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 ----------------------------------------------------------------- |Author: |Stone | |----------+------------------------------------------------------| |Version: |February 18, 2016 | ----------------------------------------------------------------- ---------------------------------------------------------------- |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Sarah Huchel | |: | | ----------------------------------------------------------------- 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 SB 1261 (Stone) Page 2 of ? 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 SB 1261 (Stone) Page 3 of ? 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 SB 1261 (Stone) Page 4 of ? 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 SB 1261 (Stone) Page 5 of ? 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. SB 1261 (Stone) Page 6 of ? -- END --