BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1202
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          Date of Hearing:   June 19, 2012

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER 
                                     PROTECTION
                                 Mary Hayashi, Chair
                      SB 1202 (Leno) - As Amended:  May 29, 2012

           SENATE VOTE  :   38-0
           
          SUBJECT  :   Dental hygienists.

           SUMMARY  :   Makes a number of changes regarding the licensure and 
          regulation of registered dental hygienists (RDHs), RDHs in 
          alternative practice (RDHAPs), and RDH's in extended functions 
          by the Dental Hygiene Committee of California (DHCC).   
          Specifically,  this bill  :   

          1)Allows an RDH licensed in another state to teach in a dental 
            hygiene college without being licensed in California if the 
            RDH holds a special permit, and authorizes the DHCC to issue a 
            special permit if the RDH has a contract to teach, has 
            completed specified education and examination requirements, 
            and pays an application fee subject to a biennial renewal fee, 
            as specified.

          2)Allows, rather than requires, the DHCC to approve educational 
            programs accredited by the Commission on Dental Accreditation 
            (CODA) of the American Dental Association (ADA) and deletes 
            language specifying that the programs be in good standing with 
            CODA.

          3)Deletes language allowing DHCC to withdraw or revoke a dental 
            hygiene program approval if CODA has placed the program on 
            probationary status, and instead allows DHCC to withdraw or 
            revoke approval if CODA has indicated intent to withdraw 
            approval or has withdrawn approval.

          4)Requires an applicant for an RDH license to complete 
            DHCC-approved instruction in gingival soft tissue curettage, 
            nitrous oxide-oxygen analgesia, and local anesthesia.

          5)Revises the requirements for issuing a California license to 
            an RDH licensed in another state by: 

             a)   Requiring out-of-state experience to have been obtained 








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               in the five years immediately preceding the application 
               date;

             b)   Expanding information relating to prior disciplinary 
               action, to include any previously issued professional or 
               vocational license (not just a dental hygiene or dental 
               license); and,

             c)   Expanding the types of exams for which an applicant must 
               provide proof of completion and of not failing more than 
               once, to include the examination given by the Western 
               Regional Examining Board (WREB) or any other clinical 
               dental hygiene examination approved DHCC.

          6)Prohibits an applicant for an RDH license who fails the 
            clinical examination three times, or who fails the examination 
            as a result of a single incidence of imposing gross trauma on 
            a patient, from being eligible to take the examination again 
            until the applicant completes remedial education approved by 
            DHCC.

          7)Authorizes an RDHAP to operate a mobile dental hygiene clinic, 
            as specified, and establishes an initial registration fee of 
            up to $150 and a biennial renewal fee of up to $250.

          8)Requires an RDHAP to register his or her place or places of 
            practice with the DHCC within 30 days of licensure, and 
            requires an RDHAP who wishes to have more than one place of 
            practice to apply for DHCC permission and pay an initial fee 
            of up to $250 and a biennial renewal fee of up to $250. 

          9)Allows, rather than requires, DHCC to seek an injunction 
            against an RDHAP who violates a requirement to obtain a 
            prescription prior to rendering services, as specified.

          10)Increases the mandatory continuing education (CE) course 
            requirement to a maximum of 10 hours per renewal period, 
            allows DHCC to adopt by regulation a measure of continued 
            competency as a condition of license renewal, and allows, 
            rather than requires, CE providers approved by the Dental 
            Board of California (DBC) to be deemed approved by DHCC.  

          11)Requires, rather than states legislative intent, that DHCC 
            grant or renew approval of educational programs that maintain 
            high-quality instructional standards and requires approval, 








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            where appropriate, of programs that meet the minimum standards 
            set by CODA or an equivalent body, as determined by DHCC.

          12)Requires a new educational program for RDHs to submit a 
            feasibility study demonstrating a need for a new educational 
            program, and apply for approval from DHCC prior to seeking 
            approval for initial accreditation from CODA or an equivalent 
            body, as determined by DHCC.  DHCC may approve, provisionally 
            approve, or deny approval of any such new educational program.

          13)Defines a new educational program for RDHs to mean a program 
            provided by a college or institution of higher education that 
            is accredited by a regional accrediting agency recognized by 
            the United States Department of Education and that has as its 
            primary purpose providing college level courses leading to an 
            associate or higher degree, that is either affiliated with or 
            conducted by a dental school approved by the DBC, or that is 
            accredited to offer college level or college parallel programs 
            by the CODA or an equivalent body, as determined by DHCC.

          14)Requires an approved dental hygiene educational program to 
            register an extramural dental facility with DHCC, as 
            specified, and defines extramural dental facility to mean any 
            clinical facility that has contracted with an approved dental 
            hygiene educational program for instruction in dental hygiene, 
            that 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.

          15)Increases maximum fee amounts as follows:

             a)   Application for an original license, up to $250 (from 
               $50);

             b)   Biennial license renewal, up to $250 (from $80); and,

             c)   Curriculum review and site evaluation for dental hygiene 
               educational programs, up to $2,100 (from $1,400).

          16)Establishes new maximum fees as follows:

             a)   Issuance of an original license, up to $250;

             b)   Registration of an extramural dental facility, up to 
               $250;








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             c)   Registration of a mobile dental hygiene unit, up to 
               $150;

             d)   Biennial renewal for a mobile dental hygiene unit, up to 
               $250;

             e)   Additional office permit, up to $250;

             f)   Biennial renewal for an additional office, up to $250; 
               and,

             g)   Initial application and biennial renewal for a special 
               permit, equal to the biennial license renewal fee (up to 
               $250).

          17)Makes technical and conforming changes.

           EXISTING LAW  

          1)Licenses and regulates RDHs, RDHAPs, and RDHs in extended 
            functions by DHCC under DBC within the Department of Consumer 
            Affairs (DCA).

          2)Requires DHCC to perform specified functions, including the 
            evaluation of all dental hygiene educational programs that 
            apply for approval.  Any dental hygiene program accredited by 
            and in good standing with CODA is deemed approved by DHCC. 

          3)Establishes requirements an applicant must meet to be issued 
            an RDH license, including completion of specified educational 
            and examination requirements. 

          4)Authorizes DHCC to issue a RDH license to an applicant who has 
            not taken a specified clinical examination, if the applicant 
            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 five 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. 

          5)Authorizes a licensed RDHAP to perform specified functions and 
            procedures in residences of the homebound, schools, 








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            residential facilities, and dental health professional 
            shortage areas.  

          6)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, as 
            specified.  

          7)Authorizes DHCC, as a condition of license renewal, to require 
            licensees to complete up to 7.5 hours of CE per renewal 
            period, as specified.  

          8)Requires CE course providers to be approved by DHCC and 
            specifies that providers approved by DBC shall be deemed 
            approved by DHCC.

          9)Requires DHCC to establish by resolution the amount of fees, 
            subject to specified maximum fee amounts, that relate to the 
            licensees under its jurisdiction.

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author, "Prior to 2008, 
          the dental hygiene profession was overseen by the DBC.  SB 853 
          (Perata) of 2008 created DHCC to be a stand-alone entity to 
          regulate the profession.  Over the last several years, DHCC and 
          the California Dental Hygienists' Association have discovered 
          areas in need of change so that DHCC is best able to oversee the 
          profession.  This is important to consumers so that there is 
          assurance that their dental hygienists are properly trained and 
          licensed.  The bill outlines many key changes and well as 
          opportunities to increase access to care and improve consumer 
          protection."

           Background  .  This bill is a follow-up measure to legislation 
          from 2008, which created the DHCC and shifted oversight of 
          dental hygiene from DBC to DHCC.  It provides a number of 
          changes and updates to the statutes governing the DHCC and its 
          regulatory authority.

          According to the author, educational programs such as dentistry 
          often hire subject experts to teach in their programs.  If a 








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          dental school wants to hire a dentist from another state who is 
          a dental expert in the field to lecture for a semester, they may 
          do so with a special permit.  Currently, dental hygiene programs 
          cannot do the same with out-of-state RDHs because no special 
          permit exists for RDH's.  Establishing a special permit for 
          RDH's will allow dental hygiene programs to contract with 
          subject experts from outside of California to teach in the 
          programs.

          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.  The program must later 
          apply to CODA for full accreditation, but students are allowed 
          to enroll, pay high tuition costs and begin classes without any 
          guarantee that the program will be accredited.  Recently, a 
          preliminary accreditation program closed, leaving students who 
          were one month from graduating with no recourse, no way to 
          graduate and no options to pursue licensure.  Allowing 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 RDH.

          All graduates of California dental hygiene programs have 
          education in extended functions, as it 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 RDH's seeking California 
          licensure, consumers are ensured that all RDH's have met the 
          same standards and training for extended functions.

          WREB provides the national test recognized by DHCC.  This bill 
          clarifies that the applicant must prove he or she has not failed 
          WREB.  Additionally, consumers are protected by requiring 
          clearer licensure requirements for out-of-state RDH's.  
          Out-of-state RDH's 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 








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          applicants are responsible for providing proof that they have 
          not been subject to disciplinary action or monitoring in another 
          state.  This bill also requires that program hours to be used 
          towards licensure must be in the immediately preceding five 
          years.

          These changes will ensure that out-of-state RDH's 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 DHCC ensures that the applicant 
          has not failed the licensure exam.  All California dental 
          hygiene students must pass a clinical licensure exam to be 
          licensed.  This language will ensure that dental hygiene 
          students from other states must also pass a clinical licensure 
          exam.

          This bill requires applicants failing the clinical exam, in 
          which public patients are used, three times or applicants 
          causing gross trauma to provide proof of remediation prior to 
          re-taking the exam.  Consumers need assurance that a student who 
          has previously caused gross trauma during an exam will not do 
          the same in a subsequent exam.

          DHCC 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.

          Currently, all dentists must register their practice location 
          sites with DBC in order to maintain oversight of the additional 
          sites.  Similarly, this bill requires RDHAP's who own their own 
          practices to report all of their registered sights with DHCC.

          This bill increases limit on mandatory CE hours from 7.5 hours 
          to 10 hours and requires courses to measure continued 
          competency.  It also specifies that providers of CE courses who 
          are approved by DBC may be approved by DHCC for dental 
          hygienists.  This language allows DHCC to set standards for 
          continued competency.  Providers of dental hygiene services will 
          be required to take clinical courses that assist them in 
          maintaining clinical competence, so that patients are assured of 








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          receiving quality dental hygiene services.

          This bill also increases the caps on fees DHCC can charge in 
          statute.  These increases give DHCC flexibility to keep its fund 
          solvent and are comparable to fee structures in other states.  
          Any actual fee increase must go through the regulatory process.

           Support  .  The California Dental Hygienists' Association states, 
          "This is a pro-consumer measure that will strengthen the 
          profession as well as provide appropriate oversight.  The bill 
          has no costs to the state and does not increase current fees.  
          SB 1202 increases the fee ceiling that the DHCC may charge for 
          fees in order to fund its activities.  Any actual fee increase 
          must go through the DHCC's public hearing process, of which 
          dental hygienists are full participants.  Any fees that are 
          adjusted would be done so to keep the fund solvent."

          The Dental Hygiene Committee of California writes, "It is 
          critical for DHCC, as well as consumers and licensees, that 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."

           Related Legislation  .  SB 1575 (Business, Professions and 
          Economic Development Committee) makes several technical cleanup 
          changes to the RDH law, in addition to numerous other provisions 
          pertaining to the health care boards within DCA.  This bill is 
          pending in Assembly Business, Professions and Consumer 
          Protection Committee.

           Previous legislation  .  SB 853 (Perata), Chapter 31, Statutes of 
          2008, creates the DHCC as a separate body within DBC to oversee 
          the practice of dental hygiene.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Dental Hygienists' Association (sponsor)
          Dental Hygiene Committee of California
           
            Opposition 
           
          None on file.








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           Analysis Prepared by  :    Angela Mapp / B.,P. & C.P. / (916) 
          319-3301