Amended in Senate June 25, 2014

Amended in Senate June 25, 2013

Amended in Assembly April 10, 2013

Amended in Assembly April 2, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 496


Introduced by Assembly Member Gordon

(Coauthors: Assembly Members Ammiano and Atkins)

(Coauthors: Senators Lara and Leno)

February 20, 2013


An act to amendbegin delete Sections 852, 2198, and 2198.1end deletebegin insert Section 2190.1end insert of the Business and Professions Code, relating to medicine.

LEGISLATIVE COUNSEL’S DIGEST

AB 496, as amended, Gordon. Medicine:begin insert continuing medical education:end insert sexual orientation, gender identity, and gender expression.

begin insert

Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under the act, a physician and surgeon is required to demonstrate satisfaction of continuing education requirements. Existing law requires all continuing medical education courses on or after July 1, 2006, to contain curriculum that includes cultural and linguistic competency, as defined, in the practice of medicine. Existing law requires accrediting associations to develop standards for compliance with the cultural competency requirement before July 1, 2006, and authorizes the development of these standards in conjunction with an advisory group that has expertise in cultural and linguistic competency issues, as specified.

end insert
begin insert

This bill would authorize the accrediting associations to update these compliance standards, as needed, in conjunction with the advisory group described above.

end insert
begin insert

Existing law, for purposes of these provisions, defines cultural competency as a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. Existing law recommends that this definition, at a minimum, include, among other things, understanding and applying cultural and ethnic data to the process of clinical care.

end insert
begin insert

This bill would expand this recommendation to include, as appropriate, information pertinent to the appropriate treatment of, and provision of care to, the lesbian, gay, bisexual, transgender, and intersex communities.

end insert
begin delete

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.

end delete
begin delete

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, 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.

end delete
begin delete

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.

end delete
begin delete

This bill would additionally require the program to address lesbian, gay, bisexual, 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, transgender, and intersex medical societies.

end delete
begin delete

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.

end delete
begin delete

This bill would also require local medical societies to develop and distribute a similar survey to lesbian, gay, bisexual, transgender, and intersex patients.

end delete
begin delete

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.

end delete
begin delete

This bill would redefine the term “cultural and linguistic competency” to also include understanding and applying the roles that sexual orientation, gender identity, and gender expression play in diagnosis, treatment, and clinical care, and 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.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P4    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 2190.1 of the end insertbegin insertBusiness and Professions
2Code
end insert
begin insert is amended to read:end insert

3

2190.1.  

(a) The continuing medical education standards of
4Section 2190 may be met by educational activities that meet the
5standards of the Division of Licensing andbegin insert thatend insert serve to maintain,
6develop, or increase the knowledge, skills, and professional
7performance that a physician and surgeon uses to provide care, or
8begin insert toend insert improve the quality of care providedbegin delete for patients, including,end deletebegin insert to
9patients. These may include,end insert
butbegin insert areend insert not limited to, educational
10activities that meet any of the following criteria:

11(1) Have a scientific or clinical content with a direct bearing on
12the quality or cost-effective provision of patient care, community
13or public health, or preventive medicine.

14(2) Concern quality assurance or improvement, risk
15management, health facility standards, or the legal aspects of
16clinical medicine.

17(3) Concern bioethics or professional ethics.

18(4) Are designed to improve the physician-patient relationship.

19(b) (1) On and after July 1, 2006, all continuing medical
20education courses shall contain curriculum that includes cultural
21and linguistic competency in the practice of medicine.

22(2) Notwithstanding the provisions of paragraph (1), a
23continuing medical education course dedicated solely to research
24or other issues that does not include a direct patient care component
25begin delete andend deletebegin insert orend insert a course offered by a continuing medical education provider
26that is not located in this statebegin delete areend deletebegin insert isend insert not required to contain
27curriculum that includes cultural and linguistic competency in the
28practice of medicine.

29(3) Associations that accredit continuing medical education
30courses shall develop standards before July 1, 2006, for compliance
31with the requirements of paragraph (1). The associations may
32begin delete developend deletebegin insert updateend insert thesebegin delete standardsend deletebegin insert standards, as needed,end insert in
P5    1conjunction with an advisory group that has expertise in cultural
2and linguistic competency issues.

3(4) A physician and surgeon who completes a continuing
4education course meeting the standards developed pursuant to
5paragraph (3) satisfies the continuing education requirement for
6cultural and linguistic competency.

7(c) In order to satisfy the requirements of subdivision (b),
8continuing medical education courses shall address at least one or
9a combination of the following:

10(1) Cultural competency. For the purposes of this section,
11“cultural competency” means a set of integrated attitudes,
12knowledge, and skills that enables a health care professional or
13organization to care effectively for patients from diverse cultures,
14groups, and communities. At a minimum, cultural competency is
15recommended to include the following:

16(A) Applying linguistic skills to communicate effectively with
17the target population.

18(B) Utilizing cultural information to establish therapeutic
19relationships.

20(C) Eliciting and incorporating pertinent cultural data in
21diagnosis and treatment.

22(D) Understanding and applying cultural and ethnic data to the
23process of clinicalbegin delete careend deletebegin insert care, including, as appropriate, information
24pertinent to the appropriate treatment of, and provision of care
25to, the lesbian, gay, bisexual, transgender, and intersex
26communitiesend insert
.

27(2) Linguistic competency. For the purposes of this section,
28“linguistic competency” means the ability of a physician and
29surgeon to provide patients who do not speak English or who have
30limited ability to speak English, direct communication in the
31patient’s primary language.

32(3) A review and explanation of relevant federal and state laws
33and regulations regarding linguistic access, including, but not
34limited to, the federal Civil Rights Act (42 U.S.C. Sec. 1981, et
35seq.), Executive Order 13166 of August 11, 2000, of the President
36of the United States, and the Dymally-Alatorre Bilingual Services
37Act (Chapter 17.5 (commencing with Section 7290) of Division
387 of Title 1 of the Government Code).

39(d) Notwithstanding subdivision (a), educational activities that
40are not directed toward the practice of medicine, or are directed
P6    1primarily toward the business aspects of medical practice,
2including, but not limited to, medical office management, billing
3and coding, and marketing shall not be deemed to meet the
4continuing medical education standards for licensed physicians
5and surgeons.

6(e) Educational activities that meet the content standards set
7forth in this section and are accredited by the California Medical
8Association or the Accreditation Council for Continuing Medical
9Education may be deemed by the Division of Licensing to meet
10its continuing medical education standards.

begin delete
11

SECTION 1.  

Section 852 of the Business and Professions Code
12 is amended to read:

13

852.  

(a) The Task Force on Culturally and Linguistically
14Competent Physicians and Dentists is hereby created and shall
15consist of the following members:

16(1) The Deputy Director of the Office of Health Equity, or his
17or her designee, and the Director of Consumer Affairs, or his or
18her designee, who shall serve as cochairs of the task force.

19(2) The Executive Director of the Medical Board of California,
20 or his or her designee.

21(3) The Executive Director of the Dental Board of California,
22or his or her designee.

23(4) One member appointed by the Senate Committee on Rules.

24(5) One member appointed by the Speaker of the Assembly.

25(b) Additional task force members shall be appointed by the
26Director of Consumer Affairs, in consultation with the Office of
27Health Equity, as follows:

28(1) Representatives of organizations that advocate on behalf of
29California licensed physicians and dentists.

30(2) California licensed physicians and dentists who provide
31health services to members of language and ethnic minority groups,
32as well as lesbian, gay, bisexual, transgender, and intersex groups.

33(3) Representatives of organizations that advocate on behalf of,
34or provide health services to, members of language and ethnic
35minority groups, as well as lesbian, gay, bisexual, transgender,
36and intersex groups.

37(4) Representatives of entities that offer continuing education
38for physicians and dentists.

39(5) Representatives of California’s medical and dental schools.

P7    1(6) Individuals with experience in developing, implementing,
2monitoring, and evaluating cultural and linguistic programs.

3(c) The duties of the task force shall include the following:

4(1) Developing recommendations for a continuing education
5program that includes language proficiency standards of foreign
6language to be acquired to meet linguistic competency.

7(2) Identifying the key cultural elements necessary to meet
8cultural competency by physicians, dentists, and their offices.

9(3) Assessing the need for voluntary certification standards and
10 examinations for cultural and linguistic competency.

11(d) The task force shall hold hearings and convene meetings to
12obtain input from persons belonging to language and ethnic
13minority groups, as well as lesbian, gay, bisexual, transgender,
14and intersex groups, to determine their needs and preferences for
15having culturally competent medical providers. These hearings
16and meetings shall be convened in communities that have large
17populations of language and ethnic minority groups, as well as
18lesbian, gay, bisexual, transgender, and intersex groups.

19(e) The task force shall report its findings to the Legislature and
20appropriate licensing boards on or before January 1, 2016.

21(f) The Medical Board of California and the Dental Board of
22California shall pay the state administrative costs of implementing
23this section.

24(g) Nothing in this section shall be construed to require
25mandatory continuing education of physicians and dentists.

26

SEC. 2.  

Section 2198 of the Business and Professions Code is
27amended to read:

28

2198.  

(a) This article shall be known and may be cited as the
29Cultural and Linguistic Competency of Physicians Act of 2003.
30The cultural and linguistic physician competency program is hereby
31established and shall be operated by local medical societies of the
32California Medical Association and shall be monitored by the
33Medical Board of California.

34(b) This program shall be a voluntary program for all interested
35physicians. As a primary objective, the program shall consist of
36educational classes which shall be designed to teach physicians
37the following:

38(1) A foreign language at the level of proficiency that initially
39improves their ability to communicate with non-English speaking
40patients.

P8    1(2) A foreign language at the level of proficiency that eventually
2enables direct communication with the non-English speaking
3patients.

4(3) Cultural beliefs and practices that may impact patient health
5care practices and allow physicians to incorporate this knowledge
6in the diagnosis and treatment of patients who are not from the
7predominate culture in California.

8(c) The program shall operate through local medical societies
9and shall be developed to address the ethnic language minority
10groups, as well as lesbian, gay, bisexual, transgender, and intersex
11groups, of interest to local medical societies.

12(d) In dealing with Spanish language and cultural practices of
13Mexican immigrant communities, the cultural and linguistic
14training program shall be developed with direct input from
15physician groups in Mexico who serve the same immigrant
16population in Mexico. A similar approach may be used for any of
17the languages and cultures that are taught by the program or
18appropriate ethnic medical societies may be consulted for the
19development of these programs.

20(e) Training programs shall be based and developed on the
21established knowledge of providers already serving target
22populations and shall be formulated in collaboration with the
23California Medical Association, the Medical Board of California,
24and other California-based ethnic medical societies, as well as
25lesbian, gay, bisexual, transgender, and intersex medical societies.

26(f) Programs shall include standards that identify the degree of
27competency for participants who successfully complete
28independent parts of the course of instruction.

29(g) Programs shall seek accreditation by the Accreditation
30Council for Continuing Medical Education.

31(h) The Medical Board of California shall convene a workgroup
32including, but not limited to, representatives of affected patient
33populations, medical societies engaged in program delivery, and
34community clinics to perform the following functions:

35(1) Evaluation of the progress made in the achievement of the
36intent of this article.

37(2) Determination of the means by which achievement of the
38intent of this article can be enhanced.

39(3) Evaluation of the reasonableness and the consistency of the
40standards developed by those entities delivering the program.

P9    1(4) Determination and recommendation of the credit to be given
2to participants who successfully complete the identified programs.
3Factors to be considered in this determination shall include, at a
4minimum, compliance with requirements for continuing medical
5education and eligibility for increased rates of reimbursement
6under Medi-Cal, the Healthy Families Program, and health
7maintenance organization contracts.

8(i) Funding shall be provided by fees charged to physicians who
9elect to take these educational classes and any other funds that
10local medical societies may secure for this purpose.

11(j) (1) Local medical societies shall develop and distribute a
12survey for both of the following groups of individuals to measure
13the degree of satisfaction with physicians who have taken the
14educational classes on cultural and linguistic competency provided
15pursuant to this section:

16(A) Language minority patients.

17(B) Lesbian, gay, bisexual, transgender, and intersex patients.

18(2) Local medical societies shall also develop an evaluation
19survey for physicians to assess the quality of education or training
20programs on cultural and linguistic competency provided pursuant
21to this section.

22(3) The information provided by these surveys shall be shared
23with the workgroup established by the Medical Board of California
24pursuant to subdivision (h).

25

SEC. 3.  

Section 2198.1 of the Business and Professions Code
26 is amended to read:

27

2198.1.  

For purposes of this article, “cultural and linguistic
28competency” means cultural and linguistic abilities that can be
29incorporated into therapeutic and medical evaluation and treatment,
30including, but not limited to, the following:

31(a) Direct communication in the patient-client primary language.

32(b) Understanding and applying the roles that culture, ethnicity,
33race, sexual orientation, gender identity, and gender expression
34play in diagnosis, treatment, and clinical care.

35(c) Awareness of how the attitudes, values, and beliefs of health
36care providers, patients, and society influence and impact
37professional and patient relations.

38(d) Developing behaviors that increase a patient’s satisfaction
39with, and trust in, his or her physicians and health care institutions.

end delete


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