BILL ANALYSIS Ó
------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 1896|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: AB 1896
Author: Chesbro (D)
Amended: 3/27/12 in Assembly
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 9-0, 6/18/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Strickland, Vargas, Wyland
ASSEMBLY FLOOR : 69-1, 5/0/12 - See last page for vote
SUBJECT : Tribal health programs: health care
practitioners
SOURCE : California Rural Indian Health Board, Inc.
DIGEST : This bill aligns California law with the
provisions of federal law which exempt a health care
practitioner licensed in any state who practices as part of
the tribal health program from the licensure requirements
of the state in which the tribal health program is located.
ANALYSIS :
Existing California law:
1. Provides for the licensure and regulation of health care
practitioners by various healing arts boards within the
Department of Consumer Affairs.
CONTINUED
AB 1896
Page
2
2. Exempts a person practicing a profession or rendering
services from any state licensure requirements if they
are practicing as an employee of a department, bureau,
office, division, or similarly constituted agency of the
federal government, and provides medical services
exclusively on a federal reservation or at any facility
wholly supported by and maintained by the United States
Government.
Existing federal Law:
1. Defines "tribal health program" as an Indian tribe or
tribal organization that operates any health program,
service, function, activity, or facility funded, in
whole or part, by the Indian Health Service (IHS).
2. Defines a "health profession" as: allopathic medicine,
family medicine, internal medicine, pediatrics,
geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, dentistry,
psychiatry, osteopathy, optometry, pharmacy, psychology,
public health, social work, marriage and family therapy,
chiropractic medicine, environmental health and
engineering, an allied health profession, or any other
health profession.
3. Authorizes a health care professional credentialed and
privileged at a federal health care institution or
location designated by the Secretary of Defense to
practice at any location, regardless of where the health
care professional or the patient are located, so long as
the practice is within the scope of the authorized
federal duties.
4. Establishes, under the Patient Protection and Affordable
Care Act (PPACA), that licensed health professionals
employed by a tribal health program shall be exempt, if
licensed in any state, from the licensing requirement of
the state in which the tribal health program performs
the services described in the contract or compact of the
tribal health program under the Indian
Self-Determination and Education Assistance Act
(ISDEAA).
CONTINUED
AB 1896
Page
3
This bill specifies that a person who is licensed as a
health care practitioner in any other state and is employed
by a tribal health program is exempt from any state
licensing requirement with respect to acts authorized under
the person's license where the tribal health program
performs specified services.
Background
Indian Health Care . The National Indian Health Board
(NIHB) represents Tribal governments, both those that
operate their own health care delivery systems through
contracting and compacting, and those receiving health care
directly from the IHS. According to the NIHB, the system
for delivering health care services to Indians is unique:
"It was designed by the federal government to carry out the
federal trust responsibility for Indian health. In
addition, federal policy dictates that the federal
government interacts with Indian tribes on a
government-to-government basis."
Treaties between the U.S. Government and Indian Tribes
frequently call for the provision of medical services, the
services of physicians, or the provision of hospitals for
the care of Indian people. Even before these treaties, the
U.S. Constitution specifically addressed the federal
government's primacy role in dealing with Indians in the
commerce and treaty clauses. Supreme Court cases, such as
Cherokee Nation v. Georgia (1831), specifically address the
relationship between Tribes, states, and the federal
government. Out of this case and others, the guardian/ward
relationship was created that forms the basis of the trust
relationship.
Indian Health Services . The IHS, an agency within the
Department of Health and Human Services, is responsible for
providing federal health services to American Indians and
Alaska Natives. The provision of health services to
members of federally-recognized tribes grew out of the
special government-to-government relationship between the
federal government and Indian tribes. This relationship,
established in 1787, is based on Article I, Section 8 of
the Constitution, and has been given form and substance by
numerous treaties, laws, Supreme Court decisions, and
CONTINUED
AB 1896
Page
4
Executive Orders. The IHS is the principal federal health
care provider and health advocate for Indian people and its
goal is to raise their health status to the highest
possible level. The IHS provides a comprehensive health
service delivery system for approximately 1.9 million
American Indians and Alaska Natives who belong to 564
federally recognized tribes in 35 states.
Patient Protection and Affordable Care Act . The original
version of the Indian Health Care Improvement Act (IHCIA)
was passed by Congress in 1976. The authorization of
appropriations for the IHCIA expired in 2000. The PPACA
reauthorized the IHCIA, and authorizes the director of IHS
to:
Facilitate advocacy and promote consultation on matters
relating to Indian health within the Department of Health
and Human Services.
Provide authorization for hospice, assisted living,
long-term, and home- and community-based care.
Extend the ability to recover costs from third parties to
tribally operated facilities.
Update current law regarding collection of reimbursements
from Medicare, Medicaid, and CHIP (Children's Health
Insurance Program) by Indian health facilities.
Allow tribes and tribal organizations to purchase health
benefits coverage for IHS beneficiaries.
Authorize IHS to enter into arrangements with the
Departments of Veterans Affairs and Defense to share
medical facilities and services.
Allow a tribe or tribal organization carrying out a
program under the ISDEAA and an urban Indian organization
carrying out a program under Title V of IHCIA to purchase
coverage for its employees from the Federal Employees
Health Benefits Program.
Authorize the establishment of a Community Health
Representative program for urban Indian organizations to
CONTINUED
AB 1896
Page
5
train and employ Indians to provide health care services.
Direct the IHS to establish comprehensive behavioral
health, prevention, and treatment programs for Indians.
The PPACA also includes provisions for health care services
provided to Indians through Tribal Health Programs. The
Act indicates that professionals who are employed by tribal
health programs shall be considered exempt from the
licensing requirements of the state in which the tribal
health program performs services under the ISDEAA.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 6/20/12)
California Rural Indian Health Board, Inc. (source)
ASSEMBLY FLOOR : 69-1, 5/3/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bradford, Brownley,
Buchanan, Butler, Campos, Carter, Cedillo, Chesbro,
Conway, Cook, Dickinson, Eng, Feuer, Fong, Fuentes, Beth
Gaines, Galgiani, Garrick, Gatto, Gordon, Grove, Hagman,
Halderman, Harkey, Hayashi, Hill, Huber, Hueso, Huffman,
Jeffries, Jones, Knight, Lara, Logue, Bonnie Lowenthal,
Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell,
Nestande, Nielsen, Norby, Olsen, Perea, V. Manuel Pérez,
Portantino, Silva, Skinner, Solorio, Swanson, Torres,
Valadao, Wagner, Wieckowski, Williams, Yamada, John A.
Pérez
NOES: Donnelly
NO VOTE RECORDED: Bonilla, Charles Calderon, Davis,
Fletcher, Furutani, Gorell, Hall, Roger Hernández, Pan,
Smyth
JJA:d 6/20/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED
AB 1896
Page
6
CONTINUED