Advocacy

2021 Legislation Status

The Legislative and Regulatory Process

Legislatively, we are working with the CANP-led Close the Provider Gap coalition to clarify important provisions of existing health care law.

Follow-up bill AB 852, also written by AB 890 author Assemblymember Jim Wood, is a vehicle for addressing these issues. While AB 890 updated the Nursing Practice Act (in the state Business & Professions Code) to allow NPs who meet specific criteria to practice without physician supervision, there are other sections of California law that need updating to ensure that NPs are fully recognized as independent providers. AB 852 would update these other sections of California law, which govern health care providers, to also include nurse practitioners.

Clarifying that NPs are included in these existing laws is critical to ensuring that NPs can practice to the full extent of their education and training.

AB 852 passed the full Assembly on a bipartisan 75-3 vote in May 2021. 

In June 2021, Assemblymember Wood made AB 852 a two-year bill, meaning that the bill can still move forward in 2022 as a vehicle for allowing NPs to practice without physician supervision. The extended timeline gives advocates and legislators additional time for key conversations around AB 890 implementation.

Board of Registered Nursing Regulatory Process Status

In order to implement the provisions of AB 890, the Board of Registered Nursing (BRN) will follow state law for outlining, editing, and finalizing regulations. CANP is actively engaged in ongoing discussions regarding AB 890 implementation occurring at the BRN and at the BRN's Nurse Practitioner Advisory Committee (NPAC). NPAC was established by AB 890 and will report to the BRN Practice Committee, which will then report to the full Board. BRN staff are in the process of drafting AB 890 regulations, as is NPAC, and are prioritizing transition to practice regulations.

Additionally, the BRN has had a preliminary presentation by the Office of Professional Examination Services to investigate whether NPs will need a supplemental examination. No determination has been made yet.

After the BRN proposes regulations, there will be an opportunity for stakeholders to comment prior to the next set of revisions. When the regulations are finalized, approved, and deemed in accordance with the law, NPs will be able to practice without physician supervision.

CANP is working with our coalition partners, the BRN, and CANP stakeholders to ensure that the regulations allow NPs to practice to the full extent of their education and training and to care more directly for patients. We will continue to keep our members informed of important milestones and ways to engage.

About AB 890

More on the BRN Process

AB 890 created two different categories of NPs, defined by the settings in which they practice and named for the section of the state code in which the law resides. Each category has different requirements the NP must complete before being allowed to practice without physician supervision. You can find more details about the two categories of NPs below and here.

 

The BRN is reviewing the requirements and in addition to those outlined below, is analyzing the necessity of a supplemental examination and will define the minimum standards for transition to practice.

 

103 NPs – Work in a Collaborative Setting

Practice Setting

103 NPs work in practice settings in which there is a collaborative medical team, such as clinics, medical group practices, home health agencies, and hospice facilities. Correctional treatment centers and state hospitals are exempt from this law and NPs at those facilities will continue to practice under standardized procedures.

 

Requirements

NPs practicing without physician supervision in collaborative practice settings must:

  • Pass a national NP board certification exam;
  • Hold a certification as an NP from an accredited national certifying body;
  • Provide documentation that NP education was consistent with BRN regulations;
  • Pass a supplemental exam only if the Office of Professional Examination Services determines that a supplemental exam is required after evaluating the national NP certification examinations against the scope of practice of NPs delineated in AB 890;
  • And complete a transition to practice of 3 years of practice or 4,600 hours.
104 NPs – NPs in Their Own Practice

Practice Setting

104 NPs work in practice settings outside of those defined in section 103, which means that an NP can open up their own practice. The option for NPs to practice in these settings begins January 1, 2023. 

 

Requirements

NPs opening their own practice must:

  • Meet all of the same requirements as 103 NPs;
  • And have practiced as an NP in good standing for at least 3 years, not inclusive of the transition to practice.
    • The BRN can reduce the number f years in this requirement for NPs who holds a Doctor of Nursing Practice (DNP).  The BRN has introduced this topic for discussion.

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