BILL ANALYSIS Ó SB 1202 Page 1 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status, and instead allows DHCC to withdraw or revoke approval if CODA has indicated intent to withdraw approval or has withdrawn approval. 4)Requires an applicant for an RDH license to complete DHCC-approved instruction in gingival soft tissue curettage, nitrous oxide-oxygen analgesia,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 SB 1202 Page 2 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, SB 1202 Page 3 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; SB 1202 Page 4 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, SB 1202 Page 5 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 SB 1202 Page 6 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 SB 1202 Page 7 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 SB 1202 Page 8 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. SB 1202 Page 9 Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916) 319-3301