BILL ANALYSIS Ó
AB 758
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Date of Hearing: January 12, 2016
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
(ACAOM), 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 by, granted candidacy status by, 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 authorizes the CAB to utilize and contract with
consultants to evaluate those training programs.
5)Requires the CAB, commencing January 1, 2017, within 30 days
of receiving curriculum from the school, to review a school's
curriculum and 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
any of the following:
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a) Is accredited by the ACAOM or another accreditation
agency recognized by the USDE;
b) Has been granted candidacy status by the ACAOM or
another accreditation agency recognized by the USDE; or,
c) Has submitted a letter of intent to pursue accreditation
to the ACAOM 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 ACAOM, 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 is keyed fiscal by the
Legislative Counsel.
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COMMENTS:
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."
Background. In 2014, the Senate Committee on Business,
Professions and Economic Development and the Assembly
Committee on Business, Professions and Consumer Protection
Committee (Committees) conducted joint sunset review 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 that was reviewed. SB 1426
(Lieu), Chapter 397, Statutes of 2014, reflected the
recommendations made for the CAB, including removing school
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approval authority from the CAB and requiring a national
accreditor to take over the school accreditation process, and
only granting the CAB a two year sunset date extension.
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 Legislature voted to only allow the CAB to
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. In fact, only three
licensing entities under DCA, including the CAB, solely
conduct school approvals without a requirement for national
accreditation. Most programs utilize a national accreditation
organization to approve training programs.
ACAOM Accreditation. The ACAOM, founded in 1982, is the only
national, USDE-approved accrediting agency for the field of
acupuncture and oriental medicine. ACAOM is the only
recognized accreditor for this profession, and as such has
established de facto national standards for acupuncture
training for both masters and doctoral level acupuncture
programs and all ACAOM accredited and candidate programs are
required to meet the applicable program standards, including
the training standards described under Program of Study in
ACAOM's Accreditation Manual. While many other states defer to
ACAOM accreditation as being a sufficient condition for
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applicants to take the state licensing exam, California has
traditionally maintained authority to conduct 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
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 the 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 the 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 began conducting site visits in 2014, after a 20
year hiatus, and stated that because of staff vacancies,
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the process was moving slowly.
In the 2012 Sunset Review Background Paper to the CAB, the
Committee staff 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
[USDE]. 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 [CAB's] responsibility and need for
approving acupuncture 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 ACAOM 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.
ACAOM 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.
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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
ACAOM "fully compliant" in its June 2013 compliance review and
ACAOM remains USDE approved. ACAOM's next review will occur
in 2016.
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 ACAOM 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
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supports the bill and writes, "AB 758 will amend language in the
Practice Act that was removed 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 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
graduate from any ACAOM approved school to become licensed in
our state. California regulation of acupuncture must be
conducted by a California regulatory agency."
The American Association of Chinese Medicine and Acupuncture
supports the bill and writes, "Protection of the public is the
most fundamental mission of the [CAB]. California has the
highest Acupuncture education and training standards in the
nation. The California public is protected only when the
training program for approval is finalized by our own California
governmental agency. Without the authority of inspecting the
school on site, CAB has no way to check whether the school
carries out the approved curriculum properly."
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
that considered this bill. AB 758 represents a direct effort to
undermine the unanimous decision of the California
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legislature?As the committee is aware, apart from ACAOM, there
is currently no other agency recognized by the USDE for
professional accreditation of [acupuncture and oriental medicine
(AOM)] schools and programs in the United States. No other AOM
accrediting agency has a pending application of the [USDE] for
such recognition. Regional accrediting agencies assess
institutional capacity, without in depth review of curriculum,
so it is important for AOM programs to have professional
accreditation to ensure student learning outcomes and
professional competencies are met by approved programs, as is
the practice throughout professional/medical education?The
Council's member colleges that have been approved by the CAB are
already undergoing oversight by ACAOM's more rigorous
accreditation process. The CAB's duplicative attempts at
oversight are not only unnecessary but a drain on the resources
of the colleges, on the student who have to incur higher tuition
to bear the burden of the additional costs of a dual regulatory
regime, and on the patients at school clinics who have to incur
higher costs to treatment."
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? the 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 by
reviewing curricular checklists, syllabi and course catalogs,
there is no discernible purpose for conducting site visits as
part of this process. Recent CAB site visit reports indicate
that the Board may already be stretching its regulatory
authority by enforcing broadly and vaguely defined rules in an
exceptionally specific and arbitrary fashion. This 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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The Southern California University of Health Sciences also
opposes the bill and writes, "It is no secret that the CAB has
been fraught with administrative and political difficulties for
decades. SB 1246, by shunting CAB school approval power to the
nationally recognized programmatic accreditor, brings a welcome
change to the regulation of the profession of acupuncture in the
State of California. The CAB has neither the professional
educational expertise, nor the financial or staff resources to
oversee California acupuncture school board approval."
POLICY ISSUES FOR CONSIDERATION:
Sunset Review Recommendations of 2014. The intent of SB 1246
was to implement the recommendations made after the thorough
sunset review process had been conducted. Further, the
recommendations are consistent with recommendations made by the
Little Hoover Commission who conducted a comparative analysis of
the school approval processes of the ACAOM and the CAB in 2004.
This bill would undo several of the solutions designed to
rectify the identified problems with the CAB, including
authorizing accreditation by any USDE national accreditation
organization and reinstating the CAB's authority to conduct
school site visits.
In addition, the changes required by SB 1246 have not gone into
effect-they will become operative on January 1, 2017- after the
CAB is next reviewed by the joint oversight Committees in March
of 2016. 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.
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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
committee staff.
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 during its 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 from various organizations and individuals as well as
statements made by the CAB staff during public CAB meetings.
As was thoroughly discussed during the 2014 Sunset Review
hearings, this is quite unlikely. The law states that the CAB
must set the curriculum standards that acupuncture schools must
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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 any 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
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 that would
not be involved in the specifics of a program, such as the
clinical chart review.
Is there a need for the bill? One has only to review the prior
sunset review and other reports about the CAB to understand that
this regulatory board has had consistent problems with its
functioning. Though many of the problems are in the past, and
the new CAB is making some changes to the way the board
operates, the sponsor continues to pressure the Legislature to
make no changes, and in this instance, reverse the recent
changes that have not yet taken effect and that the Legislature
has mandated.
Based on the aforementioned reasons, in combination with the
fact that the CAB is currently undergoing sunset review by this
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committee, that the Legislature made a 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 Acupuncture Political Action Committee
American Association of Acupuncture & Traditional Chinese
Medicine
American Association of Chinese Medicine and Acupuncture
American Institute of Acupuncture Orthopedics & Traumatology
American Traditional Chinese Medicine Society
Asian Pacific Islander American Public Affairs Association
California Acupuncture Medical Association
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California Acupuncture Oriental Medicine Association
California Acupuncturists United Association
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
UPC Medical Supplies, Inc.
Yuin University
Over 35 individuals
REGISTERED OPPOSITION:
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Acupuncture & Integrative Medicine College
American College of Traditional Chinese Medicine
AOMA Graduate School of Integrative Medicine
Atlantic Institute of Oriental Medicine
California Institute of Integral Studies
California State Oriental Medical Association
Council of Colleges of Acupuncture and Oriental Medicine
Emperor's College
National College of Natural Medicine
Southern California University of Health Sciences
Analysis Prepared by:Le Ondra Clark Harvey, Ph.D. and Vincent
Chee / B. & P. / (916) 319-3301
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