BILL ANALYSIS Ó SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT Senator Jerry Hill, Chair 2015 - 2016 Regular Bill No: SB 1194 Hearing Date: April 18, 2016 ----------------------------------------------------------------- |Author: |Hill | |----------+------------------------------------------------------| |Version: |April 11, 2016 | ----------------------------------------------------------------- ---------------------------------------------------------------- |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Sarah Huchel | |: | | ----------------------------------------------------------------- Subject: Psychology: Board of Psychology: personnel SUMMARY: Amends statutes related to psychological assistants (PAs), psychologist academic requirements, and continuing education (CE); establishes policies for posting licensee information on the Board of Psychology's (BOP) Web site; extends the BOP's sunset date to 2021; authorizes the issuance of a retired license; and makes technical amends. Existing law: 1)Establishes the BOP to enforce and administer the Psychology Licensing Law. (Business and Professions Code (BPC) § 2900 et seq.) 2)Requires a PA to be employed by a clinic, as specified; a psychological corporation; a licensed psychology clinic, as specified; or by a medical corporation. (BPC § 2913) 3)Prohibits a licensed psychologist from supervising more than three PAs at a time unless otherwise authorized by the BOP. (BPC § 2913) 4)Prohibits a board certified psychiatrist from registering, employing, or supervising more than one PA at a time. (BPC § 2913) 5)Requires the licensed psychologist, board certified SB 1194 (Hill) Page 2 of ? psychiatrist, contract clinic, psychological corporation, or medical corporation, to register the PA with the BOP. (BPC § 2913) 6)Prohibits a contract clinic, psychological corporation, or medical corporation from employing more than ten PAs at any time, and limits the number of PAs a contract clinic may register, employ, or supervise to one PA for each designated full-time staff psychiatrist. (BPC § 2913) 7)States that an applicant holding a doctoral degree in psychology from an approved institution is deemed to meet certain licensing requirements if both of the following are true: a) The approved institution offered a doctoral degree in psychology designed to prepare students for a license to practice psychology and was approved by the former Bureau for Private Postsecondary and Vocational Education on or before July 1, 1999; and, b) The approved institution has not, since July 1, 1999, had a new location, as described in § 94823.5 of the Education Code. (BPC § 2914) 8)Establishes requirements for CE. (BPC § 2915) 9) Sunsets the BOP on January 1, 2017. (BPC §§ 2920, 2933) This bill: 1)Deletes PA employment restrictions and related provisions. 2)Deletes the option for a licensed psychologist to supervise, register, or employ more than three PAs with specific authorization from the BOP. 3)Deletes provisions of law related to the employment, supervision, and registration of a PA by a BOP certified psychiatrist. 4)Deletes requirements related to an approved school and instead requires that an applicant graduate from a college or institution of higher education that is accredited by a SB 1194 (Hill) Page 3 of ? regional accrediting agency recognized by the United States Department of Education. Authorizes BOP, until January 1, 2020, to accept an applicant who possesses a doctorate degree from an institution that is not accredited by an accrediting agency recognized by the United States Department of Education but is approved to operate in this state by the Bureau for Private Postsecondary Education (BPPE). 5)Changes references from CE to "continuing professional development" (CPD) and instead of requiring licensees to submit proof of compliance to BOP, requires licensees to retain proof of compliance for submission to the BOP upon request. 6)Deletes the requirement that CE instruction be completed in California or be approved for CE credit by the American Psychological Association or its equivalent; states instead that courses shall be approved for credit by organizations approved by the BOP. 7)Deletes BOP's authority to recognize CE courses that have been approved by a nonprofit organization with at least 10 years experience managing CE programs for psychologists. 8)Deletes the exemption from CE requirements for a licensed psychologist whose practice does not include the direct provision of mental health services. 9)Deletes the requirement that a licensed psychologist choose CE instruction that is related to the assessment, diagnosis, and intervention for the client population being served or to the fields of psychology in which the psychologist intends to provide services. 10)Allows CPD credit for individuals selected by the BOP for enforcement-related functions. 11)Authorizes the BOP to post the following licensee information: a) Whether or not the licensee has any record of a disciplinary action; b) The following enforcement actions or proceedings against SB 1194 (Hill) Page 4 of ? the licensee: i) Temporary restraining orders; ii) Interim suspension orders; iii) Revocations, suspensions, probations, or limitations on practice ordered by the BOP or by a court with jurisdiction in the State, including those made part of a probationary order, cease practice order, or stipulated agreement; iv) Accusations filed by the BOP, including those accusations that are on appeal, excluding ones that have been dismissed or withdrawn where the action is no longer pending; and, v) Citations issued by the BOP. Unless withdrawn, citations shall be posted for five years from the date of issuance. c) Institutions that awarded the qualifying educational degree and type of degree awarded; d) A link to the licensee's professional website; and, e) Other information designated by the BOP in regulation. 12)Authorizes the BOP to issue a retired psychologist license, as specified. 13)Extends the BOP sunset to January 1, 2021. 14)Makes technical amendments. FISCAL EFFECT: Unknown. This bill is keyed "fiscal" by Legislative Counsel. COMMENTS: 1. Purpose. This bill is sponsored by the Author , and is one of five sunset bills the Author is sponsoring this session. SB 1194 (Hill) Page 5 of ? According to the Author's office, this bill is necessary to update provisions of the Psychology Licensing Law to reflect current practices and improve information available to consumers. 2. Oversight Hearings and Sunset Review of Licensing Boards and Programs. Beginning in 2015, the Senate Business, Professions and Economic Development Committee and the Assembly Business and Professions Committee (Committees) conducted joint oversight hearings to review 12 regulatory entities: DCA, Acupuncture Board, Board of Behavioral Sciences, California Massage Therapy Association, Court Reporters Board, Board of Pharmacy, Physician Assistant Board, Board of Podiatric Medicine, BPPE, BOP, Bureau of Real Estate, Bureau of Real Estate Appraisers and Veterinary Medical Board. This and other accompanying sunset bills are intended to implement legislative changes as recommended by Committee staff in the Background Papers prepared for each agency and program reviewed. 3. Background on BOP. The BOP regulates licensed psychologists, registered PAs, and registered psychologists. BOP is one of 30 regulatory entities that falls under the organizational structure of the Department of Consumer Affairs. It is funded by license, application, and examination fees, and receives no revenue from California's General Fund. Psychology as a profession was recognized with the Certification Act of 1958, which provided only title protection. In 1967, the Legislature statutorily defined the practice of psychology and required licensure to practice. During these early days, the Board was an examining committee under the jurisdiction of the Division of Allied Health Professions of The Board of Medical Quality Assurance (BMQA). The Psychology Examining Committee gradually became more independent in the 1970s, taking responsibility for its own operations, including the authority to adopt regulations and administrative disciplinary actions without the endorsement of BMQA. The Psychology Examining Committee officially became the BOP in 1990. SB 1194 (Hill) Page 6 of ? The BOP consists of nine members, five licensed psychologists, and four public members. The BOP is vested with the authority to implement and enforce the Psychology Licensing Law and appoints an Executive Officer (EO) to carry out its will administratively. The EO is responsible for managing 23 staff and a budget of $4.8 million. 4. Review of the BOP - Issues Identified and Recommended Changes a) Issue : Approved schools and national accreditation. Background : California is the only state that allows students from unaccredited schools to sit for psychology licensing examinations. Current law requires the BOP to accept doctoral degrees in psychology from either accredited or approved institutions. An institution is deemed approved if it is not a franchise, was approved by the Bureau for Private Postsecondary and Vocational Education on or before 1999, and has not moved to a new location since 1999. There are six schools meeting these criteria, and approvals and oversight are conducted solely by the BPPE. This issue was raised during the previous review of the BOP in 2011. At that time, the BOP was concerned about the lack of quality control over the schools' operations and curriculum and that students attending approved schools have a low pass rate on the national exam, among other issues. The BOP stated that the students from these schools should not be eligible for licensure and expressed their preference for a change in law to prohibit applicants from approved schools. This law was not changed. In an effort to increase the quality of educational programs in California, the California Private Postsecondary Education Act of 2009 was amended in 2014 (SB 1247, Lieu, Chapter 840, Statutes of 2014) to require degree granting institutions to be accredited by an agency recognized by the U.S. Department of Education (which includes national accreditation) by July 1, 2020 in order to receive BPPE approval. However, these changes are insufficient to raise SB 1194 (Hill) Page 7 of ? California's psychologists to the national standard. The main barrier is that the Association of State and Provincial Psychology Boards (ASPPB) requires member states to have regionally accredited schools to participate in their Agreement of Reciprocity for licensure. Current law will only require national accreditation. Further, California psychologists cannot join the American Psychological Association as full members; participate in certain pre-doctoral or post-doctoral programs necessary for some types of employment, including the U.S. Department of Veterans' Affairs Health and Medical Centers -- the largest employer of psychologists in the U.S; or be eligible for licensure in some states. Recommendation and Proposed Statutory Change : The Committees should remove current language authorizing graduates with degrees from unaccredited institutions to sit for licensure by the BOP and ensure that timeframes for this change accommodate current students. The BOP should provide information to the Committees as to whether regional accreditation may be preferable to other types of accreditation, and the Committees should specify the type of accreditation that should be required of institutions offering degrees intended to lead to licensure. This bill deletes current requirements related to an approved school and instead requires that an applicant for psychologist licensure graduate from a college or institution of higher education that is accredited by a regional accrediting agency recognized by the United States Department of Education. This bill also authorizes the BOP, until January 1, 2020, to accept an applicant who possesses a doctorate degree from an institution that is not accredited by an accrediting agency recognized by the U.S. Department of Education but is approved to operate in this state by the BPPE. b) Issue : Continuing education. Background : Traditional models of CE entail formal learning activities conducted in classroom or workshop settings. The BOP is seeking changes to its CE program to accommodate a broader competency model called CPD. The model was developed by the ASPPB and provides additional avenues for maintaining SB 1194 (Hill) Page 8 of ? professional competence. These options are meant to expand the ways licensees can increase their learning and to include performance-based assessments. Changes should include: 1. Redefining CE requirements as CPD requirements; 2. Removing specific course requirements found in the BPC; and, 3. Enabling the BOP to approve specific organizations that provide CPD activities. Recommendation and Proposed Statutory Change : The BOP should provide recommendations to the Committee for updating CE statutes. This bill changes references from "continuing education" to "continuing professional development," requires licensees to retain proof of CPD compliance for submission to the BOP upon request; requires CPD courses to be approved for credit by organizations approved by the BOP; allows CPD credit for individuals selected by the BOP for enforcement-related functions; and requires the BOP to promulgate regulations relating to CPD. a) Issue : Expansion of PA practice areas. Background : Applicants must accrue 3,000 hours of supervised professional experience in order to qualify for psychologist licensure. Individuals who have a Master's degree and are admitted into a doctoral program may obtain these hours by registering with the BOP as a PA. A PA provides psychological services to individuals or groups while under the supervision of a licensed psychologist or a board certified psychiatrist. Current law requires that a PA be employed only by a psychological or medical corporation, a California licensed psychology clinic, a Bronzan-McCorquodale contract clinic, a licensed psychologist, or a board certified psychiatrist. The BOP recognizes that these statutes are outdated and do not SB 1194 (Hill) Page 9 of ? reflect the employment, contract, or volunteer opportunities available in settings beyond current limitations, such as hospitals, nursing homes, and rehabilitation centers. Recommendation and Proposed Statutory Change : The BOP should provide recommendations to the Committee for updating PA statutes to focus on appropriate supervision, rather than physical setting. This bill deletes PA employment restrictions and related provisions and deletes the option for a licensed psychologist to supervise, register, or employ more than three PAs with specific authorization from the BOP. b) Issue : Retired license. Background : The Psychology Licensing Law does not authorize a retired license. Under existing law, a retired licensee may choose only between "inactive" status, which costs $25 per year, or "delinquent" status. These have negative connotations and may not respect a long and honorable career. The BOP is seeking to establish a "retired" licensure category, similar to many other healing arts programs such as the Medical Board of California, Professional Fiduciaries Bureau, Board of Behavioral Sciences, and Board of Optometry. The creation of this license would require a one-time fee and would provide a means for a retired licensee to return to active status under certain circumstances. Adding this license designation is a consistent request from licensees and is included in the BOP's 2014-2018 Strategic Plan. Recommendation and Proposed Statutory Change : The BOP should provide recommendations to the Committee for establishing a retired license. This bill authorizes the BOP to issue a retired license. c) Issue : Web site information. Background: The BOP has been very active in providing information to consumers and seeks legislative authority to post historical information on existing and past licensees' approved graduate and post-graduate education on its Web site. This will SB 1194 (Hill) Page 10 of ? enable consumers to make informed decisions when selecting a psychology provider. Recommendation and Proposed Statutory Change : The BOP should provide recommendations to the Committee for updating its public information policies. This bill authorizes the BOP to post the information on the status of its licensees relating to disciplinary and enforcement actions, academic credentials, a licensee's website, and other information designated by the BOP in regulations. 1. Prior Related Legislation. AB 773 (Baker, Chapter 336, Statutes of 2015) recast the expiration dates for certain licenses, certificates, and registrations issued by the BOP based on the date of issuance instead of a licensee's birthdate. AB 705 (Eggman, Chapter 218, Statutes of 2015) updated the Psychology Licensing Law to require employees in exempt settings be supervised by a licensed psychologist and become licensed within five years of practice, and made technical and clarifying changes. AB 1374 (Levine, Chapter 529, Statutes of 2015) eliminated the requirement for a fee in the practice of psychology so that psychological services may be provided for free, revised terms related to the practice of psychology, amended the process by which an applicant submits a verification of experience to the BOP, and made technical and clarifying changes. 2. Arguments in Support. The California Psychological Association writes, "The Board of Psychology is a licensing Board within the Department of Consumer Affairs responsible for overseeing the laws and regulations related to the licensure, practice and discipline of the diverse profession of Psychology. The Board regulates over 20,000 psychologists, registered psychologists, and psychological assistants. Psychologists are doctoral-level mental health providers with a variety of specialties. 3. The profession is very diverse and necessitates its own separate licensing board. The Board is fully funded by SB 1194 (Hill) Page 11 of ? licensing and application fees. As a result, there is absolutely no General Fund cost to the state to run the Board of Psychology. Without the sunset extension, the licensure, regulation and discipline of psychologists and pre-licensed psychologists would cease to exist in the state, cutting off access to services for millions of Californians. We are fully supportive of the four year extension in the bill, as well as the pending amendments to ensure that all eligible licensees will have graduated from an accredited institution and the establishment of a 'retired licensee' status." 4. Author's Amendments. a) On page 3, line 14, after "person," strike "is registered" and insert "shall register him or herself " This amendment clarifies that the PA is responsible for registering him or herself. b) On page 4, line 26, insert " or board certified psychiatrist " after "psychologist. This bill does not include the number of PAs a board certified psychiatrist can supervise; this amendment sets it at the same number as a licensed psychologist. c) On page 5, between lines 13 and 14, insert: (b) Possess an earned doctorate degree (A) in psychology, (B) in educational psychology, or (C) in education with the field of specialization in counseling psychology or educational psychology. Except as provided in subdivision (g), this degree or training shall be obtained from an accredited university, college, or professional school. The board shall make the final determination as to whether a degree meets the requirements of this section. d) On page 7, between lines 14 and 15, insert: (g) Until January 1, 2020, an applicant holding a doctoral degree in psychology from an approved institution is deemed to meet the requirements of this section if both of the following are true: (1) The approved institution offered a doctoral degree in SB 1194 (Hill) Page 12 of ? psychology designed to prepare students for a license to practice psychology and was approved by the former Bureau for Private Postsecondary and Vocational Education on or before July 1, 1999. (2) The approved institution has not, since July 1, 1999, had a new location, as described in Section 94823.5 of the Education Code. c) and d) are necessary to ensure that current license requirements remain in place until January 1, 2020. e) On page 8, at line 22, insert: " c) Continuing professional development means certain continuing education learning activities approved in four different categories: (1) Professional (2) Academic (3) Sponsored Continuing Education Coursework and (4) Board Certification from the American Board of Professional Psychology (ABPP). The Board may develop regulations further defining acceptable continuing professional development activities ." It is unclear presently in the bill what constitutes acceptable continuing professional development, and this amendment will help clarify what may be applied towards licensure requirements. f) On page 9, line 8, delete "credit" This is a technical correction. g) On page 9, line 9, after "board." insert: " An organization previously approved by the Board to provide or approve CE is deemed approved under this section ." "f) The board may accept sponsored CE courses that have been approved by a private, non-profit organization that has demonstrated to the Board in writing, that it has, at a minimum, a 10-year history of providing educational programming for psychologists and has documented procedures for maintaining a continuing education approval program. The Board shall adopt regulations as necessary for implementing SB 1194 (Hill) Page 13 of ? this section ." This amendment gives the Board general legislative directions for approving CE courses. h) On page 10, delete lines 1-5. This is unnecessary because this opportunity will be covered under professional CPD activities. SUPPORT AND OPPOSITION: Support: California Psychological Association Opposition: None on file as of April 12, 2016. -- END --