BILL ANALYSIS                                                                                                                                                                                                    Ó



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

          Bill No:            SB 1478         Hearing Date:    April 18,  
          2016
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          |Author:   |Committee on Business, Professions and Economic       |
          |          |Development                                           |
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          |Version:  |March 10, 2016                                        |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Nicole Billington                                     |
          |:         |                                                      |
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                               Subject:  Healing arts


          SUMMARY:  Makes several non-controversial minor, non-substantive, or  
          technical changes to various provisions pertaining to the  
          health-related regulatory Boards of the Department of Consumer  
          Affairs.

          Existing law:
          
          1) Provides for the licensing and regulation of various  
             professions and businesses by the 26 boards, 10 bureaus, 3  
             committees, two committees, one program, and one commission  
             within the Department of Consumer Affairs (DCA) under various  
             licensing acts within the Business and Professions Code  
             (BPC).

          2) Contains the following provisions relating to the Dental  
             Board of California (DBC):

              a)    Require applicants for licensure to successfully  
                complete Part I and Part II written examinations of the  
                National Board Dental Examination of the Joint Commission  
                of National Dental Examinations.  (BPC § 1632(a) and §  
                1634.1(d))

          3) Contains the following provisions relating to the Medical  
             Board of California (MBC):







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              a)    Establishes the Task Force on Culturally and  
                Linguistically Competent Physicians and Dentists under the  
                MBC.  (BPC § 852)

              b)    Requires the MBC to keep copies of complaints for ten  
                years.  (BPC § 2029) 

              c)    Creates the Bureau of Medical Statistics within the  
                MBC with the purpose of providing the MBC and its  
                divisions with statistical information necessary to carry  
                out their functions of licensing, medical education,  
                medical quality, and enforcement.  (BPC § 2380 - 2392)

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

              a)    Authorizes the BPM to elect a President and Vice  
                President as officers of the BMP.  (BPC § 2467(d))

          5) Contains the following provisions relating to the California  
             Board of Behavioral Sciences (BBS):

              a)    Allows licensed marriage and family therapist (LMFT),  
                licensed clinical social worker (LCSW), and licensed  
                professional clinical counselor (LPCC) applicants to gain  
                experience house as a W-2 employee.  (BPC § 4980.43, §  
                4996.23, and § 4999.47) 

              b)    References the term "associate social workers".  (BPC  
                § 4992.05)

              c)    Specifies that an applicant for licensure shall not be  
                eligible for examination until the school has received  
                accreditation.  (BPC § 4996.18(c)) 

              d)    Requires that an LMFT applicant for licensure must  
                submit a certification from his or her educational  
                institution certifying that the curriculum required for  
                graduation meets specified education requirements.  (BPC §  
                4980.38)

              e)    Establishes a grand-parenting period at the beginning  
                of the LPCC licensing program, which allowed the Board to  








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                accept applicants with deficiencies in education or  
                experience if they successfully completed certain  
                examinations and requirements.  (BPC § 4999.54, § 4999.52,  
                and § 4999.120)

              f)    Requires the degree that qualifies an LMFT and LPCC  
                applicant for licensure to be obtained from an accredited  
                school.  (BPC § 4980.36, § 4980.37, § 4980.78, § 4980.79,  
                and § 4999.12)

              g)    Defines acceptable school approval and equivalent  
                accrediting agencies.  (BPC § 4980.40.5)

              h)    References LMFT and LPCC registrants as "interns".   
                (BPC § 4980 - 4999.129)

          This bill:

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

              a)    Reflects the integration of Part I and II of the  
                National Dental Board Examination that becomes effective  
                in 2017 in BPC §1632(a) and § 1634.1(d).

          2) Makes the following changes relating to the Medical Board of  
             California (MBC):

              a)    Deletes obsolete language in BPC § 852 regarding  
                inoperative Task Force of Culturally and Linguistically  
                Competent Physicians and Dentists.

              b)    Eliminates the redundant requirement in BPC § 2029 to  
                keep records past the statute of limitations, as the  
                retention schedule and statute of limitations is specified  
                elsewhere in code. 

              c)    Deletes obsolete language in BPC § 2380 - 2392  
                pertaining to the nonexistent Bureau of Medical  
                Statistics.

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









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              a)    Amends BPC § 2467 to authorize the election of a  
                Secretary to the list of authorized board officer  
                positions.

          4) Makes the following changes relating to the California Board  
             of Behavioral Sciences (BBS):

              a)    Clarifies in BPC § 4980.43, § 4996.23, and § 4999.47  
                that interns, trainees, and associates may not gain  
                experience hours for work performed as an independent  
                contractor. 

              b)    Amends BPC § 4992.05 to replace "associate social  
                worker" with "associate clinical social worker" for  
                consistency. 

              c)    Specifies in BPC § 4996.18 that LCSW applicants are  
                only prohibited from taking the clinical exam until the  
                school has achieved accreditation.

              d)    Amends BPC § 4999.40, § 4999.60, and § 4999.61 to make  
                program certification requirements consistent between LPCC  
                applicants and LMFT applicants. 

              e)    Deletes language in BPC § 4999.54, § 4999.52, and §  
                4999.120 about an inoperative LPCC grand-parenting  
                provision. 

              f)    Amends the title of approved accreditation agencies in  
                BPC § 4980.36, § 4980.37, § 4980.78, § 4980.79, § 4999.12  
                to be consistent with the title used by the United States  
                Department of Education. 

              g)    Deletes BPC § 4980.40.5 that references acceptable  
                school approval.

              h)    Adds BPC § 4980.09 and § 4999.12.5 to change the title  
                of "intern" to "associate" for LMFT and LPCC applicants.

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









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          COMMENTS:
          
          1.Purpose.  This bill is one of two "committee bills" authored  
            by the Business, Professions and Economic Development  
            Committee (Committee) and is intended to consolidate a number  
            of non-controversial provisions related to various regulatory  
            programs and professions governed by the BPC.  Consolidating  
            the provisions in one bill is designed to relieve the various  
            licensing boards, bureaus, professions and other regulatory  
            agencies from the necessity and burden of having separate  
            measures for a number of non-controversial revisions.
             
             Many of the provisions of this bill are minor, technical, and  
             updating changes, while other provisions are substantive  
             changes intended to improve the ability of various licensing  
             programs and other entities to efficiently and effectively  
             administer their respective laws.

             However, as a Committee bill, if controversy or opposition  
             should arise regarding any provision that cannot be resolved,  
             then that provision will be removed from the bill.  This will  
             eliminate the chance of placing any of the other provisions  
             in jeopardy.

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

              a)    Dental Board of California (DBC).  The DBC is  
                responsible for regulating the practice of approximately  
                102,000 licensed dental health professionals, including  
                dentists, registered dental assistants, and registered  
                dental assistants in extended functions.  BPC § 1632(a)  
                and § 1634.1(d), require each applicant to successfully  
                complete Part I and Part II written examinations of the  
                National Board Dental Examination of the Joint Commission  
                on National Dental Examinations. In 2017, the Joint  
                Commission will be integrating Part I and Part II  
                examinations as one exam, thus the specification of Part I  
                and Part II examinations within the Act is no longer  
                applicable. The plural form of examination, "examinations"  
                is also inapplicable as there will only be one examination  
                and not two.









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              b)    Medical Board of California (MBC).   AB 2394   
                (Firebaugh, Chapter 802, Statutes of 2000) became  
                effective January 1, 2001 and created Task Force on  
                Culturally and Linguistically Competent Physicians and  
                Dentists.  This Task Force was created, met, and put out a  
                report to the Legislature (from DCA).  However, in 2003,  
                 AB 801  (Diaz, chapter 510, Statutes of 2003) was enacted  
                and established the Cultural and Linguistic Competency Act  
                of Physicians Act of 2003 in BPC § 2198.  As a result of  
                BPC § 2198, the MBC created a Cultural and Linguistic  
                Competency workgroup.  The Task Force on Culturally and  
                Linguistically Competent Physicians and Dentists,  
                therefore, has not been active since 2003.  This bill  
                would delete BPC § 852 pertaining to the Task Force on  
                Culturally and Linguistically Competent Physicians and  
                Dentists. 

                BPC § 2029 requires the MBC to keep copies of complaints  
                for 10 years.  However, the MBC already has its own record  
                retention schedule and BPC § 2227.5 requires the MBC to  
                keep complaints for seven years or until the statute of  
                limitations has expired, whichever is shorter.  BPC §  
                2230.5 sets forth the statute of limitations for filing an  
                accusation which is three years from the date the MBC  
                finds out about the event or seven years from the date of  
                the event, whichever occurs first.  Both of these sections  
                of law make BPC § 2029 inapplicable.  This bill would  
                delete BPC § 2029.

                The sections of law that created the Bureau of Medical  
                Statistics in the Board were enacted in 1980.  However,  
                collecting Board statistics is part of the Board's normal  
                operating functions, and a separate bureau to collect  
                statistics is not needed.

              c)    Board of Podiatric Medicine (BPM).  Current law  
                statutorily authorizes various regulatory health boards  
                within the DCA to elect a President, Vice President,  
                Secretary, and, in some cases, any other officers as the  
                board deems necessary.  The BPM is constricted in practice  
                because it is limited to the election of only two board  
                positions elected annually.  Language pertaining to the  
                election of a President and Vice President dates back to  
                the BPM's predecessor agency - the Podiatry Examining  








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                Committee.  At that time and within that structure, the  
                existence of only a President and Vice President may have  
                been optimum and sufficient.  However, the BMP has not  
                operated as an examining committee for 30 years.  The BPM  
                cites that the additional leadership position will help  
                ensure continuity, provide additional oversight, and an  
                opportunity for increased member engagement.  The reported  
                effects to BPM's budget and operations are minimal. 
                
              d)    California Board of Behavioral Sciences (BBS).  The  
                BBS currently has four license types: licensed marriage  
                and family therapists (LMFTs), licensed educational  
                psychologists (LEPs), licensed clinical social workers  
                (LCSWs), and licensed professional clinical counselors  
                (LPCCs).  

                BPC § 4980.43, § 4996.23, and § 4999.47 allow LMFT, LCSW,  
                and LPCC applicants to gain experience hours as a W-2  
                employee or a volunteer, but not as an independent  
                contractor.  However, the Board gets a significant number  
                of applications for exam eligibility from individuals who  
                are contracting and receiving a 1099 tax form.  Some  
                applicants believe that, because the statute says  
                "employed", they can be 1099 employees, which is  
                incorrect.  The Board cannot accept a 1099 form because,  
                by definition, a 1099 form is the IRS form issued to  
                independent contractors.  Applicants gaining experience  
                toward a Board license are required to be under  
                supervision; therefore, by definition, they cannot work  
                independently.  This bill would amend the law to clarify  
                that interns, trainees, and associates may not be employed  
                as independent contractors, and that they may not gain any  
                experience hours for work performed as an independent  
                contractor, reported on an IRS Form 1099, or both.

                BPC § 4996.18(c) states that an LCSW applicant is not  
                eligible for examination until his or her school or  
                department of social work has received accreditation by  
                the Commission on Accreditation of the Council on Social  
                Work Education.  The purpose of this statute is to keep an  
                LCSW applicant from becoming licensed until it is  
                confirmed that his or her school obtains the accreditation  
                required for licensure.  However, the wording of this  
                requirement could be problematic when the timing of the  








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                exams changes with the exam restructure on January 1,  
                2016.  Under the exam restructure, associates must take a  
                law and ethics exam within the first year of registration  
                in order to renew that registration.  This new requirement  
                results in the first examination being taken much sooner  
                after graduation that the previous requirement  
                (previously, both required exams were taken at the end of  
                gaining hours, a process that takes at least 2 years).   
                Since accrediting a school sometimes takes several years,  
                the language could cause a first year associate to be  
                unable to take the law and ethics exam, and consequently,  
                be unable to renew his or her associate registration.  To  
                remedy this situation, this bill would allow registrants  
                to take the law and ethics exam so that they may continue  
                renewing their registrations.  Instead, they would be  
                prohibited from taking the clinical exam, which is still  
                taken at the end of gaining hours, until the school has  
                achieved accreditation.

                BPC § 4999.54 established a grand-parenting period at the  
                beginning of the LPCC licensing program.  The Board  
                accepted applications for licensure via grand-parenting  
                for the newly established license between January 1, 2011  
                and December 31, 2011.  Until now, it was necessary to  
                keep the grand-parenting provision in law because there  
                were applicants who were still in the one-year remediation  
                period if they had deficiencies in their education and  
                experience, and there were still applicants in the exam  
                cycle attempting to pass the grand-parenting required  
                exams.  As of summer 2015, all remediation periods have  
                expired and the final grand-parenting exam has been  
                administered.  Therefore, this section is no longer  
                necessary; this bill would delete it. 

                BPC § 4980.36, § 4980.37, § 4980.78, § 4980.79, § 4999.12  
                require the degree qualifying an LMFT and LPCC applicant  
                for licensure to be obtained from an accredited school.   
                The law allows the accreditation to be from a regional  
                accrediting entity recognized by the United States  
                Department of Education (USDE) such as the Western  
                Association of Schools and Colleges.  However, the  
                applicable BPC code is not precise enough about what this  
                means, because the language it uses is not consistent with  
                the language that USDE uses when referring to the  








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                accrediting agencies it recognizes.  USDE recognizes two  
                basic categories of accreditation agencies: Regional and  
                National Institutional Accreditation Agencies and  
                Specialized Accrediting Agencies.  The Board accepts the  
                first category of USDE recognized agencies, Regional and  
                National Institutional Accreditation Agencies.  Therefore,  
                this bill would amend the LMFT and LPCC licensing law to  
                correctly identify that "Regional and National  
                Institutional Accreditation Agencies" recognized by USDE  
                are acceptable, so that the title the Board uses to  
                reference these agencies is consistent with the title used  
                by USDE.

                BPC § 4980.40.5 was put in place in 2009 to define  
                acceptable school approval due to the fact that the Bureau  
                for Private Postsecondary Education had been sunset.   
                Today, the Bureau for Private Postsecondary Education is  
                no longer sunset, and equivalent accrediting agencies are  
                already defined elsewhere in law.  This bill, therefore,  
                would delete BPC § 4980.40.5, as it is no longer needed. 

                Individuals seeking licensure who have completed their  
                Master's degree program must register with the Board and  
                gain supervised experience hours before becoming licensed.  
                 Registrants gaining supervised experience hours toward an  
                LMFT or LPCC license are referred to as "interns"  
                throughout applicable code.  Stakeholders and registrants  
                have voiced concerns that the "intern" title for LMFT and  
                LPCC registrants may not be an accurate representation of  
                their post-master's degree graduate status.  Registrants  
                gaining experience hours toward an LCSW license are  
                referred to as "associates."  This bill would change  
                reference from "intern" to "associate" for LMFT and LPCC  
                applicants to create consistency in the titles used across  
                Board license types and remedy a common misconception that  
                LMFT and LPCC interns have not yet graduated. 

          

          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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