BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1039|
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|(916) 651-1520 Fax: (916) | |
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THIRD READING
Bill No: SB 1039
Author: Hill (D)
Amended: 5/31/16
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 6-2, 4/18/16
AYES: Hill, Block, Galgiani, Hernandez, Mendoza, Wieckowski
NOES: Bates, Berryhill
NO VOTE RECORDED: Jackson
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SUBJECT: Professions and vocations
SOURCE: Author
DIGEST: This bill is an omnibus bill which includes several
changes to the statutes governing various boards and bureaus
under the Department of Consumer Affairs (DCA) and also includes
specified fee increases for several boards including the Board
of Registered Nursing (BRN), the Board of Pharmacy (BOP), the
Contractors State License Board (CSLB) and the Court Reporters
Board (CRB). This bill also eliminates the Telephone Medical
Advice Services Bureau (TMAS).
ANALYSIS:
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Existing law:
1) Establishes, under the Dental Board of California (DBC), the
Dental Corps Loan Repayment Program (DCLRP) and requires the
DBC in consultation with the Office of Statewide Health
Planning and Development, the dental community, other public
health facilities and those serving underserved communities
to develop and implement the DCLRP. (Business and
Professions Code § 1970 et seq.)
2) Establishes the Board of Podiatric Medicine (BPM) within the
jurisdiction of the Medical Board of California (MBC). (BPC
§ 2460)
3) 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) 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)
5) 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.)
6) 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 Fund,
which is continuously appropriated as it pertains to fees
collected by the BOP. (BPC § 4400)
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7) Provides that the licensure requirements for a veterinarian
practicing in California do not apply if a veterinarian from
another state provides consultation from another state or is
called to attend to a case in this state and does not open an
office or appoint a place to do business or if a veterinarian
from another state is called into this state by a law
enforcement or animal control agency to attend to cases that
are part of an investigation of an alleged violation of
federal or state animal fighting or animal cruelty laws.
(BPC § 4830)
8) Requires the certain businesses that provide telephone
medical advice services to a patient at a California address
to be registered with the TMAS 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.)
9) 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)
10) 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)
11) Provides for the licensure and regulation of
structural pest control operators and registered companies,
as defined, by the Structural Pest Control Board (SPCB),
which is within the DCA and requires a licensee to pay a
specified fee. 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
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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)
12) 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) Creates the BPM within the DCA rather than having the BPM
within the jurisdiction of the MBC. 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.
2) Specifies that the standards established for CE 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. 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.
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3) Prescribes various fee changes to be paid by licensees 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 raises specified fees, and provides for additional
fees to be paid by licensees and applicants for licensure as
well as by schools seeking approval by the BRN.
4) Modifies, on or after July 1, 2017, specified fees to be
paid by the licensees and applicants for licensure with the
BOP.
5) Specifies that a veterinarian from another state or country
does not have to be licensed in California if they are
holding a current, valid license in good standing in another
state or country and provide assistance to a California
licensed veterinarian. The California licensed veterinarian
shall maintain a valid veterinarian-client-patient
relationship and that the veterinarian providing the
assistance shall not establish a veterinarian-client-patient
relationship with the client, as specified. Clarifies that a
veterinarian in good standing from another state does not
have to be licensed in California if they are called into
this state by law enforcement agency or animal control
agency, as specified.
6) Eliminates TMAS 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.
7) Raises specified fees to be paid by the licensees and
applicants to the CSLB and requires the CSLB to establish
criteria for the approval of expedited processing
applications, as specified.
8) Raises the renewal fee limit to be assessed by the CRB from
$125 to $250.
9) Requires the operator licensed and regulated by the SPCB
prior to conducting an inspection as specified above to be
employed by a registered company. Requires that the written
inspection report be prepared and delivered to the person
requesting it, the property owner, or the property owner's
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designated agent. 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. 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. 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. Makes other clarifying and
technical changes regarding the SPCB.
Background
Clarify Jurisdiction of the BPM. Technical changes striking
references to the 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.
Clarify Continuing Education (CE) Requirements for the BRN. 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 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.
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
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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 provides more staffing to audit CE provided
pursuant to the fee increase.
Fee Changes for BRN . The BRN Fund is maintained by the BRN and
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 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.
Provide for Various Fee Increases for the Board of Pharmacy
(BOP). The BOP current statutory authority establishes both a
minimum and maximum level for all fees. The BOP uses its
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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.
Clarify the Requirements for Veterinarians from Other States.
Changes to the exemption for licensure were considered as
necessary for out-of-state veterinarians who may consult or
provide assistance to a California licensed veterinarian to make
it clear under what circumstances veterinary practice in this
state would be permissible.
Eliminate TMAS. Under current law, 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 TMAS. The registrant must 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. TMAS
ensures that all registrants file quarterly reports and checks
to make sure that all the 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.
TMAS 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 zero citations,
fines assessed, referrals for criminal or civil action, formal
disciplinary actions filed, or consumer restitution ordered by
the Bureau in the last five years. DCA licensing boards already
have concurrent authority with the practice of healthcare by
licensed and unlicensed individuals and can effectively police
this area without TMAS.
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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).
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
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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.
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.
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee analysis dated
May 27, 2016, this bill will result in one-time costs of
$260,000 and ongoing costs of $250,000 per year for BRN to audit
CE providers; increased licensing fee revenues of about $23
million per year to BRN; increased licensing fee revenues of
about $7 million per year to BOP, increased licensing fee
revenues of about $13 million per year to the CSLB; increased
licensing fee revenues of about $950,000 per year to the CRB
and; reduced expenditures (and license fee revenues) of about
$200,000 per year from the elimination of TMAS.
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SUPPORT: (Verified5/31/16)
Medical Board of California
Dental Board of California
OPPOSITION: (Verified5/31/16)
None received
ARGUMENTS IN SUPPORT: MBC is supportive of the provision in this
bill
that clarifies that MBC does not issue podiatric licenses for
the BPM. MBC states
that BPM is its own board and is completely separate from the
MBC but since the
statute is not clear and there are some conflicting provisions,
clarification is
needed.
The DBC has a support if amended position on the bill and would
like to see the
language that was amended out of the bill on April 21, 2016
dealing with foreign dental schools included back into the
measure.
Prepared by:Bill Gage / B., P. & E.D. / (916) 651-4104
5/31/16 20:45:23
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