BILL NUMBER: AB 496 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 25, 2014
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
Section 2190.1 of the Business and Professions Code,
relating to medicine.
LEGISLATIVE COUNSEL'S DIGEST
AB 496, as amended, Gordon. Medicine: continuing medical
education: sexual orientation, gender identity, and gender
expression.
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.
This bill would authorize the accrediting associations to update
these compliance standards, as needed, in conjunction with the
advisory group described above.
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.
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.
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, 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.
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.
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 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.
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 2190.1 of the
Business and Professions Code is amended to read:
2190.1. (a) The continuing medical education standards of Section
2190 may be met by educational activities that meet the standards of
the Division of Licensing and that serve to maintain,
develop, or increase the knowledge, skills, and professional
performance that a physician and surgeon uses to provide care, or
to improve the quality of care provided for
patients, including, to patients. These may include,
but are not limited to, educational activities that
meet any of the following criteria:
(1) Have a scientific or clinical content with a direct bearing on
the quality or cost-effective provision of patient care, community
or public health, or preventive medicine.
(2) Concern quality assurance or improvement, risk management,
health facility standards, or the legal aspects of clinical medicine.
(3) Concern bioethics or professional ethics.
(4) Are designed to improve the physician-patient relationship.
(b) (1) On and after July 1, 2006, all continuing medical
education courses shall contain curriculum that includes cultural and
linguistic competency in the practice of medicine.
(2) Notwithstanding the provisions of paragraph (1), a continuing
medical education course dedicated solely to research or other issues
that does not include a direct patient care component and
or a course offered by a continuing medical
education provider that is not located in this state are
is not required to contain curriculum that
includes cultural and linguistic competency in the practice of
medicine.
(3) Associations that accredit continuing medical education
courses shall develop standards before July 1, 2006, for compliance
with the requirements of paragraph (1). The associations may
develop update these standards
standards, as needed, in conjunction with an
advisory group that has expertise in cultural and linguistic
competency issues.
(4) A physician and surgeon who completes a continuing education
course meeting the standards developed pursuant to paragraph (3)
satisfies the continuing education requirement for cultural and
linguistic competency.
(c) In order to satisfy the requirements of subdivision (b),
continuing medical education courses shall address at least one or a
combination of the following:
(1) Cultural competency. For the purposes of this section,
"cultural competency" means 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. At a minimum, cultural competency is recommended to
include the following:
(A) Applying linguistic skills to communicate effectively with the
target population.
(B) Utilizing cultural information to establish therapeutic
relationships.
(C) Eliciting and incorporating pertinent cultural data in
diagnosis and treatment.
(D) Understanding and applying cultural and ethnic data to the
process of clinical care care, including, as
appropriate, information pertinent to the appropriate treatment of,
and provision of care to, the lesbian, gay, bisexual, transgender,
and intersex communities .
(2) Linguistic competency. For the purposes of this section,
"linguistic competency" means the ability of a physician and surgeon
to provide patients who do not speak English or who have limited
ability to speak English, direct communication in the patient's
primary language.
(3) A review and explanation of relevant federal and state laws
and regulations regarding linguistic access, including, but not
limited to, the federal Civil Rights Act (42 U.S.C. Sec. 1981, et
seq.), Executive Order 13166 of August 11, 2000, of the President of
the United States, and the Dymally-Alatorre Bilingual Services Act
(Chapter 17.5 (commencing with Section 7290) of Division 7 of Title 1
of the Government Code).
(d) Notwithstanding subdivision (a), educational activities that
are not directed toward the practice of medicine, or are directed
primarily toward the business aspects of medical practice, including,
but not limited to, medical office management, billing and coding,
and marketing shall not be deemed to meet the continuing medical
education standards for licensed physicians and surgeons.
(e) Educational activities that meet the content standards set
forth in this section and are accredited by the California Medical
Association or the Accreditation Council for Continuing Medical
Education may be deemed by the Division of Licensing to meet its
continuing medical education standards.
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, 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, 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, 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, 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, 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, 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) (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.