BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 880| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 880 Author: Ridley-Thomas (D), et al. Amended: 7/1/15 in Senate Vote: 21 SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 8-0, 6/29/15 AYES: Hill, Bates, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski NO VOTE RECORDED: Berryhill SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 78-0, 5/14/15 (Consent) - See last page for vote SUBJECT: Dentistry: licensure: exemption SOURCE: Oral and Facial Surgeons of California DIGEST: This bill authorizes final year dental students to practice dentistry at free sponsored events under supervision and under specified conditions. ANALYSIS: Existing law: 1)Establishes the Dental Practice Act, administered by the Dental Board of California (DBC), which is under the AB 880 Page 2 Department of Consumer Affairs, to license and regulate the practice of dentistry. (Business and Professions Code (BPC) §§ 1600 et seq.) 2)Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the DBC. (BPC § 1626) 3)Exempts from that prohibition, operations in dental schools of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program if approved by the DBC. (BPC § 1626(b)) 4)Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) §§ 1200 et seq.) 5)Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC § 1204(a)) 6)Exempts specified health care practitioners from California licensure who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California until January 1, 2018, as specified. (BPC § 901) This bill: 1)Exempts final year dental students from provisions of law prohibiting the practice of dentistry without a license for students who volunteer at a sponsored event under the supervision of dental school faculty. 2)Specifies that the exemptions only include those operations approved by the DBC that are rendered or performed under the same conditions as operations in a student's dental program. 3)Defines the following terms: AB 880 Page 3 a) "Final year student" means a student of dentistry in his or her final year of completion at a dental school approved by the DBC. "Final year student" also includes a dental student enrolled in an advanced program. b) "Licensed dentist" means a dentist licensed by the DBC. c) "Sponsored event" means an event, not to exceed 10 calendar days, administered by a sponsoring entity or a local governmental entity, or both, through which health care is provided to the public without compensation, or expectation of compensation. d) "Sponsoring entity" means a nonprofit organization pursuant to Section 501(c)(3) of the Internal Revenue Code, or a community-based organization. 4)Requires the volunteer practice of dentistry by students to comply with all of the following requirements: a) Each patient shall be sufficiently informed that a dental student may be providing some of the treatment that he or she will be receiving. b) Any information provided to the patient to give informed consent shall offer the patient the option to decline to be treated by the student. c) The volunteer practice of a student shall be supervised by faculty from the dental school in which the student is enrolled. d) Each volunteer student shall wear an identification badge that clearly identifies the student as a dental student. The identification badge shall display the student's name, the name of the student's dental school, and the name and the telephone number of the DBC. That information shall be displayed in 14-point font, at minimum. e) Requires that supervision ratios and student oversight be at least as stringent as required to meet the standards of the Commission on Dental Accreditation at each school's clinical department, laboratory, or dental extension AB 880 Page 4 program. f) Requires that supervision ratios be appropriate for the procedure being performed by the student. g) Requires the student to perform only those procedures in which he or she is credentialed or those procedures he or she is permitted to perform in the school's clinical department, laboratory, or dental extension program. 5)Requires the sponsoring entity of the sponsored event to provide the DBC with a list of the names of the volunteer students, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist. Background Access to Dental Dare and Denti-Cal. According to a 2012 report by the California Dental Association (CDA), an estimated 11 million of California's 38 million people lack any form of dental benefits. For those seven million who qualify for dental services through Medi-Cal, that coverage does not necessarily translate into access; the California State Auditor reported in December 2014 that over half the children in Denti-Cal (Medi-Cal's dental program) do not get regular services. The Auditor determined that this was primarily due to the lack of providers deterred by low reimbursement rates. Free Dental Health Care Events. In addition to the lack of participating providers in Denti-Cal, CDA also reports that there is a misdistribution of the current supply; California has over 200 dental professional shortage areas; areas where the ratio of dentists to the population is so low that the state considers the area underserved. Several not-for-profit entities have entered the market to provide free or low-cost healthcare to underserved individuals: CDA Cares, California CareForce, Remote Area Medical, and Care Harbor are a few of the major providers in this space that offer dental care (and/or other medical care, depending on the event) AB 880 Page 5 to the underserved population. These entities primarily rely on volunteers to provide services, frequently in a temporary medical space set up in a convention hall, fairground, or other public space. These volunteers are subject to professional regulation and are held to the same standard of care as in a traditional setting. This bill increases the potential pool of volunteers by allowing final year dental students to provide services at free sponsored healthcare events under supervision. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No SUPPORT: (Verified7/14/15) Oral and Facial Surgeons of California (source) California CareForce Dental Hygiene Committee of California Loma Linda University School of Dentistry University of California, Los Angeles School of Dentistry University of California, San Francisco School of Dentistry University of the Pacific, Arthur A. Dugoni School of Dentistry University of Southern California Western University of Health Sciences College of Dental Medicine OPPOSITION: (Verified7/14/15) None received ARGUMENTS IN SUPPORT: The Oral and Facial Surgeons of California write, "[We are] sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California's many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools." AB 880 Page 6 The University of the Pacific, Arthur A. Dugoni School of Dentistry writes, "Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. Free clinics and health fairs offer dental care to the most severely underserved communities. The ability to draw volunteers (both faculty and students) from schools ensures that the pool of providers will not evaporate and that they will be fresh and eager to serve the community." ASSEMBLY FLOOR: 78-0, 5/14/15 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Linder, Medina Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104 7/15/15 15:14:07 **** END ****