BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 705
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          Date of Hearing:   April 9, 2013

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                              Richard S. Gordon, Chair
                  AB 705 (Blumenfield) - As Amended:  April 3, 2013
           
          SUBJECT  :   Combat to Care Act.

           SUMMARY  :   Requires the Board of Registered Nursing (BRN) to  
          promulgate regulations that identify the military education,  
          training, and experience that is equivalent or transferable to  
          coursework required for licensure as a registered nurse (RN)  
          and, upon receipt of an applicant's record of education,  
          training, and experience completed in the Armed Forces, provide  
          the applicant with a list of coursework, if any, that the  
          applicant must complete for license eligibility.  Specifically,  
           this bill  :  

          1)Requires BRN, by January 1, 2015, to promulgate regulations  
            identifying Armed Forces education, training, and experience  
            that is equivalent or transferable to coursework required for  
            RN licensure. 

          2)Requires BRN to provide a veteran applicant qualified as a  
            "medical service technician - independent duty" or the  
            equivalent with a list of coursework, if any, that the  
            applicant must complete to be eligible for RN licensure.

          3)Makes Legislative findings and declarations.

          4)Makes other technical and clarifying amendments. 

           EXISTING LAW  :

          1)Establishes BRN to license and regulate the practice of  
            nursing. (Business and Professions Code (BPC) Section 2701)

          2)Requires all boards regulated under the BPC to provide for  
            methods of evaluating education, training, and experience  
            obtained in the armed services, if applicable to the  
            requirements of the business, occupation, or profession  
            regulated.  (BPC 35)

          3)Requires the rules and regulations of the Department of  








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            Consumer Affairs healing arts boards to provide for methods of  
            evaluating education, training, and experience obtained in  
            military service if such training is applicable to the  
            requirements of the particular profession or vocation  
            regulated by the board. (BPC 710)

          4)Requires, by July 1, 2015, the Chancellor of the California  
            Community Colleges, using common course descriptors and  
            pertinent standards of the American Council on Education, to  
            determine for which courses credit should be awarded for prior  
            military experience. (Education Code Section 66025.7)

          5)Requires BRN to evaluate for RN licensure the training record  
            submitted by any person who has served on active duty in the  
            medical corps of any of the Armed Forces and completed the  
            course of instruction required to qualify him or her for  
            rating as a medical service technician--independent duty, or  
            other equivalent rating in his particular branch, and whose  
            service in the armed forces has been under honorable  
            conditions. (BPC 2736.5) 

          6)Permits a person who has served on active duty in the medical  
            corps of any of the armed forces, in which no less than an  
            aggregate of 12 months was spent in rendering bedside patient  
            care, and who has completed the basic course of instruction in  
            nursing required by his or her particular branch of the armed  
            forces, and whose service in the armed forces has been under  
            honorable conditions to sit for an licensed vocational nurse  
            (LVN) license exam. (BPC 2873.5) 

           FISCAL EFFECT  :   Unknown  

           COMMENTS  :    
           
            1)Purpose of this bill  . This bill would require BRN to develop  
            regulations identifying the specific military coursework,  
            training, and experience that would count towards RN  
            licensure, and also identify any coursework that the RN  
            license applicant lacks. Current law already requires BRN to  
            recognize certain military coursework, training, and  
            experience, but BRN does not appear to be in compliance.  This  
            bill would direct BRN to explicitly conform its regulatory  
            behavior to current law. This bill is author sponsored.   

          2)Author's statement  . According to the author, "The second and  








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            third largest military occupational specialties require  
            high-quality medical training - training that, upon returning  
            to civilian life, veterans have difficulty transferring  
            towards credit for healthcare-related employment. According to  
            the California Employment Development Department, registered  
            nurses currently have more than 100,000 job openings  
            statewide. Recognizing the experience and training of veterans  
            with medical training as credit towards a nursing license  
            would help fill these much-needed healthcare positions with  
            highly trained veterans." 

           3)Issues with existing law and compliance  . Several laws already  
            in effect require BRN to develop regulations that establish  
            criteria for evaluating military experience and training  
            towards RN licensure. The statute that this bill amends  
            explicitly directs BRN to evaluate the records of military  
            personnel who are designated as a "medical service  
            technician-independent duty," or the equivalent thereof, for  
            RN licensure. A "medical service technician-independent duty"  
            translates most directly to a LVN or physician assistant (PA)  
            civilian license, although there is coursework that is  
            applicable toward licensure as an RN. It is unclear whether  
            the regulations developed by BRN sufficiently aid veterans  
            toward licensure as a RN as directed by statute.      

            Until 2000, there were parallel training requirements in the  
            military and civilian worlds to qualify for the RN license  
            examination. BRN adopted regulations in 1976 and 1985 that  
            specifically identified military titles and supplemental  
            experience that would be exhaustive of BRN requirements.  In  
            2000, BRN determined that the military coursework had changed  
            and was no longer directly transferrable.  BRN then updated  
            the regulations for evaluating military training to be broadly  
            descriptive, which made identifying any specific relevant  
            military coursework difficult. BRN has not evaluated military  
            coursework since, although the board reports they were told by  
            military representatives in 2010 that the military does not  
            have a directly comparable RN training program. 
                
            4)Delegation of evaluation duties from BRN to the schools.   As  
            noted above, current law requires BRN to evaluate military  
            education and training regardless of whether military and  
            civilian programs are identical.  These laws are designed to  
            help military applicants identify what coursework and  
            experience completed in the military is transferrable so that  








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            military applicants do not duplicate their efforts in pursuit  
            of licensure.   
             
            According to BRN, it has effectively delegated the duty of  
            identifying eligible military coursework to approved RN  
            programs, for which BRN is required to approve the curriculum.  
             However, according to the Executive Director (ED), BRN does  
            not know to what extent, if any, schools are providing credit  
            for military experience and education.  The ED stated that BRN  
            has never spoken to schools about accepting military  
            coursework and experience for credit, nor has BRN suggested  
            which military coursework may be transferrable.  This raises a  
            concern about compliance, because those schools may not have  
            sufficient incentives to accept military credit because it  
            would cause students to spend less time and money (especially  
            lucrative GI Bill funding) on their programs. 

            In lieu of BRN providing any direct assistance to military  
            applicants, BRN directs applicants to the Board of Vocational  
            Nurses and Psychiatric Technicians (BVNPT). BVNPT has  
            identified a direct pathway to licensure as a vocational nurse  
            from military service.  If a military applicant is lacking  
            coursework, BVNPT identifies which courses they need to be  
            eligible to sit for the licensing exam. BRN noted that after  
            gaining LVN licensure - credited in part to their military  
            training - the military applicant could take a LVN to RN  
            "bridge" program, which supplements the applicant's LVN  
            training to be eligible for the RN exam. 
              
            BRN insists that they are helping military applicants by  
            rerouting them towards LVN licensure so they can get a job as  
            soon as possible, but if a military applicant wants to become  
            an RN directly, BRN has little information to give.  BRN does  
            not have any information what additional coursework applicants  
            may need based on their military transcripts, about which  
            schools (if any) give credit to military education and  
            experience, and which schools give more credit to military  
            coursework than others. BRN does, however, provide assistance  
            to non-military applicants. Upon receipt of a inadequate  
            application from an out-of-state or international applicant  
            for licensure, BRN reports that it notifies the applicants of  
            his or her transcript deficiencies and recommends supplemental  
            coursework. BRN did not offer an explanation for the  
            discrepancy.  









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            This bill directs BRN to reassert itself as the central  
            authority for RN licensure requirements so that military  
            applicants may go to one location to understand what further  
            education they may need based on their military training and  
            experience. 

           5)Question for the Committee  .  The Committee may wish to inquire  
            of BRN as to the deficiencies, if any, in existing law that  
            prevents BRN from effectuating the letter and spirit of the  
            statutes already in place directing BRN to aid veteran  
            applicants.  

          6)Related Legislation  . AB 555 (Salas) directs the Legislature,  
            via intent language, to enact legislation that would  
            streamline the licensure process of various professions and  
            vocations for veterans and members of the military separating  
            from service. That bill is in the Assembly Business,  
            Professions and Consumer Protection Committee.  

             AB 704 (Blumenfield) would require the Emergency Medical  
            Services Authority to develop and adopt regulations to accept  
            military education, training, and practical experience toward  
            the qualifications and requirements for EMT-I certification,  
            EMT-II certification, or EMT-P licensure, as specified. That  
            bill is in the Assembly Business, Professions and Consumer  
            Protection Committee.  
           
            AB 851 (Logue) would require the Dental Board of California  
            (DBC) to accept education, training, and practical experience  
            completed by an applicant in military service toward the  
            qualifications and requirements to receive a license or  
            certificate if that education, training, or experience is  
            equivalent to the standards of the board. If DBC accredits or  
            otherwise approves schools offering educational course credit  
            for meeting licensing and certification qualifications and  
            requirements, the bill would, not later than July 1, 2014,  
            require those schools seeking accreditation or approval to  
            have procedures in place to evaluate an applicant's military  
            education, training, and practical experience toward the  
            completion of an educational program that would qualify a  
            person to apply for licensure or certification, as specified.  
            That bill is in the Assembly Business, Professions and  
            Consumer Protection Committee.  
             
            AB 859 (Gomez) would state the intent of the Legislature to  








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            enact legislation that would promote and pursue programmatic  
            changes to nursing and paramedic licensure requirements for  
            California's military medical personnel in order to recognize  
            the talent, skills, and training of these military medical  
            personnel. That bill is in the Assembly Rules Committee.  
             
            AB 1057 (Medina) would require each BPC board to inquire in  
            every application for licensure if the applicant is serving  
            in, or has previously served in, the military. That bill is in  
            the Assembly Business, Professions and Consumer Protection  
            Committee.  

          7)Previous Legislation  . AB 1976 (Logue) of 2012 would have  
            required healing arts boards within DCA, as well as  
            professional licensure programs within the Department of  
            Public Health (DPH), to accept military training towards  
            licensure requirements, as applicable, and would have required  
            boards that accredit schools to ensure schools have procedures  
            in place to accept military training. That bill was held in  
            the Assembly Appropriations Committee. 

            AB 1932 (Cook) of 2012 would have required DCA healing arts  
            boards to issue a written report to the California Department  
            of Veterans Affairs by Jan. 1, 2014 detailing the methods for  
            evaluating the education, training, and experience obtained by  
            applicants in military service and whether that education,  
            training, and experience is applicable to the boards'  
            requirements for licensure.  That bill was held in the Senate  
            Rules Committee.   

            AB 2659 (Blumenfield) Chapter 406, Statutes of 2012 permits  
            the Department of Motor Vehicles (DMV) to waive the driving  
            skills test required to obtain a commercial driver's license  
            (CDL) for a person with a U.S. Armed Forces military driver's  
            license in compliance with federal regulations. 

            SB 289 (Ed Hernandez) Chapter 352, Statutes of 2012, clarifies  
            that DPH has the authority to approve certain clinical  
            laboratory scientist training programs owned and operated by  
            the United States military that are at least 52 weeks long.   

           8)Double-referral  . This bill is double-referred, and if passed  
            by this Committee, it will be referred to the Veterans Affairs  
            Committee. 









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           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California Association of County Veterans Service Officers
          Vietnam Veterans of America - California State Council

           Opposition 
           
          None
           
          Analysis Prepared by  :    Sarah Huchel / B.,P. & C.P. / (916)  
          319-3301