BILL ANALYSIS Ó
AB 758
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
AB 758
(Chau) - As Introduced February 25, 2015
SUBJECT: Acupuncture: education and training programs.
SUMMARY: Allows acupuncture schools to receive approval from
another accreditation agency recognized by the United States
Department of Education (USDE) as an alternative to the
Accreditation Commission for Acupuncture and Oriental Medicine
(ACOAM), requires the California Acupuncture Board (CAB) to
conduct site visits to acupuncture schools, and requires the CAB
to impose a fee for the site visits.
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)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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3)Defines an "approved educational and training program," for
purposes of licensure as an acupuncturist, as a school or
college that meets the following: (BPC § 4927.5(a))
a) Offers curriculum that has been submitted to and
approved by the CAB and includes specified hours of
didactic and laboratory training and supervised clinical
instruction;
b) Is approved by the Bureau of Private and Postsecondary
Education (BPPE) or the appropriate out-of-state
governmental educational authority; and,
c) Is accredited or granted candidacy status by the ACAOM,
or has submitted a letter of intent to pursue accreditation
to the ACAOM.
4)Requires the CAB, until January 1, 2017, to investigate and
evaluate each school or college applying for approval under
BPC § 4939 and may utilize and contract with consultants to
evaluate those training programs.
5)Requires the CAB, commencing January 1, 2017, to review a
school's curriculum, within 30 days of receiving curriculum
from the school, determine whether the curriculum satisfies
the CAB's requirements, and notify the school or college, the
ACAOM, and the BPPE of whether the CAB has approved the
curriculum. (BPC § 4927.5(b))
THIS BILL:
6)Defines "approved educational and training program" as a
school or college offering education and training in the
practice of an acupuncturist that, among other things, meets
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any of the following:
a) Is accredited by the ACOAM or another accreditation
agency recognized by the USDE;
b) Has been granted candidacy status by the ACOAM or
another accreditation agency recognized by the USDE; and,
c) Has submitted a letter of intent to pursue accreditation
to the ACOAM or another accreditation agency recognized by
the USDE within 30 days of receiving full institutional
approval, and is granted candidacy status within three
years of the date the letter was submitted.
7)Requires the CAB, within 30 days after receiving the
curriculum, to review the curriculum, determine whether the
curriculum satisfies the requirements established by the CAB,
and notify the school or college, the ACOAM, any other
accreditation agency recognized by the USDE, and the BPPE of
whether the CAB has approved the curriculum.
8)States that the section will become operative on January 1,
2017.
9)Requires the CAB to conduct site visits to each site of a
school or college of acupuncture to inspect or reinspect the
school or college for purposes of approval or continued
approval of its training program.
10)Requires the CAB to impose a fee for the site visits in an
amount to recover direct reasonable regulatory costs incurred
by the CAB in conducting the inspection and evaluation of the
school or college.
FISCAL EFFECT: Unknown. This bill has been keyed fiscal by the
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Legislative Counsel.
COMMENTS:
11)Purpose. This bill is sponsored by the Council of
Acupuncture and Oriental Medicine Associations . According to
the author, "AB 758 strengthens California Acupuncture
standards by requiring schools for acupuncture and Chinese
medicine to receive accreditation by ACAOM or any [USDE]
approved accrediting agency. To ensure compliance with state
education and training standards, it also requires the CAB to
conduct site visits.
Since the passage of [SB 1246] concerns have been raised among
the acupuncture community about ACAOM and the removal of the
authority for the CAB to perform site visits of schools? The
CAB began conducting site visits of acupuncture schools in
2014 and found compliance issues with many of the 16
acupuncture schools they reviewed which are also accredited by
ACAOM. Without CAB site visits acupuncture schools could go
many years without being in compliance with state law without
an ACAOM review to ensure compliance. Without changes to
California law, we could weaken what are considered the
highest acupuncture standards in the Nation."
12)Background. In 2014, the Senate Business and Professions
Committee and the Assembly Business, Professions and Consumer
Protection Committee (Committees) conducted joint oversight
hearings to review nine regulatory entities, including the
CAB. The Committees began their review of the licensing
agencies in March 2014, and conducted two days of hearings.
The resulting sunset bills were intended to implement
Committee staff recommendations reflected in the Background
Papers prepared for each agency reviewed. SB 1426 (Lieu),
Chapter 397, Statutes of 2014, reflected the recommendations
for CAB.
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CAB School Approval. 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.
Due to several issues raised during the 2014 Sunset Review
Oversight Hearings, including a failure to conduct site visits
for 20 years, the CAB will only perform school site visits to
review implementation of policies and procedures, facilities
and clinical training until January 1, 2017. Additionally, it
is important to note that it is no longer common practice for
licensing entities, under the DCA, to approve schools versus
utilize a private national accreditation organization to
approve training programs.
ACAOM Accreditation. The ACAOM is the only national,
USDE-approved accrediting agency for the field of acupuncture
and oriental (Asian) medicine. While many other states defer
to ACAOM accreditation as being a sufficient condition for
applicants to take the licensing exam in their states,
California has traditionally conducted its own school approval
process. As of January 1, 2017, this will no longer be the
case.
There are approximately 65 acupuncture schools throughout the
U.S., 36 of which are approved by the CAB. Twenty one of the
CAB-approved schools are located in California and 15 are
located in other states. Sixty of the 65 schools are already
accredited by the ACAOM.
In 2004, the Little Hoover Commission (LHC) conducted a
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comprehensive comparative analysis of the school approval
processes of the ACAOM and the CAB. The LHC's report found
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 Committees' 2014 Sunset Review Background
Paper, because CAB performs its own school approvals, there
are a number of consequences and problems. These include:
a) Students who are educated in accredited schools that are
not approved by CAB receive only partial credit for their
training. If they wish to gain licensure in California,
they must complete a CAB approved training program.
b) The CAB is slow to approve applications for schools
located outside of California due to budget constraints.
c) The CAB had just began conducting site visits in 2014,
after a 20 year hiatus; and stated that because of staff
vacancies, the process was moving slowly.
In the 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
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educational programs."
As a result of the sunset review recommendations from 2012 and
2014, the Committees thoroughly investigated the available
USDE-approved acupuncture accrediting organizations. After a
comprehensive investigation and review of the available
evidence, the Committees decided to recommend ACOAM as the
required accreditation entity for California acupuncture
schools, which was enacted by SB 1246 (Lieu), Chapter 397,
Statutes of 2014. The Legislature clearly indicated that
using a national, USDE-approved acupuncture school
accreditation agency will help free up the CAB's time and
resources to address the other salient issues identified
during its prior sunset reviews.
ACOAM and USDE/NACIQI Review. In a letter to the Committees
dated March 9, 2015, the National Guild for Acupuncture and
Oriental Medicine discussed ACAOM's 2011 USDE and National
Advisory Committee on Institutional Quality and Integrity
(NACIQI) review. The letter included editorial statements
pointing out issues ACAOM was required to address in order to
maintain USDE approval.
In response, ACAOM sent a letter to the Committees, dated March
26, 2015, to clarify and explain the issues. First, it
explained, "The primary context of the letter refers to a
perceived negative review ACAOM received in 2011 from the
[USDE] and the [NACIQI]. ACAOM, like other accrediting
agencies, is on a five-year recognition cycle with USDE? The
last review was conducted in 2011, followed by a compliance
report review in 2013 and the next comprehensive review for
continuing recognition will occur in 2016."
Among other things, ACAOM noted that the issues identified in
the 2011 review have since been resolved. The NACIQI deemed
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ACAOM "fully compliant" in its June 2013 compliance review and
ACAOM remains USDE approved. ACAOM's next review will occur
in 2016.
13)Prior Related Legislation. SB 1246 (Lieu), Chapter 397,
Statutes of 2014, among other things, removed CAB's authority
to approve schools and requires acupuncture schools to be
accredited by the ACOAM and repealed the CAB's authority to
investigate and evaluate each school or college applying for
approval or continued approval.
SB 1236 (Price), Chapter 332, Statutes of 2012, extended the
sunset date for the CAB and other boards under the DCA and the
term of the Board's Executive Officer by two years, until
January 1, 2015, and made technical and clarifying changes to
statutes governing CAB-approved acupuncture training programs.
ARGUMENTS IN SUPPORT:
The Council of Acupuncture and Oriental Medicine Associations
supports the bill and writes, "AB 758 will amend language in the
Practice Act that was removed last year under SB 1246.
Unfortunately, that 2014 bill will open California to a flood of
graduates who wish to take the California Acupuncture Licensing
Exam. A "free for all" situation will reduce public safety and
cause harm to our profession. Authority to regulate schools and
graduates of those schools and graduates of those schools should
remain within California instead of in the hands of an outside
agency."
The Asian Pacific Islander American Public Affairs Association
writes in support, "California has the most acupuncture
licensees and the most acupuncture schools in the nation. AB
758 will prevent California from becoming an "open" state for a
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graduate from any ACAOM approved school to become licensed in
our state. California regulation of acupuncture must conducted
by a California regulatory agency."
ARGUMENTS IN OPPOSITION:
The Council of Colleges of Acupuncture and Oriental Medicine
writes in opposition to the bill, "The [Committee] was
instrumental in 2014 in passing SB 1246 unanimously as did the
full Assembly and Senate and every other legislative committee.
AB 758 represents a direct effort to undermine the unanimous
decision of the California legislature?As the committee is
aware, apart from ACAOM, there is currently no other agency
recognized by the USDOE for professional accreditation of
[acupuncture] schools and programs in the United States.
Regional accrediting agencies assess institutional capacity."
The California State Oriental Medical Association opposes the
bill unless amended to require programmatic accreditation by a
specialized agency recognized by the USDE, specifically it
writes, "Effective in 2017, last year's Sunset Review bill
limited the CAB's role in educational oversight to establishing
curricular requirements for acupuncture training programs.
Accordingly, SB 1246 also eliminated the CAB's authority to
investigate and evaluate schools...Given that curricular reviews
can be effectively performed via administrative desk checks,
there is no discernible purpose for conducting site visits as
part of this process. Finally, recent CAB site visit reports
indicate that it may already be stretching its regulatory
authority by enforcing broadly defined rules in an exceptionally
specific and arbitrary fashion. This enforcement activity
raises concerns regarding potential underground regulation. By
extending site visit activities beyond the CAB's 2017 reduction
in regulatory scope, AB 758 heightens these concerns."
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POLICY ISSUES FOR CONSIDERATION:
Sunset Review Recommendations. The intent of SB 1246 was to
implement the recommendations made by the Committee staff after
the thorough sunset review process had been conducted. This
bill would undo several of the solutions designed to rectify the
identified problems with the CAB, including requiring the CAB to
use a national accreditation organization and remove the CAB's
authority to conduct school site visits.
In addition, the changes have not gone into effect-they will
become operative on January 1, 2017-when the CAB is next
reviewed by the joint oversight Committees. Ongoing discussions
regarding the CAB and ACAOM school approval are taking place in
preparation for the law to go into effect, and the Committees
are working to resolve the CAB's concerns with the loss of its
school-approval authority. Therefore, this measure is
premature.
Agency Transparency and Quality. The CAB and the sponsors of
this bill argue that because ACAOM is not a "non-governmental
agency," there are transparency issues regarding ACAOM's
process. Further, the CAB argues that ACAOM's school approval
standards do not meet CAB's own standards which are detailed in
Title 16 California Code of Regulations § 1399.434-1399.436.
While ACAOM, and most other national accrediting organizations,
are not required to meet the same open meeting and public
document standards that the CAB must meet, almost all of ACAOM's
processes, procedures, and standards are publicly available.
ACAOM has also been very forthcoming with producing documents
and answering questions presented by the legislative policy
Committees.
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Further, ACAOM's standards are available for the Committees to
examine, are developed through a public comment period, and are
approved by the USDE. While CAB's general standards are listed
in its regulations, it has yet to produce the specific criteria
it uses when approving schools. For instance, the CAB has
criticized ACAOM's clinical chart review process. However, when
asked to produce the criteria for chart review that the CAB has
been using on recent school site visits, it was unable to.
The "Flood" of Out of State Acupuncturists. A popular concern
raised by supporters of this measure is the possibility that the
law, which will go into effect in 2017, will allow a flood of
individuals from outside of California to take the California
licensing examination. This is reflected in the form letters
sent in from various organizations and individuals as well as
statements made by the CAB staff during public CAB meetings last
year.
As was thoroughly discussed during last year's Sunset Review
hearings, this is quite unlikely. The law states that the CAB
must set the curriculum standards that acupuncture schools must
adhere to. The California curriculum standards are the most
stringent in the nation. As such, out of state applicants would
be unable to apply for licensure in this state because the
curriculum standards in their academic programs are not
equivalent to those required by the CAB. In essence, the out of
state institutions would need to completely change their
curriculum standards in order to conform to California's
curriculum standards so that their graduates would be eligible
to take the California licensing examination.
Accreditation by a USDE Approved Entity. On its face, the
request for the law to be expanded to include school approval by
any entity approved by the USDE may not seem problematic.
However, if this happens, the current standards for school
approval would be lessened-which is contradictory to what the
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CAB indicates it desires. For example, this bill would allow a
number of regional accreditors, who focus broadly on approving
an institution e.g. faculty and premises, not the specifics of
an acupuncture program, to be the entity that approves
acupuncture schools and programs. This is contradictory to what
the CAB claims it desires e.g. a regional accreditor would not
be involved in the specifics of a program such as the clinical
chart review etc.
Based on the aforementioned reasons, in combination with the
recent review of the CAB, the Legislature's recent decision to
remove the CAB's school approval authority and require
accreditation of all acupuncture schools by the ACAOM, as well
as the fact that the law has not even been implemented, it is
not clear that the need for this bill has been established.
REGISTERED SUPPORT:
Council of Acupuncture and Oriental Medicine Associations
(sponsor)
Alhambra Medical University
American Association of Chinese Medicine and Acupuncture
Asian Pacific Islander American Public Affairs Association
California Acupuncture Medical Association
California Acupuncture Oriental Medicine Association
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California Labor Federation
Chinese Herb Trade Association of America
Heilongjiang University of Chinese Medicine
Korean Acupuncture & Asian Medicine Association
National Guild of Acupuncture and Oriental Medicine
Office and Professional Employees International Union
United Acupuncture Association
Over 35 individuals
REGISTERED OPPOSITION:
Acupuncture & Integrative Medicine College
American College of Traditional Chinese Medicine
California State Oriental Medical Association
Council of Colleges of Acupuncture and Oriental Medicine
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Emperor's College
Southern California University of Health Sciences
Analysis Prepared by:Le Ondra Clark Harvey, Ph.D. and Vincent
Chee / B. & P. / (916) 319-3301