BILL NUMBER: AB 496	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 25, 2013
	AMENDED IN ASSEMBLY  APRIL 10, 2013
	AMENDED IN ASSEMBLY  APRIL 2, 2013

INTRODUCED BY   Assembly Member Gordon
    (   Coauthors:   Assembly Members 
 Ammiano   and Atkins   ) 
    (   Coauthors:   Senators   Lara
  and Leno   ) 

                        FEBRUARY 20, 2013

   An act to amend Sections 852, 2198, and 2198.1 of the Business and
Professions Code, relating to medicine.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 496, as amended, Gordon. Medicine: sexual orientation, gender
identity, and gender expression.
   Existing law creates the Task Force on Culturally and
Linguistically Competent Physicians and Dentists. Existing law
requires the Director of Health Care Services and the Director of
Consumer Affairs to serve as cochairs of the task force. Existing law
requires that the task force consist of, among other people, the
Executive Director of the Medical Board of California and the
Executive Director of the Dental Board of California. Existing law
additionally requires the Director of Consumer Affairs, in
consultation with the Director of Health Care Services, to appoint as
task force members, among other people, California licensed
physicians and dentists who provide health services to members of
language and ethnic minority groups and representatives of
organizations that advocate on behalf of, or provide health services
to, members of language and ethnic minority groups. Existing law
required the task force to report its findings to the Legislature and
appropriate licensing boards by January 1, 2003.
   This bill would replace the Director of Health Care Services with
the Deputy Director of the Office of Health Equity, or his or her
designee, as cochair of the task force. The bill would also instead
require the appointment of members to be made in consultation with
the Office of Health Equity. The bill would authorize a designee of
the Director of Consumer Affairs to serve as cochair of the task
force and would authorize designees of the Executive Director of the
Medical Board of California and the Executive Director of the Dental
Board of California to serve as task force members. The bill would
require the licensed task force members and advocate task force
members to be providers of health services to, or advocates on behalf
of, members of language and ethnic minority groups as well as
lesbian, gay, bisexual,  and transgender  
transgender, and intersex  groups. The bill would require the
task force to report its findings to the Legislature and appropriate
licensing boards by January 1, 2016.
   Existing law, the Cultural and Linguistic Competency of Physicians
Act of 2003, establishes the cultural and linguistic physician
competency program which is operated by local medical societies of
the California Medical Association and is monitored by the Medical
Board of California. That voluntary program consists of educational
classes for all interested physicians and is designed to teach
foreign language and cultural beliefs and practices that may impact
patient health care practices and allow physicians to incorporate
this knowledge in the diagnosis and treatment of patients who are not
from the predominate culture in California.  Existing law
also defines "cultural and linguistic competency" for the purposes of
those provisions as meaning cultural and linguistic abilities that
can be incorporated into therapeutic and medical evaluation and
treatment, including understanding and applying the roles that
culture, ethnicity, and race play in diagnosis, treatment, and
clinical care, and awareness of how the attitudes, values, and
beliefs of health care providers and patients influence and impact
professional and patient relations. 
   This bill would additionally require the program to address
lesbian, gay, bisexual,  and transgender  
transgender, and intersex  groups of interest to local medical
societies. The bill would require the training programs to be
formulated in collaboration with California-based lesbian, gay,
bisexual,  and transgender   transgender, and
intersex  medical societies.  The  
   Existing law requires local medical societies to develop and
distribute a survey for language minority patients to measure the
degree of satisfaction with physicians who have taken the educational
classes on cultural and linguistic competency described above. 

   This bill would also require local medical societies to develop
and distribute a similar survey to lesbian, gay, bisexual,
transgender, and intersex patients.  
   Existing law also defines "cultural and linguistic competency" for
the purposes of those provisions as meaning cultural and linguistic
abilities that can be incorporated into therapeutic and medical
evaluation and treatment, including understanding and applying the
roles that culture, ethnicity, and race play in diagnosis, treatment,
and clinical care, and awareness of how the attitudes, values, and
beliefs of health care providers and patients influence and impact
professional and patient relations. 
    This  bill would  also  redefine the
term "cultural and linguistic competency"  as  
to also include  understanding and applying the roles that
 culture, ethnicity, race,  sexual orientation,
gender identity, and gender expression play in diagnosis, treatment,
and clinical care, and  awareness of how the attitudes,
values, and beliefs of health care providers, patients, and society
influence and impact professional and patient relations 
 developing behaviors that increase a patient's satisfaction
  with, and trust in, his or her physicians and health care
institutions  . The bill would also make related technical,
nonsubstantive changes.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 852 of the Business and Professions Code is
amended to read:
   852.  (a) The Task Force on Culturally and Linguistically
Competent Physicians and Dentists is hereby created and shall consist
of the following members:
   (1) The Deputy Director of the Office of Health Equity, or his or
her designee, and the Director of Consumer Affairs, or his or her
designee, who shall serve as cochairs of the task force.
   (2) The Executive Director of the Medical Board of California, or
his or her designee.
   (3) The Executive Director of the Dental Board of California, or
his or her designee.
   (4) One member appointed by the Senate Committee on Rules.
   (5) One member appointed by the Speaker of the Assembly.
   (b) Additional task force members shall be appointed by the
Director of Consumer Affairs, in consultation with the Office of
Health Equity, as follows:
   (1) Representatives of organizations that advocate on behalf of
California licensed physicians and dentists.
   (2) California licensed physicians and dentists who provide health
services to members of language and ethnic minority groups, as well
as lesbian, gay, bisexual,  and transgender  
transgender, and intersex  groups.
   (3) Representatives of organizations that advocate on behalf of,
or provide health services to, members of language and ethnic
minority groups, as well as lesbian, gay, bisexual,  and
transgender  transgender, and intersex  groups.
   (4) Representatives of entities that offer continuing education
for physicians and dentists.
   (5) Representatives of California's medical and dental schools.
   (6) Individuals with experience in developing, implementing,
monitoring, and evaluating cultural and linguistic programs.
   (c) The duties of the task force shall include the following:
   (1) Developing recommendations for a continuing education program
that includes language proficiency standards of foreign language to
be acquired to meet linguistic competency.
   (2) Identifying the key cultural elements necessary to meet
cultural competency by physicians, dentists, and their offices.
   (3) Assessing the need for voluntary certification standards and
examinations for cultural and linguistic competency.
   (d) The task force shall hold hearings and convene meetings to
obtain input from persons belonging to language and ethnic minority
groups, as well as lesbian, gay, bisexual,  and transgender
  transgender, and intersex  groups, to determine
their needs and preferences for having culturally competent medical
providers. These hearings and meetings shall be convened in
communities that have large populations of language and ethnic
minority groups, as well as lesbian, gay, bisexual,  and
transgender   transgender, and intersex  groups.
   (e) The task force shall report its findings to the Legislature
and appropriate licensing boards on or before January 1, 2016.
   (f) The Medical Board of California and the Dental Board of
California shall pay the state administrative costs of implementing
this section.
   (g) Nothing in this section shall be construed to require
mandatory continuing education of physicians and dentists.
  SEC. 2.  Section 2198 of the Business and Professions Code is
amended to read:
   2198.  (a) This article shall be known and may be cited as the
Cultural and Linguistic Competency of Physicians Act of 2003. The
cultural and linguistic physician competency program is hereby
established and shall be operated by local medical societies of the
California Medical Association and shall be monitored by the Medical
Board of California.
   (b) This program shall be a voluntary program for all interested
physicians. As a primary objective, the program shall consist of
educational classes which shall be designed to teach physicians the
following:
   (1) A foreign language at the level of proficiency that initially
improves their ability to communicate with non-English speaking
patients.
   (2) A foreign language at the level of proficiency that eventually
enables direct communication with the non-English speaking patients.

   (3) Cultural beliefs and practices that may impact patient health
care practices and allow physicians to incorporate this knowledge in
the diagnosis and treatment of patients who are not from the
predominate culture in California.
   (c) The program shall operate through local medical societies and
shall be developed to address the ethnic language minority groups, as
well as lesbian, gay, bisexual,  and transgender 
 transgender, and intersex  groups, of interest to local
medical societies.
   (d) In dealing with Spanish language and cultural practices of
Mexican immigrant communities, the cultural and linguistic training
program shall be developed with direct input from physician groups in
Mexico who serve the same immigrant population in Mexico. A similar
approach may be used for any of the languages and cultures that are
taught by the program or appropriate ethnic medical societies may be
consulted for the development of these programs.
   (e) Training programs shall be based and developed on the
established knowledge of providers already serving target populations
and shall be formulated in collaboration with the California Medical
Association, the Medical Board of California, and other
California-based ethnic medical societies, as well as lesbian, gay,
bisexual,  and transgender   transgender, and
intersex  medical societies.
   (f) Programs shall include standards that identify the degree of
competency for participants who successfully complete independent
parts of the course of instruction.
   (g) Programs shall seek accreditation by the Accreditation Council
for Continuing Medical Education.
   (h) The Medical Board of California shall convene a workgroup
including, but not limited to, representatives of affected patient
populations, medical societies engaged in program delivery, and
community clinics to perform the following functions:
   (1) Evaluation of the progress made in the achievement of the
intent of this article.
   (2) Determination of the means by which achievement of the intent
of this article can be enhanced.
   (3) Evaluation of the reasonableness and the consistency of the
standards developed by those entities delivering the program.
   (4) Determination and recommendation of the credit to be given to
participants who successfully complete the identified programs.
Factors to be considered in this determination shall include, at a
minimum, compliance with requirements for continuing medical
education and eligibility for increased rates of reimbursement under
Medi-Cal, the Healthy Families Program, and health maintenance
organization contracts.
   (i) Funding shall be provided by fees charged to physicians who
elect to take these educational classes and any other funds that
local medical societies may secure for this purpose. 
   (j) A survey for language minority patients shall be developed and
distributed by local medical societies, to measure the degree of
satisfaction with physicians who have taken the educational classes
on cultural and linguistic competency provided under this section.
Local medical societies shall also develop an evaluation survey for
physicians to assess the quality of educational or training programs
on cultural and linguistic competency. This information shall be
shared with the workgroup established by the Medical Board of
California.  
   (j) (1) Local medical societies shall develop and distribute a
survey for both of the following groups of individuals to measure the
degree of satisfaction with physicians who have taken the
educational classes on cultural and linguistic competency provided
pursuant to this section:  
   (A) Language minority patients.  
   (B) Lesbian, gay, bisexual, transgender, and intersex patients.
 
   (2) Local medical societies shall also develop an evaluation
survey for physicians to assess the quality of education or training
programs on cultural and linguistic competency provided pursuant to
this section.  
   (3) The information provided by these surveys shall be shared with
the workgroup established by the Medical Board of California
pursuant to subdivision (h). 
  SEC. 3.  Section 2198.1 of the Business and Professions Code is
amended to read:
   2198.1.  For purposes of this article, "cultural and linguistic
competency" means cultural and linguistic abilities that can be
incorporated into therapeutic and medical evaluation and treatment,
including, but not limited to, the following:
   (a) Direct communication in the patient-client primary language.
   (b) Understanding and applying the roles that culture, ethnicity,
race, sexual orientation, gender identity, and gender expression play
in diagnosis, treatment, and clinical care.
   (c) Awareness of how the attitudes, values, and beliefs of health
care providers, patients, and society influence and impact
professional and patient relations. 
   (d) Developing behaviors that increase a patient's satisfaction
with, and trust in, his or her physicians and health care
institutions.