BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  AB 2699|
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                                 THIRD READING


          Bill No:  AB 2699
          Author:   Bass (D)
          Amended:  8/27/10 in Senate
          Vote:     21

           
           SENATE BUSINESS, PROF & ECON DEVELOP COMM :  5-1, 6/28/10
          AYES:  Negrete McLeod, Aanestad, Calderon, Correa, Florez
          NOES:  Yee
          NO VOTE RECORDED:  Wyland, Corbett, Walters

           ASSEMBLY FLOOR  :  67-3, 6/2/10 - See last page for vote


           SUBJECT  :    Healing arts:  licensure exemption

           SOURCE  :     Author


           DIGEST  :    This bill exempts, until January 1, 2014, 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.

           ANALYSIS  :    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  
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            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. 

          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, until January 2, 2014,  
             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 those services, he or  
                    she:

                    1)          Obtains authorization from the board  
                      to participate in the sponsored event.

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                    2)          Satisfies the following requirements:

                       ?              The health care practitioner  
                         has not committed any act or been convicted  
                         of a crime constituting grounds for denial  
                         of licensure or registration, and is in good  
                         standing in each state in which he or she is  
                         licensed or certified.

                       ?              The health care practitioner  
                         has the appropriate education and experience  
                         to participate in a sponsored event, as  
                         determined by the board.

                       ?              The health care practitioner  
                         agrees to comply with all applicable  
                         practice requirements.

                    1)          Submits to the board, on a form  
                      prescribed by the board, a request for  
                      authorization to practice without a license,  
                      and pays a nominal fee, in an amount determined  
                      by the board by regulation, to cover the cost  
                      of developing the authorization process and  
                      processing the request.

                  A.        The care is provided under all of the  
                    following circumstances:

                    1)          To uninsured or underinsured persons.

                    2)          On a short-term voluntary basis, not  
                      to exceed a 10-calander-day period per  
                      sponsored event.

                    3)          In association with a sponsoring  
                      entity that complies with specified  
                      requirements. 

                    4)          Without charge to the recipient or to  
                      a third party on behalf of the recipient.

          1. Allows the Board to deny a health care practitioner  

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             authorization to practice without a license if the  
             health care practitioner fails to comply with the  
             requirements of this section or for any act that would  
             be grounds for denial of an application for licensure.

          2. 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 each applicable board for which  
                 an out of state health care practitioner is  
                 participating in the sponsored event by completing a  
                 registration form that includes the name of the  
                 sponsoring authority, its officers or organization  
                 officials, specified 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.

          3. 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 calendar days of the change.

          4. Requires the sponsoring entity additionally do the  
             following:

               A.     Within 15 calendar 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  

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                 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.

          5. 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.

          6. States that the exemption from licensure for health care  
             practitioners shall not be construed to authorize to a  
             health care practitioner to render care outside the  
             scope of practice authorized by his or her license or  
             certificate.

          7. Authorizes the board to terminate authorization for a  
             health care practitioner to provide health care services  
             pursuant to this bill for failure to comply with the  
             requirements of this bill.

          8. Requires the board provide both the sponsoring entity  
             and the health care practitioner with a written notice  
             of termination including the basis for that termination.  
             The health care practitioner may, within 30 days after  
             the date of the receipt of notice of termination, file a  
             written appeal to the board. The appeal shall include  
             any documentation the health care practitioner wishes to  
             present to the board.

          9. Prohibits a health care practitioner whose authorization  
             to provide health care services has been terminated from  
             providing health care services unless and until a  
             subsequent request for authorization has been approved  

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             by the board. A health care practitioner who provides  
             health care services in violation is deemed to be  
             practicing health care in violation of the law and be  
             subject to any applicable administrative, civil, or  
             criminal fines, penalties, and other sanctions.

          10.Specifies the provisions of this bill are severable. 

          11.Defines the following terms: board, sponsoring entity,  
             and uninsured or underinsured person. 

           Background
           
           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 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.

           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  

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          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.  

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/30/10)

          Los Angeles County Board of Supervisors (source) 
          California Academy of Physician Assistants
          Planned Parenthood Los Angeles Advocacy Project
          Service Employees International Union

           OPPOSITION  :    (Verified  8/30/10)

          American Nurses Association of California
          California Nurses Association

           ARGUMENTS IN SUPPORT  :    The Los Angeles County Board of  
          Supervisors 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  

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          and dental.

           ARGUMENTS IN OPPOSITION  :    The California Nurses  
          Association indicate 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.   
           

           ASSEMBLY FLOOR  :  
          AYES:  Adams, Ammiano, Anderson, Arambula, Bass, Beall,  
            Bill Berryhill, Blakeslee, Block, Blumenfield, Bradford,  
            Brownley, Buchanan, Caballero, Charles Calderon, Carter,  
            Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,  
            DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,  
            Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,  
            Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,  
            Huber, Huffman, Jeffries, Knight, Logue, Bonnie  
            Lowenthal, Ma, Mendoza, Miller, Nestande, Niello,  
            Nielsen, V. Manuel Perez, Ruskin, Saldana, Silva,  
            Skinner, Smyth, Solorio, Torlakson, Torrico, Tran,  
            Villines, John A. Perez
          NOES:  Portantino, Salas, Swanson
          NO VOTE RECORDED: Tom Berryhill, Jones, Lieu, Monning,  
            Nava, Norby, Audra Strickland, Torres, Yamada, Vacancy


          JA:nl  8/30/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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