California

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

California only credentials drug abuse treatment facilities. Individuals who wish to practice as an addiction counselor must receive a credential from an approved certification board. Each board requires the individual to complete education and experience requirements. The various credentials require a high school degree or higher. Cal. Health and Safety Code §11833

Licensed professional clinical counselors in California may provide counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues, including personal growth, adjustment to disability, crisis intervention, and psychosocial and environmental problems. Diagnostic ability is not outlined in statute. Cal. Business and Professions Code §4999.20

The law specifies that Medi-Cal Peer Support Specialist Certification Programs can be established either by counties, or an agency representing counties. The California Behavioral Health Directors’ Association has identified the California Mental Health Services Authority (CalMHSA) as the entity that will represent counties for the implementation of a State-approved Medi-Cal Peer Support Specialist Certification Program, to support consistency statewide. CalMHSA, on behalf of the counties they represent, and any other counties that seek to implement their own Medi-Cal Peer Support Specialist Certification Program, must adhere to the state standards set forth in Behavioral Health Information Notice (BHIN) 21-041. Cal. W&I §14045.14

Full independent practice authority for low-risk pregnancies but physician relationship required for prescriptive authority.

NMs may practice independently for “low-risk” pregnancies. The certificate to practice nurse midwifery authorizes the holder to attend cases of low-risk pregnancy and childbirth and to provide prenatal, intrapartum, and postpartum care, including interconception care, family planning care, and immediate care for the newborn.

If the pregnancy does not meet the definition of “low-risk,” a physician relationship is required. The NM must practice with a physician and surgeon under mutually agreed-upon policies and protocols that delineate the parameters for consultation, collaboration, referral, and the transfer of the patient’s care signed by both the NM and physician and surgeon. Cal. Bus. & Prof. Code §2746.5

NMs are authorized to provide and order drugs, and medical devices including controlled substances (Schedule II-V) only under the supervision of a physician and when directed by the standardized procedures or protocols developed by the supervising physician and the midwife. Cal. Bus. & Prof. Code §2746.51

Transition to independent practice and prescribing period required.

NPs may apply to practice independently after completing the transition to practice requirement of three years or 4,600 hours. Prior to three years or 4,600 hours, NPs must practice pursuant to standard operating procedures which specifies scope and extent of supervision. Cal. Bus. & Prof. Code §2836.1

If approved, the NP may independently prescribe, order, dispense, procure or furnish pharmacological agents including controlled substances. Schedules II-V are allowed but Schedule II authority requires the completion of extra continuing education requirements. Cal. Bus. & Prof. Code §2837

NPs are authorized to sign POLST forms under the supervision of a physician if its within the scope of practice authorized by law. Cal. Prob. Code §4780(c)

NPs are recognized in state policy as primary care providers. Primary care provider means a person responsible for coordinating and providing primary care to members, within the scope of their license to practice, for initiating referrals and for maintaining continuity of care. A primary care provider may be a primary care physician or nonphysician medical practitioner including a nurse practitioner, certified nurse midwife or physician assistant. 22 Cal. Code of Reg. §53810(gg)

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Additional allowable procedures are authorized by statute. Cal. Bus. & Prof. Code §2-7-3041

Optometrists may administer all pharmaceutical agents for the diagnosis and treatment of eye diseases, including epinephrine auto-injections to counter anaphylaxis. Optometrists may administer vaccines. Cal. Bus. & Prof. Code §2-7-3041(d) and Cal. Bus. & Prof. Code §2-7-3041(g)

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Cal. Bus. & Prof. Code §2-7-3059(e)

Registered dental hygienists in alternative practice (RDHAPs) must have a documented relationship with at least one licensed dentist for referrals, consultations, and emergency services. They are authorized to provide any services that do not require direct supervision of a dentist in personal residences of the homebound, nursing homes, hospitals, residential care facilities, schools, and other underserved areas. RDHAPs can provide services independently for 18 months, after which the patient must be seen by a licensed dentist or physician. The dentist may write a prescription valid for two years authorizing the RDHAP to continue providing dental hygiene services.Cal. Bus. & Prof. Code §1911 and Cal. Bus. & Prof. Code §1922-1931

Statute does not identify dental therapists as an oral health provider.

California Medicaid will reimburse for live video and store-and-forward teledentistry services. Cal. Welfare and Institutions Code §14132.72. and Denti-Cal Manual, Teledenistry

Pharmacists may administer any COVID-19 vaccines approved or authorized by the federal Food and Drug Administration. Pharmacists may also administer vaccines listed on the routine immunization schedules recommended by the federal Advisory Committee on Immunization Practices and published by the federal Centers for Disease Control and Prevention (CDC) for persons three years of age and older.

Pharmacists must complete an immunization training program endorsed by the CDC or the Accreditation Council for Pharmacy Education, be certified in basic life support and comply with all state and federal recordkeeping and reporting requirements. Cal. Bus. & Prof. Code §4052.8

California does not allow pharmacists to modify prescriptions.

A pharmacist must complete a training course in the subject area of hormonal contraception drug therapy and must include instruction in specific content areas. A written protocol for hormonal contraception drug therapy must be approved by the Board of Pharmacy. 16 Cal. Code of Reg. §1746.1

A pharmacist must complete a training course in the subject area of tobacco cessation drug therapy and must include instruction in specific content areas. A written protocol for tobacco cessation drug therapy must be approved by the Board of Pharmacy. 16 Cal. Code of Reg. §1746.2

Supervision by a physician is required for practice and prescriptive authority.

A PA may perform medical services as authorized by this chapter if the following requirements are met:

1. The PA renders the services under the supervision of a licensed physician and surgeon.
2. The PA renders the services pursuant to a practice agreement.
3. The PA is competent to perform the services.
4. The PA’s education, training and experience have prepared the PA to render the services.

CAL. BUS. & PROF. CODE § 3502(a),(b),(d),(e)

The PA shall furnish or order a drug or device in accordance with the practice agreement and consistent with the PA’s educational preparation or for which clinical competency has been established and maintained. The PA may furnish or order only those Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act that have been agreed upon in the practice agreement. CAL. BUS. & PROF. CODE § 3502.1

Statute limits the number of PAs a physician may supervise.

A physician and surgeon shall not supervise more than four PAs at any one time. CAL. BUS. & PROF. CODE § 3516(b)

Chart co-signatures may be determined at the practice level.

A PA and his or her supervising physician shall establish in writing guidelines for the adequate supervision of the PA which shall include one or more of the following mechanisms:

1. Countersignature and dating of all medical records written by the PA within 30 days that the care was given by the PA;
2. The supervising physician may adopt protocols to govern the performance of a PA for some or all tasks. […] The supervising physician shall review, countersign, and date a minimum of 5% sample of medical records of patients treated by the PA functioning under these protocols within 30 days.

16 CA ADC § 1399.545

Statute allows adaptable proximity.

“Supervision” means that a licensed physician and surgeon oversees the activities of, and accepts responsibility for, the medical services rendered by a PA. Supervision, as defined in this subdivision, shall not be construed to require the physical presence of the physician and surgeon, but does require the following:

1. Adherence to adequate supervision as agreed to in the practice agreement.
2. The physician and surgeon being available by telephone or other electronic communication method at the time the PA examines the patient.

CAL. BUS. & PROF. CODE § 3501(f)(1)-(2)

A PA may perform medical services as delegated by the supervising physician at the practice level. Cal. Bus. & Prof. Code §3502