BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 512
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          Date of Hearing:   April 9, 2013

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                              Richard S. Gordon, Chair
                 AB 512 (Rendon) - As Introduced:  February 20, 2013
           
          SUBJECT  :   Healing arts:  licensure exemption.

           SUMMARY  :   Extends the sunset date, from 2014 to 2018, of the  
          California licensure exemption for health care practitioners who  
          are licensed or certified in other states and who provide health  
          care services on a voluntary basis to uninsured or underinsured  
          persons in California, as specified. 

           EXISTING LAW  :

          1)Provides that a physician and surgeon or osteopathic physician  
            and surgeon who practices or attempts to practice medicine in  
            California without a license or certificate is guilty of a  
            public offense punishable by a fine not exceeding $10,000, by  
            imprisonment in the state prison, by imprisonment in a county  
            jail not exceeding one year, or by both fine and imprisonment.  
            (Business and Professions Code (BPC) BPC Section 2052)

          2)Makes it unlawful for any person to practice as a dentist,  
            nurse, optometrist, dental hygienist, physician assistant or  
            vocational nurse without a valid license, certificate or  
            registration issued by the regulatory boards that regulate  
            these professionals. (BPC 1626, 2050, et al.)

          3)Establishes the Chiropractic Initiative Act of California  
            (Initiative Act), approved by voters on November 7, 1922 to  
            regulate the practice of chiropractors.  Requires the Board of  
            Chiropractic Examiners, upon receipt of a specified fee, to  
            issue a license to any person licensed to practice  
            chiropractic in another state, provided that the other state  
            had the same general requirements as California at the time  
            the license was issued, and that the other state grants  
            reciprocal registration. (BPC 1000, et seq.)

          4)Provides that in a state of emergency, as defined, a health  
            care practitioner licensed in another state that offers or  
            provides health care for which he or she is licensed, is  
            exempt from licensure. (BPC 1627.5, 2395, 3502.5, et al.)








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          5)Establishes reciprocity eligibility requirements for certain  
            health care practitioners who are licensed in other states,  
            including physicians and surgeons, nurses, and dentists. (BPC  
            2153.5, 4848, et al.) 

          6)Exempts from state licensure, until January 1, 2014, health  
            care practitioners who are licensed or certified in other  
            states and who provide health care services on a voluntary  
            basis to uninsured or underinsured persons in California. (BPC  
            901)

           FISCAL EFFECT  :   Unknown 

           COMMENTS  :   

           1)Purpose of this bill  . This bill extends to 2018 the sunset  
            date of the California licensure exemption for specified  
            health care practitioners who are licensed or certified in  
            other states and who provide health care services on a  
            voluntary basis to uninsured or underinsured persons in  
            California. Prior legislation from 2010 authorized health  
            providers licensed in other states to do volunteer work in  
            California, but many Department of Consumer Affairs (DCA)  
            healing arts boards have yet to finalize the regulations  
            necessary to effectuate that bill.  This bill is intended to  
            extend the opportunity to volunteer for professionals whose  
            allied California boards have already passed implementing  
            regulations, while giving those boards that have not yet  
            passed regulations more time to do so. This bill is sponsored  
            by the County of Los Angeles.

           2)Author's statement  .  According to the author, "[H]ealing arts  
            boards were required to promulgate regulations before  
            out-of-state practitioners were allowed to volunteer and the  
            boards can also deny permission to the health care provider  
            from volunteering for failure to comply with California's  
            stringent practicing requirements. The Medical Board of  
            California (MBC) promulgated the regulations in August 2012.  
            The regulations, however, were not done in time to allow  
            out-of-state practitioners to volunteer at the CareNow Health  
            Event in Los Angeles last fall. The statute that provided for  
            these regulations now is set to expire. This program needs  
            more time to demonstrate its success."









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           3)Health fair volunteer exemptions  . AB 2699 (Bass), Chapter 270,  
            Statutes of 2010, created a four-year exemption from  
            California licensure for health care practitioners who are  
            licensed or certified in other states and who provide health  
            care services on a voluntary basis to uninsured or  
            underinsured persons in California.  That bill allowed an  
            out-of-state healthcare provider to work in California if his  
            or her license is in good standing and he or she receives  
            permission from, and registers with, the appropriate DCA  
            licensing board.  The entity sponsoring the free health care  
            event is required to notify the appropriate DCA license board  
            and the county health department in writing of the event and  
            maintain a list of its healthcare volunteers.

              a)   Health fair providers  . Remote Area Medical (RAM)  
               Volunteer Corps, based in Tennessee, is a non-profit  
               organization founded in 1985 which has staged hundreds of  
               medical clinics both in the United States and worldwide.   
               RAM provided 19,500 California patients with nearly 46,000  
               vision, dental, and medical services from 2009 to 2011. RAM  
               is planning another event in California for 2013.   

               Care Harbor (previously known asCareNow), a nonprofit  
               supported by the Los Angeles medical, dental and vision  
               professional community, provided services to more than  
               7,400 patients from 2011-2012. Approximately 3,100  
               volunteers provided patients with free dental exams and  
               cleanings, tooth extractions, vision exams and prescription  
               glasses, mammograms, Pap smears, podiatry consultations and  
               more. 

               These events were staffed by California-licensed healthcare  
               professionals. Both organizers believe that they could  
               provide more services if they could attract a greater  
               number of volunteer healthcare professionals, including  
               those licensed in other states. 

              b)   DCA healing arts boards  . Many healing arts boards have  
               promulgated regulations to effectuate AB 2699, but not all.  
                MBC completed its regulations in 2012 and have one  
               application in process for an out-of-state physician and  
               surgeon volunteer. The Dental Board of California has six  
               volunteer dentists approved, and the Board of Optometry and  
               the Acupuncture Board are working on their own regulations.  









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           4)Arguments in support  . The County of Los Angeles states, "There  
            are more than two million uninsured persons in Los Angeles  
            County.  Even with the beginning of health care reform  
            implementation in January 2014, there will still remain a  
            residually uninsured population who will continue to benefit  
            from the health sponsored events, such as the Care Harbor  
            Health Events in Los Angeles.  An extension date of AB 2699  
            will continue to provide access to needed health care and  
            dental services to uninsured and underinsured persons."

           5)Arguments in opposition  . The California Nurses Association  
            states, "The scope of services provided at the free events  
            targeted by the law is broad, and may include several invasive  
            procedures.  Un- and underinsured patients deserve to have the  
            protection of state enforcement when undergoing any  
            procedures.  It is simply unfair to burden un- and  
            underinsured patients with the costs and challenges of suing a  
            practitioner who lives in another state.  These patients  
            should have the same rights as everyone else to seek help from  
            the appropriate state regulatory board if they have been  
            harmed or injured by a healing arts practitioner, or if they  
            believe that the practitioner has otherwise not practiced in  
            accordance with our state laws."

           6)Previous legislation  . AB 2699 (Bass), Chapter 270, Statutes of  
            2010 created a pilot program to allow exemption from  
            California licensure, until January 1, 2014, for health care  
            practitioners who are licensed or certified in other states  
            and who provide health care services on a voluntary basis to  
            uninsured or underinsured persons in California.  

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          Los Angeles County (sponsor)
          Association of California Healthcare Districts

           Opposition 
           
          California Nurses Association
          American Nurses Association of California
           
          Analysis Prepared by  :    Sarah Huchel / B.,P. & C.P. / (916)  








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