AB 890 Allows Nurse Practitioners to Expand Their Scope of Practice Despite Medical Board of California’s Opposition

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By Ellen Williams

AB 890 (Wood), as amended August 28, 2020, amends sections 650.01, 805, and 805.5 of, and adds Article 8.5 (commencing with section 2837.100) to the Business and Professions Code to authorize a two-tiered framework for certified nurse practitioners (NP) to practice independently, without the supervision of a physician or surgeon, if they meet certain educational, training or examination requirements.

Prior to the passage of this bill, NPs must have physician supervision, and operate under specified protocols and procedures, which are developed collaboratively by nurses, physicians, and the administration of an organized health care system.  The Board of Registered Nursing (BRN) and the Medical Board of California (MBC) have jointly promulgated guidelines for standardized procedures in section 1474, Title 16 of the California Code of Regulations. NPs are regulated by BRN.

This bill permits NPs in specified health care settings to operate independently from these established protocols and procedures if they complete a three-year “transition to practice.”  It also permits, as of January 1, 2023, NPs to operate independently from these protocols and procedures outside of a health care setting after completing the transition to practice.

Of note, AB 890 adds section 2837.102 to the Business and Professions Code to require BRN to establish a Nurse Practitioner Advisory Committee, consisting of four qualified nurse practitioners, two doctors with demonstrated experience working with nurse practitioners, and one member of the public. The Committee will advise and make recommendations to BRN on all matters related to nurse practitioners, including education and appropriate standard of care, and will provide recommendations and guidance when the BRN is considering disciplinary action against a nurse practitioner.  The bill also requires NPs to disclose to patients that they are not a physician, to maintain professional liability insurance, and to refer patients to a physician if the condition of the patient is beyond the skill and training of the NP, among other requirements.

The bill also amends section 805 of the Business and Professions Code to require administrators of peer review entities to file reports with BRN if any adverse action is taken against an NP in a peer review process within 15 days, and clarifies that if a peer review body takes action as a result of BRN’s or another state’s licensing board’s revocation or restriction of a NP’s license, it need not file an 805 report.

At its August 13, 2020, meeting, MBC, discussed recent amendments to the bill—including the fact that the amended version of the bill creates a committee for independent nurse practitioners as opposed to a separate board as the bill originally opposed.  The bill was also further amended to add additional requirements for a NP to practice independently, and to specify the circumstances under which a NP must consult with a physician.  The Board discussed whether or not the amendments addressed its previous concerns from its May meeting (Agenda Item 10), when it voted to oppose the bill. At the May meeting, several Board members mentioned that the Board typically opposes scope of practice bills and questioned whether a NP board could adequately regulate independently practicing NPs.  Others raised concerns that the bill would not address the need for underserved populations to access skilled healthcare.  Ultimately, the Board unanimously voted at both meetings to oppose the bill, and the Board maintained its opposition as the bill was subsequently amended in August.

Governor Newsom signed AB 890 on September 29, 2020 (Chapter 265, Statutes of 2020).

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