BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 323 (Hernandez) - Nurse practitioners:  scope of practice
          
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          |Version: April 22, 2015         |Policy Vote: B., P. & E.D. 7 -  |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: May 4, 2015       |Consultant: Brendan McCarthy    |
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          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  







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            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;








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              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.


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