BILL ANALYSIS                                                                                                                                                                                                    






                        SENATE HEALTH AND HUMAN SERVICES
                               COMMITTEE ANALYSIS
                        Senator Deborah V. Ortiz, Chair


          BILL NO:       AB 1253                                      
          A
          AUTHOR:        Matthews and Thomson                         
          B
          AMENDED:       May 2, 2001
          HEARING DATE:  June 13, 2001                                
          1
          FISCAL:        NonFiscal/Judiciary/URGENCY                  
          2
                                                                      
          5
          CONSULTANT:                                                 
          3
          McCarthy / ak
                                        

                                     SUBJECT
                                         
                                    Nursing

                                     SUMMARY  

          This bill adds to the list of providers who may be  
          reimbursed under the Victims of Crime Program,  
          psychiatric-mental health nurses, as defined, and revises  
          the description of psychiatric-mental health nurses in  
          various codes to add certified clinical nurse specialists  
          who participate in expert clinical practice in the  
          specialty of psychiatric mental health nursing.

                                     ABSTRACT  

          Existing Law:
          1.Licenses and regulates registered nurses through the  
            Board of Registered Nursing (BRN), and provides for the  
            certification of "clinical nurse specialists" for  
            registered nurses who meet certain requirements,  
            including possessing a master's degree in a clinical  
            field of nursing.

          2.Establishes a program, administered by the State Board of  
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          Thomson)Page 2


          
            Control, to reimburse victims of crime for the pecuniary  
            losses they suffer as a direct result of criminal acts.   
            The program is funded by restitution fines, which are  
            required to be imposed by the court on all persons  
            convicted of a misdemeanor or a felony.

          3.Includes in the definition of "pecuniary loss," for  
            purposes of the Victims of Crime Program, the amount of  
            psychiatric, psychological, or other mental health  
            counseling related expenses which became necessary as a  
            direct result of the crime, and specifies that these  
            counseling services may only be reimbursed if provided by  
            specified individuals, including physicians,  
            psychologists, clinical social workers, and marriage and  
            family therapists.

          4.Includes in the definition of "psychotherapist," for  
            purposes of provisions of law regarding privileged  
            communications between patients and psychotherapists, a  
            licensed registered nurse who possesses a master's degree  
            in psychiatric-mental health nursing.

          5.Includes (for purposes of provisions of law prohibiting  
            health care service plans or disability insurers from  
            prohibiting covered persons from selecting the type of  
            mental health or vision service provider of their  
            choice), upon referral by a physician and surgeon, those  
            licensed registered nurses who are on a list maintained  
            by the BRN of psychiatric-mental health nurses who  
            possess a master's degree in psychiatric mental health  
            nursing and two years of supervised experience in  
            psychiatric-mental health nursing.

          This bill:
          1.Adds to the list of providers who may be reimbursed for  
            mental health counseling services under the Victims of  
            Crime Program, an advanced practice registered nurse who  
            is certified as a clinical nurse specialist, as  
            specified, and who participates in expert clinical  
            practice in the specialty of psychiatric-mental health  
            nursing, and a registered nurse who possesses a master's  
            degree in psychiatric-mental health nursing and is listed  
            as a psychiatric-mental health nurses by the BRN.

          2.Revises the description of psychiatric-mental health  
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            nurses, for purposes of provisions of law regarding  
            privileged communications between patients and  
            psychotherapists, by including an advanced practice  
            registered nurse who is certified as a clinical nurse  
            specialist, as specified, and participates in expert  
            clinical practice in the specialty of psychiatric-mental  
            health nursing.

          3.Revises the description of psychiatric-mental health  
            nurses, for purposes of provisions of law prohibiting  
            health care service plans or disability insurers from  
            prohibiting covered persons from selecting the type of  
            mental health provider of their choice, by adding an  
            advanced practice registered nurse who is certified as a  
            clinical nurse specialist, as specified, and participates  
            in expert clinical practice in the specialty of  
            psychiatric-mental health nursing.

                                  FISCAL IMPACT  

          Unknown.

                            BACKGROUND AND DISCUSSION






















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          1.Intent of the bill
            Since 1998, the Board of Registered Nursing (BRN) has  
            been able to issue clinical nurse specialist  
            certifications to registered nurses who meet certain  
            requirements.  The stated intent of this bill is to  
            enable these clinical nurse specialists, who practice in  
            the field of psychiatric-mental health nursing, to be  
            reimbursed under the Victims of Crime Program, and to  
            update outdated definitions of psychiatric-mental health  
            nurses with the current clinical nurse specialist title.   
            However, according to the BRN, not all of the nurses that  
            meet the current definition of being on a list maintained  
            by BRN of  psychiatric-mental health nurses with a  
            master's degree and two years of supervised experience in  
            psychiatric-mental health nursing, meet the new  
            definition of certified clinical nurse specialists.

            According to the author, this bill is sponsored by the  
            American Nurses Association of California to enable  
            clinical nurse specialists in the field of  
            psychiatric-mental health nursing to be reimbursed for  
            counseling services to victims of crime, and to make  
            title changes in various provisions of law to reflect the  
            current title for nurses with a  master's degree in a  
            clinical nursing field.
          
          2.Support
            This bill is supported by the California Association of  
            Psychiatric Mental Health Nurses in Advanced Practice  
            (Association), which states that current law  
            discriminates against victims who attempt to seek therapy  
            from more than 400 licensed clinical nurse specialists in  
            California.  According to the Association, although  
            psychiatric-mental health clinical nurse specialists are  
            legally recognized providers of mental health services,  
            they are not specifically listed in the Program.

            The California Psychiatric Association also supports  
            making psychiatric advanced practice nurses eligible for  
            reimbursement for their professional services, as  
            provided in this bill.

          3.Related legislation
            SB 716 (Machado) redefines the term "psychotherapist"  
            such that communication between a psychotherapist and a  
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            patient remain confidential and privileged.

                                  PRIOR ACTIONS

           Assembly Floor:          77 - 0  Pass
          Assembly Health:         13 - 0  Do Pass as Amended

                                    POSITIONS  

          Support:       American Nurses Association of California  
          (sponsor)
                         California Association of Psychiatric Mental  
          Health Nurses
                            in Advanced Practice
                         California Psychiatric Association
                         Kaiser Permanente

          Oppose:   None received






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