BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON
          BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
                              Senator Jerry Hill, Chair
                                2015 - 2016  Regular 

          Bill No:            SB 1039         Hearing Date:    April 18,  
          2016
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          |Author:   |Hill                                                  |
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          |Version:  |April 12, 2016                                        |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Bill Gage                                             |
          |:         |                                                      |
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                         Subject:  Professions and vocations

          SUMMARY:  This is an omnibus bill which includes several changes to a  
          number of boards under the Department of Consumer Affairs and  
          also includes specified fee increases for several boards  
          including the Board of Registered Nursing, the Pharmacy Board,  
          the Contractors State License Board and the Court Reporters  
          Board.  This measure would also eliminate the current Telephone  
          Medical Advice Services Bureau. 

          Existing law:
          
          1)Requires the Office of Statewide Health Planning and  
            Development to establish the Health Professions Education  
            Foundation to, among other things, solicit and receive funds  
            for the purpose of providing scholarships, as specified.   
            (Health and Safety Code (HSC)  128330 et seq.)

          2)Contains the following provisions relating to the Dental Board  
            of California (DBC):
            
             a)   Provides for the licensure and regulation of persons  
               engaged in the practice of dentistry by the DBC which is  
               within the Department of Consumer Affairs (DCA).  (Business  
               and Professions Code (BPC)  1600 et seq.)

             b)   Provides that the DBC shall be responsible for the  
               approval of foreign dental schools, as specified, and that  
               the DBC may contract with outside consultants or a national  







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               professional organization to survey and evaluate foreign  
               dental schools and that the consultant or organization  
               shall report to the DBC regarding its findings in the  
               survey and evaluation.  (BPC  1636.4 (b))

             c)   Requires the DBC to establish a technical advisory group  
               to review and comment upon the survey and evaluation of a  
               foreign dental school by the outside consultant or  
               organization prior to any final action taken by the DBC  
               regarding certification of the foreign dental school and  
               that the technical advisory shall consist of members, as  
               specified.  (BPC  1636.4 (c))

             d)   Specifies that any foreign dental school that wishes to  
               be approved by the DBC shall make an application to the DBC  
               for its approval, which shall be based upon a finding by  
               the DBC that the educational program of the foreign dental  
               school is equivalent to that of similar accredited  
               institutions in the United States and adequately prepares  
               its students for the practice of dentistry; that  
               curriculum, faculty qualifications, student attendance,  
               plant and facilities, and other factors shall be reviewed  
               and evaluated by the DBC; and that the DBC shall identify  
               by rule the standards and review procedures and methodology  
               to be used in the approval process and that the DBC shall  
               not grant approval if deficiencies found are of such  
               magnitude as to prevent the students in the school from  
               receiving an educational base suitable for the practice of  
               dentistry.  (BPC  1636.4 (d))

             e)   Requires the DBC to make periodic surveys and  
               evaluations of all approved schools to ensure continued  
               compliance with those standards and qualifications, as  
               specified above, and that the DBC may provide for  
               provisional approval of foreign dental schools so that the  
               school has an opportunity to provide evidence that  
               deficiencies noted at the time of initial application have  
               been remedied and that permanent approval may be granted.   
               (BPC  1634 (e))

             f)   States that a school shall pay a registration fee  
               established by rule of the DBC, not to exceed one thousand  
               dollars ($1,000), at the time of application of approval  
               and shall pay all reasonable costs and expenses the DBC  








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               incurs for the conduct of the approval survey.  (BPC  1634  
               (f))

          3)Contains the following provisions relating to the California  
            Board of Podiatric Medicine (BPM):  

             a)   Creates the BPM within the jurisdiction of the Medical  
               Board of California.  
             (BPC  2460)

             b)   Provides that certificates to practice podiatric  
               medicine and registrations of spectacle lens dispensers and  
               contact lens dispensers, among others, expire on a certain  
               date during the second year of a 2-year term if not  
               renewed.  (BPC  2423)

          4)Contains the following provisions relating to the Board of  
            Registered Nursing (BRN): 
           
             a)   Provides for the licensure and regulation of nurse  
               practitioners by the BRN which is within the DCA.  (BPC   
               2700 et seq.)

             b)   Requires the BRN to adopt regulations establishing  
               standards for continuing education for licensees, as  
               specified, and that the standards shall take cognizance of  
               specialized areas of practice.  (BPC  2811.5)

             c)   Prescribes various fees to be paid by licensees and  
               applicants for licensure for the BRN and requires these  
               fees to be credited to the BRN Fund, which is a  
               continuously appropriated fund as it pertains to fees  
               collected by the BRN.   
             (BPC  2786.5, 2815, 2815.5, 2830.7 and 2838.2.)

          5)Contains the following provisions relating to the California  
            State Board of Pharmacy (BOP):  

             a)   Provides for the licensure and regulation of pharmacists  
               by the BOP within the DCA.  (BPC  4000 et seq.)

             b)   Prescribes various fees to be paid by licensees and  
               applicants for licensure, and requires all fees collected  
               on behalf of the BOP to be credited to the BOP Contingent  








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               Fund, which is continuously appropriated as it pertains to  
               fees collected by the BOP.  (BPC  4400)

          6)Requires the certain businesses that provide telephone medical  
            advice services to a patient at a California address to be  
            registered with the Telephone Medical Advice Services Bureau  
            and further requires telephone medical advice services to  
            comply with the requirements established by the DCA, among  
            other provisions, as specified.  (BPC  4999 et seq.)

          7)Contains the following provisions relating to the Contractors  
            State License Board (CSLB):

             a)   Provides for the licensure and registration of  
               contractors by the CSLB within the DCA.  (BPC  7000 et  
               seq.)

             b)   Prescribes various fees to be paid by licensees and  
               applicants for licensure with the CSLB, and requires fees  
               and civil penalties received under the Contractors' State  
               License Law to be deposited in the Contractors' License  
               Fund, which is a continuously appropriated fund as it  
               pertains to fees collected by the CSLB.  
             (BPC  7137 and 7153.3)

          8)Contains the following provisions relating to the Court  
            Reporters Board (CRB): 

             a)   Provides for the licensure and regulation of shorthand  
               reporters by the CRB within the DCA.  (BPC  8000 et seq.)

             b)   Authorizes the CRB by resolution to establish a fee for  
               renewal of a certificate issued by the CRB not to exceed  
               $125, as specified, and that all fees and revenues received  
               by the CRB are deposited into the Court Reporters' Fund,  
               which is a continuously appropriated fund as it pertains to  
               fees collected by the CRB.  (BPC  8031)

          9)Contains the following provisions relating to the Structural  
            Pest Control Board (SPCB):

             a)   Provides for the licensure and regulation of structural  
               pest control operators and registered companies, as  
               defined, by the Structural Pest Control Board (SPCB), which  








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               is within the DCA and requires a licensee to pay a  
               specified fee.  
             (BPC  8500 et seq.)

             b)   Places certain requirements on a registered company or  
               licensee with regards to wood destroying pests or  
               organisms, including that a registered company or licensee  
               is prohibited from commencing work on a contract until an  
               inspection has been made by a licensed Branch 3 field  
               representative, as defined, or operator, that the address  
               of each property inspected or upon which work was completed  
               is required to be reported to the SPCB, as specified, and  
               that a written inspection report be prepared and delivered  
               to the person requesting the inspection or his or her  
               agent.  Also requires that the original inspection report  
               to be submitted to the SPCB upon demand; for the written  
               report to contain certain information, including a  
               foundation diagram or sketch of the structure or portions  
               of the structure inspected; and requires the report, and  
               any contract entered into, to expressly state if a  
               guarantee for the work is made, and if so, the terms and  
               time period of the guarantee.  (BPC  8516 and 8519)

             c)   Defines control service as the regular inspection of a  
               property after a report has been made in compliance with  
               the requirements of an inspection as specified above, and  
               any corrections as have been agreed upon and have been  
               completed.  (BPC  8516 (g)).

          This bill:

          1)Makes the following changes relating to the Dental Board of  
            California (DBC):

             a)   Declares that it is the intent of the Legislature to  
               enact future legislation that would establish a Dental  
               Corps Scholarship Program, as specified, to increase the  
               supply of dentists serving in medically underserved areas.

             b)   Authorizes the DBC, in lieu of conducting its own survey  
               and evaluation of a foreign dental school, to accept the  
               findings of any commission or accreditation agency approved  
               by the DBC, if the findings meet the DBC's specified  
               standards and allows the DBC to adopt those findings as  








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               their own.  

             c)   Specifies that the new requirements for approval of  
               foreign dental schools as described above would not apply  
               to any foreign dental school currently seeking approval by  
               the DBC prior to January 1, 2017.

             d)   Deletes the requirement for the DBC to establish a  
               technical advisory group.

          2)Makes the following changes relating to the Board of Podiatric  
            Medicine (BPM):

             a)   Creates the BPM within the DCA rather than having the  
               BPM within the jurisdiction of the Medical Board of  
               California (MBC).

             b)   Revises the requirement that certificates to practice  
               podiatric medicine expire at 12 midnight on the last day of  
               the birth month of the licensee during the second year of a  
               two-year term if not renewed and provides for requirements  
               for renewal of an unexpired certificate. 

             c)   Makes other technical and conforming changes regarding  
               the BPM.

          3)Makes the following changes relating to the Board of  
            Registered Nursing (BRN): 

             a)   Specifies that the standards established for continuing  
               education for nurses shall take cognizance of specialized  
               areas of practice, as currently required, but in addition  
               the content shall be relevant to the practice of nursing  
               and shall be related to the scientific knowledge or  
               technical skills required for the practice of nursing or be  
               related to direct or indirect patient or client care.

             b)   Requires the BRN to audit continuing education providers  
               at least once every five years to ensure adherence to  
               regulatory requirements, and shall withhold or rescind  
               approval from any provider that is in violation of the  
               regulatory requirements.

             c)   Prescribes various fee changes to be paid by licensees  








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               and applicants for licensure and requires these fees to be  
               credited to the BRN Fund, which is a continuously  
               appropriated fund as it pertains to fees collected by the  
               BRN and also would raise specified fees, and would provide  
               for additional fees to be paid by licensees and applicants  
               for licensure as well as by schools seeking approval by the  
               BRN.

          4)Makes the following change relating to the California State  
            Board of Pharmacy (BOP): 

             a)   Modifies, on or after July 1, 2017, specified fees to be  
               paid by the licensees and applicants for licensure with the  
               BOP.

          5)Makes the following change relating to the Telephone Medical  
            Advice Services Bureau (Bureau):  

             a)   Eliminates the Bureau and repeals the requirement that  
               certain businesses that provide telephone medical advice  
               services to a patient at a California address to be  
               registered with the Bureau. 

             b)   Eliminates other related provisions in the Health and  
               Safety Code and the Insurance Code regarding telephone  
               medical advice services.

          6)Makes the following change relating to the Contractors State  
            License Board (CSLB):

             a)   Raises specified fees to be paid by the licensees and  
               applicants to the CSLB and would also require the CSLB to  
               establish criteria for the approval of expedited processing  
               applications, as specified.

          7)Makes the following change relating to the Court Reporters  
            Board (CRB):

             a)   Raises the renewal fee limit to be assessed by the CRB  
               from $125 to $250.

          8)Makes the following change relating to the Structural Pest  
            Control Board (SPCB):  









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             a)   Requires the operator licensed and regulated by the SPCB  
               prior to conducting an inspection as specified in Item #  
               21, above, to be employed by a registered company, except  
               as specified.

             b)   Requires that the written inspection report be prepared  
               and delivered to the person requesting it, the property  
               owner, or the property owner's designated agent, as  
               specified, and would not require the address of an  
               inspection report prepared for use by an attorney for  
               litigation to be reported the SPCB or assessed a filing  
               fee.

             c)   Allows an inspection report to be a complete, limited,  
               supplemental or reinspection report, as defined.

             d)   Requires all inspection reports to be submitted to the  
               SPCB and maintained with field notes, activity forms, and  
               notices of completion until one year after the guarantee  
               expires if the guarantee extends beyond 3 years.

             e)    Requires the inspection report to clearly list the  
               infested or infected wood members or parts of the structure  
               identified in the required diagram or sketch.

             f)   Clarifies the definition of "control service agreement"  
               as an agreement, including extended warranties, to have a  
               licensee conduct over a period of time regular inspections  
               and other activities related to the control or eradication  
               of wood destroying pests and organisms.

             g)   Makes other clarifying and technical changes regarding  
               the SPCB.
          
          FISCAL  
          EFFECT:  Unknown.  This bill has been keyed "fiscal" by  
          Legislative Counsel.
          
          COMMENTS:
          
          1.Purpose.  This measure is sponsored by the Author.  According  
            to the Author this bill is intended to be an omnibus bill  
            which includes several changes to a number of boards under the  
            Department of Consumer Affairs and would also include  








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            necessary fee increases for certain boards to ensure they  
            continue to operate without a major structural deficit and  
            maintain adequate reserves.  With the advent of the BreEZe  
            project, which is an attempt to replace multiple antiquated  
            standalone information technology (IT) systems for most of the  
            boards under the DCA, some boards have anticipated what may be  
            significant costs and have also provided projections of future  
            fund conditions which show less than possibly 3 months in  
            reserve because of overall increased budgetary costs for these  
            individual boards.  (Typically, boards consider seeking fee  
            increases when they project their funds in will be at, or dip  
            below, a three-month reserve.)  

          This measure also provides the Dental Board with the ability to  
            rely on a national accrediting agency in approving foreign  
            dental schools, makes other clarifying substantive changes for  
            the Structural Pest Control Board in regards to inspection  
            conducted by structural pest control operators and their  
            companies and eliminates the Telephone Advice Medical Services  
            Bureau which is no longer necessary to provide oversight of  
            remote advice provided by healthcare practitioners.

          2.Background.  The following is background and reasons for the  
            more significant and substantive provision in this measure:

             a)   DBC Approval of Foreign Dental Schools.  In 1997, the  
               Legislature recognized the need to ensure that graduates of  
               foreign dental schools who have received an education that  
               is equivalent to that of accredited institutions in the  
               United States and that adequately prepares their students  
               for the practice of dentistry shall be subject to the same  
               licensure requirements as graduates of approved dental  
               schools or colleges.

                AB 1116  (Keeley) was introduced and supported by a  
               coalition of various professional dental organizations,  
               because the process at the time for evaluating foreign  
               dental school graduates was observed to be inadequate  
               primarily because there was no effective way for the DBC to  
               evaluate the quality of dental education received by  
               foreign dental school graduates.  Additionally, the  
               analysis indicated that California's licensing standards  
               for foreign dental graduates were unusually lenient and out  
               of sync with the requirements in the rest of the United  








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               States. The sponsor and supporters of this bill advocated  
               for the passage of AB 1116 in order for California to move  
               to a stricter and more uniform educational standard to  
               assure that all licensed dentists are equally qualified. 

               AB 1116 was signed by the Governor on October 7, 1997 and  
               required, in pertinent part, the following:

                  a)        Revision of the requirements for licensure of  
                    applicants who are graduates of foreign dental  
                    schools;
                  b)        The Board to be responsible for the approval  
                    of foreign dental schools based on prescribed  
                    standards (California Code of Regulations  1024.1);  
                    and
                  c)        Establishment of procedures regarding this  
                    approval process.

               In addition, the Legislature urged all California dental  
               schools to provide in their curriculum a two year course of  
               study that may be used by graduates of foreign dental  
               schools to attain the prerequisites for licensure in  
               California. 

               Since the implementation of AB 1116 in 2003, there have  
               been a limited number for foreign dental schools seeking  
               DBC approval.  One school in Mexico has been approved and  
               one school in Moldova is in the application process.  It is  
               important to specify that the DBC does not "accredit"  
               dental schools, but rather evaluates foreign dental schools  
               in order to determine that the education is equivalent with  
               the accredited institutions in the United States.   
               Accreditation of dental education programs in the United  
               State has been vested in the Commission on Dental  
               Accreditation (CODA) by the United States Department of  
               Education.  Educational standards are established by the  
               CODA and revised as knowledge, techniques, and technology  
               affects the educational needs and goals of dental education  
               and thus, the practice of dentistry in the United States.   
               The DBC accepts dental education programs that are  
               accredited by the CODA as meeting the educational  
               requirements for dental licensure in California.  The CODA  
               was established in 1975 and recognized by the United States  
               Department of Education as the sole agency to accredit  








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               dental and dental-related education programs conducted at  
               the post-secondary level in the United States.  

               Prior to 2003, the CODA did not have in place processes for  
               the review and approval of foreign dental schools.   
               Therefore, the only alternative at that time, to be  
               compliant with statutory requirement, was to establish a  
               process by which the DBC would be responsible for the  
               approval of foreign dental schools. 
               Since 2003, the CODA has established processes for review  
               and accreditation of foreign dental schools' education  
                                                                                     programs.  International consultation and accreditation  
               fee-based services are available to international  
               pre-doctoral dental education programs, upon request.  Once  
               an international dental education program meets the  
               established criteria, consultation and accreditation  
               services will be provided in accordance with the CODA  
               policies and procedures. 

               This measure will allow the DBC to accept the findings of a  
               CODA approved foreign dental school in lieu of conducting  
               its own evaluation.  This would also alleviate the  
               necessity of forming a technical advisory group, which adds  
               an extra layer of review that is unnecessary. 

             a)   Clarify Jurisdiction of the BPM. Technical changes  
               striking references to the Medical Board of California  
               (MBC) in the podiatry practice act are intended to reflect  
               the independent status of each board.  While the BPM was  
               once housed within the MBC, it has been an independent  
               entity since the late 1980's and relies on the MBC only for  
               contractually specified duties, which the MBC provides for  
               other boards, as well.  The BPM is independently  
               responsible for determining the eligibility of its  
               licensees and making final disciplinary decisions.

             b)   Clarify Continuing Education (CE) Requirements for the  
               BRN and Provide for Various Fee Increases.   CE Changes  .   
               All BRN licensees are required by statute to complete 30  
               hours of CE during each two year renewal cycle to ensure  
               continued competence.  Licensees are required to submit  
               proof of their compliance by signing a statement under  
               penalty of perjury and agreeing to produce documentation  
               upon request.  The BRN relies on adherence to CE standards  








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               as the primary method of assuring the continued competence  
               of its licensees, but it has not institutionalized regular  
               audits of licensees' CEs or CE providers (CEPs) since 2002.  
                This issue was raised in the 2011 Sunset Review Report.  

               Prior to 2002, the BRN conducted random audits of CEs and  
               CEPs, averaging 2,700 RN CEs and 282 CEPs per year.  The  
               BRN completed only 200 RN CE audits from 2011 to 2014 and  
               no CEP audits since 2001, citing lack of staff.  This is  
               particularly concerning because the BRN acknowledges that  
               CE compliance is "essential to ensure public safety and  
               protection." While BRN reports having made multiple  
               requests in the past 14 years to obtain additional staffing  
               for audits, it only very recently redirected existing staff  
               towards this work.   

               A 2009 article titled, "State-Sponsored Quackery:  Feng  
               Shui and Snake Oil for California Nurses" detailed the  
               BRN's lax CEP approval process.  Reporters uncovered a  
               nursing CEP called Clearsight, which offered credits for a  
               class in "energetic medicine."  "Energetic medicine" is  
               Clearsight's name for therapeutic touch, the manipulation  
               of alleged energy fields such as chakras and auras over the  
               body. (The practitioner's hands make no actual contact with  
               the patient.) ?. Clearsight introduces you to the skills of  
               Free Will, the art of energy diagnosis, how to make  
               Separations from your Healee so you do not take another  
               person's energy or disease home and how to release old  
               patterns and stuck energy in your body and auric field.  
               When you use Clearsight healing skills you clear and clean  
               the entire energy field (chakras, channels and aura) and  
               grow and evolve evenly at the rate of growth you are ready  
               to access."



               After some prodding to remind BRN that Clearsight's  
               provider application was public record, the reporter  
               received a copy of the application and discovered that  
               it was blank in some places and that the instructor's  
               educational credentials consisted of a BA in  
               comparative religion and a ministerial certificate  
               from the Church of Divine Man, a psychic institute  
               that offers healings, psychic readings, and other such  








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               activities.  Clearsight is no longer an approved CEP,  
               but only because its license lapsed in 2014; no  
               disciplinary actions were ever taken against it.  This  
               is understandable because, as the article notes, the  
               BRN supported the approval of CEPs that promote  
               education with little to no scientific merit.   
               Refinement of CEP regulations have not since occurred.

               There was an additional article in 2016 titled, "The  
               Miseducation of California Nurses:  Legal Loophole  
               Enables Spread of Anti-Choice Medical Myths," which  
               highlighted a BRN CE Provider, Heartbeat  
               International, offering credits to nurses who take a  
               class about undoing a pill-induced abortion; a  
               procedure unsupported by sufficient evidence.  When  
               confronted with the information, the BRN was basically  
               nonresponsive to the reporter and cited code sections  
               that restate that the BRN approves the provider and  
               the provider accepts full responsibility for course  
               content and instructor qualifications.  According to  
               the acting EO, the BRN began looking further into the  
               CE provider when the reporter started looking into  
               them for this story.  BRN indicated they do not audit  
               CE providers regularly, but do look into them when an  
               issue with one is raised.     

               During the comprehensive sunset review oversight of  
               the BRN in 2015 conducted by the Senate Committee on  
               Business, Professions and Economic Development and  
               Assembly Committee on Business and Professions  
               (Committees), staff recommended the following:  "The  
               BRN should review its criteria for CEPs and require  
               content to be science-based and directly related to  
               professionally appropriate practice.  The BRN should  
               continue to pursue additional staffing for CE  
               auditors, but should simultaneously rebalance its  
               existing workload and prioritize ongoing CE and CEP  
               audits."  
                
               This measure reflects the recommendation made in 2015  
               during sunset review and would provide more staffing to  
               audit CE provided pursuant to the fee increase.  

               Fee Changes  .  The BRN Fund is maintained by the BRN and  








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               includes the revenues and expenditure related to licensing  
               nurses.  According to the BRN, the cause of its projected  
               deficit is an ongoing problem.  Annual increases in  
               enforcement expenditures (Attorney General, Office of  
               Administrative Hearings, and Evidence/Witness fees) since  
               approximately FY 2010/11 were able to be absorbed as a  
               result of budget bill language in FY 2010/11.  However, the  
               following have been annual increases from FY 2010/11 to FY  
               2014/15 and projected for FY 2015/16:  $2,278,000 million  
               in FY 2010/11, along with an additional $2,872,338 through  
               budget bill language in FY 2010/11, $2,284,607 million in  
               FY 11/12, $4,074,512 million in FY 13/14, a BCP  
               augmentation of $2,700,000 million along with an additional  
               $3,330,833 in FY 14/15, and $1,820 million projected in FY  
               15/16.  Also, increasing costs to the BRN as a result of  
               unanticipated BreEZe cost increases (which increased from  
               $2,444,396 million in FY 2014/15 to $5,182,708 million in  
               FY 2015/16 and $4,997,301 in FY 2016/17).  As of March 31,  
               2016, the BRN has expended approximately $10,596,070 on  
               BreEZe.  

               The BRN further indicates that as a result of the high  
               volume of work regularly referred to the Office of the  
               Attorney General, they have requested additional deputies  
               beginning in FY 2016/17 and 10 senior legal analysts to  
               comply with the data reporting requirements contained in SB  
               467 (Hill, Chapter 656, Statutes of 2015).  The BRN will  
               have to help pay for these augmentations if approved by the  
               Legislature and the Governor.

               The BRN notes that fees were increased for the first time  
               in 19 years in 2011 when enforcement was authorized  
               additional staff of 34 and then 27 more staff in 2014/15.   
               Fees were increased to the current statutory limit  
               beginning in October 2015, as approved by the Office of  
               Administrative Law.

               Due to the addition of the approximately 61 enforcement  
               positions as indicated above, the BRN has been without  
               comparable administrative support in the area of  
               information technology, human resources, supply  
               coordination and delivery, mail delivery, etc.  The BRN  
               also transitioned from its legacy systems into BreEZe in  
               October 2013 and did not fully understand or appreciate the  








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               length of time it would take until well after the initial  
               go-live date to use the system to cashier money, approve  
               applicants to take the registered nurse licensure exam,  
               issue licenses, complete license renewals, issue license  
               verifications, etc.  As a result, the BRN is in need of  
               additional funding to support and improve the call center,  
               cashiering, license renewals, licensee support, initial  
               licensing, administrative support, legislation,  
               contracting, social media and public records act requests.

               The BRN also underwent a fee audit of all fees to determine  
               whether the BRN was charging appropriate fees in order to  
               conduct its business at an adequate service level to  
               provide public protection.  It was found that the BRN has  
               not been charging enough fees for many areas and has not  
               been collecting enough fees to support the increased  
               enforcement efforts.  The proposed fee increases for the  
               BRN are as follows:

                    ---------------------------------------------------- 
                   |Fee Names                 |Current| Board  | Board  |
                   |                          |  Fees |Proposed|Proposed|
                   |                          |       |        |   Fee  |
                   |                          |       |Minimum |  Caps  |
                   |                          |       |  Fees  |        |
                   |--------------------------+-------+--------+--------|
                   |INITIAL APPLICATIONS      |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Interim permit -          |   $50 |   $100 |    $250|
                   |registered nurse          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Temporary certificate -   |   $50 |   $100 |    $250|
                   |registered nurse          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Temporary certificate -   |   $50 |   $100 |    $250|
                   |public health nurse       |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Temporary certificate -   |   $50 |   $150 |    $500|
                   |nurse anesthetist         |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Temporary certificate -   |   $50 |   $150 |    $500|
                   |nurse midwife             |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Temporary certificate -   |   $50 |   $150 |    $500|








          SB 1039 (Hill)                                          Page 16  
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                   |nurse practitioner        |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial exam app -        |  $150 |   $300 |  $1,000|
                   |registered nurse (CA      |       |        |        |
                   |grad)                     |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial exam app -        |   None|   $350 |  $1,000|
                   |registered nurse          |       |        |        |
                   |(Out-of-state)            |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial exam app -        |   None|   $750 |  $1,500|
                   |registered nurse          |       |        |        |
                   |(International)           |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Repeat exam app -         |  $150 |   $250 |  $1,000|
                   |registered nurse          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Endorsement app -         |  $100 |   $350 |  $1,000|
                   |registered nurse          |       |        |        |
                   |(Out-of-state)            |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Endorsement app -         |   None|   $750 |  $1,500|
                   |registered nurse          |       |        |        |
                   |(International)           |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - public      |  $150 |   $300 |  $1,000|
                   |health nurse              |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - clinical    |  $150 |   $500 |  $1,500|
                   |nurse specialist          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - nurse       |  $150 |   $500 |  $1,500|
                   |anesthetist               |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - nurse       |  $150 |   $500 |  $1,500|
                   |midwife                   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - nurse       |  $150 |   $400 |  $1,500|
                   |midwife furnishing        |       |        |        |
                   |--------------------------+-------+--------+--------|








          SB 1039 (Hill)                                          Page 17  
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                   |Initial app - nurse       |  $150 |   $500 |  $1,500|
                   |practitioner              |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - nurse       |  $150 |   $400 |  $1,500|
                   |practitioner furnishing   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Psychiatric mental health |   None|   $350 |    $750|
                   |nurse listing app         |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - continuing  |  $300 |   $500 |  $1,000|
                   |education provider        |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Initial app - new school  |$5,000 |$40,000 | $80,000|
                   |of nursing                |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |RENEWAL APPLICATIONS      |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - registered  |  $150 |   $180 |    $750|
                   |nurse                     |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - registered  |   None|   $350 |  $1,000|
                   |nurse 8-year, no exam     |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - public      |   None|   $125 |    $500|
                   |health nurse              |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - clinical    |  $100 |   $150 |  $1,000|
                   |nurse specialist          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - nurse       |  $100 |   $150 |  $1,000|
                   |anesthetist               |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - nurse       |  $100 |   $150 |  $1,000|
                   |midwife                   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - nurse       |   $30 |   $150 |  $1,000|
                   |midwife furnishing        |       |        |        |
                   |--------------------------+-------+--------+--------|








          SB 1039 (Hill)                                          Page 18  
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                   |Renewal app - nurse       |   None|   $150 |  $1,000|
                   |practitioner              |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - nurse       |   $30 |   $150 |  $1,000|
                   |practitioner furnishing   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Renewal app - continuing  |  $200 |   $250 |  $1,000|
                   |education provider        |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Continuing approval -     |$3,500 |$15,000 | $30,000|
                   |school of nursing         |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $65 |    $90 |    $375|
                   |registered nurse          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   None|    $63 |    $250|
                   |public health nurse       |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $37 |    $75 |    $500|
                   |clinical nurse specialist |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $37 |    $75 |    $500|
                   |nurse anesthetist         |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $37 |    $75 |    $500|
                   |nurse midwife             |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $15 |    $75 |    $500|
                   |nurse midwife furnishing  |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   None|    $75 |    $500|
                   |nurse practitioner        |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |   $15 |    $75 |    $500|
                   |nurse practitioner        |       |        |        |
                   |furnishing                |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |








          SB 1039 (Hill)                                          Page 19  
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                   |--------------------------+-------+--------+--------|
                   |Delinquent renewal -      |  $100 |   $125 |    $500|
                   |continuing education      |       |        |        |
                   |provider                  |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |MISCELLANEOUS FEES        |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Duplicate - pocket        |   $50 |    $50 |     $75|
                   |license                   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Duplicate - wall          |   $30 |    $60 |    $100|
                   |certificate               |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |License certification -   |    $2 |    $20 |     $30|
                   |simple letter             |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |License verification -    |   $60 |   $100 |    $200|
                   |endorsement out-of-state  |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |License verification -    |   $60 |   $100 |    $200|
                   |international credentials |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Duplicate - NCLEX-RN exam |   None|    $60 |    $100|
                   |results                   |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Copy - transcripts        |   $30 |    $50 |    $100|
                   |out-of-state              |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Major curriculum change - |  $500 |  $2,500|  $5,000|
                   |school of nursing         |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |                          |       |        |        |
                                                           |--------------------------+-------+--------+--------|
                   |Modification of penalty - |   None|     $50|     $50|
                   |probation                 |       |        |        |
                   |--------------------------+-------+--------+--------|
                   |Petition for              |   None|     $50|$50     |
                   |reinstatement             |       |        |        |
                    ---------------------------------------------------- 
          
             d)   Provide for Various Fee Increases for the Board of  
               Pharmacy (BOP).  The BOP current statutory authority  








          SB 1039 (Hill)                                          Page 20  
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               establishes both a minimum and maximum level for all fees.   
               The BOP uses its regulatory authority to establish each fee  
               within this range.  As a result of a regulatory change that  
               took effect July 1, 2014, with few exceptions, all of the  
               BOP's fees are at their statutory maximums.  The BOP  
               indicates that it is seeking to realign its current fee  
               structure to address a structural imbalance in its current  
               budget resulting from an increase in annual authorized  
               expenditures that is not offset by a corresponding increase  
               in revenue.  As a precursor to establishing the new fee  
               schedules, the DCA's Budget Office completed a fee analysis  
               of the BOP's fund condition and fee structure in late 2015.  
                As part of its assessment, the DCA noted that the board is  
               currently required to maintain a reserve level of one year.  
                As of July 1, 2015, the board fund reserve was 4.9 months  
               and is projected to drop to 3.0 months in reserve on July  
               1, 2016.  The BOP considered the findings of the DCA when  
               considering establishment of new fees.  The assessment by  
               the DCA concluded that the board's current fee levels are  
               not sufficient to keep the board's fund solvent in the long  
               term, and will lead to a deficit early in FY 2018/19.   
               Specifically, the BOP's fund is expected to drop to about  
               three months in reserve in FY 2016/17 and will go into  
               deficit thereafter.

             Currently, the BOP's authorized and actual expenditures  
               exceed actual revenue.  Based on projections provided by  
               the DCA, in FY 2014/15 this deficit was about $1.14 million  
               or 6 percent shortfall.  Based on projections for FY  
               2015/16 the deficit will grow to $3.5 million or 20 percent  
               shortfall.  By FY 2017/18, the deficit is projected to be  
               $4.2 million or 26 percent shortfall and the BOP's budget  
               will become all but insolvent with only 0.1 months in  
               reserve on July 1, 2018.

             The reason for the deficit according to the BOP is that over  
               the last five fiscal years its authorized expenditures  
               increased by approximately 50 percent.  The growth is  
               primarily in the BOP's enforcement expenditures and  
               reflects continued focus on its mandate as well as its  
               focus on responding to change that impact the BOP's  
               jurisdiction (e.g., Consumer Protection Enforcement  
               Initiative from FY 2010-11, prescription drug abuse  
               epidemic, sterile compounding).








          SB 1039 (Hill)                                          Page 21  
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               The proposed fee increases for the BOP are as follows:


                 --------------------------------------------------------------- 
                |         Current Fee, Proposed Statutory Minimum Fee,          |
                |     Proposed Statutory Maximum Fee, and Percentage Change     |
                |                                                               |
                 --------------------------------------------------------------- 
                |------------------------+---------+--------+--------+----------|
                |                        | Current |Proposed|Proposed|Percentage|
                |Fee Type                |   Fee   |        |        |          |
                |                        |         |Statutor|Statutor|  Change  |
                |                        |         |   y    |   y    |   from   |
                |                        |         |Minimum |Maximum | Current  |
                |                        |         |        |        |    to    |
                |                        |         |        |        | Proposed |
                |                        |         |        |        |Statutory |
                |                        |         |        |        | Minimum  |
                |------------------------+---------+--------+--------+----------|
                |Centralized Hospital    |  $800   |  $820  | $1,150 |    3%    |
                |Packaging               |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Clinic Permit           |  $520   |  $520  |  $570  |    0%    |
                |------------------------+---------+--------+--------+----------|
                |Designated              |  $330   |  $150  |  $210  |   -55%   |
                |Representative          |         |        |        |          |
                |Certificate - Third     |         |        |        |          |
                |Party Logistics         |         |        |        |          |
                |Provider                |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Designated              |  $330   |  $150  |  $210  |   -55%   |
                |Representative          |         |        |        |          |
                |Certificate -           |         |        |        |          |
                |Veterinary Food-Animal  |         |        |        |          |
                |Drug Retailers          |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Designated              |  $330   |  $150  |  $210  |   -55%   |
                |Representative          |         |        |        |          |
                |Certificate -           |         |        |        |          |
                |Wholesalers             |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Hypodermic Needle and   |  $165   |  $170  |  $240  |    3%    |
                |Syringe                 |         |        |        |          |








          SB 1039 (Hill)                                          Page 22  
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                |------------------------+---------+--------+--------+----------|
                |Intern Pharmacist       |  $115   |  $165  |  $230  |   43%    |
                |------------------------+---------+--------+--------+----------|
                |Non-Resident Pharmacy   |  $520   |  $520  |  $570  |    0%    |
                |------------------------+---------+--------+--------+----------|
                |Non-Resident Sterile    |  $780   | $2,380 | $3,335 |   205%   |
                |Compounding             |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Non-Resident Third      |  $780   |  $780  |  $820  |    0%    |
                |Party Logistics         |         |        |        |          |
                |Provider                |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Non-Resident Wholesaler |  $780   |  $780  |  $820  |    0%    |
                |------------------------+---------+--------+--------+----------|
                |Pharmacist Initial      |  $195   |  $195  |  $215  |    0%    |
                |License Fee             |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Pharmacist Licensure    |  $260   |  $260  |  $285  |    0%    |
                |Exam                    |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Pharmacy                |  $520   |  $520  |  $570  |    0%    |
                |------------------------+---------+--------+--------+----------|
                |Pharmacy Technician     |  $105   |  $140  |  $195  |   33%    |
                |------------------------+---------+--------+--------+----------|
                |Sterile Compounding     |  $780   | $1,645 | $2,305 |   111%   |
                |------------------------+---------+--------+--------+----------|
                |Third Party Logistics   |  $780   |  $780  |  $820  |    0%    |
                |Provider                |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Veterinary Food-Animal  |  $425   |  $435  |  $610  |    2%    |
                |Drug Retailer           |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Wholesale Drug          |  $780   |  $780  |  $820  |    0%    |
                |------------------------+---------+--------+--------+----------|
                |                        |         |        |        |          |
                 --------------------------------------------------------------- 
                 ---------------------------------------------------------------- 
                |          Current Fee, Proposed Statutory Minimum Fee,          |
                |     Proposed Statutory Maximum Fee, and Percentage Change      |
                |                                                                |
                 ---------------------------------------------------------------- 
                 --------------------------------------------------------------- 
                |                        | Current |Proposed|Proposed|Percentage|
                |Fee Type                |   Fee   |        |        |          |








          SB 1039 (Hill)                                          Page 23  
          of ?
          
          
                |                        |         |Statutor|Statutor|  Change  |
                |                        |         |   y    |   y    |   from   |
                |                        |         |Minimum |Maximum | Current  |
                |                        |         |        |        |  Fee to  |
                |                        |         |        |        | Proposed |
                |                        |         |        |        |Statutory |
                |                        |         |        |        | Minimum  |
                |                        |         |        |        |   Fee    |
                 --------------------------------------------------------------- 
                |Centralized Hospital    |  $800   |  $805  | $1,125 |    1%    |
                |Packaging Renewal       |         |        |        |          |
                 --------------------------------------------------------------- 
                |Clinic Renewal          |  $325   |  $325  |  $360  |    0%    |
                 --------------------------------------------------------------- 
                |Designated              |  $195   |  $215  |  $300  |   10%    |
                |Representative          |         |        |        |          |
                |Certificate - Third     |         |        |        |          |
                |Party Logistics         |         |        |        |          |
                |Provider Renewal        |         |        |        |          |
                 --------------------------------------------------------------- 
                |Designated              |  $195   |  $215  |  $300  |   10%    |
                |Representative -        |         |        |        |          |
                |Veterinary Food-Animal  |         |        |        |          |
                |Drug Retailers Renewal  |         |        |        |          |
                 --------------------------------------------------------------- 
                |Designated              |  $195   |  $215  |  $300  |   10%    |
                |Representative -        |         |        |        |          |
                |Wholesalers Renewal     |         |        |        |          |
                 --------------------------------------------------------------- 
                |Hypodermic Needle and   |  $165   |  $200  |  $280  |   21%    |
                |Syringe Renewal         |         |        |        |          |
                 --------------------------------------------------------------- 
                |Non-Resident Pharmacy   |  $325   |  $325  |  $360  |    0%    |
                |Renewal                 |         |        |        |          |
                 --------------------------------------------------------------- 
                |Non-Resident Sterile    |  $780   | $2,270 | $3,180 |   191%   |
                |Compounding Renewal     |         |        |        |          |
                 --------------------------------------------------------------- 
                |Non-Resident Third      |  $780   |  $780  |  $820  |    0%    |
                |Party Logistics         |         |        |        |          |
                |Provider Renewal        |         |        |        |          |
                 --------------------------------------------------------------- 
                |Non-Resident Wholesaler |  $780   |  $780  |  $820  |    0%    |
                |Renewal                 |         |        |        |          |








          SB 1039 (Hill)                                          Page 24  
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                 --------------------------------------------------------------- 
                |Pharmacist Renewal      |  $195   |  $360  |  $505  |   85%    |
                 --------------------------------------------------------------- 
                |Pharmacy Renewal        |  $325   |  $665  |  $930  |   105%   |
                 --------------------------------------------------------------- 
                |Pharmacy Technician     |  $130   |  $140  |  $195  |    8%    |
                |Renewal                 |         |        |        |          |
                 --------------------------------------------------------------- 
                |Sterile Compounding     |  $780   | $1,325 | $1,855 |   70%    |
                |Renewal                 |         |        |        |          |
                 --------------------------------------------------------------- 
                |Third Party Logistics   |  $780   |  $780  |  $820  |    0%    |
                |Provider Renewal        |         |        |        |          |
                 --------------------------------------------------------------- 
                |Veterinary Food-Animal  |  $325   |  $330  |  $460  |    2%    |
                |Drug Retailer           |         |        |        |          |
                |Renewal                 |         |        |        |          |
                |------------------------+---------+--------+--------+----------|
                |Wholesale Drug Renewal  |  $780   |  $780  |  $820  |0%        |
                |                        |         |        |        |          |
                 --------------------------------------------------------------- 

             e)   Eliminate the Telephone Medical Advice Services Bureau  
               (Bureau).  The Bureau was created in 1999 (AB 285, Corbett,  
               Chapter 535, Statutes of 1999) in response to a situation  
               in which a Senator's constituent was unable to contact her  
               physician over the phone, received inadequate service at a  
               clinic, and then died after surgery at a hospital.   
               Telephone medical advice was not at issue. 

               Current law now requires any business that provides  
               telephone medical advice services to a patient in  
               California and who employs or contracts with five or more  
               health care professionals to register with the Bureau.  A  
               business fills out a registration form provided by the  
               Bureau and pays a fee.  The registrant must then renew  
               every two years and file quarterly reports which, among  
               other requirements, list all California and out-of-state  
               employees who provide medical advice services to California  
               patients.  The Bureau verifies those licensees.  There are  
               61 registrants as of 2015.

                Enforcement.  The Bureau ensures that all registrants file  
               quarterly reports and checks to make sure that all the  








          SB 1039 (Hill)                                          Page 25  
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               licensees provided on the list by the registrant are  
               properly licensed.  However, there is no effort to  
               independently confirm the accuracy of the lists provided -  
               for example, whether the registrant has provided a  
               comprehensive list of their licensed providers or whether  
               any non-California licensed providers offered advice to  
               Californians.  Despite this honor system, some  
               discrepancies have been found.  In these cases, according  
               to the Bureau, it works with the registrants to correct  
               errors and does not pursue discipline.  

               Registrants are also required to provide complaint data to  
               the Bureau on a quarterly basis, consisting of numbers of  
               complaints.  The Bureau is not made aware of the nature or  
               resolution of the issues from the registrant, but rather  
               the registrant sends the complainant a form to fill out and  
               mail to the Bureau.  The Bureau also solicits consumer  
               complaints on its Web site, though the consumer must  
               download the complaint form and mail it to the Bureau. 

               Even with these obstacles, the Bureau receives, on average,  
               21 consumer complaints per year.  In the past five years,  
               105 complaints were received, and all but two were closed  
               without referral for investigation.  According to the most  
               recent DCA reports, there have been no citations or fines  
               assessed, referrals for criminal or civil action, formal  
               disciplinary actions filed, or consumer restitution ordered  
               by the Bureau in the last five years.

                Budget  .  The Bureau's enabling legislation required DCA to  
               set fees for registration and renewal "sufficient to pay  
               the costs of administration."  Fees were set for the  
               initial registration and renewal at $7,500.  Under BPC   
               128.5, DCA entities are required to reduce license fees to  
               the amount that will reduce any surplus funds equal to the  
               entity's operating budget for the next two years.  The  
               Bureau is in violation of this statute.  The Bureau has had  
               over five years' reserve since at least 2009, when numbers  
               were available, and is presently on track to have nearly a  
               six-year reserve by the end of 2016 ($1,144,000).  Fees  
               have not been adjusted since 2001.  
             
               Concurrent Authority and Emerging Technologies  .  It may be  
               argued that consumers are already protected from unlicensed  








          SB 1039 (Hill)                                          Page 26  
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               providers by the other DCA regulatory health boards because  
               telehealth statutes have evolved to authorize and regulate  
               the provision of healthcare remotely via the telephone and  
               other technologies.  

               Although the Bureau insists that "telephone medical advice"  
               differs from "telemedicine," the law does not make such a  
               clear distinction.  Under BPC  4999.7, "telephone medical  
               advice" means a telephonic communication between a patient  
               and a health care professional in which the health care  
               professional's primary function is to provide to the  
               patient a telephonic response to the patient's questions  
               regarding his or her or a family member's medical care or  
               treatment. "Telephone medical advice" includes assessment,  
               evaluation, or advice provided to patients or their family  
               members.  Under BPC  2290.5 "Telehealth" means the mode of  
               delivering health care services and public health via  
               information and communication technologies to facilitate  
               the diagnosis, consultation, treatment, education, care  
               management, and self-management of a patient's health care  
               while the patient is at the originating site and the health  
               care provider is at a distant site.  Telehealth facilitates  
               patient self-management and caregiver support for patients  
               and includes synchronous interactions and asynchronous  
               store and forward transfers.  Telehealth includes telephone  
               medical advice, and all licensing laws and practice  
               restrictions apply to individuals caring for patients in  
               California whether face to face or remotely.

               While telephone medical advice services may have been  
               critical to the provision of remote care in 1999, the  
               Internet and mobile device apps have accelerated and  
               encouraged the provision of remote advice by healthcare  
               professionals.  Doctors on Demand, Teladoc, and even  
               Planned Parenthood are some of many current businesses that  
               bypass the telephone to connect patients and healthcare  
               licensees.  These emerging platforms are outside of the  
               Bureau's jurisdiction and the healthcare licensees are  
               subject to regulation by the DCA's regulatory boards.   
               There have been no widespread issues of unlicensed activity  
               in these areas.

                Recommendation During Sunset Review  .  During the  
               Committees' comprehensive sunset review oversight of the  








          SB 1039 (Hill)                                          Page 27  
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               DCA and regulatory entities in 2015-16, staff indicated,  
               "It does not appear that the Bureau is providing consumer  
               protection by confirming self-reported registrant data.   
               The Bureau has not managed its budget within statutory  
               mandates, and has failed to keep pace with technological  
               innovations.  Because the provision of remote healthcare is  
               already regulated by the DCA health care boards, the Bureau  
               is not necessary." 

             f)   Provide for Various Fee Increases for the Contractors  
               State License Board.
             The proposed fee increases for the CSLB seeks to provide the  
               Board with sufficient funding to support its existing  
               budget and provide for reasonable inflationary cost  
               increases.  While costs have increased in every area in the  
               last few years, the most significant areas are in Personal  
               Services, DCA Pro Rata and Enforcement.  The CSLB  
               anticipates that it will have, by FY 2018/19, a deficit of  
               approximately $6 million.  

             CSLB needs a fee increase in order to continue to provide its  
               existing level of service to both licensees and consumers.   
               In FY 2012/13, CSLB spent approximately $54 million, and in  
               the current budget year we expect to spend approximately  
               $61 million, an increase of approximately 16% and close to  
               $8.5 million.  Of that $8.5 million in increased spending  
               $4.4 million went to Personal Services, which includes  
               salary, benefits, and retirements.  During that time  
               period, CLSB added 4 positions, which were approved through  
               the annual budget process.  The amount CSLB pays to DCA in  
               pro rata charges increased by $2 million.  A significant  
               portion of that $2 million increase is due to DCA's new  
               BreEZe IT system.   While CSLB was previously scheduled to  
               be included in the BreEZe system, it is now not currently  
               scheduled to be included.  CSLB also had increased  
               enforcement costs of about $2 million, which is primarily  
               costs for the use of services by the Attorney's General's  
               Office and the Office of Administrative Hearings.  If CSLB  
                                                                             is not able implement a fee increase, we will have to  
               reduce costs in Enforcement, beginning with cuts to our  
               proactive enforcement (stings and sweeps).

             The proposed fee increases for the CSLB are as follows:
             








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                          ---------------------------------- 
                         |          |     |     |     |     |
                         |          | Cur | Prop| Prop|     |
                         |          |  re | osed| osed|%    |
                         |  DESCRIPT|  nt |     |     |Increase|
                         |  ION     |     | New | Incr|     |
                         |          |  Fe | Fee | ease|     |
                         |          |  e  |     |     |     |
                          ---------------------------------- 
                         |----------+-+---+-+---+-+---+-----|
                         |License   | |   | |   | |   |     |
                         |Pocket/Wal| $| 11| $| 13| $|  2|    1|
                         |l         | | .0| | .0| |  .|    8|
                         |Replcment | | 0 | | 0 | |  0|    %|
                         |          | |   | |   | |  0|     |
                         |          | |   | |   | |   |     |
                         |----------+-+---+-+---+-+---+-----|
                         |          | |   | |   | |   |     |
                         |Hazard    | |   | |   | |   |     |
                         |Cert      | $| 75| $| 90| $| 15|    2|
                         |          | | .0| | .0| | .0|    0|
                         |          | | 0 | | 0 | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |          |     |     |     |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |Additi    | |   | |   | |   |     |
                         |onal      | $| 75| $| 75| $|  -|   0%|
                         |Class     | | .0| | .0| |   |     |
                         |Origin    | | 0 | | 0 | |   |     |
                         |al        | |   | |   | |   |     |
                         |Apps      | |   | |   | |   |     |
                         |----------+-+---+-+---+-+---+-----|
                         |Sup &     | |   | |   | |   |     |
                         |RME/RMO   | |   | |   | |   |     |
                         |Apps      | $| 75| $|300| $|225|   30|
                         |          | | .0| |.00| |.00|   0%|
                         |          | | 0 | |   | |   |     |
                          ---------------------------------- 
                          ----------------------------------------------------------------------------------------------------------- 
                         |Personne   |           |           |           |           |           |           |           |           |








          SB 1039 (Hill)                                          Page 29  
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                         |l/Office   |           |           |           |           |           |           |           |           |
                         |r          | $         |     -     | $         |150.00     | $         |150.00     | $         |     -     |
                         |Change     |           |           |           |           |           |           |           |           |
                          ----------------------------------------------------------------------------------------------------------- 
                          ---------------------------------- 
                         |          | |   | |   | |   |     |
                         |Re-Exam   | |   | |   | |   |     |
                         |Applicatio| $| 60| $| 60| $|  -|   0%|
                         |ns        | | .0| | .0| |   |     |
                         |          | | 0 | | 0 | |   |     |
                          ---------------------------------- 
                         |Initial   | |   | |   | |   |     |
                         |License - | |   | |   | |   |     |
                         |Active    | $|180| $|220| $| 40|    2|
                         |          | |.00| |.00| | .0|    2|
                         |&         | |   | |   | | 0 |    %|
                         |Inactive  | |   | |   | |   |     |
                          ---------------------------------- 
                         |Reg.      | |   | |   | |   |     |
                         |Fee-Home  | |   | |   | |   |     |
                         |Improvemen| |   | |   | |   |     |
                         |t         | $| 75| $| 90| $| 15|    2|
                         |Salesperso| | .0| | .0| | .0|    0|
                         |n (HIS)   | | 0 | | 0 | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                         |          | |   | |   | |   |     |
                         |Asbestos  | $| 75| $| 90| $| 15|    2|
                         |Cert      | | .0| | .0| | .0|    0|
                         |          | | 0 | | 0 | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                         |Origina   | |   | |   | |   |     |
                         |l App     | $|300| $|360| $| 60|    2|
                         |Fee -     | |.00| |.00| | .0|    0|
                         |Contrac   | |   | |   | | 0 |    %|
                         |tors      | |   | |   | |   |     |
                         |----------+-+---+-+---+-+---+-----|
                         |Reactiva  | |   | |   | |   |     |
                         |te        | $|360| $|430| $| 70|    1|
                         |License   | |.00| |.00| | .0|    9|
                         |-         | |   | |   | | 0 |    %|
                         |Contract  | |   | |   | |   |     |
                         |ors       | |   | |   | |   |     |








          SB 1039 (Hill)                                          Page 30  
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                          ---------------------------------- 
                          ---------------------------------- 
                         |          |     |     |     |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |          | |   | |   | |   |     |
                         |          | |   | |   | |   |     |
                         |Biennial  | $| 75| $| 90| $| 15|    2|
                         |Renewal - | | .0| | .0| | .0|    0|
                         |HIS       | | 0 | | 0 | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                         |          | |   | |   | |   |     |
                         |          | |   | |   | |   |     |
                         |Biennia   | $|360| $|430| $| 70|    1|
                         |l         | |.00| |.00| | .0|    9|
                         |Renewal   | |   | |   | | 0 |    %|
                         |          | |   | |   | |   |     |
                         |Contrac   | |   | |   | |   |     |
                         |tor       | |   | |   | |   |     |
                         |----------+-+---+-+---+-+---+-----|
                         |          | |   | |   | |   |     |
                         |          | |   | |   | |   |     |
                         |          | |   | |   | |   |     |
                         |4-Yr      | $|180| $|220| $| 40|    2|
                         |Timely    | |.00| |.00| | .0|    2|
                         |Inactive  | |   | |   | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |          |     |     |     |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |Delinqu   | |   | |   | |   |     |
                         |ent -     | $| 37| $| 45| $|  7|    2|
                         |HIS       | | .5| | .0| |  .|    0|
                         |Renewal   | | 0 | | 0 | |  5|    %|
                         |          | |   | |   | |  0|     |
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                         |Delinquen | |   | |   | |   |     |
                         |t         | $|180| $|215| $| 35|    1|
                         |Renewal   | |.00| |.00| | .0|    9|
                         |-         | |   | |   | | 0 |    %|








          SB 1039 (Hill)                                          Page 31  
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                         |Contactor | |   | |   | |   |     |
                         |          | |   | |   | |   |     |
                         |----------+-+---+-+---+-+---+-----|
                         |Delinq    | |   | |   | |   |     |
                         |uent      | |   | |   | |   |     |
                         |4-Yr      | $| 90| $|110| $| 20|    2|
                         |Inacti    | | .0| |.00| | .0|    2|
                         |ve        | | 0 | |   | | 0 |    %|
                         |          | |   | |   | |   |     |
                          ---------------------------------- 
                          ---------------------------------- 
                         |          |     |     |     |     |
                          ---------------------------------- 

             g)   Provide for Renewal Fee Increase for Court Reporters  
               Board.  As part of its fiduciary oversight, the CRB closely  
               monitors the budget, and it projected that the CRB would  
               need to address a projected deficit for $489,000 occurring  
               in fiscal year 2017-18.  The deficit is caused by a steady  
               increase in expenditures over the years and a slow decline  
               in the number of licensees.  Having already implemented all  
               cost-savings measures, including reduction of onsite school  
               reviews and reduction of exam development workshops, the  
               CRB looked at the various options for increasing revenue.   
               The CRB contends that they looked at increasing the license  
               examination fees, but with a relatively small number of  
               candidates annually, even a substantial hike in the exam  
               fee would not significantly improve the CRB long-term  
               solvency.  The CRB also evaluated the possibility of  
               providing continuing education to increase revenue,  
               ultimately finding the required increase in staff would not  
               make it cost-effective, nor would it be a mission-critical  
               activity.

               The existing cap of $125.00 was set in 1951.  The CRB  
               reached that cap in 2010.  The CRB states that it has  
               worked diligently to cut expenses wherever possible and to  
               operate as efficiently as possible.  However, all costs  
               continue to rise, including the pro rata amount the CRB  
               pays to the DCA.  While costs rise, the CRB indicates that  
               revenue has slowly decreased as court reporters of the Baby  
               Boom era begin to retire.  

               The CRB also administers the Transcript Reimbursement Fund  








          SB 1039 (Hill)                                          Page 32  
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               (TRF) which is funded at $300,000 per year and which was  
               set up in 1981 to increase access to justice by providing  
               low or no-cost transcripts to qualified indigent litigants.  
                Since its inception, the TRF has provided over $8.5  
               million in transcript costs to claimants.  It is critical  
               that the CRB be able to raise the license fees in order to  
               maintain a healthy fund balance.  Business & Professions  
               Code 8030.2(a) prohibits a transfer being made from the  
               Court Reporters Fund to the Transcript Reimbursement Fund  
               if the transfer will result in reduction of the balance of  
               the Court Reporters Fund to an amount less than six months'  
               operating budget.  

               An increase of the fee cap to $250 would allow the CRB to  
               make incremental increases to the license fee as required  
               to maintain a foundation strong enough to fund the  
               activities necessary to fulfill the CRB's legislative  
               mandate, specifically, licensing, enforcement, school  
               oversight and administration of the TRF.

             h)   Clarify Inspection Requirements for Licensees of the  
               Structural Pest Control Board.  Currently, the SPCB Act  
               (Act) outlines the procedures to be followed during the  
               performance of wood destroying organism pest inspections  
               and in the preparation of the accompanying inspection  
               reports and also provides guidelines for the preparation of  
               a notice of work completed and not completed after a  
               company completes work under a contract.  In 2010, the SPCB  
               created an Act Review Committee and tasked it with  
               reviewing the Act for the purpose of making recommendations  
               to modernize and improve the language for the benefit of  
               consumers and the pest control industry.  The proposed  
               changes in this measure related to SPCP are the result of  
               that review and are intended to clarify its provisions.
          
          2.Related Legislation.   AB 1116  (Keeley, Chapter 792, Statutes  
            of 1997) established procedures for accreditation of foreign  
            dental schools by the Board, as specified.  Stated legislative  
            intent that this provision is to provide for evaluation of  
            foreign dental schools that provide an education equivalent to  
            similar, accredited institutions in the United States.
          
          
          3.Arguments in Opposition.  Former  Senator Richard Polanco  is  








          SB 1039 (Hill)                                          Page 33  
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            opposed to the proposed language in the bill pertaining to  
            "Foreign Dental Schools" and believes it is contrary to the  
            Legislature's intent pertaining to approval of foreign dental  
            schools provided for in AB 1116 (Kelley ) that was intended to  
            address the dentistry issues of foreign dental school  
            graduates.  "The board is attempting to remove itself from  
            some key provisions that are the legislative intent which  
            placed the responsibility of conducting the survey and  
            evaluation of a foreign dental school squarely with the board  
            and not to accept the finding of any other commission or  
            accreditation agency."  The Senator believes that the process  
            pursuant to AB 1116 is working and it should not be changed or  
            amended  

          Both the  Latin American Dental Association  and the  Southern  
            California Filipino Dental Society, Inc.  are also opposed to  
            the provisions in this measure that would allow the Dental  
            Board to accept the findings of any commission or  
            accreditation agency approved by the DBC for purposes of  
            accrediting foreign dental schools, if the findings meet the  
            DBC's specified standards and allows the DBC to adopt those  
            findings as their own.  They believe that such a change will  
            have a negative effect on the dental access to care for people  
            of California by decreasing the number of minority dentists in  
            California and believe that it will be impossible for another  
            dental school to be approved and for the existing one to be  
            re-approved.

          4.Author's amendments.  The Author is accepting amendments to  
            reinstate BPC  4999.2, 4999.7, Insurance Code  10279, and  
            Health and Safety Code  1348.8 but without reference to the  
            Telephone Medical Advice Services Bureau or registration, and  
            clarifies that responsibility for enforcing California license  
            requirements of healthcare professionals who provide medical  
            advice services resides with the respective healing arts  
            boards.  
          
          SUPPORT AND OPPOSITION:
          
           Support:  

          Mega Termite & Pest Control
          Newport Exterminating
          Western Exterminator Company








          SB 1039 (Hill)                                          Page 34  
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          Opposition:  

          Former Senator Richard Polanco
          Latin American Dental Association
          Southern California Filipino Dental Society


                                      -- END --