BILL ANALYSIS Ó AB 512 Page 1 ASSEMBLY THIRD READING AB 512 (Rendon) As Introduced February 20, 2013 Majority vote BUSINESS & PROFESSIONS 13-0APPROPRIATIONS 16-0 ----------------------------------------------------------------- |Ayes:|Gordon, Jones, Bocanegra, |Ayes:|Gatto, Harkey, Bigelow, | | |Campos, Dickinson, | |Bocanegra, Bradford, Ian | | |Eggman, Hagman, Holden, | |Calderon, Campos, | | |Maienschein, Mullin, | |Donnelly, Eggman, Hall, | | |Skinner, Ting, Wilk | |Holden, Linder, Pan, | | | | |Quirk, Wagner, Ammiano | |-----+--------------------------+-----+--------------------------| | | | | | ----------------------------------------------------------------- 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) 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 Sections 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 AB 512 Page 2 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 Sections 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 Sections 1627.5, 2395, 3502.5, et al.). 5)Establishes reciprocity eligibility requirements for certain health care practitioners who are licensed in other states, including physicians and surgeons, nurses, and dentists. (BPC Sections 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 Sections 901). FISCAL EFFECT : According to Assembly Appropriations Committee, in 2013-14, negligible fee-supported costs to the licensing boards affected. The amount could increase in later years, depending on the number of practitioners and events subject to the bill, but the amounts would still be minor and fee-supported. If boards that have not yet adopted regulations to authorize practitioners to participate in health fairs do so, there could be additional costs to the extent the regulations are not completed prior to current law's sunset. Based on regulations adopted by three boards thus far, costs for further regulations should be minimal and absorbable to the boards. 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 AB 512 Page 3 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." 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 licensing 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. AB 512 Page 4 Care Harbor (previously known as CareNow), 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. 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 AB 512 Page 5 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." Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916) 319-3301 FN: 0000234