BILL ANALYSIS Ó AB 1253 Page 1 Date of Hearing: April 7, 2015 ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS Susan Bonilla, Chair AB 1253 Steinorth - As Introduced February 27, 2015 SUBJECT: Optometry: license: retired volunteer service designation. SUMMARY: Limits the issuance of a license with a retired volunteer service designation to an optometrist who holds a retired license for less than three years, and requires the holder of a retired license issued for more than three years to meet certain requirements, including passing clinical and jurisprudence examinations, in order for the State Board of Optometry (Board) to issue a license with retired volunteer service designation. EXISTING LAW 1)Provides, pursuant to the Optometry Practice Act, for the licensure and regulation of optometrists by the Board within the Department of Consumer Affairs. (Business and Professions Code (BPC) Section 3000 et seq.) 2)Defines the practice of optometry to include the prevention and diagnosis of disorders and dysfunctions of the visual system, and the treatment and management of certain disorders AB 1253 Page 2 and dysfunctions of the visual system, as well as the provision of rehabilitative optometric services, as specified. (BPC Section 3041) 3)Requires the Board to adopt regulations that require, as a condition to license renewal, that all licensees submit proof satisfactory to the Board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the Board or by other means deemed equivalent by the Board. (BPC Section 3059) 4)Provides that a license expires at midnight on the last day of the licenseholder's birth month following its original issuance and thereafter at midnight on the last day of the licenseholder's birth month every two years if not renewed. (BPC Section 3146) 5)Authorizes an expired license to be renewed at any time within three years after its expiration, and a retired license issued for less than three years to be reactivated to active status by filing an application for renewal, paying all fees, and submitting proof of completion of the required number of hours of continuing education (CE) for the last two years. (BPC Section 3147) 6)Authorizes the Board to reactivate or restore to active status a license that is not renewed within three years after its expiration, or a retired license issued for more than three years, if specified requirements are met, including the passage of both the National Board of Examiners in Optometry's Clinical Skills examination, or other clinical examination approved by the Board, and the Board's jurisprudence examination. (BPC Section 3147.6) AB 1253 Page 3 7)Requires the Board to issue, upon application and payment of prescribed fees, a retired license to an optometrist who holds a current and active license; exempts a retired licensee from CE requirements, and prohibits a retired licensee from practicing optometry. (BPC Section 3151) 8)Requires the Board to issue, upon application and payment of prescribed fees, a license with retired volunteer service designation to an optometrist who holds a retired license or a license that is current and active. (BPC Section 3151.1) 9)Requires an applicant for a license with retired volunteer service designation to certify that he or she has completed the required number of CEs and that the sole purpose of the license is to provide voluntary, unpaid optometric services at health fairs, vision screenings, and public service eye programs. (BPC Section 3151.1(b) (c)) 10)Requires the holder of a retired license with volunteer service designation to renew that license biennially, and to certify that he or she has completed the CE requirements and that the sole purpose of the license is to provide voluntary, unpaid optometric services. (BPC Section 3151.1(d)) 11)Limits the fee for a retired license, and the biennial renewal fee for a retired license with volunteer designation, to fifty dollars ($50). (BPC Section 3152) THIS BILL 1)Specifies that the Board may issue a license with retired volunteer service designation to an optometrist who holds a AB 1253 Page 4 retired license for less than three years. 2)Requires the holder of a retired license issued for more than three years to meet certain requirements, including the passage of both the National Board of Examiners in Optometry's Clinical Skills examination, or other clinical examination approved by the Board, and the Board's jurisprudence examination, in order for the Board to issue, upon application and payment of the prescribed fee, a license with volunteer service designation. 3)Clarifies that a license with retired volunteer service designation expires at midnight on the last day of the licenseholder's birth month every two years if not renewed. FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel. COMMENTS 1)Purpose. This bill is sponsored by the Board. According to the author, "[This bill] is a consumer protection measure which will ensure that retired optometrists are up to date and current on standard optometric practices. Existing law allows for someone who practiced optometry decades ago to quickly maintain a retired volunteer license simply by signing up and paying a fee. [This bill] will clarify that the Board will only issue a 'retired volunteer license' to an applicant if their regular optometrist license retired within the last three years. If it has been longer than three years, the optometrist would have to reapply to the Board as a new applicant. Consumers hold a reasonable expectation that optometrists at a health fair remain sufficiently educated in standard and current practices and knowledge. [This bill] AB 1253 Page 5 will follow through on this expectation." 2)Background. Retired and Retired Volunteer Service Licenses. SB 1215 (Emmerson), Chapter 359, Statutes of 2012, recently established both retired licenses and licenses with retired volunteer service designation for optometrists. Prior to these new license categories, licensees who were entering retirement had to choose between keeping an active license, and paying renewal fees, or having their license expire and put on delinquent status before the license was cancelled. In addition, SB 1215 made it easier for retired optometrists to volunteer by creating the volunteer service designation. Regulations implementing the fees for these license categories, set at twenty-five dollars ($25) for retired licenses and fifty dollars ($50) for retired volunteer licenses, became effective on April 1, 2014. An optometrist with retired volunteer status is able to practice solely for the purpose of volunteering his or her services at health fairs, vision screenings, and public service eye programs. There is no limitation on the scope of services that may be provided. Active retired volunteers are required to certify that they meet CE requirements, and must continue to meet CE requirements as a condition of renewal. Continuing Education Requirements. BPC Section 3059 requires the Board to adopt CE requirements for licensees, and Section 1536 of Title 16 of the California Code of Regulations outlines those requirements. Licensees are required to complete 40 hours of continuing optometric education course work within two years immediately preceding the license expiration date, while optometrists certified to use therapeutic pharmaceutical agents are required to complete 50 hours of CEs. According to the Board, while a retired licensee will have to certify that they have met these CE requirements, this CE requirement is only applicable to the AB 1253 Page 6 licensee's last renewal period, because retired licensees are not required to complete CEs. As a result, under existing law, a retired licensee who has not maintained an active license may be eligible for a retired volunteer license at any point in time without completing any additional CEs. No Time Frame for Retired Volunteer Licenses. The Board notes that because there is no time frame for a retired volunteer license, it may allow a retired licensee who has not practiced for decades and who has not kept up with any CE requirements to convert their license to retired volunteer status and start practicing again, which may pose a risk to consumers. According to the Board, consumers who rely on retired volunteer optometrists rightfully expect that the licensee is up to date on current standards, practices, and education within the optometry field, regardless of whether those services are paid for or not. Because these license categories are new, there are currently no retired licensees who have been out of practice for more than three years and thus would be ineligible to convert their license to a retired volunteer license. In addition, there is no basis to determine whether allowing licensees who have been on retired status for more than three years provide, or have provided, substandard care to consumers. However, the Board seeks to prevent that possibility by limiting the time period a licensee can be out of practice. In addition, the Board notes that the practice of optometry is subject to great change, especially with regards to scope of practice, which may increase the likelihood that someone who is out of practice for longer than three years might not be able to provide the same level of service, especially when there are no limitations on the scope of services a volunteer can provide. 3)Prior Legislation. SB 1215 (Emmerson), Chapter 359, Statutes of 2012, required the Board to issue a retired license to an optometrist with a current and active license, prohibited the holder of a retired license from engaging in the practice of optometry, and authorized the holder of a retired license to AB 1253 Page 7 reactive the license if certain conditions were met. The bill also required the board to issue a retired license with a volunteer service designation to an optometrist with a retired or current and active license, and required that applicant to certify completion of specified continuing education hours, and established renewal procedures for that license designation. ARGUMENTS IN SUPPORT. The California Board of Optometry writes in support, "Existing law allows for the holder of a retired license to convert said license to a retired volunteer service license at any time - even if their retired license is many years old, and have not practiced optometry in several years. Consumers have a reasonable expectation that an optometrist who serves at a public health fair, for example, [is] licensed and up to date on current practices within the field of optometry. AB 1253 will uphold this expectation by establishing time frames and expiration dates for retired volunteer service licenses. This policy aims to increase consumer protection, which is especially critical in the health field, specifically dealing with one's vision and eyesight." According to the California Optometric Association (COA), "This measure clarifies the pathway for obtaining a 'retired volunteer' license. COA supports giving retired doctors of optometry the ability to provide eye care in a volunteer capacity for those in need." ARGUMENTS IN OPPOSITION. None on file. POLICY ISSUES FOR CONSIDERATIONS. According to the author, the time period for a retired license to convert to a retired volunteer license is limited to three years because that is the AB 1253 Page 8 established time period for a license to be expired or on retired status before it can be reactivated without having to retake examinations. However, the author may wish to consider whether limiting the time period to three years may have the inadvertent effect of limiting the pool of potential volunteers who are able to provide competent services to those in need. While the author raises a legitimate concern regarding the amount of time someone can be out of practice and still engage in practice, especially in light of the limited CE requirement, the author may wish to consider whether such concerns about keeping up to date with current practices could be mitigated by, for example, an additional CE requirement. As a result, the author may wish to consider increasing the amount of time a retired licensee can convert to a retired volunteer license, without having to retake examinations, and contingent upon the licensee's completion of the additional CE requirements. This may provide a balanced approach to ensuring that all consumers, regardless of their ability to pay, are provided with competent services, and promote access to care by limiting barriers to volunteers. SUGGESTED AUTHOR'S AMENDMENTS. On page 2, line 6, strike "three" and insert "five" On page 2, line 10, strike "three" and insert "five" On page 2, line 15, insert the following: "If the applicant has held a retired license for more than three years, the applicant AB 1253 Page 9 shall complete, and certify on the application that he or she has completed, an additional 50 hours of formal continuing optometric education course work." REGISTERED SUPPORT / OPPOSITION: Support State Board of Optometry (sponsor) California Optometric Association Opposition None on file. Analysis Prepared by:Eunie Linden / B. & P. / (916) 319-3301 AB 1253 Page 10