BILL ANALYSIS                                                                                                                                                                                                    Ó



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

          Bill No:            SB 1261         Hearing Date:    April 18,  
          2016
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          |Author:   |Stone                                                 |
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          |Version:  |February 18, 2016                                     |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Sarah Huchel                                          |
          |:         |                                                      |
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               Subject:  Physicians and surgeons:  licensure exemption


          SUMMARY:  Authorizes physicians licensed out of state to work in  
          California free clinics for up to 60 days a year, as specified.   


          Existing law:
          
          1) Establishes the Medical Board of California (MBC), to  
             regulate the practice of medicine in California. (Business  
             and Professions Code (BPC) § 2000 et seq.) 

          2) Establishes the Osteopathic Medical Board (OMBC) to enforce  
             provisions of law related to osteopathic physicians and  
             surgeons. (BPC § 2450)  

          3) Provides that a physician and surgeon who practices or  
             attempts to practice medicine in California without a license  
             or certificate is guilty of a public offense punishable by a  
             fine not exceeding $10,000, by imprisonment, or by both fine  
             and imprisonment.  (BPC § 2052)

         4)Exempts health care practitioners licensed in another state or  
            territory from California licensure during a state of  
            emergency, as specified. (BPC § 900)

         5)Authorizes the MBC and the OMBC to establish reciprocity  
            provisions for those individuals holding an unlimited license  







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            to practice osteopathic medicine in another state, as  
            specified.  (BPC §§ 2135, 2153.5)

          6) Exempts from California licensure, until January 1, 2018, out  
             of state health care practitioners who voluntarily  
             participate in "sponsored events" for uninsured or  
             underinsured individuals for no more than ten calendar days,  
             as specified. 
          (BPC § 901)

          This bill:

           1) Defines "board" as the MBC.

           2) Defines a "free clinic"  as a clinic operated by a  
             tax-exempt, nonprofit corporation supported in whole or in  
             part by voluntary donations, bequests, gifts, grants,  
             government funds or contributions, that may be in the form of  
             money, goods, or services. In a free clinic there shall be no  
             charges directly to the patient for services rendered or for  
             drugs, medicines, appliances, or apparatuses furnished. 

          3)Defines a "uninsured or underinsured person" as a person who  
            does not have health care coverage, including private coverage  
            or coverage through a program funded in whole or in part by a  
            governmental entity, or a person who has health care coverage,  
            but the coverage is not adequate to obtain those health care  
            services offered by the physician.

          4)Exempts a physician who offers or provides health care  
            services at a free clinic from California licensure if all of  
            the following are met:

             a)   The physician obtains authorization from the MBC to  
               participate in a free clinic after submitting a copy of his  
               or her valid license or certificate from each state in  
               which he or she holds licensure or certification and a  
               photographic identification. The MBC shall notify the free  
               clinic, within 20 calendar days of receiving a request for  
               authorization, whether that request is approved or denied.

             b)   The physician has not committed any act or been  
               convicted of a crime constituting grounds for denial of  
               licensure or registration, as specified, and is in good  








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               standing in each state in which he or she holds licensure  
               or certification.

             c)   The physician has the appropriate education and  
               experience to participate in a free clinic, as determined  
               by the MBC.

             d)   The physician agrees to comply with all applicable  
               California practice requirements.

             e)   The services are provided under all of the following  
               circumstances:

               i)     To uninsured or underinsured persons;

               ii)    On voluntary basis, for a total of days not to  
                 exceed 60 days in a calendar year. The 60 days need not  
                 be consecutive. 

               iii)   In association with a free clinic enrolled in the  
                 Medi-Cal program.

               iv)    Without charge to the recipient or to a third party  
                 on behalf of the recipient.

          5)Requires the free clinic seeking to provide, or arrange for  
            the provision of, health care services under this section to  
            register with the MBC and the county health department of the  
            county in which the health care services were provided, as  
            specified.  

          6)Requires the free clinic to maintain a list of physicians  
            associated with the provision of health care services and  
            maintain a copy of each physician's current license or  
            certification and to require each physician to attest in  
            writing that his or her license or certificate is not  
            suspended or revoked pursuant to disciplinary proceedings in  
            any jurisdiction. 

          7)Prohibits a contract of liability insurance issued, amended,  
            or renewed in this state on or after January 1, 2017, from  
            excluding coverage of a physician or a free clinic that  
            provides, or arranges for the provision of, health care  
            services, provided that the practitioner or free clinic  








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            complies with current law.

          8)Authorizes the MBC to terminate authorization for a physician  
            to provide health care services for failure to comply with the  
            law, as specified, and provides for an appeals process for the  
            physician.

          9)States that the provisions of this law are severable, and that  
            if any provision of this bill or its application is held  
            invalid, that invalidity shall not affect other provisions or  
            applications that can be given effect without the invalid  
            provision or application.

          
          FISCAL  
          EFFECT:  Unknown.  This bill is keyed "fiscal" by the  
          Legislative Counsel. 

          
          COMMENTS:
          
          1. Purpose.  This bill is sponsored by the Author.  According to  
             the Author, "Currently, it is prohibited for a licensed out  
             of state doctor to practice medicine in California for an  
             extended period of time.  In parts of the state like Palm  
             Springs, many semi-retired doctors flock to the region during  
             the winter time.  According to many of the health clinics in  
             that region, they receive numerous requests for doctors  
             looking to volunteer. 

             The current law limits out of state doctors to only practice  
             at specified events when in California.  There is currently a  
             shortage of doctors practicing at these clinics across  
             California.  It is good public policy to allow licensed  
             doctors, who are in good standing in their own state but are  
             visiting California, to volunteer and help alleviate that  
             shortage." 

          2. Background.  This bill is modeled after current law which  
             exempts a broad range of health care practitioners from  
             California licensure requirements to participate in free  
             sponsored healthcare events for up to ten days.  The  
             authorizing bill,  AB 2699  (Bass, Chapter 270, Statutes of  
             2010), was enacted to facilitate programs provided by such  








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             entities as Remote Area Medical Volunteer Corps and CareNow,  
             which provide multi-day health fairs that provide services  
             for thousands of un- and underinsured individuals.    

             If the Author's office is concerned about the lack of primary  
             care services for un- and underinsured individuals, the  
             Author may consider instead exploring other ways to advance  
             practice opportunities for currently licensed California  
             healthcare providers without compromising state oversight for  
             our most vulnerable populations.          

          3. Prior Legislation.  AB 512  (Rendon, Chapter 111, Statutes of  
             2013) extended the sunset date, from January 2014, to January  
             2018, on existing law permitting qualified, out-of-state  
             health care practitioners to volunteer their services on a  
             limited basis at health care events designed to provide free  
             services for underinsured and uninsured individuals in  
             California.
           
             AB 2699  (Bass, Chapter 270, Statutes of 2010) exempted from  
             state licensure, until January 1, 2014, specified health care  
             practitioners who are licensed or certified in other states  
             and who provide health care services on a voluntary basis to  
             uninsured or underinsured persons in California, as  
             specified. 
          
           4. Policy Considerations  .  This bill exempts only physicians and  
             surgeons from California licensure requirements for the  
             purpose of serving in free clinics.  The Author's office did  
             not clarify why other healthcare licensees, especially other  
             primary care providers such as nurse practitioners and  
             physicians assistants, are not included.  Justification for  
             the exemption also lacks basic evidence of necessity,  
             explanation for 60 days of unlicensed practice, how many  
             clinics may be affected, and whether the licensing boards  
             affected, which should also include the OMBC, are in favor of  
             such a change.

          
          SUPPORT AND OPPOSITION:
          
           Support:  None on file as of April 12, 2016. 

           Opposition:  None on file as of April 12, 2016. 








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