BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1246
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          SENATE THIRD READING
          SB 1246 (Lieu)
          As Amended  August 19, 2014
          Majority vote 

           SENATE VOTE  :33-0  
           
           BUSINESS & PROFESSIONS    11-0  APPROPRIATIONS      17-0        
           
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          |Ayes:|Bonilla, Jones,           |Ayes:|Gatto, Bigelow,           |
          |     |Bocanegra, Campos,        |     |Bocanegra, Bradford, Ian  |
          |     |Dickinson, Eggman,        |     |Calderon, Campos,         |
          |     |Gordon, Hagman,           |     |Donnelly, Eggman, Gomez,  |
          |     |Maienschein, Skinner,     |     |Holden, Jones, Linder,    |
          |     |Wilk                      |     |Pan, Quirk,               |
          |     |                          |     |Ridley-Thomas, Wagner,    |
          |     |                          |     |Weber                     |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Extends the sunset date of the California Acupuncture  
          Board (CAB) to January 1, 2017, revises acupuncture program  
          approval requirements, and extends the sunset date of CAB's  
          authority to appoint an executive officer (EO) to January 1,  
          2016.  Specifically,  this bill :   

          1)Extends the sunset date for the CAB and its duties until  
            January 1, 2017, except that the CAB's authority to appoint an  
            EO is extended to 2016.

          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:









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             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),  
               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.

            Specifies that if an applicant began his or her educational  
            and training program at a school or college that submitted an  
            eligibility report to, or attained candidacy status from, the  
            ACAOM, but the commission subsequently denied the school or  
            college candidacy status or accreditation, respectively, the  
            CAB may review and evaluate the program curriculum to  
            determine whether to waive the requirements, as specified,  
            with respect to that applicant.

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

          6)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.

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

          8)Makes other technical and clarifying changes. 








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           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee:

          1)Ongoing costs of about $3.3 million per year to support the  
            California Acupuncture Board's licensing activities, supported  
            by licensing fees (all costs/revenues are Acupuncture Fund).

          2)Minor reduction in costs and revenues after January 1, 2017,  
            due to the elimination of the Board's authority to approve  
            educational programs.

          3)Staff costs to promulgate regulations, potentially in the  
            range of $100,000, to address internationally trained  
            applicants.

          4)By changing the process for accrediting schools by the Board,  
            it is possible that an increased number of individuals would  
            meet the state's licensing requirement to have graduated from  
            an accredited school.  This could increase the number of  
            applicants for licensure.  This could result in a potential  
            increase in licensing costs in the range of $100,000 or more  
            due to increased applications (Acupuncture Fund), and a  
            commensurate one-time revenue spike due to increased fee  
            revenues from exam fees as well as higher revenues ongoing.

           COMMENTS  :   

          1)Purpose of this bill.  This bill extends the sunset date of  
            the CAB until January 1, 2017, and extends its authority to  
            appoint an EO until January 1, 2016, 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  
            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  








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            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 BPED and BPCP  
            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 Department of Consumer Affairs, 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  
            for licensure.  Currently, there are over 16,000 acupuncture  
            licensees in California.  









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            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 by two years, until  
            January 1, 2017, and extends its authority to appoint an EO  
            for one-year until January 1, 2016, 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  
               ACAOM is a private, not-for-profit organization whose  
               primary purposes are to establish comprehensive educational  
               and institutional requirements for acupuncture and Oriental  








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               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 five 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  
               process to include ACAOM and CAB approval for schools and  
               training programs beginning in January 2017.  In order for  








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               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.  This  
               bill extends the sunset date of CAB's authority to appoint  
               an EO until January 1, 2016.  


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


                                                                FN: 0004986