BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 512|
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THIRD READING
Bill No: AB 512
Author: Rendon (D)
Amended: As introduced
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 10-0, 6/10/13
AYES: Lieu, Emmerson, Block, Corbett, Galgiani, Hernandez,
Hill, Padilla, Wyland, Yee
SENATE APPROPRIATIONS COMMITTEE : 7-0, 6/24/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 74-0, 4/25/13 - See last page for vote
SUBJECT : Healing arts: licensure exemption
SOURCE : Los Angeles County Board of Supervisors
DIGEST : This bill extends the sunset date, from January 2014,
to January 2018, on existing law permitting 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.
ANALYSIS :
Existing law:
1.Provides that a physician and surgeon or osteopathic physician
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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 and/or imprisonment.
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.
3.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.
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.
5.Establishes reciprocity eligibility requirements for certain
health care practitioners who are licensed in other states,
including physicians, surgeons, nurses and dentists.
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.
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.
Background
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
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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.
Free health clinics . Since the passage of AB 2699, there have
been several events held across the state. The Remote Area
Medical (RAM) 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.
Comments
According to the author's office, there are more than two
million uninsured people in Los Angeles County, and even after
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the Affordable Care Act's 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 out-of-state medical
professionals is due to expire at the beginning of January 2014.
This bill is necessary because it extends the sunset on
existing 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Likely one-time costs between $40,000 and $75,000 for the
adoption of regulations by the Acupuncture Board (Acupuncture
Fund).
Likely one-time costs between $40,000 and $75,000 for the
adoption of regulations by the Osteopathic Medical Board
(Osteopathic Medical Board of California Contingent Fund).
Likely one-time costs between $40,000 and $75,000 for the
adoption of regulations by the Naturopathic Medical Committee
(Naturopathic Doctors Fund).
Minor ongoing costs to various licensing boards (various
funds). The boards that have adopted regulations to implement
the existing exemption have had only a few applications to
participate. Extending this program is not likely to result
in significant ongoing workload to the various licensing
boards.
SUPPORT : (Verified 6/24/13)
Los Angeles County Board of Supervisors (source)
Association of California Healthcare Districts
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California State Board of Pharmacy
Medical Board of California
OPPOSITION : (Verified 6/24/13)
American Nurses Association\California
California Nurses Association
ARGUMENTS IN SUPPORT : The bill's sponsor, the Los Angeles
County Board of Supervisors, states, "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 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 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 states, "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 writes, "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
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need, as proposed in this measure."
ARGUMENTS IN OPPOSITION : The California Nurses Association
writes, "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 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 note, "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."
ASSEMBLY FLOOR : 74-0, 4/25/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gordon, Gorell, Gray,
Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Maienschein, Mansoor,
Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,
Nestande, Olsen, Patterson, Perea, V. Manuel Pérez, Quirk,
Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting, Torres,
Wagner, Waldron, Weber, Wieckowski, Wilk, Williams, John A.
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Pérez
NO VOTE RECORDED: Gomez, Lowenthal, Nazarian, Pan, Yamada,
Vacancy
MW:ej 6/25/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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