NP Expanded Scope of Practice Independently for California HHA
Since the CARES Act was enacted in March 2020, nurse practitioners (NPs) have been authorized to certify eligibility for home health services, as well as to establish and review home health care plans. This provision also permanently extended to clinical nurse specialists (CNSs) and physician assistants (PAs), allowing them to order, certify, and recertify home health services for Medicare patients, provided they follow both federal and state laws.
The current regulation specifies compliance with "state laws," meaning that while federal regulation permits these healthcare providers to order home health services, they must also adhere to any additional state-specific requirements. Nationwide, this authority remains in place following the CARES Act, yet it mandates that NPs collaborate with a physician to fulfill the state's requirements.
California Scope of Services Expansion for Californian Nurse Practitioners Starting January 2024, California Assembly Bill 890 (AB 890) – Section 2837.104 – introduces a significant development: qualified nurse practitioners may now practice independently, without the need for standardized procedures or physician supervision, under certain conditions. This change marks a step forward in expanding the role and autonomy of NPs within the scope of state compliance while aligning with federal standards for home health services.
Under Section 2837.104, nurse practitioners (NPs) with additional experience may practice independently outside the settings specified in Section 2837.103. To qualify, these NPs must have maintained good standing as nurse practitioners for at least three years beyond their transition-to-practice period. They are also required to consult and collaborate with other healthcare providers based on the clinical needs of their patients and to establish referral plans for managing complex cases.
To verify a nurse practitioner's (NP) license status and practice authority in California, you can use the California Board of Registered Nursing's (BRN) online verification system. This tool provides up-to-date information on licensure status, including any advanced practice certifications.
What qualifications must a nurse practitioner meet to be eligible for independent practice?
NP passes a national NP board certification examination.
The NP must be properly certified by “a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and those national certifications need to be recognized by the BRN.”
The nurse practitioner must provide documentation to show their training was “consistent with current BRN standards and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement in the new law.”
The NP must finish a California transition-to-practice (TTP) requirement of three full-time equivalent years or 4600 hours – according to BRN regulations.
REFERENCES:
MEDICARE BENEFIT MANUAL
30.2.1 – Definition of an Allowed Practitioner (Rev. 11386, Issued: 04-27-22, Effective: 01-01-22, Implementation: 05-26-22) Allowed practitioners in addition to physicians, can certify and recertify beneficiaries for eligibility, order home health services, and establish and review the care plan. Allowed practitioners are defined at § 484.2 as a physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) as defined at this part. NPs, CNSs, and PAs are required to practice in accordance with state law in the state in which the individual performs such services. Physician assistant means an individual as defined at § 410.74(a) and (c). Clinical nurse specialist means an individual as defined at § 410.76(a) and (b), and who is working in collaboration with the physician as defined at § 410.76(c)(3). Nurse practitioner means an individual as defined at § 410.75(a) and (b), and who is working in collaboration with the physician as defined at § 410.75(c)(3). Individual states have varying requirements for conditions of practice, which determine whether a practitioner may work independently without a written collaborative agreement or supervision from a physician, or whether general or direct supervision and collaboration is required. In the absence of State law governing collaboration, collaboration is to be evidenced by NPs documenting their scope of practice in the medical record, and indicating the relationships that they have with physicians to deal with issues outside their scope of practice.
Reference: https://go.cms.gov/manual-home-health
California Regulation relating to NPs Expanded Scope of Service as of 2024:
In California, nurse practitioners (NPs) have varying levels of practice authority based on their certification and experience. Historically, NPs were required to collaborate with or be supervised by physicians to perform certain medical functions. However, recent legislative changes have expanded their scope of practice.
Assembly Bill 890 (AB 890):
Enacted in 2020, AB 890 introduced pathways for NPs to practice independently, without standardized procedures or physician supervision, under specific conditions. This legislation established two categories of independent practice:
Section 2837.103 NPs (103 NPs): Effective January 1, 2023, NPs meeting certain education and experience requirements can practice independently within defined healthcare settings, such as clinics or group practices. They must have a master's degree in nursing or a related clinical field, hold a valid California registered nurse license, and have completed a transition to practice program.
Section 2837.104 NPs (104 NPs): Beginning January 1, 2024, NPs with additional experience can practice independently outside the specified settings of Section 2837.103. These NPs must have practiced as a nurse practitioner in good standing for at least three years beyond the transition to practice period. They are required to consult and collaborate with other healthcare providers based on the patient's clinical condition and establish referral plans for complex cases.
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