BILL ANALYSIS Ó
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|Hearing Date:April 28, 2014 |Bill No:SB |
| |1246 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: SB 1246Author:Lieu
As Amended:April 23, 2014 Fiscal: Yes
SUBJECT: The Acupuncture Board.
SUMMARY: Extends the sunset date for the California Acupuncture Board
(CAB) until January 1, 2017; grants the CAB authority to employ
personnel until January 1, 2017; specifies that any executive officer
appointed on or after January 1, 2015 shall not have served as an
executive officer for the CAB prior to January 1, 2015; requires
educational and training programs to be accredited by the
Accreditation Commission for Acupuncture and Oriental Medicine
commencing January 1, 2017.
Existing law:
1) Provides for the licensure and regulation of the practice of
acupuncture by the CAB within the Department of Consumer Affairs
(DCA). (Business and Professions Code (BPC) § 4928 et seq.)
2) Establishes the CAB until January 1, 2015 and renders the CAB
subject to review by the appropriate policy committees of the
Legislature. (BPC § 4928)
3) Permits the CAB, with the approval of the Director of the DCA, to
employ personnel and appoint an executive officer until January 1,
2015. (BPC § 4934)
4) Grants the CAB authority to establish standards for the approval of
schools and colleges offering education and training in the
practice of acupuncture, including standards for the faculty in
those schools and colleges and tutorial programs. (BPC § 4939 et
seq.)
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5) Allows the CAB to charge a fee for the inspection or re-inspection
of a school or college of acupuncture for purposes of approval and
permits the CAB to recover the direct costs incurred by the CAB in
conducting the inspection and evaluation of the school or college.
(BPC § 4973)
This bill:
1) Extends the CAB until January 1, 2017.
2) Extends the CAB's authority, with the approval of the Director of
the DCA, to employ personnel until January 1, 2017.
3) Specifies that the CAB, with the approval of the Director of the
DCA, may appoint an executive officer on January 1, 2015.
4) Further specifies that the executive officer shall not have served
as the executive officer of the CAB at any time prior to January 1,
2015.
5) Defines "approved educational and training programs" as a program
approved by the CAB until January 1, 2017.
6) Repeals the CAB's authority to establish standards for the approved
educational and training programs and charge fees for the approval
of schools or colleges commencing January 1, 2017.
7) Requires that approved educational and training programs be
accredited by the Accreditation Commission for Acupuncture and
Oriental Medicine commencing January 1, 2017.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1. Purpose. This bill is one of six "sunset review bills" authored by
the Chair of this Committee. This bill provides for the CAB to be
reviewed by the appropriate policy committees of the Legislature,
and makes legislative changes regarding the CAB recommended in the
Committee's Background Paper.
2. Oversight Hearings and Sunset Review of Licensing Boards and
Commission of DCA. In 2014, the Senate Business and Professions
Committee and the Assembly Business, Professions and Consumer
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Protection Committee (Committees) conducted joint oversight
hearings to review 9 regulatory entities: Bureau of Automotive
Repair; Bureau of Home Furnishings and Thermal Insulation; Bureau
for Private Postsecondary Education (BPPE); California Massage
Therapy Certification program; California Acupuncture Board;
California Tax Preparers Program; Dental Hygiene Committee of
California; Professional Fiduciaries Bureau; and Structural Pest
Control Board. This Committee also reviewed the performance and
effectiveness of the Community Interest Development Manager's
Certification Program.
The Committees began their review of the aforementioned licensing
agencies in March and conducted two days of hearings and then more
recently held a hearing on the BPPE. This bill, and the
accompanying sunset bills, are intended to implement legislative
changes as recommended by staff of the Committee's which are
reflected in the Background Papers prepared by Committee staff for
each bureau and program reviewed for this year.
3. Background. Review of the CAB, Issues Identified and Recommended
Changes. The following are some of the major issues pertaining to
the CAB or areas of concern reviewed and discussed by the Committee
during the review of the CAB, along with background information
concerning each particular issue. Recommendations were made by
Committee staff regarding the particular issues or problem areas
which needed to be addressed.
a) Issue : National Accreditation.
Background . The CAB approves training programs at acupuncture
schools and colleges, in particular their curriculum programs, to
ensure they meet the standards adopted by the CAB. The school
approval process requires review of the application, governance,
program curriculum, catalogs, admission policies, student and
faculty policies and procedures, and financial solvency. An
on-site visit is also performed to review implementation of
policies and procedures, facilities and clinical training. It is
rare practice for health care licensing boards, under the DCA, to
approve schools versus utilize a national accreditation
organization to approve health care training programs .
The ACAOM is the nationally recognized accrediting agency for the
field of acupuncture and oriental (Asian) medicine. While many
other states defer to ACAOM accreditation as being a sufficient
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condition for applicants to take the licensing exam in their
states, California does not accept accreditation by ACAOM, nor
does it require graduation from an accredited school as a
condition of being eligible to take the licensing exam. Instead,
it conducts its own school approval process.
In 2004, the Little Hoover Commission (LHC) conducted a
comprehensive comparative analysis of the school approval process
of the ACAOM, to the school approval process of the CAB. The
LHC's report concluded that the processes used by ACAOM appeared
to be superior to the school approval process used by the CAB and
could be used by the state to ensure the quality of education for
potential licensees.
According to the Committee's 2014 Sunset Review Background Paper,
because California performs its own school approvals, there are a
number of consequences and problems. These include:
1) Students who are educated in accredited schools that
are not approved by California receive only partial credit
for their training. If they wish to gain licensure in
California, they must complete a CAB approved training
program.
2) The CAB is slow to approve applications for
schools located outside of California due to budget
constraints.
3) The CAB has recently begun conducting site visits.
However, because of staff vacancies, this has been a slow
process.
In the Committee's 2012 Sunset Review Background Paper to the
CAB, the Committee wrote:
"?It should also be required that these acupuncture schools
either have currently, or obtain within a reasonable time,
accreditation from an accrediting agency recognized by the
United States Department of Education. Especially since the
accrediting process for these schools appears to be superior
to that of the Board. At some time in the future,
consideration could be given, based on the success of
accreditation of these schools, to eliminating the Board's
responsibility and need for approving acupuncture
educational programs."
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[ The current language in this measure reflects this recommended
change .]
a) Issue: Continued Regulation by the CAB.
Background : The health, safety and welfare of consumers are
protected by a well-regulated acupuncture profession. According
to a review of past Sunset Review Background Papers, it is
evident that the current CAB members inherited a program with
little to no infrastructure and no institutional knowledge was
passed down from prior CAB staff. In recognition of this,
Committee staff has reached out to the Executive Officer of the
CAB in an effort to ensure that the Executive Officer
communicates to the CAB and CAB staff the importance of
addressing the concerns that were highlighted during the 2012 and
prior Sunset Review Hearings. It appears as if several of these
recommendations remain unaddressed; thus, in the Committee's 2014
Sunset Review Background Paper, the Committee directed the CAB to
immediately focus its attention on addressing specific critical
areas of deficiency and return to update the Committee's on the
CAB's progress at the next Sunset Review Hearing in 2016.
Recommendation : The CAB should be continued with a two-year
extension of its sunset date.
[ The current language in this measure reflects this recommended
change .]
1. Current Related Legislation. SB 1242 (Lieu, 2014) amends the
Automotive Repair Act and updates the sunset provisions for the
Bureau of Automotive Repair. ( Status : This bill will also be heard
before the BP&ED Committee during today's hearing.)
SB 1243 (Lieu, 2014) Extends until January 1, 2017, the term of the
Veterinary Medical Board, which provides for the licensing and
registration of veterinarians and registered veterinary technicians
and the regulation of the practice of veterinary medicine by the
Veterinary Medical Board. The bill also extends the terms of the
executive officer of the Veterinary Medical Board. This bill also
extends to January 1, 2019, the law regulating the practice of
common interest development managers, and the law establishing the
California Tax Education Council, which provides for the Council to
register and regulate tax preparers. This bill also subjects the
board and organizations to be reviewed by the appropriate policy
committees of the Legislature. ( Status : This bill will also be
heard before the BP&ED Committee during today's hearing.)
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SB 1244 (Lieu, 2014) Extends until January 1, 2019 the term of the
Structural Pest Control Board which provides for the licensing and
regulation of individuals and business involved in the structural
pest control industry in California. The bill also extends the
term of the Board's executive officer and subjects the Board to be
reviewed by the appropriate policy committees of the Legislature.
( Status : This bill will also be heard before the BP&ED Committee
during today's hearing.)
SB 1245 (Lieu, 2014) Extends until January 1, 2019 the term of the
Dental Hygiene Committee of California which provides for the
licensing and regulation of dental hygienists. The bill also
extends the term of the Committee's executive officer and subjects
the Committee to be reviewed by the appropriate policy committees
of the Legislature.
( Status : This bill will also be heard before the BP&ED Committee
during today's hearing.)
SB 1247 (Lieu, 2014) Extends until January 1, 2019 the term of the
California Private Postsecondary Education Act of 2009, which
provides for the regulation of private postsecondary educational
institutions by the Bureau for Private Postsecondary Education in
the Department of Consumer Affairs. The bill also extends the
term of the Student Tuition Recovery Fund under the administration
of the bureau, and subjects the Bureau to review by the appropriate
policy committees of the Legislature. ( Status : This bill will also
be heard before the BP&ED Committee during today's hearing.)
2. Arguments in Support. The Council of Colleges of Acupuncture and
Oriental Medicine support the bill and write in their letter, "The
Council has been the national membership association for
acupuncture and Oriental colleges and programs in the U.S. since
1982. The mission of the Council is to advance acupuncture and
oriental medicine by promoting educational excellence in the field.
The current membership of the Council is 54 colleges, of which 26
are currently approved by the California Acupuncture Board through
the board's independent school approval process. The Council's
member colleges, all of which have been approved in accordance with
ACAOM's national accreditation standards, believe that the quality
of acupuncture education for students, patient safety, and consumer
protection are best maintained by acupuncture educational
institutions participating in an accreditation process with a USDE
recognized accreditor such as ACAOM. Accreditation protects
patients, students, and the profession by ensuring that graduates
are well qualified as entry-level practitioners able to sit for
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licensing and certification exams."
The National Certification Commission for Acupuncture and Oriental
Medicine points out in their letter that nationwide, every state
with an acupuncture practice act requires ACAOM accredited
education- the sole outlier is California.
Five Branches University supports the bill and writes in their
letter, "Our university [is concerned] about the continuing failure
of the CAB to address the useful recommendations of the Senate
Committee?we would like to see a responsible Acupuncture Board in
California that meets the same rigorous requirements of other
health profession Boards [which] require accreditation of schools."
The California State Oriental Medicine Association is California's
largest English-language professional association of licensed
acupuncturists. CSOMA has represented acupuncture and Oriental
medical providers across the state for more than two decades.
CSOMA shared their support of the move to national accreditation
instead of the CAB's school approval process in their letter,
"?require applicants for licensure under the Acupuncture Board to
graduate from a program that has achieved candidacy or
accreditation by an accrediting agency recognized by the U.S.
Department of Education as an authority for the equality of
education and training in acupuncture and Oriental medicine."
The Southern California University of Health Sciences (SCUHS)
writes, "SCUHS urges you to require the CAB to adopt CAB approved
schools to be accredited by an accreditation agency recognized by
the United Stated Department of Education. A USDE recognized
accreditation agency will strengthen the oversight of acupuncture
schools by a rigorous review process that includes a periodic and
comprehensive self-study with peer review and a site visit process
by highly qualified educators. In addition, accreditation process
has well-articulated standards that examine all aspects of an
institution from governance to faculty and curriculum. By
requiring accreditation of CAB approved schools, the student is
protected as a consumer because the state is no longer approving
unaccredited institutions. These unaccredited institutions do not
have the same imperative to offer high quality programs. When a
student graduates from a non-accredited but CAB-approved
acupuncture program, the qualification that she or he has cannot be
universally transferred to another state. In other words, graduates
from CAB approved but non-accredited programs may not practice in
states that require graduation from an accredited program."
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Both the Atlantic Institute of Oriental Medicine and the Southwest
Acupuncture College also support the bill and write in their
letters, "In spite of the clear language of these recommendations
from the Committee, the CAB has not only failed to implement the
recommendations, but has even refused to put the recommendations on
any CAB meeting agenda?members of the [public] recently attended
CAB committee meetings last Friday, April 18, 2014?At none of these
meetings were the recommendations of the Senate Committee on the
agenda, nor were the [members of the public] allowed to bring up
the recommendations for consideration at these meetings."
The Pacific College of Oriental Medicine and the National College
of Natural Medicine supports the bill and writes, "It is clear that
the CAB is not demonstrating interest in considering, let alone
implementing, the Senate committee's sunset review recommendations,
and is pursuing its own agenda? this was evident at the April 18,
2014 meeting in a recommendation from the CAB [Executive Officer]
that the budget of the board and the size of its staff be
substantially increased so that the board itself will have the
capacity to perform accreditation and examination functions that
the board has for some time been unable to perform, but which are
already being performed by [national testing and accreditation
organizations] at a high level."
The University of East-West Medicine also supports the bill and
writes, "The failure of the CAB to consider the Senate committee's
recommendations reflects the unwillingness of the board to move
forward with the sunset recommendations?Please take immediate and
decisive action to mandate adherence by the CAB to your committee's
recommendations."
Yo San University supports the bill and writes, "The Yo San
University community of students, faculty, staff, alumni and clinic
patients express deep concern regarding the continuing failure of
the CAB to implement the Sunset Review recommendations of your
Senate committee?The recommendations from the Committee were
clearly articulate, and the CAB has not only failed to implement
them, they have even refused to put the recommendations on the CAB
meeting agenda."
The American College of Traditional Chinese Medicine supports the
bill and writes, "The purpose of this letter is to offer our
continued strong support for the incorporation of accreditation by
an accreditor recognized by the United States Department of
Accreditation?We support the mission of the CAB to 'protect,
benefit and inform the people of California by exercising the
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licensing, regulatory and enforcement mandates of the Acupuncture
Licensure Act.' We feel that incorporation of accreditation?will
strengthen the ability of the CAB to meet its mission."
South Baylo University supports the bill and writes, "We express
our concern about the implementation of the Sunset Review
recommendations of this Senate committee by the California
Acupuncture Board?So far, the CAB has failed to implement the
recommendations and did not put the recommendations on any of the
CAB meeting agendas. Because the CAB has postponed considering the
Senate committee's recommendations, which reflects the delay of the
board to move forward with the sunset recommendations, South Baylo
University asks that the committee closely follows up the adherence
by the CAB to the committee's recommendations."
The Oregon College of Oriental Medicine writes, "Considering the
CAB's demonstrated difficulty with approving schools and the
significant amount of resources that it requires for the CAB to
oversee this process, the CAB should act on recommendations made
during prior Sunset Review Hearings and?require all schools of
acupuncture to obtain accreditation from an agency approved by the
U.S. Department of Education?Accreditation is a process for
continuous improvement that is virtually universal in higher
education. By California requiring accreditation, the state will
ensure that all programs operating in the state or sending
candidates to the state provide a high quality training program
that protects patients and students."
SUPPORT AND OPPOSITION:
Support:
Atlantic Institute of Oriental Medicine
American College of Traditional Chinese Medicine
California State Oriental Medical Association
Council of colleges of Acupuncture and Oriental Medicine
Five Branches University
National Certification Commission for Acupuncture and Oriental
Medicine
National College of Natural Medicine
Oregon College of Oriental Medicine
Pacific College of Oriental Medicine
South Baylo University
Southern California University of Health Sciences
Southwest Acupuncture College
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University of East-West Medicine
Yo San University of Traditional Chinese Medicine
Over 60 licensed acupuncturists
Over 120 acupuncture students
2 individuals
Opposition:
2 licensed acupuncturists
Consultant:Le Ondra Clark, Ph.D.