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SB-554 Nurse practitioners: physician assistants: buprenorphine.(2017-2018)

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Date Published: 04/17/2017 02:49 PM
SB554:v97#DOCUMENT

Amended  IN  Senate  April 17, 2017
Amended  IN  Senate  March 27, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 554


Introduced by Senator Stone

February 16, 2017


An act to add Article 8.5 (commencing with Section 2837.50) to Chapter 6 of Division 2 of Sections 2836.4 and 3502.1.5 to the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


SB 554, as amended, Stone. Nurse practitioners: independent practice. physician assistants: buprenorphine.
Existing federal law requires practitioners, as defined, who dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment to obtain annually a separate registration with the United States Attorney General for that purpose. Existing federal law authorizes waiver of the registration requirement for a qualifying practitioner who submits specified information to the United States Secretary of Health and Human Services. Existing federal law, the Comprehensive Addiction Recovery Act of 2016, defines a qualifying practitioner for these purposes to include, among other practitioners, a nurse practitioner or physician assistant who, among other requirements, has completed not fewer than 24 hours of initial training, as specified, and is supervised by, or works in collaboration with, a qualifying physician, if the nurse practitioner or physician assistant is required by state law to prescribe medications for the treatment of opioid use disorder in collaboration with or under the supervision of a physician.
Existing state law, the Nursing Practice Act, establishes the Board of Registered Nursing in the Department of Consumer Affairs for the licensure and regulation of nurse practitioners. The act authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances subject to physician and surgeon supervision.
This bill would prohibit construing the Nursing Practice Act or any provision of state law from prohibiting a nurse practitioner from furnishing or ordering buprenorphine when done in compliance with the provisions of the Comprehensive Addiction Recovery Act, as specified.
Existing state law, the Physician Assistant Practice Act, establishes the Physician Assistant Board within the jurisdiction of the Medical Board of California for the licensure and regulation of physician assistants. The act authorizes a physician assistant, while under the supervision of a licensed physician authorized to supervise a physician assistant, to administer or provide medication to a patient, or transmit orally, or in writing on a patient’s record or in a drug order, an order to a person who may lawfully furnish the medication, as specified.
This bill would prohibit construing the Physician Assistant Practice Act or any provision of state law from prohibiting a physician assistant from administering or providing buprenorphine to a patient, or transmit orally, or in writing on a patient’s record or in a drug order, an order for buprenorphine to a person who may lawfully furnish buprenorphine when done in compliance with the provisions of the Comprehensive Addiction Recovery Act, as specified.

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 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 these provisions is a crime.

This bill would authorize a nurse practitioner who holds a certification from a national certifying body, recognized by the board, to be certified by the board as an independent nurse practitioner and to perform certain nursing functions without the supervision of a physician and surgeon, if the independent nurse practitioner meets specified requirements and practices in medically underserved areas or with medically underserved populations, as defined by the federal Health Resources and Services Administration.

The bill would prohibit a person from advertizing or hold himself or herself out as an “independent nurse practitioner” unless the person is certified by the board as an independent nurse practitioner pursuant to this bill. By expanding the scope of an existing 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: YESNO   Local Program: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 2836.4 is added to the Business and Professions Code, to read:

2836.4.
 Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering buprenorphine when done in compliance with the provisions of the Comprehensive Addiction Recovery Act (P.L. 114-198), as enacted on July 22, 2016, including the following:
(a) The requirement that the nurse practitioner complete not fewer than 24 hours of initial training provided by the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Nurses Credentialing Center, the American Psychiatric Association, the American Association of Nurse Practitioners, the American Academy of Physician Assistants, or any other organization that addresses the following:
(1) Opioid maintenance and detoxification.
(2) Appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of opioid use disorder.
(3) Initial and periodic patient assessments, including substance use monitoring.
(4) Individualized treatment planning, overdose reversal, and relapse prevention.
(5) Counseling and recovery support services.
(6) Staffing roles and considerations.
(7) Diversion control.
(8) Other best practices, as identified by the United States Secretary of Health and Human Services.
(b) The requirement that the nurse practitioner have other training or experience that the United States Secretary of Health and Human Services determines will demonstrate the ability of the nurse practitioner to treat and manage opiate-dependent patients.
(c) The requirement that the nurse practitioner be supervised by, or work in collaboration with, a licensed physician and surgeon.

SEC. 2.

 Section 3502.1.5 is added to the Business and Professions Code, to read:

3502.1.5.
 Neither this chapter nor any other provision of law shall be construed to prohibit a physician assistant from administering or providing buprenorphine to a patient, or transmitting orally, or in writing on a patient’s record or in a drug order, an order to a person who may lawfully furnish buprenorphine when done in compliance with the provisions of the Comprehensive Addiction Recovery Act (P.L. 114-198), as enacted on July 22, 2016, including the following:
(a) The requirement that the physician assistant complete not fewer than 24 hours of initial training provided by the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Nurses Credentialing Center, the American Psychiatric Association, the American Association of Nurse Practitioners, the American Academy of Physician Assistants, or any other organization that addresses the following:
(1) Opioid maintenance and detoxification.
(2) Appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of opioid use disorder.
(3) Initial and periodic patient assessments, including substance use monitoring.
(4) Individualized treatment planning, overdose reversal, and relapse prevention.
(5) Counseling and recovery support services.
(6) Staffing roles and considerations.
(7) Diversion control.
(8) Other best practices, as identified by the United States Secretary of Health and Human Services.
(b) The requirement that the physician assistant have other training or experience that the United States Secretary of Health and Human Services determines will demonstrate the ability of the nurse practitioner to treat and manage opiate-dependent patients.
(c) The requirement that the physician assistant be supervised by, or work in collaboration with, a licensed physician and surgeon.

SECTION 1.Article 8.5 (commencing with Section 2837.50) is added to Chapter 6 of Division 2 of the Business and Professions Code, to read:
8.5.Independent Nurse Practitioners
2837.50.

(a)The board shall establish the category of independent nurse practitioner and shall establish the qualifications and the scope of independent practice as set forth in this article.

(b)The qualifications for a certification by the board as an independent nurse practitioner shall include compliance with all of the following:

(1)Meeting all of the licensing requirements of Article 8 (commencing with Section 2834).

(2)Holding a certificate of independent nurse practitioner issued by a national certifying agency recognized by the board.

(c)Notwithstanding any law, the board shall specify the scope of practice of an independent nurse practitioner to include all of the following:

(1)The nursing practice of a nurse practitioner as set forth in Article 8 (commencing with Section 2834) performed under the supervision of a supervising physician and surgeon as set forth in that article.

(2)Specific aspects of the nursing practice of a nurse practitioner as set forth in Article 8 (commencing with Section 2834), including, but not limited to, standardized procedures, as set forth in Section 2725, that may be independently performed by an independent nurse practitioner. Functions identified by the board pursuant to this paragraph may be performed by an independent nurse practitioner, certified pursuant to this article, without the supervision of a physician and surgeon. An independent nurse practitioner shall be authorized to practice independently pursuant to this paragraph only in medically underserved areas or with medically underserved populations, as defined by the federal Health Resources and Services Administration.

(d)No person shall advertise or hold himself or herself out as an “independent nurse practitioner” unless the person is certified by the board as an independent nurse practitioner pursuant to this article.

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.