BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2699| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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 CONTINUED AB 2699 Page 2 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. CONTINUED AB 2699 Page 3 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 CONTINUED AB 2699 Page 4 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 CONTINUED AB 2699 Page 5 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 CONTINUED AB 2699 Page 6 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 CONTINUED AB 2699 Page 7 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 CONTINUED AB 2699 Page 8 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 **** END **** CONTINUED