BILL ANALYSIS
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|Hearing Date:June 28, 2010 |Bill No:AB |
| |2699 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 2699Author:Bass
As Amended:May 12, 2010 Fiscal: Yes
SUBJECT: Healing arts: licensure exemption.
SUMMARY: Exempts from state licensure specified health care
practitioners who are licensed or certified in other states and who
provide health care services on a voluntary basis to uninsured or
underinsured persons in California, as specified.
Existing law:
1) Provides that a physician and surgeon or osteopathic physician and
surgeon who practices or attempts to practice medicine in
California without a license or certificate is guilty of a public
offense punishable by a fine not exceeding $10,000, by imprisonment
in the state prison, by imprisonment in a county jail not exceeding
one year, or by both fine and imprisonment.
2) Makes it unlawful for any person to practice as a dentist, nurse,
optometrist, dental hygienist, physician assistant or vocational
nurse without a valid license, certificate or registration issued
by the regulatory boards that regulate these professionals.
3) Establishes the Chiropractic Initiative Act of California
(Initiative Act), approved by voters on November 7, 1922, and
became effective on December 21, 1922 to regulate the practice of
chiropractors. Provides under the Initiative Act that the Board of
Chiropractic Examiners, upon receipt of specified fee, to issue a
license to any person licensed to practice chiropractic in another
state, provided that the other state had the same general
requirements as California at the time the license was issued, and
that other state grants reciprocal registration to chiropractic
examiners.
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4) Provides that in a state of emergency, as defined, a health care
practitioner licensed in another state that offers or provides
health care for which he or she is licensed, is exempt from
licensure.
5) Establishes reciprocity eligibility requirements for certain health
care practitioners who are licensed in other states, including
physicians and surgeons, nurses, and dentists.
This bill:
1)Exempts from state licensure specified health care practitioners
that are licensed or certified in good standing in another state,
district, territory of the United States and who offer or provide
health care services in California under the following requirements:
a) Prior to providing care, he or she submits to the board a
valid copy of his or her license or certificate and a
photographic identification issued by the state in which he or
she holds licensure or certification.
b) The care is provided under all of the following circumstances:
i) To uninsured or underinsured persons.
ii) On a short-term voluntary basis, not to exceed a 10-day
period per sponsored event.
iii) In association with a sponsoring entity that complies with
specified requirements.
iv) Without charge to the recipient or to a third party on
behalf of the recipient.
2)Defines a health care practitioner for purposes of item #1) above,
as a physician and surgeon, osteopathic physician and surgeon,
chiropractor, dentist, dental hygienist, nurse, vocational nurse,
optometrist, or physician assistant.
3)Requires the sponsoring entity seeking to provide, or arrange for
the provision of, health care services to do both of the following:
a) Register with the licensing board by completing a
registration form that includes the name of the sponsoring
authority, its officers or organization officials, specified
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contact information for the sponsoring entity and its officers,
and, any additional information required by the licensing
board.
b) Provide the information required above to the county
health department of the county in which the health care
services will be provided, along with any additional
information that may be required by that department.
4)Requires the sponsoring entity to notify in writing the licensing
board and the county health department of any change to the
information required by #3) above within 30 days of the change.
5)Requires the sponsoring entity additionally do the following:
a) Within 15 days of the provision of health care services,
it must file a report with the licensing board and the county
health department on the date, place, type, and general
description of the care provided, along with a listing of the
health care practitioners who participated in providing that
care.
b) Maintain a list of health care practitioners associated
with the provision of health care services under this bill.
Requires the sponsoring entity to maintain a copy of each
health care practitioner's current license or certification and
shall require each health care practitioner to attest in
writing that his or her license or certificate is not suspended
or revoked pursuant to disciplinary proceedings in any
jurisdiction. The sponsoring entity shall maintain these
records for a period of at least five years following the
provision of health care services and shall, upon request,
furnish those records to the licensing board or any county
health department.
6)Allows a licensing board to revoke the registration of a sponsoring
entity that fails to comply with item # 5) above.
7)Prohibits a contract of liability insurance issued, amended, or
renewed in this state on or after January 1, 2011, from excluding
coverage of a health care practitioner or a sponsoring entity that
provides, or arranges for the provision of, health care services
under this bill, provided that the practitioner or entity complies
with the requirements of this bill.
8)States that the exemption from licensure for health care
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practitioners shall not apply to a health care practitioner who
renders care outside the scope of practice authorized by his or her
license or certificate.
9)Defines the following terms: board, sponsoring entity, and uninsured
or underinsured person.
FISCAL EFFECT: According to the Assembly Appropriations Committee
analysis, unknown, likely absorbable workload to healing arts
fee-supported professional boards to account for intermittent
temporary licensure of various health professionals.
COMMENTS:
1.Purpose. The Los Angeles County Board of Supervisors , the Sponsor
of this measure, state that current law prohibits out-of-state
health care practitioners from practicing in California without a
license. Thousands of low-income children, families, and
individuals in California are uninsured or underinsured and do not
receive basic health, vision, and dental care screenings. Lack of
basic health services and preventive care may lead to more serious
and costly problems in the future. In August 2009, the Remote Area
Medical (RAM) Volunteer Corps conducted an eight-day health event in
Los Angeles County. Volunteer medical, dental and other health care
practitioners provided $2.9 million in free services to over 14,000
patient encounters during the event. While the event was extremely
successful, RAM experienced a shortage of volunteer health care
professionals because of restrictions in State law which prohibits
volunteer out-of-state licensed medical personnel from providing
short-term services. As a result, thousands of residents needing
services were turned away. Another RAM event was held at the Los
Angeles Sports Arena from April 27 to May 3, 2010, and over 6,600
uninsured and underinsured received services, most of which were
vision and dental.
2.Background.
a) Licensure Requirements. Generally, health care practitioners,
including physician and surgeons, osteopathic physicians,
dentists, physician assistants, nurses, and dental hygienists
must be licensed in California to practice in the state. There
are limited exemptions to this general rule. For example, health
care practitioners who provide care during a state of emergency
upon request by the Director of Emergency Medical Services
Authority are exempt from licensure. Additionally, a physician
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and surgeon who is practicing in another state may be exempted
from licensure when he or she has been invited by the United
States Olympic Committee (Committee) to provide medical services
in in-state events sanctioned by the Committee, and the services
provided are limited to those sanctioned by the Committee, as
specified. Additionally, licensing boards allow health care
practitioners who are licensed or certified in other states to
practice in California under specified requirements.
b) Free Health Clinics. Remote Area Medical (RAM) Volunteer
Corps, based in Tennessee, is a non-profit organization founded
in 1985, and has staged hundreds of medical clinics both in the
United States and worldwide. In August 2009, RAM conducted an
eight-day health event in Los Angeles County. Volunteer health
care practitioners, such as doctors, nurses, dentists,
chiropractors and optometrists, provided various medical services
to more than 6,300 uninsured and underinsured residents of the
county. On April 27 to May 3, 2010, RAM conducted its second
free health clinic in Los Angeles. Thousands of people sought
and received treatments but many people had to be turned away.
Organizers of the event indicated that a shortage of volunteer
health care practitioners hampered their effort, and if existing
law allowed for certain exemption for health care practitioners
at these types of health clinic events, additional medical
volunteers could have been recruited.
3.Arguments in Support. Supporters such as the Planned Parenthood
Advocacy Project state that this bill ensures that free health
clinics, such as the RAM events in Los Angeles, would not be
hampered by shortages of medical personnel, and allow more
practitioners to volunteer.
4.Arguments in Opposition. The California Nurses Association
indicates that this bill does not assure that practitioners who come
to California are competent, and have passed adequate background
checks, and patients who are injured or harmed by out-of state
practitioners would have little recourse, because the state's
healing arts boards do not have the authority to regulate or enforce
discipline practitioners who are not licensed in California.
The American Nurses Association of California (ANA/C) has taken an
oppose unless amended position on this bill and states that the
current process for reciprocity between states for out-of-state
practitioners is a good process because it allows health care boards
to review candidates individually. ANA/C would like to see clarity
to the current language and to identify what is lacking with the
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current reciprocity requirements.
5.Author's Technical Amendments. The author would like to amend this
bill to include podiatrists in the definition of health care
practitioners.
SUPPORT AND OPPOSITION:
Support:
Los Angeles County Board of Supervisors (Sponsor)
California Academy of Physician Assistants
Planned Parenthood Los Angeles Advocacy Project
Service Employees International Union
Oppose unless Amended:
American Nurses Association of California
Opposition:
California Nurses Association
Consultant:Rosielyn Pulmano