BILL ANALYSIS Ó
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|Hearing Date:April 22, 2013 |Bill No:SB |
| |562 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 562Author:Galgiani
As Introduced: February 22, 2013 Fiscal: Yes
SUBJECT: Dentists: mobile or portable dental units.
SUMMARY: Specifies that portable dental units must register with, and
be subject to regulation by, the Dental Board of California in the
same manner that mobile dental clinics or units are currently
regulated.
Existing law:
1) Authorizes the Dental Board of California to license and regulate
those engaged in the practice of dentistry. (BPC § 1601.1)
2) Authorizes a dentist to operate a mobile dental clinic or unit that
is registered with regulations adopted by the Dental Board of
California. (BPC § 1657)
3) Specifies registration requirements for mobile dental clinics or
units. (BPC § 1657)
4) The Mobile Health Care Service Act, requires mobile service units
to be licensed by the State Department of Health Care Services.
(HSC § 1765.101)
5) Outlines the following specifications: (BPC § 1765.150)
a) The mobile unit shall be of sufficient size and shall be
arranged in a manner that is appropriate for the provision of
those health care services that it is licensed to provide.
b) The mobile unit shall be equipped with appropriate
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utilities for the comfort and safety of patients. The Office
of Statewide Health Planning and Development shall review and
approve hospital-provided utility connections for mobile units
that require utility hookups with general acute care hospitals.
c) The mobile unit shall be maintained in good repair and in
a clean and sanitary manner.
d) All proposed modifications to previously approved services
and procedures shall be reviewed and approved by the state
department before they are implemented. Modifications to the
mobile service unit shall be approved by the Department of
Housing and Community Development.
e) The licensee shall report to the department the location
of the site at least 24 hours prior to the operation of a
mobile unit at any site for the first time.
f) Notification shall be waived when the mobile unit operates
at any site for the first time at the request of federal,
state, or local authorities for the purposes of responding to
state or locally declared emergencies, federally declared
emergencies and declared public health emergencies.
6) Requires a licensee using mobile services to maintain written
transfer agreements that shall include, but shall not be limited
to, provisions for communication with, and transportation to, one
or more nearby hospitals and other health facilities as needed to
meet medical emergencies. (HSC § 1765.160 (c))
This bill:
1) Authorizes a dentist licensed by the Dental Board of California to
operate one mobile or portable dental unit.
2) Specifies that a mobile or portable unit shall pay the fees
established by the Dental Board of California.
3) Specifies that regulations regarding mobile or portable dental
units includes the following requirements:
a) Follow-up and emergency care.
b) Maintenance.
c) Availability of provider and patient records and
treatment information for patients and other appropriate
parties.
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FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. The bill is sponsored by the California Dental Association
(CDA). According to the Author, current law provides the Dental
Board of California the authority to regulate mobile dental units,
but did not envision the use of portable equipment, as the statutory
language does not appear flexible enough to provide the same
authority over portable dental units. As Californians rely on the
Dental Board of California to ensure proper consumer protections
through regulations, regardless of location or manner in which those
services are provided, it is imperative to update the statute to
extend the Dental Board of California's authority over all practice.
2.Background.
a) Mobile Units. Primary care clinics are defined as facilities
that directly or indirectly deliver health care services,
including dental services, to patients in an outpatient setting.
In accordance with the scope of services permitted by existing
law, primary care clinics currently operate dental clinics
throughout the state, including mobile health vans. Mobile
service units are licensed by the Department of Health Care
Services pursuant to provisions of the Health and Safety Code and
provide medical, diagnostic and treatment services to help ensure
the availability of health care services for patients who receive
care in remote or underserved areas. Patients, who are served by
mobile units, face significant transportation, language and
economic barriers when accessing health care. For example,
according to the U.S. Surgeon General, California children are 12
times more likely to miss school because of dental problems than
children from higher-income families (Health States Initiative,
2008).
b) Regulation of Mobile Units. Currently, mobile units are
licensed with the Department of Health Care Services and
regulated by the Dental Board of California. According to the
CDA, the regulation of mobile dental units is not robust enough.
Traditionally, mobile units have been operated by non-profit
organizations with the expressed intent of providing services to
underserved areas. Over the past five years, many for-profit
companies have begun sending mobile units to these areas. The
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CDA reports that some of the for-profit units have provided
services exclusively to patients who have insurance and avoided
providing non-reimbursable services to those who do not have
insurance. In response, in 2010, the CDA and the Dental Health
Foundation created an "information kit" for schools to consider
when selecting mobile dental units to provide services to
children at their school. These guidelines were distributed to
school districts throughout California. Another problem noted by
the CDA is that some mobile units provide services but do not
provide coordination of care with a patient's existing dental
provider which may lead to duplication of services.
c) Mobile and Portable Units in Other States. The issue of
regulating mobile and portable units is one that several states
are exploring. For example, in response to concerns about
appropriate parental consent, Arizona State Representative Doris
Goodale has introduced House Bill 2426 which would require double
parental notification before a mobile dental unit can provide
treatment to children; one for routine cleaning and sealants, and
a second for irreversible procedures such as restorations or
extractions.
d) Portable Units. Portable units, are defined as activities
engaged in by licensed dental professionals outside of a mobile
unit, e.g., setting up portable dental equipment in a school
auditorium. These types of services are not covered under the
existing statute that regulates mobile units.
e) Dental Board of California Memo. In August of 2012, the CDA
approached the Dental Board of California to determine if the
Board would adopt regulations that would include portable units
and require units to provide coordination of care services. In a
memo from the Board's legislative and regulatory analyst, the
Board notes that seeking these changes via regulations may
conflict with existing statute and thus a statutory change should
be pursued instead.
3.Arguments in Support. The Sponsor's comments state, "CDA has heard
from dentists that they have had children come into their offices
who have clearly had some basic dental work recently completed, but
the parent does not know who did the work or what exactly was
completed. The community-based dentist must begin again with new
radiographs (which
re-exposes children unnecessarily) and a new treatment plan. Services
that are easy to accomplish have already been provided and billed,
leaving the community-based dentist to provide the care that is more
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complex, time-consuming and costly to provide, without consultation
with the original treating dentist. Further, it is entirely unclear
upon completion of this treatment, how the child will be followed
and who is responsible for ongoing care, as there is no
communication between treating providers. This model places the
burden of treatment on the community dentist, fragments care, and is
not conducive to the child receiving coordinated and appropriate
ongoing care."
4.Related Legislation. SB 1202 (Leno, Chapter 331, Statutes of 2011).
Among other provisions, authorized a registered dental hygienist in
alternative practice to operate a mobile dental hygiene clinic under
certain circumstances if various requirements are met, including the
payment of a fee not to exceed $250.00.
SB 1213 (Ducheny, Chapter 360, Statutes of 2007). Required that
the licensee of a mobile unit operating at a new site report the
location of the site to the department at least 24 hours prior to
the operation at the site, unless this requirement is waived.
AB 2390 (Reyes, Chapter 347, Statutes of 2003). Among other
provisions, exempted certain mobile service units from the
provisions of the Dental Practice Act that regulate mobile dental
clinics, or units and additional places of practice.
AB 2404 (Reyes, Chapter 111, Statutes of 2001). Prohibited the
department from requiring, after the initial licensure, or the
initial approval of the addition to existing licensure of a parent
facility, to operate a mobile service unit, that each site where
the mobile unit operates be licensed or approved by the department
unless the mobile unit will be operating outside of the proposed
area. Specified that a mobile unit shall not operate at any site
unless the site has been reported by the licensee to the department
at least 15 days before the mobile unit's first visit to the site.
Specified that prior to the operation of a mobile unit at any site
for the first time, the licensee shall report the site to local
authorities for purposes of obtaining approvals as provided under
the above provisions.
5.Suggested Amendments.
a) The Author should consider amending the term "portable unit"
to "portable dental operation" in order to more accurately
describe the services being provided.
b) In order to provide consistency, the Author should also
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include a definition of "portable dental operation" and a
definition of "mobile unit" in the bill.
SUPPORT AND OPPOSITION:
Support: None received as of April 4, 2013
Opposition: None received as of April 4, 2013
Consultant: Le Ondra Clark, Ph.D.