BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                  SB 1202|
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                              UNFINISHED BUSINESS


          Bill No:  SB 1202
          Author:   Leno (D)
          Amended:  8/20/12
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEVELOP COMM  :  9-0, 4/09/12
          AYES:  Price, Emmerson, Corbett, Correa, Hernandez, Negrete 
            McLeod, Strickland, Vargas, Wyland

           SENATE APPROPRIATIONS COMMITTEE  :  7-0, 5/24/12
          AYES:  Kehoe, Walters, Alquist, Dutton, Lieu, Price, 
            Steinberg

           SENATE FLOOR  :  38-0, 5/30/12
          AYES:  Alquist, Anderson, Berryhill, Blakeslee, Calderon, 
            Cannella, Corbett, Correa, De León, DeSaulnier, Dutton, 
            Emmerson, Evans, Fuller, Gaines, Hancock, Harman, 
            Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu, 
            Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio, 
            Simitian, Steinberg, Vargas, Walters, Wolk, Wright, 
            Wyland, Yee
          NO VOTE RECORDED:  Runner, Strickland

           ASSEMBLY FLOOR  :  78-0, 8/23/12 - See last page for vote


           SUBJECT  :    Dental hygienists

           SOURCE  :     California Dental Hygienists Association


           DIGEST  :    This bill makes a number of clean up changes 
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          regarding the licensure and regulation of registered dental 
          hygienists by the Dental Hygiene Committee of California 
          (DHCC); and increases various regulatory fee ceilings.

           Assembly Amendments  (1) delete the provision which provided 
          that the mandatory continuing education requirements not 
          exceed 10 hours per renewal period; (2) delete the 
          provision which specified that providers approved by the 
          Dental Board of California may be deemed approved by the 
          DHCC; (3) delete the provision which authorized the DHCC to 
          adopt by regulation a measure of continued competency as a 
          condition of license renewal; (4) decrease the biennial 
          license renewal fee from $250 to $160; and (5) clarify the 
          fee for certification of licensure not exceed one-half of 
          the renewal fee.

           ANALYSIS  :    Existing law:

           1. Licenses and regulates registered dental hygienists 
             (RDH), registered dental hygienists in alternative 
             practice (RDHAP), and registered dental hygienists in 
             extended functions by the DHCC under the Dental Board of 
             California (DBC) within the Department of Consumer 
             Affairs.

           2. Requires the DHCC to perform specified functions, 
             including, the evaluation of all RDH, RDHAP, and 
             registered dental hygienists in extended functions 
             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. 

           3. Authorizes the DHCC to employ employees and examiners 
             necessary to carry out the functions of the DHCC. 

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

           5. Authorizes the DHCC to issue a RDH license to an 
             applicant who has not taken the specified clinical 
             examination, if the applicant submits certain 
             information including proof that he or she has been in 

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             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. 

           6. Under a general provision, prohibits a Department of 
             Consumer Affairs 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. 

           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.  

           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.  

           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.  

           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.

           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.  

          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 

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             and examination requirements and the payment of an 
             application fee, subject to biennial renewal 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 educational program.

           3. 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.

           4. 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 five 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.

           1. Prohibits an applicant for a RDH license who has failed 
             the 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.

           2. Authorizes a RDHAP to operate a mobile dental hygiene 
             clinic, as specified, and establishes a fee not to 
             exceed $250.


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           3. Requires a RDHAP to register his or her place or places 
             of practice, within 30 days with the DHCC.  

           4. Authorizes a RDHAP to apply for approval of the DHCC to 
             have an additional place of practice, and establishes a 
             biennial renewal fee. 

           5. Authorizes the DHCC to seek an injunction against a 
             violation by a RDHAP of the requirement to obtain a 
             prescription prior to rendering services

           6. Specifies that providing services without a written 
             prescription on the part of a RDHAP shall constitute 
             unprofessional practice and a cause revocation of 
             suspension of the license.

           7. Requires the Committee to grant or renew approval of 
             only those educational programs that meet their 
             standards and, where appropriate, meet the minimum 
             standards set by the commission or an equivalent body, 
             as determined by the committee.

           8. Requires a new educational program for registered 
             dental hygienists, as defined, to also submit a 
             feasibility study demonstrating a need for a new 
             educational program and requires a new educational 
             program to apply to the committee for specified approval 
             prior to seeking initial accreditation from the 
             commission or an equivalent body, as determined by the 
             committee.

           9. Defines "extramural dental facility" to mean any 
             clinical facility that has contracted with 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.

           10.Increases the maximum fee amounts for various fees as 
             follows:


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              A.    Application for an original license, and the fee 
                for issuance of an original license, from $70 to 
                $250.

              B.        Biennial license renewal fee from $80 to 
                $160.

              C.        Curriculum review and site evaluation for 
                dental hygiene educational programs fee from $1,400 
                to $2,100.

           1. Establishes new maximum fees as follows:

              A.    The fee for registration of an extramural dental 
                facility shall not exceed $250.

              B.        The fee for registration of 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 initial application and biennial special 
                permit fee is equal to the biennial license renewal 
                fee.

           1. Specifies the fee for certification of licensure shall 
             not exceed one-half of the renewal fee.

           2. Makes technical, nonsubstantive and conforming changes

           Background
           
          The following is background and reasons for the specific 
          provisions of the bill as indicated by the author:

           1.Special Permits  .  The bill creates a special permit that 
            allows a RDH licensed in another state to teach in a 

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            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.

           2.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.

           3.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 requirements for out-of-state RDHs.  
            Out-of-state licensees who have not practiced for more 

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            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. 

           4.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.

           5.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.

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           6.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.  Similarly, the bill requires RDHAPs, 
            who own their own practices, to report all of their 
            registered sights to the DHCC.

           7.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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  No

          According to the Assembly Appropriations Committee: 

           One-time costs for development and promulgation of 
            regulations and standards related to approval of 
            educational programs, registration of places of practice 
            and mobile clinics for RDH-APs, and registration of 
            extramural dental facilities, as well as workload 
            analysis to support fee increases, in the range of 
            $80,000. 

           One-time costs in the range of $100,000 to modify 
            informational technology (IT) systems to support a number 
            of changes made by this bill. 

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           Likely minor ongoing costs, under $50,000, to manage 
            various new requirements and to exercise the additional 
            authority granted to the committee by this bill. 

           All costs would be funded through the Dental Hygiene 
            special fund. As this bill raises statutory maximum 
            levels for existing fees and creates statutory maximum 
            levels for new fees, additional revenue will not be 
            generated until the committee increases fees by 
            resolution as authorized under existing law. However, 
            additional costs related to this bill are expected to be 
            fully covered by increased fee revenue. 

           SUPPORT  :   (Verified  5/24/12)(unable to reverify at time 
          of writing)

          California Dental Hygienists Association (source) 
          Dental Hygiene Committee of California 


           ASSEMBLY FLOOR  : 78-0, 08/23/12
          AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill 
            Berryhill, Block, Blumenfield, Bonilla, Bradford, 
            Brownley, Buchanan, Butler, Charles Calderon, Campos, 
            Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, 
            Eng, Feuer, Fletcher, Fong, Fuentes, Furutani, Beth 
            Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove, 
            Hagman, Halderman, Hall, Harkey, Hayashi, Hill, Huber, 
            Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue, 
            Bonnie Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell, 
            Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan, 
            Perea, V. Manuel Pérez, Portantino, Silva, Skinner, 
            Smyth, Solorio, Swanson, Torres, Valadao, Wagner, 
            Wieckowski, Williams, Yamada, John A. Pérez
          NO VOTE RECORDED: Donnelly, Roger Hernández

          JJA:nl  8/25/12   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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