BILL ANALYSIS
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|Hearing Date:August 5, |Bill No:AB |
|2002 |1943 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 1943Author:Chu
As Amended: August 5, 2002 Fiscal: Yes
SUBJECT: Acupuncture.
SUMMARY: Codifies and increases entry-level curriculum
standards for acupuncturists, in addition to stating
legislative intent.
Existing law:
1)Provides for the licensing and regulation of
acupuncturists by the Acupuncture Board (Board) within
the Department of Consumer Affairs (Department).
2)Defines the practice of acupuncture as the stimulation of
a certain point or points on or near the surface of the
body by the insertion of needles to prevent or modify the
perception of pain or to normalize physiological
functions, including pain control, for the treatment of
certain diseases or dysfunctions of the body and includes
the techniques of electroacupuncture, cupping, and
moxibustion.
3)Requires the Board to establish standards for the
approval of schools and colleges offering education and
training in the practice of acupuncture, including
standards for the faculty in those schools and colleges,
and tutorial programs. Regulations adopted by the Board
require a minimum of 2,348 education hours, divided into
specified areas.
This bill:
1)Provides that it is the intent of the Legislature, in the
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event that SB 1951 is enacted in the statutes of 2002, to
consider for implementation the recommendations of the
Milton Marks 'Little Hoover' Commission on California
State Government Organization and Economy to increase
curriculum hours for the licensure of acupuncturists in
excess of 3,000 hours up to 4,000 hours to fully and
effectively provide health services under their scope of
practice.
2)Provides that it is the intent of the Legislature that
the Commission shall provide recommendations for
reviewing the competence of licensed acupuncturists not
subject to the 3,000 hour minimum curriculum requirement,
and provide recommendations for training, testing or
continuing education that would be required for these
individuals to meet the standards for continued
licensure.
3)Requires schools and colleges offering education and
training in the practice of acupuncture to include a
minimum of 3,000 hours of study in curriculum pertaining
to acupuncture, in order to receive approval from the
Board for training programs. Requires the Board to
establish the specifics of the 3,000 hours of study by
January 1, 2004.
4)Provides that the 3,000 hour requirement shall apply to
all students entering acupuncture training programs on or
after January 1, 2005.
FISCAL EFFECT: Unknown.
COMMENTS:
1.Purpose. According to information provided by the
Author, this measure was introduced to increase
educational standards and quality of care for individuals
practicing acupuncture in the state of California. The
Author believes that increased professional standards
would result in increased quality of care for consumers
and produce a pool of more confident and experienced
acupuncture practitioners to meet the growth and demand
for acupuncture treatment.
2.Authority of the Acupuncture Board. The Legislature has
authorized the Board to establish standards for approval
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of institutions and colleges offering education and
training programs in the practice of acupuncture and
oriental medicine. Additionally, the Legislature has
authorized the Board to establish the amount and content
of the education required to be licensed as an
entry-level acupuncturist.
3.Chronology of Curriculum Hours for Acupuncturists. In
1975, certification standards were legislated in
California at 1,350 hours. 650 acupuncturists were
grandfathered into the system. Acupuncture, acupressure,
moxibustion, and cupping were initially included in the
acupuncturists' scope of practice. In 1980, legislation
expanded the definition of acupuncture to include
techniques of electroacupuncture, cupping and
moxibustion, and the use of herbs, nutrition, Oriental
massage, and exercise (Chapter 1313, Statutes of 1980).
In 1985, educational standards were increased to 2,348
hours (1,548 of theoretical training and 800 hours of
clinical instruction). In 2000, the Board proposed an
increase of curriculum hours to 3,200 hours through
administrative regulations. In 2002, the Board- created
Task Force on Competencies voted to adopt recommendations
for an increase of curriculum to 3,000 hours.
4.How Many Board Approved Schools Will Be Impacted by this
Legislation? There are currently 30 Board approved
schools. It appears that 11 of the 30 schools are below
3,000 hours. Therefore, at least 11 schools will have to
modify their curriculum to retain their approval status
with the Board. Additionally, while 19 of the Board
approved schools may currently offer a program above
3,000 hours there is no guarantee that their specific
curriculum will be the same as what is approved by the
Board. Therefore, even schools above 3,000 may have to
make changes to their curriculum.
5.Is the Increase in Hours Justified or Just a Barrier to
Entry? Generally speaking, requirements and standards
should only be increased when there is data indicating
that there is injury to the public, or that there are
specific educational deficiencies. Absent this
justification, increased hours can be viewed as an
unnecessary barrier to entry.
According to the letter of support from the Council of
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Acupuncture and Oriental Medicine Associations (Sponsor),
their profession has long held that 4,000-hour training
programs should be the minimal standard for the
profession. The Sponsor states that educational
standards were last raised to 2,348 in 1985 and schools
have since continued to swell their programs up over
3,100, including 750 hours of unstandardized curriculum.
The Sponsor states that 35% of licensees surveyed report
that their acupuncture training program did not
adequately prepare them for their first year in practice.
Proponents argue generally that students should expect
quality education, regardless of which school they
attend. Proponents point out that current education
standards for acupuncture have not changed since 1984,
while the profession has grown and changed significantly,
and that this bill will standardize education so that
graduates will be better equipped to serve in the complex
arena of modern health care.
On the other hand, the proposed increase of hours may
have an adverse impact on students and colleges. The
increase will most likely require colleges to increase
didactic and clinical faculty, classrooms and other
resources to accommodate the additional hours. The
financial impact on colleges has been estimated in the
millions of dollars. The additional hours could add up
to a year to current programs, which will substantially
increase student tuition and loans.
6.Joint Legislative Sunset Review Committee and SB 1951.
The Joint Legislative Sunset Review Committee (Joint
Committee), pursuant to statutory requirements, reviews
licensing boards approximately every four years. The
Board is one of several health-related boards that
underwent review by the Joint Committee between 2001-02.
As part of this review process, both the Joint Committee
and the Department make recommendations regarding the
operation of these boards and the regulation of the
professions.
Specific to the educational requirements and scope of
practice of acupuncturists, the Department and the Joint
Committee both recommended further study of the
acupuncture profession by an independent consultant. The
Joint Committee report states that: "There is much
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debate within the acupuncture profession surrounding the
level of education that is needed for acupuncturists to
practice effectively, and the scope of practice which
determines exactly what tasks they may or may not
perform. The Board has acknowledged this debate by
establishing the Task Force on Competencies and Outcomes.
The Department concurs with the Joint Committee's
preliminary recommendation that the scope of practice for
acupuncturists needs to be clarified and codified in
statute. To resolve this debate, the Department
recommends an independent consultant be retained by the
Department, with funding provided by the Board, to assess
the educational needs of practitioners and the scope of
practice of acupuncturists. As the practice of
acupuncture evolves, it may be necessary to make changes
to the practice act in order to reflect contemporary
health care. To prepare for these changes, this
independent health care consultant working with the
Department should assess the practice and report to the
Board, the Department, and the Joint Committee prior to
the Board's next sunset review."
SB 1951 (Figueroa) was introduced to incorporate the
recommendations of the Joint Committee relative to the
Board. SB 1951 as initially amended, required an
independent consultant to conduct a comprehensive
analysis of the scope of practice and educational
requirements for acupuncturists, and makes other changes
related to the Board. It should be noted that the Author
of SB 1951 recently agreed to accept an amendment that
will request the Little Hoover Commission, rather than an
independent consultant, to conduct the specified
comprehensive analysis.
7.Does the Measure's Intent Language Undermine SB 1951?
According to the letter of opposition from the Council of
Colleges of Acupuncture and Oriental Medicine (Council),
the Council strongly believes that AB 1943's intent
language undermines the Joint Committee's recommendation
in SB 1951. The Council argues that the intent language
is attempting to circumvent the role of the Little Hoover
Commission by limiting its investigative authority. The
Council states that AB 1943's intent language predisposes
that the Little Hoover Commission is required to find
that education hours for colleges must exceed 3,000
hours. According to the Council, this does not allow the
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Little Hoover Commission to determine through its own
research and public hearings the appropriate number of
education hours. By implication, AB 1943 would preclude
a finding by the Little Hoover Commission that less than
3,000 hours for a core curriculum of a college may be
sufficient.
According to the Accreditation Commission for Acupuncture
and Oriental Medicine (ACAOM), the legislative intent
language basically has the effect of biasing or
predisposing the Little Hoover Commission to recommending
increases to the curriculum requirement to a level up to
4,000 hours. The ACAOM argues that this language is
inconsistent with SB 1951 and thwarts the intent of the
Joint Committee which is to have the Little Hoover
Commission (or an independent consultant) provide an
"independent" and unbiased assessment as to the
appropriate educational standards for licensure,
including whether they should remain as they are,
increased, or decreased. If, for example, the Little
Hoover Commission believes that 3,000 hours or less was
adequate to protect consumers, AB 1943 would prevent a
fully independent assessment of what the educational
standards should be relative to the best interests of the
consumer. The ACAOM believes that it biases the entire
"assessment" towards increasing hours, which is not an
"independent assessment" and is not what SB 1951
contemplates. The ACAOM proposes the following
amendment: "It is the intent of the Legislature to
consider for implementation, if SB 1951 is enacted...,
the recommendations of the Milton Marks 'Little Hoover'
Commission on the curriculum requirements for the
licensure of acupuncturists."
An alternative approach suggested by the ACAOM is to
change the intent language as follows: it is the intent
of the Legislature to consider for implementation, if SB
1951 (Figueroa) is enacted in the statutes of 2002, [ the ]
ANY recommendations of the Milton Marks "Little Hoover"
Commission on California State Government Organization
and Economy to increase curriculum hours for the
licensure of acupuncturists in excess of 3,000 hours up
to 4,000 hours to fully and effectively provide health
services under their scope of practice.
8.Should the Implementation Timeframe Be Extended to 2006?
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According to the letter of opposition from the Council,
while they appreciate the language delaying the
implementation of the 3,000-hour requirement until 2005,
this still imposes difficulties for colleges. The
Council states, as it is expected that it will take
approximately two years for the Board to determine and
approve curriculum and promulgate regulations, very
little time, if any, would be left for colleges to
institute new courses, and hire the faculty necessary to
comply with the law. For this reason, the Council
requests that the effective date be changed to January 1,
2006.
9.Author Does Not Intend to Grandfather Current Licensed
Acupuncturists. This measure expresses the intent of the
Legislature to have the Little Hoover Commission provide
recommendations for reviewing the competencies of
licensed acupuncturists not subject to the 3,000 hour
minimum curriculum requirement and provide
recommendations for training, testing or continuing
education that would be required for these individuals to
meet the standards for continued licensure. It is
appropriate and necessary for the Legislature and the
Board to ensure the competency of those acupuncturists
not subject to the increase in hours.
SUPPORT AND OPPOSITION:
Support :
American Association of Oriental Medicine
American College of Oriental-Western Integrated Medicine
American Federation of Government Employees AFL-CIO Local 2391
Association of Korean Oriental Medicine & Acupuncture of
California
California Acupuncture Board
California Alliance of Acupuncture Medicine
California Certified Acupuncturists Association
California Labor Federation, AFL-CIO
California State Oriental Medicine Association
California Teachers of Acupuncture and Oriental Medicine
Chinese American Civil Rights Organization
Chinese American Political Action Committee
Coalition for the Advancement of Traditional Oriental Medicine
Council of Acupuncture and Oriental Medicine Associations
Esparza-Katz Productions (Moctesuma Esparza)
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Florida State Oriental Medicine Association
Japanese Acupuncture Association of California
Kiwanis Club of Monterey Park
National Board of Acupuncture and Orthopedics
National Guild for Acupuncture and Oriental Medicine
Sacramento County Supervisor Illa Collin
San Francisco Labor Council, AFL-CIO
Sherman Oaks Chamber of Commerce
United California Practitioners of Chinese Medicine
South Baylo University
Southern California University of Health Sciences
Acupuncture Continuum Clinic
Acupuncture Wellness Clinic
Almond Grove Traditional Chinese Medicine & Acupuncture Clinic
Asahi Comprehensive Health Center
Balance and Harmony Acupuncture and Oriental Medicine Clinic
California Acupuncture Center
California Acupuncture Medical Association
Chinese Health Institute
Chinese Herb Academy
Delicate Balance Health Care Center
East/West Health Center
Golden Rainbow Acupuncture
Healing Touch Acupuncture Clinic
Kan-Sai Health Center, Inc.
Las Tunas Acupuncture & Herbs Clinic
Meridian Acupuncture Clinic
Numerous individual acupuncturists
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Opposition :
Accreditation Commission for Acupuncture and Oriental
Medicine
Acupuncture and Oriental Medicine Alliance
Council of Colleges of Acupuncture and Oriental Medicine
Emperor's College
Northwest Institute of Acupuncture and Oriental Medicine
Oregon College of Oriental Medicine
Pacific College of Oriental Medicine
Santa Barbara College of Oriental Medicine
Tai Sophia Institute
Consultant:Kristin J. Triepke