BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                 UNFINISHED BUSINESS


          Bill No:  SB 562
          Author:   Galgiani (D)
          Amended:  9/6/13
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM.  :  10-0, 4/22/13
          AYES:  Price, Emmerson, Block, Corbett, Galgiani, Hernandez,  
            Hill, Padilla, Wyland, Yee

           SENATE APPROPRIATIONS COMMITTEE  :  7-0, 4/29/13
          AYES:  De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg

           SENATE FLOOR  :  32-0, 5/6/13 (Consent)
          AYES:  Anderson, Beall, Block, Calderon, Cannella, Corbett,  
            Correa, De León, DeSaulnier, Emmerson, Evans, Fuller, Gaines,  
            Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Knight, Leno,  
            Lieu, Liu, Monning, Nielsen, Padilla, Pavley, Price, Roth,  
            Steinberg, Wright, Wyland
          NO VOTE RECORDED:  Berryhill, Jackson, Lara, Walters, Wolk, Yee,  
            Vacancy, Vacancy

           ASSEMBLY FLOOR  :  76-0, 9/10/13 - See last page for vote


           SUBJECT  :    Dentists:  mobile or portable dental units

           SOURCE :     California Dental Association


           DIGEST  :    This bill requires the Dental Board of California  
          (DBC) to develop registration and operating regulations for  
          mobile dental units and dental practices that routinely use  
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          portable dental units, and deletes restrictions limiting  
          dentists to operating only one mobile dental clinic.  

           Assembly Amendments  clarify the definition of a "mobile dental  
          unit;" require registration for dental practices using portable  
          dental units to provide treatment in nondental office locations;  
          require DBC to promulgations requiring a mobile dental unit or a  
          practice routinely using portable dental units identify a  
          licensed dentists responsible for the unit or practice; and make  
          other technical and clarifying changes.

           ANALYSIS  :    

          Existing law:

          1. Authorizes a dentist to operate a mobile dental clinic or  
             unit that is registered with regulations adopted by the DBC.

          2. Specifies registration requirements for mobile dental clinics  
             or units. 

          3. Under the Mobile Health Care Service Act, requires mobile  
             service units to be licensed by the Department of Health Care  
             Services (DHCS).

          4. Outlines the following specifications: 

             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  
                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  

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                by DHCS 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 DHCS 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.

          5. 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. 

          This bill:   

          1. Requires a dental practice that routinely uses portable  
             dental units to be registered and operated in accordance with  
             regulations to be established by DBC, and prohibits the  
             regulations from preventing or lessening competition in  
             service areas.  

          2. Deletes the restriction on a licensed dentist operating only  
             one mobile dental clinic or unit registered as a dental  
             office or facility. 

          3. Requires DBC to adopt regulations requiring a registrant to  
             identify a licensed dentist responsible for the mobile dental  
             unit or portable practice, and requires the regulations to  
             include, but not be limited to, requirements for availability  
             of follow-up and emergency care, maintenance and availability  
             of provider and patient records, and provision of treatment  
             information to patients and other appropriate parties.  

          4. Exempts portable dental units from requirements related to  
             additional offices, clinics operated by federal entities,  
             federally recognized Indian tribes or tribal organizations,  

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             intermittent clinics, and mobile service units, as specified.

          5. Defines the following terms:

             A.    "Mobile dental unit" means a self-contained facility,  
                which may include a trailer or van, in which dentistry  
                will be practiced that may be moved, towed, or  
                transported from one location to another; and,

             B.    "Portable dental unit" means a self-contained unit  
                housing equipment used for providing dental treatment  
                that is transported to, and used on a temporary basis  
                at, non-dental office locations.

          6. Makes other technical or clarifying changes.

           Background
           
           Nontraditional dental practice settings  .  California regulates  
          the practice of dentistry in many settings beyond the  
          traditional brick-and-mortar office:  

          1.  Mobile service unit  .  A mobile service unit is basically a  
             primary clinic on wheels, typically in a specialized  
             commercial coach.  These units are approved by the Department  
             of Public Health and may provide dental services, in addition  
             to other procedures, but are not regulated by DBC. 

          2.  Mobile dental clinic  .  A mobile dental clinic, or mobile  
             dental unit, is a commercial coach, trailer, van, or other  
             self-contained unit that may appear similar to a mobile  
             service unit, but only provides dental services.  A mobile  
             dental clinic is regulated by DBC, and may be operated by a  
             dentist after receiving a permit from DBC and proving that  
             the unit complies with existing health and safety  
             regulations.  

          3.  Portable dental unit .  A portable dental unit consists of  
             portable dental chair and suitcase-like container housing a  
             collection of dental tools which may be set up to enable a  
             dental professional to perform dental services at various  
             field sites.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    

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          Local:  No

          According to the Senate Appropriations Committee, one-time costs  
          of about $75,000 to $150,000 for DBC to update regulations  
          (State Dentistry Fund).

           SUPPORT  :   (Verified  9/10/13) 

          California Dental Association (source)
          California Academy of Physician Assistants
          California Primary Care Association
          The Children's Partnership


           ARGUMENTS IN SUPPORT  :    According to the author's office,  
          existing law provides DBC 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 DBC 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 DBC's authority over all practice.

          The bill's sponsor, the California Dental Association, states,  
          "Lifting the numerical restriction will encourage access to care  
          by allowing dentists to cover multiple sites with multiple  
          mobile and/or portable units, either themselves or through  
          general supervision of dental hygienists."


           ASSEMBLY FLOOR :  76-0, 9/10/13
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,  
            Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Beth  
            Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,  
            Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,  
            Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,  
            Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,  
            Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel  
            Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,  
            Ting, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams,  
            Yamada, John A. Pérez

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          NO VOTE RECORDED:  Donnelly, Mansoor, Vacancy, Vacancy


          MW:d  9/11/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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