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Yes, CANP is proud to be the sponsor of SB 1375. As an organization, we exist to support removal of restrictions on NP practice so that patients can receive timely and high-quality care in all health care settings.
SB 1375 updates provisions in existing law, enacted by AB 154 (Atkins, Chapter 662, Statutes of 2013) and AB 890 (Wood, Chapter 265, Statutes of 2020), authorizing NPs meeting specified criteria to practice without physician supervision, including first trimester abortion care. CANP is a nonpartisan organization committed to advancing the NP practice in California.
The Close the Provider Gap coalition was originally formed and led by CANP in 2019 in support of AB 890 to draw attention to the severity of California’s growing provider shortage and demonstrate how NPs can help all Californians, especially those in underserved and rural communities, gain desperately needed access to quality health care. During the legislative discussions surrounding AB 890, the coalition grew to nearly 80 organizations that supported fully utilizing nurse practitioners to help close the state’s growing provider gap. Members of the Close the Provider Gap coalition continue to engage in current legislative efforts, like SB 1375. You can learn more about the coalition here.
AB 154 increased the types of trained health professionals who can provide early abortions by allowing NPs, certified nurse midwives, and physician assistants to perform early abortions under a standardized procedure. CANP supported AB 154 in 2013.AB 890 authorizes NPs who meets certain requirements to practice without physician supervision.
SB 1375 will clarify that NPs who have been practicing for three or more years satisfy the transition to practice requirement established in AB 890. The bill would also allow NPs to utilize prior practice experience to satisfy the transition to practice requirement. This is often referred to as “grandparenting” by making it clear that the transition to practice will only apply to new licensees.
SB 1375 updates the statute to clarify that NPs practicing pursuant to AB 890's removal of physician supervision can provide early abortions. Allowing independent NPs to provide abortion care would significantly expand access to critically needed services.
AB 890 defines eligibility requirements for NPs to practice independently, including national certification and completion of postgraduate transition to practice requirements in California. Under AB 890, the TTP is a period of time intended to allow newly licensed NPs to receive hands on experience and mentoring, working under physician supervision, for a period of three full-time equivalent years of practice or 4,600 hours.
SB 1375 would clarify that nurse practitioners who have been practicing for three or more years satisfy the transition to practice requirement established in AB 890 and could also utilize prior practice experience to satisfy the requirement. It would update statutes relating to early abortion services to allow NPs qualified to practice independently to provide first trimester abortion care. NPs are currently providing this abortion care under physician supervision.
SB 1375 includes language that would delete the BRN’s authority to promulgate regulations on the transition to practice (TTP) and instead clarifies in the statute that NPs who have been practicing a minimum of three full-time equivalent years or 4,600 hours as of January 1, 2023, have satisfied the TTP requirement.
No, AB 890 amended the Business and Professions Code. Abortion care is delineated in the Health & Safety Code. This means that NPs who are currently providing first trimester abortions, would have to continue to do so under standardized procedures. SB 1375 removes such requirements, thereby ensuring that this procedure, as that of other procedures within an NP’s scope of practice in California, would be independent of physician supervision.
Of note, thirteen states currently allow nurse practitioners to perform aspiration abortions in the first trimester, which includes California. Of those, nine allow nurse practitioners to perform abortions without physician supervision. This includes: Clorado, Hawaii, Maine, Massachusetts, Montana, New Hampshire, Oregon, Vermont, and Washington.
Too many Californians, particularly those in rural and underserved communities, are struggling to access high-quality health care. With only 50 primary care doctors for every 100,000 people, the state is facing a dire provider shortage.
A projection by the California Future of Health Workforce Commission, comprised of a statewide group of senior leaders across multiple sectors, found that within the next decade, California will face a shortfall of more than 4,100 primary care clinicians, with a disproportionate impact on the seven million Californians living in counties already experiencing shortfalls of primary care, dental care, or mental health care providers. The majority of populations in those federally-designated areas are Latino, Black, and Native American. In addition, more than 40% of counties in California do not have clinics that provide abortions, leaving people unable to access reproductive services.
Over 40 percent of counties in California do not have clinics that provide abortions. By giving more trained and qualified nurse practitioners the ability to provide abortions without the supervision of a doctor, SB 1375 is a proactive step to further increase access to affordable, quality abortion and reproductive care in California.
When you join the California Association for Nurse Practitioners (CANP), you enter a close-knit community where information and ideas are freely exchanged, helping members stay at the top of their profession and play a powerful role in health care today.
All members are encouraged to get involved, and your level of engagement is entirely up to you. Some of the opportunities include:
You can renew your membership by completing and submitting the online renewal form.
CANP has a long history of being actively engaged in the legislative process, educating legislators and policy makers about the role nurse practitioners play in California's health care delivery system, and protecting and expanding NP practice. Through its advocacy efforts, CANP helps thousands of nurse practitioners speak as one, providing a collective voice in the State Capitol.
Our Annual Educational Conference is the state’s only event focused exclusively on continuing education for advanced practice nursing. Each year, CANP leaders work with members to design a program of courses featuring some of the most influential figures in the industry. That’s in addition to other educational opportunities that CANP membership delivers.
The benefits of CANP membership include discounts on products, services and resources vital to you and your practice. These include items that make routine tasks easier, tools for managing your practice, and information channels that expand your knowledge base – as well as your career opportunities.
You do not automatically become a member of AANP when you join CANP.
CANP accepts personal and business checks, Visa, MasterCard, American Express and Discover. We also offer members the ability to pay in four equal quarterly payments. You can even arrange automatic renewal payments – for the full year or on a quarterly basis – by selecting the Auto Pay option when choosing your member type. Please note that if you select the Auto Pay option you are not eligible to receive the Controlled Substance II course at no charge.
Membership expires one year from the join date.
Complete and submit the online membership application.
Complete a Board of Registered Nursing-Approved Controlled Substance II (CS II) Authority Course. Submit the Continuing Education certificate, a written request for CS II Authority and a copy of the course outline to the following address:
California Board of Registered Nursing
Advanced Practice Unit
PO Box 944210
Sacramento, CA 94244-2100
If you are currently enrolled in an NP program, inquire with your educational institution regarding their plan to include this content if you have already completed your pharmacology course. Most, if not all, NP programs are including a separate lecture with the BRN-required content if the students have already finished their pharmacology course.
California’s Health and Safety Code Section 11154 (a) states: “Except in the regular practice of his or her profession, no person shall knowingly prescribe, administer, dispense, or furnish a controlled substance to or for any person or animal which is not under his or her treatment for a pathology or condition…” You may want to speak to an attorney for your specific situation if you are covering for other health care providers whose patients may require CS II medications in their absence. CANP offers members three free 15-minute legal consultations per year with an attorney who is also a licensed NP.
California law does not require a health care provider to utilize anti-fraud prescription blanks for CS medications if the patient is certified as “terminally ill” as defined in Health and Safety Code Section 11159.2 (d). The prescription must indicate that the prescriber has certified that the patient is terminally ill by printing the words "11159.2 exemption" on the prescription blank. Certification can only be made by a physician.
No, California law was changed and no longer requires the physician’s name and DEA number on a prescription pad of an NP. The California Board of Registered Nursing and California State Board of Pharmacy concur with this answer.
Yes, the SP must include a “patient-specific protocol” for CS II and III; additionally, the SP must address the diagnosis of illness, injury, or condition for which the CS II is to be furnished. Refer to details in the Business and Professions code.
View an example of controlled substance furnishing protocols.
The BRN website FAQ document addresses a similar question, stating:
You must first be clinically competent to provide care to this new patient population. Clinically competent is defined in California Code of Regulations (CCR) Section 1480(c) as “…to possess and exercise the degree of learning, skill, care and experience ordinarily possessed and exercised by a member of the appropriate discipline in clinical practice.” In this instance, you would have to demonstrate knowledge and skills comparable to those of an adult nurse practitioner. Clinical competence in this new specialty can be achieved by successful completion of theory course(s) and a supervised clinical practicum at an advanced level for the new patient population.
Most facilities use the standardized procedure rather than a disease based format because it is nearly impossible to cover every clinical problem that could materialize. The BRN has posted the standardized procedure guidelines. You will also need the furnishing piece of it in which you must list all drugs and devices that you will furnish. We have included the link to the pharmacy regulations.
Upon researching the Medi-Cal policies, we do not see anything that precludes the NP from performing and billing for 1st trimester ultrasounds. We have included the link to the Medi-Cal early pregnancy document for you to utilize as necessary. We have also copied the announcement that went out regarding NP's ability to bill Medi-Cal.
“After much discussion with the staff at the Department of Health Care Services (DHCS), they have expedited their state plan amendment processes and are now granting Medi-Cal provider numbers to nurse practitioners, which will allow NPs to bill directly for services provided, rather than under a physician's number. AB 1591, Chan, Chapter 719, Statutes of 2006 requires DHCS to permit a certified nurse practitioner to bill Medi-Cal independently for his or her services. Further, the statute requires that the Department make payment directly to the certified nurse practitioner if he or she bills independently for his or her services. 14132.41 (b) defined ‘certified’ as ‘nationally board certified in a recognized specialty.’ The code does not limit or specify which certifications will be recognized or accepted by Medi-Cal.”
DHCS issued this provider bulletin with more detail implementing this change — see item #17 referenced in this link.
Nurse practitioners are not specifically authorized to offer acupuncture and the state acupuncture licensing board is very clear defining who is allowed to offer acupuncture. If you have taken the required certification courses and licensed with the state, you are allowed to offer acupuncture but you would need to make this clear in your practice, that you are functioning as an acupuncturist.
In order to prescribe Buprenorphine, you must complete additional training. See this presentation from AANP about how to do this. Several California NPs have completed the education and received the authorization from the DEA to prescribe Suboxone.
There is a proliferation of these types of programs across the country and the students will vary based on faculty and program. Something to remember is that universities are moving significant portions of education online for cost-savings and student preference. Online forums allow working students to participate more easily, opening up this population to higher education opportunities.
The office manager is responsible for the operations of the office — scheduling, billing and the like. They do not/should not have clinical oversight of clinical staff in the office unless they are also a clinical staff, but do not have legal authority over a clinical staff person of a higher license. This means that an office manager who is also a medical assistant can have clinical oversight of other MAs in the office, but not RNs, NPs, physicians, etc.
There is no case statute or law that states DNPs cannot be called “doctor” in a clinical setting in California. Some states have enacted legislation to prevent DNPs from being called doctor. These measures have not been found to be unconstitutional. However, the BRN’s concern is that patients will think the DNP is a physician and the DNP will have to demonstrate that the patient was informed that he or she was an NP, not a physician.
No, they cannot. The death certificate must be signed by a physician.
Only Medicare and Medi-Cal name nurse practitioners. Some private and HMO insurance allow NPs on their panels. However, many private and HMO insurances do not allow NPs on their panels. It is the decision of the insurance companies, not a law. Frequently, NPs have to bill under their collaborating physician. It may be necessary to call the insurance companies to ask how they want billing done for NPs.
Since NPs practice under their own scope of practice and under protocols, she/he is responsible for his/her own actions. However, if under consultation, the physician instructs the NP to treat the patient incorrectly, the physician can be held accountable for the NP's actions. If the NP makes the decision himself/herself, the NP is liable. This does not mean the physician will not be sued in a lawsuit. The physician can still be named but eventually not be held liable.
There is no set time period. The patient must sign a release form before another physician can send the NP records. The release form states who the records are being released to. The physician cannot argue that the medical records can only be sent to another physician. The patient can release his/her medical records to whomever they wish. The process should not take more than a couple of weeks. The physician transferring the records can charge a reasonable copying fee. If the physician continues to refuse to transfer medical records, you can report him/her to the Medical Board.
As an independent contractor you cannot take advantage of the U.S. Department of Labor's assistance in getting your paycheck. However, you can sue in small claims court for back wages if it is not more than $10,000. If it is more than $10,000, you will have to file a suit in civil court. As far as abandonment, it is very difficult to prove in a primary care practice where there are other health care providers who can take your patients.
The physician cannot refuse to pay you for services performed. Abandoning a patient indicates you are leaving that patient without anyone to care for him/her. This is a common threat. However, an NP must be able to demonstrate that there were other providers to see the patients assigned to the NP. Usually a 30-day notice is considered sufficient time for the patient to get another healthcare provider. If the physician terminates the NP before 30 days, it is the physician’s responsibility to provide the appropriate care.
You need to be very careful in this area as an NP cannot pay the collaborating physician individual-to-individual, as this is against the corporate practice of medicine. You need to speak to an attorney about your individual situation to determine if you are following the law. If following the law, payments can vary from no fee to $500-$3,000 or more. It depends also on your type of practice.
Many physicians prefer to bill "incident to" because they can receive 100% of the physician rate. That may be why you are being told you cannot use your own number. However, when billing incident to, you must be very careful, as a physician must be on the premises. The physician must also be an integral part of the patient’s care. If a physician is not on the premises, you must use your own number and bill at 85% of the physician rate. Review and understand the definition of incident to billing before you become involved in-patient care and billing.
A new ruling and law came down from the California Supreme Court on May 8, 2018, It is called the “ABC Test” for Independent Contractor. In order for the NP to be an Independent Contractor, the hiring entity must establish each of three following factors:
If any of these factors are not met, the NP cannot be an independent contractor.
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