BILL NUMBER: SB 491 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 14, 2013
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 and is practicing in a clinic, health facility,
county medical facility, accountable care organization, or group
practice . 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 at
least 4160 hours and is practicing in one of the following:
(A)
(1) A clinic, health facility, or county medical
facility.
(B)
(2) An accountable care organization, as defined in
Section 3022 of the federal Patient Protection and Affordable Care
Act (Public Law 111-148).
(C)
(3) 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 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 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)
( d) A nurse practitioner practicing under
this section shall maintain professional liability insurance that is
appropriate for his or her practice setting.
(f)
(e) 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)
(f) The board shall adopt regulations by July 1, 2015,
establishing the means of documenting completion of the requirements
of this section.
(h)
(g) 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.