BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1246
                                                                  Page  1

          Date of Hearing:   June 24, 2014

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                               Susan A. Bonilla, Chair
                     SB 1246 (Lieu) - As Amended:  June 15, 2014

           SENATE VOTE  :   33-0
           
          SUBJECT  :   Acupuncture.

           SUMMARY  :   Extends the sunset date of the California Acupuncture  
          Board (CAB) to January 1, 2017, revises acupuncture program  
          approval requirements, and specifies that any executive officer  
          (EO) appointed on or after January 1, 2015 shall not have served  
          as an executive officer for the CAB prior to January 1, 2015.   
          Specifically,  this bill  :   

          1)Extends the sunset date for the CAB and its duties until  
            January 1, 2017.

          2)Defines an "approved educational and training program" to mean  
            a program approved by the CAB under current standards, until  
            January 1, 2017. 

          3)Removes "tutorial programs" from those entities for which CAB  
            is required to establish standards for approval until January  
            1, 2017.

          4)Defines an "approved educational and training program" after   
            January 1, 2017 to mean a school or college offering education  
            and training in the practice of an acupuncturist that meets  
            the following requirements:

             a)   Offers a CAB-approved curriculum that includes at least  
               3,000 hours, of which at least 2,050 hours are didactic and  
               laboratory training and at least 950 hours are supervised  
               clinical instruction;
              
             b)   Requires the CAB, within 30 days after receiving  
               curriculum to review the curriculum to determine whether  
               the curriculum satisfies the requirements established by  
               CAB, and notify the school or college, the Accreditation  
               Commission for Acupuncture and Oriental Medicine (ACAOM),  
               and the Bureau of Private Postsecondary Education (BPPE),  








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               of the CAB's approval.

             c)   Has received full institutional approval, as specified,  
               in the field of traditional Asian medicine or in the case  
               of institutions located outside of California, approval by  
               the appropriate governmental educational authority using  
               standards equivalent to California's; and,

             d)   Is accredited or has been granted candidacy status by  
               ACAOM.

          5)Specifies that any EO of the CAB appointed on or after January  
            1, 2015, cannot have served as the CAB's EO at any time prior  
            to January 1, 2015.

          6)Extends the CAB's authority to appoint an (EO) until January  
            1, 2017. 

          7)Specifies that an individual who graduates in the first or  
            second graduating class of a school or college that has been  
            granted candidacy status by ACAOM is deemed to have completed  
            an approved educational and training program.  

          8)Requires the CAB to establish standards for the acceptance of  
            educational training and clinical experience received outside  
            of the United States and Canada beginning on January 1, 2017.

          9)Repeals the CAB's authority to investigate and evaluate each  
            school or college applying for approval or continued approval  
            and CAB's authority to recover the associated costs on January  
            1, 2017.

          10)Repeals the $3,000 application fee for the approval of a  
            school or college on January 1, 2017.

          11)Makes other technical and clarifying changes. 

           EXISTING LAW:  

          1)Establishes the CAB to regulate of the practice of acupuncture  
            within the Department of Consumer Affairs (DCA). (Business and  
            Professions Code (BPC) Section 4928 et seq.)

          2)Defines "acupuncturist" to mean an individual to whom a  
            license has been issued to practice acupuncture which is in  








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            effect and is not suspended or revoked.  (BPC 4927(c))

          3)Defines "acupuncture" to mean "the stimulation of a certain  
            point or points on or near the surface of the body by the  
            insertion of needles to prevent or modify the perception of  
            pain or to normalize physiological functions, including pain  
            control, for the treatment of certain diseases or dysfunctions  
            of the body and includes the techniques of  
            electro-acupuncture, cupping and moxibustion."  (BPC 4927(d))

          4)Establishes the CAB until January 1, 2015 and renders the CAB  
            subject to review by the appropriate policy committees of the  
            Legislature.  (BPC 4928)

          5)Permits the CAB, with the approval of the Director of the DCA,  
            to employ personnel and appoint an EO until January 1, 2015.   
            (BPC 4934)

          6)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.)

          7)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)

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           1)Purpose of this bill  .  This bill extends the sunset date of  
            the CAB and its authority to appoint an EO until January 1,  
            2017 and makes other changes related to accreditation  
            requirements and the leadership of the CAB in order to address  
            issues identified during the CAB's 2014 sunset review. This  
            bill is author sponsored.  

           2)Author's statement  .  According to the author, "[This bill]  
            extends until January 1, 2017, the provisions establishing the  
            [CAB], directs the board to hire a new [EO] as of January 1,  
            2015 who has not served as an [EO] before and requires all  








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            acupuncture schools to be accredited by the [ACAOM].  Unless  
            legislation is carried this year to extend the sunset dates  
            for the [CAB], it will be repealed on January 1, 2015."

           3)Oversight Hearings and Sunset Review of Licensing Boards of  
            DCA  .  In March and April of 2014, the Assembly Business,  
            Professions and Consumer Protection (BPCP) Committee and the  
            Senate Business, Professions and Economic Development (BPED)  
            Committee conducted a joint oversight hearing to review nine  
            regulatory entities, including the CAB.  The Committees began  
            their review of these entities in March and conducted three  
            days of public hearings.  This bill, like other sunset bills,  
            is intended to implement the legislative changes recommended  
            in the background reports authored by the Senate BPED and  
            Assembly BPCP Committees.

            The sunset review process itself provides a formal opportunity  
            and mechanism for the DCA, the Legislature, the boards and  
            bureaus, and interested parties and stakeholders to discuss  
            the performance of the boards, bureaus, and committees, and  
            make recommendations for improvements. This is performed on a  
            standard four-year cycle as envisioned by SB 2036  
            (McCorquodale) (Chapter 908, Statutes of 1994).  The major  
            provisions of this bill are based on specific issues raised  
            and addressed in the reports released by the BPED committee.  

           4)California Acupuncture Board  .  In 1976, California became the  
            eighth state to license acupuncturists.  Acupuncturists are  
            allowed to engage in the practice of acupuncture,  
            electroacupuncture, perform or prescribe the use of oriental  
            massage, acupressure, moxibustion, cupping, breathing  
            techniques, exercise, heat, cold, magnets, nutrition, diet,  
            herbs, plant, animal, and mineral products, and dietary  
            supplements to promote, maintain, and restore health as  
            specified.  

          In order to be licensed as an acupuncturist in California, an  
            applicant must be at least 18 years of age and complete either  
            an educational and training program that includes 3,000 hours  
            of study in the practice of acupuncture, or a supervised  
            tutorial program which is approved by the CAB.  An applicant  
            must also pass a California-specific written examination that  
            tests an applicant's knowledge in the practice of acupuncture.  
             The CAB does not currently grant reciprocity to those  
            individuals who have taken and passed the national examination  








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            for licensure.  Currently, there are over 16,000 acupuncture  
            licensees in California.  

            The 2014 BPED background paper for the CAB identified multiple  
            issues relating to the administration and oversight of the  
            CAB, and its ability to properly regulate and license  
            acupuncturists.  These issues include a lack of communication  
            to its licensees through CAB's Web site and listserve,  
            application backlogs, failure to query a National Practitioner  
            Databank to check the history of licensees, failure to  
            complete an audit of a national licensing examination, and  
            concerns with the CAB's school approval process.  

            This bill extends the sunset of the CAB and its authority to  
            appoint an EO for two-years until January 1, 2017, specifies  
            that any EO appointed on or after January 1, 2015 may have not  
            served as the EO prior to January 1, 2015, and revises the  
            current approval process for schools.  The CAB was last  
            reviewed in 2012.  

              a)   Accreditation  .  The Senate BPED Committee's background  
               paper expressed concerns about CAB's school approval  
               process.  Currently, the CAB establishes standards for the  
               approval of schools and colleges offering education and  
               training, including setting standards for faculty and  
               tutorial programs.  The approval process requires the CAB  
               to review a school's application, its governance,  
               curriculum, catalogs, and admission policy, among other  
               items.  The CAB also conducts onsite visits.  

             According to the CAB, the time required to process and review  
               a new school application can take anywhere from six to 12  
               months.  In addition, those institutions "approved" by CAB  
               must also receive approval from the BPPE.  There are  
               currently 38 schools approved by CAB, including 16 located  
               outside of California.  Only those students who attend  
               CAB-approved schools are eligible to sit for the licensing  
               examination.  Graduates from non-approved schools are not  
               eligible and must either enter an approved program or  
               request special approval from the CAB.  
                
                The ACAOM is a national accrediting body, approved by the  
               United States Department of Education (USDE), which  
               accredits acupuncture schools both in California and  
               nationwide. According to the organization's Web site, the  








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               ACAOM is a private, not-for-profit organization whose  
               primary purposes are to establish comprehensive educational  
               and institutional requirements for acupuncture and Oriental  
               medicine programs, and to accredit programs and  
               institutions that meet these requirements.  While all other  
               states defer to ACAOM accreditation as being a sufficient  
               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.  

               Because of ACAOM's nationwide ubiquity, many California  
               schools choose to receive ACAOM's accreditation in addition  
               to the approval of CAB.  Currently only 5 of 22 schools  
               approved by the CAB in California do not have ACAOM  
               accreditation as well.  All other schools in California  
               have dual approval/accreditation.  

               According to the Senate BPED background paper CAB's  
               administration of its own school-approval process creates a  
               problem for students who are educated in ACAOM-accredited  
               schools that are not approved by CAB.  For those students  
               educated outside of California at an educational  
               institution that has not been approved by CAB, if they wish  
               to gain licensure in California, they must complete a  
               CAB-approved training program or receive special approval  
               from the CAB to have their education counted.  According to  
               the Senate BPED background paper, the CAB has been slow to  
               approve applications for schools located outside of  
               California due to budget constraints and staff vacancies,  
               although the CAB has recently begun conducting ongoing site  
               reviews of the schools seeking CAB approval. 

               The Senate BPED background paper noted that this issue has  
               been a concern raised during past sunset reviews of the  
               CAB.  During the 2012 sunset review process, the Senate  
               BPED Committee then recommended that "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  
               [USDE]."

               This bill addresses the accreditation issue raised by the  
               Senate BPED Committee by revising the current accreditation  








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               process to include ACAOM and CAB approval for schools and  
               training programs beginning in January 2017.  In order for  
               a school or training program to be approved, it would need  
               CAB approval of its curriculum and ACAOM accreditation.   
               This bill provides a two-year implementation delay in order  
               to provide schools, CAB and ACAOM time to review standards  
               and implement the joint process.  This bill does not alter  
               the current BPPE approval process, so schools seeking to  
               provide education in the practice of acupuncture would need  
               approval of their curriculum standards from CAB, and  
               receive accreditation from ACAOM and approval from BPPE. 

              b)   Continued regulation by the CAB  .  Although the report  
               noted several areas where the CAB has failed to address  
               important administrative issues, the Senate BPED background  
               paper determined that it is necessary to extend the sunset  
               of the CAB in order to maintain an appropriate regulatory  
               authority for licensees and maintain consumer protection.   
               While the sunset review process typically results in a four  
               year extension for satisfactorily performing entities, this  
               bill only grants the CAB a two-year sunset extension.  The  
               CAB will be required to address the Assembly BPCP and  
               Senate BPED Committees on its progress in addressing all  
               the issues identified in the report in 2017.  CAB has  
               received two-year extensions in four of its last five  
               sunset reviews.

              c)   Personnel  .  Currently, the CAB is authorized to employ  
               personnel, including the authority to appoint an EO.  As  
               with the other provisions relating to Acupuncture, the  
               CAB's authority to appoint an EO has been extended by  
               two-years until January 1, 2017.  However, this bill  
               specifically states that the EO appointed on or after  
               January 1, 2015, cannot have served as the EO of the CAB  
               any time prior to January 1, 2015.  

           5)Arguments in support  .  The California State Oriental Medicine  
            Association writes in support, "CSOMA strongly supports a  
            requirement that applicants for licensure under the CAB  
            graduate from a program that has achieved candidacy or  
            accreditation by an accrediting agency recognized by the  
            [USDE] as an authority for the quality of education and  
            training in acupuncture and Oriental medicine.   
            Accreditation-in conjunction with the CAB's continued  
            authority to create, modify, review, and approve  








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            California-specific curricula requirements-will create a  
            robust regulatory framework for the education of licensed  
            acupuncturist."

           6)Arguments in opposition  .  The National Guild of Acupuncture  
            and Oriental Medicine, writes in opposition, "[this] bill  
            removes the authority of the [CAB] to approve schools.  This  
            creates several problems including the elimination of  
            curriculum standards that are written in the regulations.   
            These standards are the highest in the nation."

           7)Comments for the Committee  .  The sunset review process  
            provides the Legislature with the opportunity to address  
            serious concerns raised about boards, bureaus, commissions and  
            other entities which are charged with the protection of  
            consumers and licensee oversight.  While many issues can be  
            addressed through the sunset review process and its subsequent  
            legislation, there are often issues that remain unresolved and  
            which need additional time to find resolution.  

          While this bill addresses a number of important issues that were  
            raised during the sunset hearing, the issue of the California  
            Licensure Examination (CALE), its perceived shortcomings, and  
            whether or not it should be phased out in favor of the  
            national exam is notably absent from this bill.  This  
            Committee may wish to discuss what further work remains to be  
            done in conjunction with the Senate BPED committee, the  
            Administration, and other relevant stakeholders to finally  
            resolve the licensure examination troubles that have plagued  
            the CAB for the past nine years.  

            Finally, while the authority for many of the boards to appoint  
            EOs and employ personnel is provided in statute, this bill  
            specifies that the EO appointed on or after January 1, 2015,  
            may not have served prior to January 1, 2015.  The Committee  
            may wish to inquire of the author as to what necessitates the  
            change in personnel required by this bill. 

           8)Related legislation  .  SB 1242 (Lieu) of 2014 amends the  
            Automotive Repair Act and updates the sunset provisions for  
            the Bureau of Automotive Repair.  This bill is pending in the  
            Assembly Business, Professions and Consumer Protection  
            Committee.










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            SB 1243 (Lieu) of 2014 extends until January 1, 2017 the  
            provisions establishing the Veterinary Medical Board and the  
            term of the executive officer, and extends the Certified  
            Common Interest Development Manager program and the Tax  
            Preparer program to January 1, 2019.  This bill is pending in  
            the Assembly Business, Professions and Consumer Protection  
            Committee.

            SB 1244 (Lieu) of 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 review by the appropriate policy  
            committees of the Legislature.  This bill is pending in the  
            Assembly Appropriations Committee. 

            SB 1245 (Lieu) of 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.  This bill  
            is pending in the Assembly Business, Professions and Consumer  
            Protection Committee. 

            SB 1247 (Lieu) of 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 BPPE within 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.  This bill is pending in  
            the Assembly Business, Professions and Consumer Protection  
            Committee.
             
             AB 1147 (Bonilla, Gomez & Holden) of 2013 revises and recasts  
            the massage therapy act and extends the operation of the  
            California Massage Therapy Council until December 1, 2017.   
            This bill is pending in the Senate Business, Professions and  
            Economic Development Committee.

            AB 2741 (Bonilla) of 2014 extends the sunset date on the  
            Professional Fiduciaries Bureau (PFB) from January 1, 2015 to  








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            January 1, 2019.  This bill is pending in the Senate Business,  
            Professions and Economic Development Committee.

            AB 2740 (Bonilla) of 2014 requires the Bureau of Electronic  
            and Appliance Repair, Home Furnishings and Thermal Insulation  
            (BEARHFTI) to be subject to review by the Legislature before  
            January 1, 2019, and requests that BEARHFTI report on  
            specified concerns to the Legislature by March 1, 2015.  This  
            bill is pending in the Senate Business, Professions and  
            Economic Development Committee.

           9)Previous legislation  .  SB 1236 (Price) Chapter 332, Statutes  
            of 2012, extends the sunset dates of numerous boards,  
            committees and programs under the Department of Consumer  
            Affairs (DCA) and makes related conforming and technical  
            changes.  
             
             AB 1391 (Eng) of 2010, would have extended the sunset date of  
            the CAB and its authority to appoint an EO from January 1,  
            2011 to January 1, 2017.  This bill was held in the Senate  
            Business, Professions and Economic Development Committee.  

            SB 963 (Ridley-Thomas), Chapter 385, Statutes of 2008,  
            extended the sunset date on seven boards and their respective  
            EOs until January 1, 2011.

            SB 233 (Figueroa) of 2005 provides for the sunset of the Board  
                                                               and modifies the definition of acupuncture.  This bill was  
            held in the Senate Appropriations Committee.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          American College of Traditional Chinese Medicine
          AOMA Graduate School of Integrative Medicine
          Atlantic Institute of Oriental Medicine
          California State Oriental Medical Association
          Council of Colleges of Acupuncture and Oriental Medicine
          Japanese Acupuncture Association of California
          Oregon College of Oriental Medicine
          Pacific College of Oriental Medicine
          Southwest Acupuncture College
          Multiple individuals
          Association of Korean Asian Medicine and Acupuncture of  








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          California (04/23/14 version)
          Council of Colleges of Acupuncture and Oriental Medicine  
          (04/23/14 version)
          Southern California University of Health Sciences (04/23/14  
          version)
           
            Opposition 
           
          American Traditional Chinese Medicine Traumatology Association
          American Association of Acupuncture & Traditional Chinese  
          Medicine
          Council of Acupuncture and Oriental Medicine Associations
          National Guild of Acupuncture and Oriental Medicine
          California Acupuncture Medical Association (04/23/14 version)
          California Acupuncture Medicine Association (04/23/14 version)
          California Acupuncture Oriental Medicine Association (04/23/14  
          version)
          California Certified Acupuncturists Association (04/23/14  
          version)
          Chiu's Acupuncture Clinic (04/23/14 version)
          CNA Medical Group, Inc. (04/23/14 version)
          Korean Acupuncture & Asian Medicine Association in the U.S.A.  
          (04/23/14 version)
          Li Sage Acupuncture Clinic (04/23/14 version)
          North American Oriental & Western Medicine Academy (04/23/14  
          version)
          Pine Springs Acupuncture Clinic (04/23/14 version)
          Sacramento Chinese Culture Foundation (04/23/14 version)
          United Acupuncture Association (04/23/14 version)
          United California Practitioners of Chinese Medicine (04/23/14  
          version)
          Multiple individuals 

           Analysis Prepared by  :    Elissa Silva / B.,P. & C.P. / (916)  
          319-3301