BILL ANALYSIS Ó SB 1246 Page 1 SENATE THIRD READING SB 1246 (Lieu) As Amended August 19, 2014 Majority vote SENATE VOTE :33-0 BUSINESS & PROFESSIONS 11-0 APPROPRIATIONS 17-0 ----------------------------------------------------------------- |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: SB 1246 Page 2 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. SB 1246 Page 3 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 SB 1246 Page 4 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. SB 1246 Page 5 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 SB 1246 Page 6 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 SB 1246 Page 7 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