Newsom relaxes workforce rules while protecting physician supervision model

March 31, 2020
Area(s) of Interest: Scope of Practice Public Health 

Gov. Gavin Newsom issued an executive order on Monday easing the path for many health care professionals to practice in an expanded capacity during the COVID-19 outbreak.

Newsom said his executive order would temporarily expand the health care workforce and allow health care facilities to staff at least an additional 50,000 hospital beds the state needs to treat COVID-19 patients.

The order gives the California Department of Consumer Affairs (DCA) the authority to temporarily loosen restrictions on staff-to-patient ratios at medical facilities and scope of practice rules for nurse practitioners (NP) and physician assistants (PA).

On a call with reporters Monday afternoon, DCA Director Kimberly Kirchmeyer said the state would temporarily give hospitals the authority to lift the cap on the number of NPs who can serve under a supervising physician. Current law allows for no more than four NPs to serve under the supervision of any individual physician.

There is no lifting of the supervision requirement for PAs, NPs or other allied health professionals. The supervision requirement is still in place at this time.

Specifically, DCA will execute waivers that have already been vetted by DCA and its respective licensing boards. Any further waivers will have to be requested by the appropriate trade associations or other interested parties. After the request is made, DCA will go through its internal review process with its directors and the applicable licensing boards and then post any approved waiver requests on its website. The waivers already approved are as follows:

  1. Waiver of any CME or examination requirements for the renewal of licenses that expire from March 31, 2020, through June 30, 2020, and allow up to six months after the state of emergency declaration is lifted for licensees to make up these requirements. This applies to physicians as well as other licensees who are due for renewal during this window.
  2. Reinstatement of inactive/retired licenses (who have been retired or inactive for five years or less) without the CME or other requirements and an abbreviated license application to bring these practitioners into the workforce quickly.
  3. Allow nursing students to use their time working during this crisis to count toward their clinical hours, as clinical rotations through their educational institutions have been suspended through this crisis.
  4. Remove the current ratios in place for physicians supervising nurse practitioners and physician assistants. Physicians can now supervise the number of NPs or PAs they can competently and confidently supervise without a statutory ratio in place.

The new rules are in line with recommendations from the U.S. Health and Human Services Department and are consistent with actions recommended by the California Medical Association and other medical provider groups, including the California Dental Association, California Pharmacists Association and the California Primary Care Association.

A full text of the governor’s executive order is available here.


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