491 (Hernandez, 2013) would have authorized a nurse practitioner to practice independently after a period of physician supervision. That bill was held on the Assembly Appropriations Committee's Suspense File. Staff Comments: The only costs that may be incurred by a local agency relate to crimes and infractions. Under the California Constitution, such costs are not reimbursable by the state. -- END --