CDPH Denies Petitions to Broaden Medical Staff Membership for Advanced Practice Providers

While the outcome is not unexpected, CDPH’s reasoning is noteworthy. The Department concluded that the requested changes would exceed its regulatory authority by expanding medical staff eligibility beyond the framework that the legislature established in Assembly Bill (AB) 890. At the same time, CDPH expressly left open the possibility of a targeted rulemaking to bring Title 22 into conformity with AB 890’s nurse practitioner provisions.

Background and Petitions

• Petitions Filed: One by the California Association of Nurse Anesthesiology and another by the American Nurses Association/California.

• Requested Changes: Amend Title 22 to allow “licensed independent practitioners” or broader categories of advanced licensed providers (with emphasis on advanced practice registered nurses) to be members of organized medical staffs.

• Outcome:  CDPH denied both petitions, relying on substantially similar legal analysis.

CDPH’s Decision

CDPH concluded that the proposed regulatory revisions would conflict with the statutory framework created by AB 890 and the related California Business and Professions Code (BPC) provisions governing nurse practitioner certification and medical staff eligibility. Specifically, CDPH emphasized that AB 890 establishes a targeted pathway for nurse practitioners who meet heightened training, experience, and certification requirements, and it delineates the scope of medical staff rights for those certified nurse practitioners.

By contrast, the petitions would have extended medical staff membership to a broader class of independent licensed practitioners, which CDPH found to be beyond the agency’s authority and inconsistent with legislative intent.

Potential Future Rulemaking Aligned to AB 890

While denying the petitions, CDPH expressly acknowledged the need to review Title 22 medical staff regulations to ensure alignment with AB 890 and indicated it may consider future, narrower rulemaking.

Immediate Implications for Hospital Medical Staffs

The immediate takeaway for hospital medical staff leaders and governing bodies is that existing Title 22 provisions remain in force.

• No Categorical Expansion for Now: Medical staff membership remains defined by current regulations and statutes; advanced practice providers are not broadly eligible at this time.

• AB 890 Remains Operative: Despite CDPH’s decision, AB 890 allows nurse practitioners licensed under BPC section 2837.104 (i.e., “104 nurse practitioners”) to be eligible for medical staff membership. Hospital medical staffs should apply certification-based eligibility criteria for nurse practitioners where appropriate.