BILL ANALYSIS Ó
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|Hearing Date:June 10, 2013 |Bill No:AB |
| |512 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 512Author:Rendon
As Introduced: February 20, 2013 Fiscal:Yes
SUBJECT: Healing arts: licensure exemption.
SUMMARY: Extends the sunset date, from January 2014 to January 2018,
on current law that permits qualified, out-of-state health care
practitioners to volunteer their services on a limited basis at health
care events designed to provide free services for underinsured and
uninsured individuals in California.
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 § 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 seq.)
3)Establishes the Chiropractic Initiative Act of California, 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
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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, a health care practitioner
licensed in another state that offers or provides health care for
which the health care practitioner is licensed is exempt from
licensure. (BPC §§ 1627.5, 2395, 3502.5, et seq.)
5)Establishes reciprocity eligibility requirements for certain health
care practitioners who are licensed in other states, including
physicians, surgeons, nurses and dentists. (BPC §§ 2153.5, 4848, et
seq.)
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)
This bill: Exempts from state licensure, until January 1, 2018,
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.
FISCAL EFFECT: According to the Assembly Appropriations Committee
Analysis dated April 17, 2013, the costs to the affected licensing
boards are anticipated to be negligible. The analysis indicates that
the amount could increase in later years, depending on the number of
practitioners and events, but the amounts would still be minor and
could be supported by fees. If licensing 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 the current law's sunset.
Based on regulations adopted by three boards thus far, costs for
further regulations should be minimal and absorbable.
COMMENTS:
1.Purpose. This bill is sponsored by the Los Angeles County Board of
Supervisors . According to the Author, there are more than two
million uninsured people in Los Angeles County and even after
Affordable Care Act implementation, one million individuals in Los
Angeles County are estimated to remain uninsured. Many individuals
rely on government or non-profit sponsored health events to receive
medical screenings, services and treatment. For example, more than
4,900 people received free medical, vision and dental care during
the four day CareNow clinic event held at the Los Angeles Memorial
Coliseum. The law that allows these health events to use
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out-of-state medical professionals is due to expire at the beginning
of January 2014. AB 512 is necessary because it extends the sunset
on current law that allows qualified, out-of-state practitioners to
volunteer their services on a limited basis for health care events
from January 2014 to January 2018. These free health events are
needed to enable thousands of uninsured and underinsured
Californians to get the care they desperately need.
2.Background. Passage of Assembly Bill 2699 . Prior to the passage of
AB 2699 (Bass, Chapter 270, Statutes of 2010), health care
practitioners, including physician and surgeons, osteopathic
physicians, dentists, physician assistants, nurses and dental
hygienists were required to be licensed in California in order to
practice in the state for any length of time and in any setting.
The only exemptions included health care practitioners who provided
care during a state of emergency upon request by the Director of
Emergency Medical Services Authority, or if a physician and surgeon
who was practicing in another state had been invited by the United
States Olympic Committee (Committee) to provide medical services
during in-state events sanctioned by the Committee.
In 2010, AB 2699 established that health care professionals who were
licensed or certified outside of California were permitted to
provide health care services to underinsured and uninsured
Californians at health care events. These professionals could only
provide these services for up to 10 days. In addition, the law
included a number of provisions to ensure patient safety including:
For Health Care Practitioners:
The practitioner must obtain authorization from the
respective California licensing or certifying board to
participate in the sponsored event.
The practitioner must be in good standing in each state in
which the practitioner is licensed or certified.
The practitioner must not have committed any act or been
convicted of a crime constituting grounds for denial of
licensure or certification.
The practitioner must have the appropriate education and
experience to participate in a sponsored event.
The practitioner whose authorization to provide health
care services has been terminated and is deemed to be
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practicing health care in violation of the law is subject to
any applicable administrative, civil, and criminal fines,
penalties and other sanctions.
For the Sponsors of Health Care Events:
Requires the sponsoring entity seeking to provide, or
arrange for the provision of, health care services to do both
of the following:
o Register with each applicable licensing or
certifying board for which an out of state health care
practitioner is participating in the sponsored event by
completing a registration form.
o Provide the information on the registration form to
the county health department of the county in which the
health care services will be provided.
Requires the sponsoring entity to notify in writing the
licensing or certifying board and the county health department
of any change to the information on the registration form
within 30 calendar days of the change.
Within 15 calendar days of the provision of health care
services, the sponsoring entity must file a report with the
licensing or certifying board and the county health department
on the date, place, type and general description of the care
provided, along with a listing of the health care practitioners
who participated in providing services.
Requires the sponsoring entity to maintain a copy of each
health care practitioner's current license or certification and
shall require each health care practitioner to attest in
writing that his or her license or certificate is not suspended
or revoked pursuant to disciplinary proceedings in any
jurisdiction. The sponsoring entity shall maintain these
records for a period of at least five years following the
provision of health care services and shall, upon request,
furnish those records to the licensing or certifying board or
any county health department.
For the Licensing or Certifying Boards:
Authorizes the board to terminate authorization for a
health care practitioner to provide health care services
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pursuant to this bill for failure to comply with the
requirements of this bill.
Requires the board provide both the sponsoring entity and
the health care practitioner with a written notice of
termination including the basis for that termination.
Allows the board to deny a health care practitioner
authorization to practice without a license if the health care
practitioner fails to comply with the requirements or for any
act that would be grounds for denial of an application for
licensure or certification.
Free Health Clinics . Since the passage of AB 2699, there have been
several events held across the state. The Remote Area Medical
Volunteer Corps is a non-profit organization that has staged
hundreds of medical clinics both in the United States and worldwide.
Over the past four years, RAM conducted health events in Los
Angeles County where volunteer health care practitioners, such as
doctors, nurses, dentists, chiropractors and optometrists provided
various medical services to over 19,000 uninsured and underinsured
residents of the county. Additionally, more than 7,000 people
received free medical, vision and dental care during the four day
CareNow clinic event held at the Los Angeles Memorial Coliseum.
Department of Consumer Affairs Healing Arts Boards . Many healing
arts boards have promulgated regulations to support the enactment of
AB 2699. For example, the Medical Board of California completed its
regulations in 2012 and has 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. Across the healing arts boards that regulate health
care practitioners, there have been no complaints from consumers or
other health care practitioners and no disciplinary action taken
against practitioners for care provided to patients during a
sponsored health care event.
1.Arguments in Support. The Los Angeles County Board of Supervisors
as the sponsors of the bill state that, "Since it has taken a
significant amount of time for the healing arts boards to promulgate
the regulations to allow out-of-state practitioners to volunteer
their services, current law has not had sufficient time to work,
thus the need for the four year extension... There are more than two
million uninsured persons in the Los Angeles County. Even with the
beginning of health care reform implementation in January 2014,
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there will still remain a residually uninsured population who will
continue to benefit from health sponsored events, such as the Care
Harbor Health Events in Los Angeles. An extension of the sunset
date will continue to provide access to needed health care and
dental services to uninsured and underinsured persons."
The Medical Board of California also supports the bill. They state in
their letter, "The Board has already promulgated regulations to
implement existing law, and believes the sunset date should be
extended to allow more individuals to volunteer health care services
at sponsored free health care events in California. The bill will
help to ensure that these health care events have enough providers
to serve more uninsured and underinsured consumers in California,
which furthers the Board's mission of promoting access to care."
The California State Board of Pharmacy notes, "The Board appreciates
the?efforts to ensure Californians' can receive needed and necessary
health care services during states of emergency and at sponsored
health care events."
The Association of California Healthcare Districts supports the bill
when they write, "The majority of California's health care districts
are located in rural areas and many have limited access to qualified
individuals who provide health care services. Although districts do
not directly employ physicians, presenting districts' communities
with access to qualified physicians will only increase access to
health care services during times of need, as proposed in this
measure."
2.Support if Amended. The California Board of Behavioral Sciences
supports the bill if amended. In their letter they write, "The
Board supports the intent of this bill is to provide basic medical,
dental and vision services to the uninsured and underinsured.
However, licensees of the Board of Behavioral Sciences do not
provide these basic services. Instead, they provide psychotherapy
services, which is a long-term process. Therefore, the Board asks
the author to narrow the scope of this bill to exclude the Board of
Behavioral Sciences."
3.Arguments in Opposition. The California Nurses Association opposes
the bill. In their letter they write, "?the law raises serious
patient safety concerns and creates lower standards of care for un
and underinsured patients. Without California licensure,
out-of-state healing arts boards do not have any authority to
regulate or enforce discipline against an out-of-state practitioner
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who harms a patient, or otherwise violates our state's laws. Under
this bill, if a patient is harmed or injured by an out-of-state
practitioner, the state could terminate that practitioner's
authorization to provide care in California, but the only recourse
available to the patient would be to sue." They also note, "As BPC
Section 901's enabling legislation moved through the Legislature in
2010, we raised questions regarding the recruitment process for
these free health care events, and the necessity to recruit
practitioners from other states. These questions remain relevant as
we look toward the full implementation of the Affordable Care
Act?Despite its good intentions, this law limits patient
protections, and creates a lesser standard of care for underinsured
and uninsured patients."
The American Nurses Association/California also opposes the bill.
They note in their letter, "Over the last several years, both the
legislature and administration have focused on improving patient
protection by reforming the way that the state investigates
complaints and enforces discipline against healing arts
practitioners. This law undermines those efforts, as California
practitioners are held to standards designed to protect patients
that would not apply to any of the out-of-state practitioners."
4.Prior Related Legislation. AB 2699 (Bass, Chapter 270, Statutes of
2010) created a pilot program that allowed out-of-state licensed or
certified health care practitioners to provide free health care
services on a short-term, voluntary basis, and without possessing a
California medical license, to uninsured and underinsured
individuals in California. The bill also permitted these
out-of-state medical professionals to provide these services in the
event of a declared state of emergency.
SUPPORT AND OPPOSITION:
Support:
Los Angeles County Board of Supervisors (Sponsor)
Medical Board of California
California State Board of Pharmacy
Association of California Healthcare Districts
Support if Amended:
California Board of Behavioral Sciences
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Opposition:
California Nurses Association
American Nurses Association/California
Consultant:Le Ondra Clark, Ph.D.