BILL ANALYSIS                                                                                                                                                                                                    


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                                 THIRD READING

          Bill No:  AB 2683
          Author:   Hernandez (D)
          Amended:  7/15/10 in Senate
          Vote:     21

          AYES:  Negrete McLeod, Aanestad, Calderon, Corbett, Correa,  
            Florez, Yee
          NO VOTE RECORDED:  Wyland, Walters
          SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  72-0, 5/20/10 (Consent) - See last page  
            for vote

           SUBJECT  :    Optometry

           SOURCE  :     Board of Optometry

           DIGEST  :    This bill authorizes optometrists to practice in  
          long-term care settings such as skilled nursing facilities  
          (nursing homes), psychiatric hospitals, and intermediate  
          care facilities.

           ANALYSIS  :    

          Existing law:

          1. Licenses and regulates the practice of optometry by the  


                                                               AB 2683

             Board of Optometry (Board) within the Department of  
             Consumer Affairs (DCA).

          2. Requires an optometrist to notify the Board in writing  
             of the address or addresses where he or she is to  
             engage, or intends to engage, in the practice of  

          3. Exempts an optometrist from notifying the Board if he or  
             she engages in temporary practice which is limited to  
             seven calendar days during a 30-day period and 54 days  
             during the calendar year at any the following settings:

                   A facility licensed by the Department of Public  

                   A public institution, including, but not limited  
                to, a school, community college, or correctional  

                   A mobile unit operated by a governmental agency  
                or nonprofit or charitable organization.

                   The home of a non-ambulatory patient.

                   The practice location of a licensed optometrist  
                who is absent for a reason approved by the Board.

          4. Authorizes an assistant in the office of a physician and  
             surgeon or optometrist under the direct responsibility  
             and supervision of a physician and surgeon or  
             optometrist to fit prescription lenses.

          5. Specifies additional duties that an assistant may  
             perform in the office of, and under the direct  
             supervision of, an ophthalmologist or optometrist.

          This bill:

          1. Authorizes an optometrist to engage in the practice of  
             optometry at any health facility or residential care  
             facility, provided the optometrist:

             A.    Maintains a primary business office, separate from  



                                                               AB 2683

                the health facility or residential care facility,  
                that meets all of the following requirements:

                         Is open to the public during normal  
                   business hours by telephone and for purposes of  
                   billing services or access to patient records.

                         Is licensed to the optometrist or the  
                   employer of the optometrist as a local business  
                   with the city or county in which it is located.

                         Is registered by the optometrist with the  

                         Is owned or leased by the optometrist or by  
                   the employer of the optometrist.

                         Is not located in or connected with a  
                   residential dwelling.

          B. Maintains or discloses patient records in the following  

                   Records are maintained and made available to the  
                patient in such a way that the type and extent of  
                services provided to the patient are conspicuously  
                disclosed.  The disclosure of records shall be made  
                at or near the time services are rendered and shall  
                be maintained at the primary business office.

                   The optometrist complies with all federal and  
                state laws and regulations regarding the maintenance  
                and protection of medical records, including, but not  
                limited to, the federal Health Insurance Portability  
                and Accountability (HIPA) Act of 1996.

                   The optometrist keeps all necessary records for a  
                minimum of seven years from the date of service.  Any  
                information shall be certified by the optometrist as  
                being true, accurate, and complete.

                   Records shall be maintained for each prescription  
                as part of the patient's chart, including the  
                optometrist's name and license number, the place of  



                                                               AB 2683

                practice or primary business office, and the  
                description of the goods and services for which the  
                patient is charged and the amount charged.

                   A copy of any referral or order requesting  
                optometric services for a patient from the health  
                facility's or residential care facility's  
                administrator, director of social services, the  
                attending physician and surgeon, the patient, or a  
                family member shall be kept in the patient's medical  

             C.    Possesses and appropriately uses the instruments  
                and equipment required for all optometric services  
                and procedures performed within the health facility  
                or residential care facility.

          2. Exempts an optometrist from providing notification to  
             the Board of each health facility or residential care  
             facility, provided all requirements are met.

          3. Defines certain terms for purposes of the above  
             provisions, including:

             A.    Health facility as specified in the Health and  
                Safety Code, exclusive of a hospital, as defined.

             B.    Residential care facility as a residential  
                facility licensed by the Department of Social  

          4. Authorizes an assistant to fit prescription lenses and  
             perform those additional duties in any setting where  
             optometry or ophthalmology is practiced, under the  
             direct responsibility and supervision of a physician and  
             surgeon, optometrist, or ophthalmologist, respectively.

          5. Defines "setting" for purposes of # 4 above, to include,  
             but not be limited to, any facility licensed by the  
             Department of Public Health or the Department of Social  

          6. Makes technical, clarifying and conforming changes.



                                                               AB 2683


           Optometrists diagnose and treat vision problems and eye  
          diseases and write prescriptions for eyeglasses, contact  
          lenses, and medications.  Optometrists are required to  
          complete at least three years of study at an accredited  
          college or university before beginning specialized  
          optometry training.  The specialized training is four years  
          in duration and the optometry student must then pass  
          written and clinical state board examinations prior to  
          licensure.  Currently, more than 6,500 optometrists  
          practice in California.

          In 2007, AB 986 (Eng) authorized optometrists to practice  
          at temporary locations in a similar fashion to statutes  
          that authorize dentists to work at temporary practice  
          locations, such as nursing homes, schools, and other public  
          institutions.  However, those provisions only authorized a  
          limited term timeframe for the practice of optometry at  
          these temporary locations; seven calendar days during a  
          30-day period and 54 days during the calendar year.  

           Prior Legislation  

          AB 986 (Eng), Chapter 276, Statutes of 2007, allowed the  
          practice of optometry at temporary locations under certain  
          conditions, established a retention period for optometrists  
          to maintain patient records, and increased licensing fees.

          SB 929 (Polanco), Chapter 676, Statutes of 2000, among  
          other things, authorized assistants working in the office  
          of an optometrist or ophthalmologist, and under the direct  
          supervision of an optometrist or ophthalmologist, to  
          perform a number of optometric tests and procedures.
           FISCAL EFFECT :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/4/10)

          Board of Optometry (source)
          Advanced Eyecare, Inc.
          Chairman, UC Davis Eye Center
          Vision Service Plan



                                                               AB 2683

           ARGUMENTS IN SUPPORT  :    According to the author:

            "California laws are vague and do not adequately address  
            notification, standard of practice and record keeping  
            requirements for optometrists who practice in health  
            facilities.  A definition of optometric care in  
            non-traditional settings is needed in order to allow  
            optometrists to provide this type of care in a way that  
            will protect the public and increase access to care.   
            Furthermore, due to low overhead costs and potentially  
            high profit margins, increasing numbers of optometrists  
            are providing this type of care either part-time or as a  
            sole mode of practice.

            "Additionally, over the next several years and decades,  
            Californian's and the nations' baby boom generation are  
            reaching age 65 and represent among the fastest growing  
            population in the state and in the nation.  It is  
            projected that the number of elderly patients who live in  
            assisted living facilities, traditional nursing homes,  
            and various tiers of intermediate care is expected to  
            double by year 2030.  The concomitant expectation is that  
            a great number of professional services, such as  
            optometric services will be rendered for a  
            non-ambulatory, or relatively immobile, percentage of the  
            population.  The Board wants to ensure that optometric  
            services rendered to patients in these settings are  
            provided in a manner as consistent as possible with the  
            level of care that would be provided by the practitioner  
            in his/her regular practice location."

           ASSEMBLY FLOOR  : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Bass, Beall,  
            Bill Berryhill, Tom Berryhill, Blakeslee, Block,  
            Blumenfield, Bradford, Brownley, Buchanan, Caballero,  
            Charles Calderon, Carter, Chesbro, Conway, Cook, Coto,  
            Davis, De Leon, DeVore, Emmerson, Eng, Feuer, Fong,  
            Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,  
            Gilmore, Hagman, Hall, Hayashi, Hernandez, Hill, Huber,  
            Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie  
            Lowenthal, Ma, Mendoza, Miller, Monning, Nestande,  



                                                               AB 2683

            Niello, Nielsen, Norby, V. Manuel Perez, Portantino,  
            Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio,  
            Audra Strickland, Swanson, Torlakson, Torres, Torrico,  
            Tran, Yamada
          NO VOTE RECORDED:  De La Torre, Evans, Fletcher, Harkey,  
            Nava, Villines, John A. Perez, Vacancy

          JJA:mw  8/4/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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