BILL ANALYSIS Ó
-----------------------------------------------------------------------
|Hearing Date:April 9, 2012 |Bill |
| |No:1202 |
-----------------------------------------------------------------------
SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 1202Author:Leno
As Amended:March 29, 2012 Fiscal:Yes
SUBJECT: Dental hygienists.
SUMMARY: Makes a number of clean up changes regarding the licensure
and regulation of registered dental hygienists by the Dental Hygiene
Committee of California; increases various regulatory fee ceilings.
Existing law:
1)Licenses and regulates registered dental hygienists (RDH), registered
dental hygienists in alternative practice (RDHAP), and registered
dental hygienists in extended functions (RDHEF) by the Dental
Hygiene Committee of California (DHCC) under the Dental Board of
California (DBC) within the Department of Consumer Affairs (DCA).
2)Requires the DHCC to perform specified functions, including, the
evaluation of all RDH, RDHAP, and RDHEF educational programs that
apply for approval. Provides that, any dental hygiene program
accredited by and in good standing with the Commission on Dental
Accreditation is required to be approved by the DHCC. (Business and
Professions Code (BPC) § 1905 (a))
3)Authorizes the DHCC to employ employees and examiners necessary to
carry out the functions of the DHCC. (BPC § 1905 (b))
4)Establishes the requirements which an applicant must meet to be
issued an RDH license, including completion of specified educational
and examination requirements. (BPC § 1917)
5)Authorizes the DHCC to issue a RDH license to an applicant who has
not taken the specified clinical examination, if the applicant
SB 1202
Page 2
submits certain information including proof that he or she has been
in clinical practice as an RDH or has been a full-time faculty
member of an accredited RDH education program for at least 5 years
preceding the application date, and proof that the applicant has not
been subject to disciplinary action by another state where he or she
was previously licensed as an RDH. (BPC § 1917.1)
6)Under a general provision, prohibits a DCA licensing board, including
the DHCC, from imposing limitations or additional requirements on an
applicant to take an examination when the applicant has failed a
prior examination. (BPC § 135)
7)Authorizes a licensed RDHAP to perform specified functions and
procedures in residences of the homebound, schools, residential
facilities, and dental health professional shortage areas. (BPC §
1926)
8)Specifies that an RDHAP may not provide services without a written
prescription for dental hygiene services from a dentist or physician
and specifies that failure to comply with the requirement shall be
considered unprofessional conduct. (BPC § 1931)
9)Authorizes the DHCC, as a condition of license renewal, to require
licensees to complete up 7.5 hours of continuing education per
renewal period, as specified. (BPC § 1936.1)
10)Requires continuing education course providers to be approved by the
DHCC and specifies that providers approved by the Dental Board of
California shall be deemed approved by the DHCC. (BPC § 1936.1 (c))
11) Requires the DHCC to establish by resolution the amount of the
fees, subject to specified maximum fee amounts, that relate to the
licensed under its jurisdiction. (BPC § 1944)
This bill:
1)Authorizes the DHCC to issue a special permit to a RDH licensed in
another state authorizing him or her to teach in a dental hygiene
program in California without holding a California license upon
meeting certain requirements, including the completion of
educational and examination requirements and the payment of an
application fee for the special permit.
2)Recasts the provision requiring the DHCC to approve an educational
program accredited by the Commission on Dental Accreditation to
instead make it permissive, that the DHCC may approve such an
SB 1202
Page 3
educational program.
3)Authorizes the DHCC to additionally employ consultants and authorizes
the DHCC to establish an advisory committee to provide information
about the state clinical examination.
4)Requires an applicant for a RDH license to complete a
Committee-approved instruction in gingival soft tissue curettage,
nitrous oxide-oxygen analgesia, and local anesthesia.
5)Revises the requirements for issuing a California license to a RDH
licensed in another state to require:
a) The out-of-state experience to have been obtained in the 5
years immediately preceding the application date.
b) Expands the information relating to disciplinary action to
include any other state where the applicant was previously issued
any professional or vocational license.
c) Proof that the applicant has not, more than one time in the
prior 5 years, failed the DHCC's clinical examination, the
examination given by the Western Regional Examining Board, or any
other clinical dental hygiene examination approved by the DHCC.
6)Prohibits an applicant for a RDH license who has failed the state
clinical examination three times, or who has failed the examination
because he or she has imposed gross trauma on a patient from being
eligible to take the examination again until the applicant completes
remedial education approved by the DHCC.
7)Authorizes a RDHAP to operate a mobile dental hygiene clinic, as
specified, and establishes a fee not to exceed $250.
8)Requires a RDHAP to register his or her place or places of practice,
within 30 days with the DHCC.
9)Authorizes a RDHAP to apply for approval of the DHCC to have an
additional place of practice, and establishes a biennial renewal
fee.
10) Authorizes the DHCC to seek an injunction against a violation by a
RDHAP of the requirement to obtain a prescription prior to rendering
services
11)Specifies that providing services without a written prescription on
SB 1202
Page 4
the part of a RDHAP shall constitute unprofessional practice and a
cause revocation of suspension of the license.
12)Increases the mandatory continuing education course requirement to
not exceed 10 hours per renewal period, and specifies that providers
approved by the Dental Board of California may be deemed approved by
the DHCC.
13)Authorizes the DHCC to adopt by regulation a measure of continued
competency as a condition of license renewal.
14)Defines "extramural dental facility" to mean any clinical facility
employed by an approved dental hygiene educational program for
instruction in dental hygiene which exists outside or beyond the
walls, boundaries, or precincts of the primary campus of the
approved program and in which dental hygiene services are rendered.
Requires a dental hygiene educational program shall register an
extramural dental facility with the DHCC as specified.
15)Increases the maximum fee amounts for various fees as follows.
a) Application for an original license from $50 to $250.
b) Biennial license renewal fee from $80 to $250.
c) Curriculum review and site evaluation for dental hygiene
educational programs fee from $1,400 to $2,100.
16)Establishes new maximum fees as follows:
a) The fee for registration of an extramural dental facility
shall not exceed $250.
b) The fee for a mobile dental hygiene unit shall not exceed
$150.
c) The biennial renewal fee for a mobile dental hygiene unit
shall not exceed $250.
d) The fee for an additional office permit shall not exceed $250.
e) The biennial renewal fee for an additional office shall not
exceed $250.
f) The special permit fee is equal to the biennial license
renewal fee.
SB 1202
Page 5
17)Makes technical, nonsubstantive and conforming changes.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the California Dental Hygienists
Association (Sponsor) who states the Dental Hygiene Committee of
California (DHCC) was created in 2008 to oversee and regulate the
dental hygiene profession. Since the establishment of DHCC and its
authority, there are several changes that would improve the DHCC
oversight and authority.
SB 1202 seeks to enact these changes and the sponsor seeks to enhance
the DHCC's authority to adequately oversee their growing profession.
2.Background. The following is background and reasons for the specific
provisions of the bill as indicated by the Author.
a) Special Permits. The bill creates a special permit that
allows a RDH licensed in another state to teach in a California
dental hygiene program without a license provided that he or she
obtains a special permit form the DHCC. Similar language and a
special permit already exists for dentistry.
Educational programs such as dentistry often hire subject experts
to teach in their programs. If a dental school wants to hire a
DDS from another state, who is a dental expert in his or her
field, to lecture for a semester, they may do so with a special
permit. Currently, dental hygiene programs cannot invite
out-of-state dental hygienists because no special permit exists
for RDHs. Establishing a special permit for RDHs will allow
dental hygiene programs to contract with subject experts from
outside of California to teach in the programs.
b) DHCC Dental Hygiene Program Approval Authority. The bill
gives the DHCC the authority to approve or not approve accredited
dental hygiene programs. The sponsor states that in addition to
deleting obsolete sections, this provision clarifies that the
DHCC makes recommendations to the DBC regarding dental hygiene;
adds consultants to the list of people the DHCC may employ;
allows the DHCC to create an advisory board to review clinical
examinations.
SB 1202
Page 6
The Commission on Dental Accreditation (CODA) accredits all dental
hygiene programs. Current law states that if CODA accredits a
program, the DHCC must accept CODA's approval. CODA grants
dental hygiene programs preliminary accreditation even though
programs do not meet the standards necessary for full
accreditation. With preliminary accreditation, programs are able
to operate and accept students, but they cannot graduate students
or provide proper channels for licensure without full
accreditation. In other words, the program must later apply to
CODA for full accreditation, but students are allowed to enroll,
pay high tuition costs and begin classes without the guarantee
that the program will be accredited. Recently, a program with
preliminary accreditation closed leaving students, who were one
month from graduating, with no recourse, no way to graduate and
no options to pursue licensure. Allowing the DHCC oversight and
authority for approval or non-approval of programs will prevent
schools that do not meet the accreditation standards from being
approved in the first place and protect future students from
entering into a program that will not lead them to become a
licensed registered dental hygienist.
c) Completion of Course in Expanded Functions for Initial
Licensure. The bill clarifies that all RDHs seeking licensure
must all meet the same level of education. All graduates of
California dental hygiene programs have education in expanded
functions as that is a requirement of licensure. Many out of
state dental hygienists do not have the training or education in
expanded functions because these functions are not allowed in
their states. By standardizing the educational requirements for
all RDHs seeking California licensure, consumers are ensured that
all applicants have met the same standards and training for
expanded functions.
d) Out-of-State License Applicant Requirements. The bill
requires that program hours to be used towards licensure must be
in the immediately preceding five years. The bill requires proof
that the applicant has not been subject to any professional
disciplinary action or monitoring in another state. The bill
clarifies that the applicant must prove he or she has not
previously failed the DHCC's or another clinical examination.
The Western Regional Examination Board (WREB) provides the national
test recognized by DHCC. The bill clarifies that the applicant
must prove he or she has not failed WREB. Additionally,
consumers are protected by requiring clearer licensure
SB 1202
Page 7
requirements for out-of-state RDHs. Out-of-state licensees who
have not practiced for more than five years are required to pass
a clinical competence exam in order to obtain California
licensure. Furthermore, out-of-state applicants are responsible
for providing proof that they have not been subject to
disciplinary action or monitoring in another state.
These changes will ensure that out-of-state RDHs are not coming to
California to escape disciplinary actions in another state. With
the current process of licensure by credential and/or allowing
graduates from other states to take WREB for initial licensure,
it is critical that the DHCC ensures that the applicant has not
failed the clinical examination. All California dental hygiene
students must pass a clinical licensure examination to be
licensed. This language will ensure that dental hygiene students
from other states must also pass a clinical licensure
examination.
e) Remediation Requirements. The bill requires applicants
failing the clinical examination three times, or applicants
causing gross trauma, to provide proof of remediation prior to
re-taking the examination.
If a dental hygiene student is unable to pass the examination after
three attempts, remediation is required before they are allowed
to re-take the examination. Remediation is also required for
students retaking the examination if the student, in a previous
clinical examination (which uses public patients), caused gross
trauma that required intervention by a doctor or dentist as well
as follow-up by a medical or dental professional. Consumers need
assurance that a student who has previously caused gross trauma
during an examination will not do the same in a subsequent
examination.
f) Mobile Clinics. The bill authorizes RDHAPs to establish
mobile clinics. The DHCC also licenses RDHAPs to work with
patients outside the current traditional dental care delivery
system. RDHAPs are homebound, in residential care facilities,
schools, rural areas and/or institutions. Allowing RDHAPs to
have a mobile clinic will further increase their ability to bring
crucial services to individuals who require additional attention
and increased access to care.
g) Requires RDHAPs to Register Additional Sites. Currently, all
dentists must register their practice location sites with the CDB
in order to maintain oversight of the additional sites.
SB 1202
Page 8
Similarly, the bill requires RDHAPs, who own their own practices,
to report all of their registered sights to the DHCC.
h) Continuing Education. The bill increases the maximum number
of continuing education hours that the DHCC may require for
biennial renewal of a license from 7.5 hours to
10 hours. The bill further requires courses to measure continued
competency. Providers of continuing education courses who are
approved by the DBC may be approved by the DHCC for dental
hygienists.
This language allows the DHCC to set standards for continued
competency - a huge consumer protection issue in health care.
Providers of dental hygiene services would be required to take
clinical courses that would assist them in maintaining clinical
competence, so that patients would be assured of receiving
quality dental hygiene services.
i) Increase Statutory Maximum Fee Levels. Sought by and
supported by the California Dental Hygienists Association, the
increase in the cap will give the DHCC flexibility to keep the
fund solvent and would be comparable to fee structures in other
states. Any actual fee increase would be required to go through
the regulatory process, according to the Sponsor.
In a January 31, 2012 letter, the DHCC requests that the current
fee ceiling be increased to give DHCC more flexibility to
maintain necessary funds for the functions of the DHCC. The DHCC
states that the proposal is not an actual fee increase, just an
increase to the fee ceiling that the the DHCC may charge for a
biennial license renewal. The fee ceiling has not been modified
for over two decades (1990) and was increased from $30 to $80 at
that time. Some examples of other biennial license renewal fees
in other states are: New York = $128; Maine = $175; and Nevada =
$600.
1.DHCC Fee Bill Worksheet. Included with this analysis is a Fee
Background Information Questionnaire (Questionnaire) which was
completed by the Sponsor and the DHCC. This Questionnaire is
required by the DHCC to justify any fee increases and provide
background information on requested fee increases. The
Questionnaire is to include fund condition statements displaying a
history of past years of actual and five years of projected
expenditures and revenues with (a) current statutory maximum fee
amounts and (b) proposed statutory maximum fee amounts. It also is
to include a schedule of fee revenue by various fee "categories"
SB 1202
Page 9
displaying a history of past years of actual and five years of
projected revenue based on (a) current fees and (b) proposed fees
and includes the workload (e.g., number of licensees) and fee
charged per category. It is to provide a schedule displaying two
years of expenditures by program component. It is to provide a
table of comparison of existing and proposed fees which includes the
percentage by which the fee will change. Lastly, it should provide
the history for the past 10 years of legislative fee increase
authorizations.
The following is a summary of the Board's responses to the
Questionnaire:
a) What is the projected deficit, and what is the cause of the
deficit? The current projected deficit estimate (March 2012) by
the DHCC is $167,000 if no new unforeseen program functions or
mandates arise. In the instance that new program functions or
mandates do arise, the deficit would be greater.
The projected fund deficit will be caused by the DHCC's inability
to generate adequate revenue to maintain fund solvency due to the
progressively higher cost of doing business. With DHCC facing
increased cost from enforcement agencies (i.e., Department of
Justice, Dental Board Investigators, etc.), travel expenses
related to exams and enforcement, contracting with dental schools
to administer the RDH clinical exam, staff salaries and benefits,
departmental costs, and the general cost for office resources,
the current revenue generating modes cannot sustain the DHCC's
fund solvency without additional revenue.
b) Are specific fee categories subsidizing the expenditures of
other categories? Currently, each DHCC program function is
self-sustaining and there is no program function that is
subsidizing another.
c) Comparison of the existing and proposed fees. The bill
proposes to increase the application for an original license from
$50 to $250; a 500% increase. The bill increases the biennial
license renewal fee from $80 to $250; a 312% increase. The bill
increases the fee for curriculum review and site evaluation for
educational programs from $1,400 to $2,100; a 50% increase.
The Questionnaire indicates that the current proposed request for
this legislation does not include any increase in fees. The DHCC
is only requesting to raise the fee ceiling on selected fees in
order to provide flexibility for the DHCC to increase revenue in
SB 1202
Page 10
the future to maintain its fund solvency and to afford the cost
of program functions. One of the primary DHCC revenue-generating
fee categories is the RDH biennial license renewal fee which is
currently at its ceiling of $80.00. The renewal fee ceiling has
not increased in over 20 years; however, the cost of doing
business has increased exponentially over this time period.
2.Related Legislation. SB 853 (Perata, Ch. 31, 2008) created the
Dental Hygiene Committee of California (DHCC) as a separate body
within the Dental Board of California to oversee the many aspects of
dental hygiene with consumer protection being the top priority.
Prior to the creation of the DHCC, dental hygiene issues were
overseen by the Dental Board.
SB 1575 (Business, Professions and Economic Development Committee) is
the Committee's annual health-related omnibus bill in the current
Legislative Session, makes several technical cleanup changes to the
RDH law. This bill will be heard by this Committee on April 23.
3.Arguments in Support. In sponsoring the bill, California Dental
Hygienists Association (CDHA) states that it has seen a need for
clean up language to address several items that have come up since
the DHCC's inception. SB 1202 provides DHCC with the authority
needed to carry out the duties outlined in statute. The bill also
allows RDHAPs, those hygienists who practice in nursing homes,
schools and visit the disabled, to establish mobile dental hygiene
clinics, thereby improving access to oral health care in the
community. CDHA believes that the bill is a pro-consumer measure
that will strengthen the profession as well as provide appropriate
oversight.
The Dental Hygiene Committee of California (DHCC) states that SB 1202
is a clean-up bill that includes language that was inadvertently
left out of SB 853 (Perata) which created the DHCC and other
language needed to clarify and revise existing statute. The DHCC
states, it is critical that the DHCC have the ability to do its
work. This can be done by continuing its mandate of licensing
qualified dental hygienists and allowing the enforcement program to
actively protect California consumers.
4.Proposed Author's Amendments. The Author will be proposing the
following amendments in Committee to clarify that the special permit
allowing a registered dental hygienist from another state to teach
in a California dental hygiene school is subject to renewal every
two years, and to correctly refer to the National Dental Hygiene
SB 1202
Page 11
Board Examination.
Amend page 5, line 20 to read:
(e) Paying an application fee as provided by Section 1944 ;
subject to a biennial renewal fee described in Section 1944 .
Amend page 15, lines 38 to 39 to read:
(k) The initial application and biennial special permit fee is an
amount equal to the biennial renewal fee specified in paragraph
(6) of subdivision (a).
On page 7, lines 9 to 10, and page 8, lines 19 to 20, strike out
"National Board Dental Hygiene Examination" and insert: National
Dental Hygiene Board Examination.
5.Technical Amendment. Committee staff notes the following technical
clarifying amendment:
On page 11, line 16, strike out "has a license and"
SUPPORT AND OPPOSITION:
Support:
California Dental Hygienists Association (Sponsor)
Dental Hygiene DHCC of California
Opposition: None received as of April 4, 2012.
Consultant:G. V. Ayers