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 ----------------------------------------------------------------- |Author: |Committee on Business, Professions and Economic | | |Development | |----------+------------------------------------------------------| |Version: |March 10, 2016 | ----------------------------------------------------------------- ---------------------------------------------------------------- |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Nicole Billington | |: | | ----------------------------------------------------------------- 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): SB 1478 (Committee on Business, Professions and Economic Development) Page 2 of ? 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 SB 1478 (Committee on Business, Professions and Economic Development) Page 3 of ? 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): SB 1478 (Committee on Business, Professions and Economic Development) Page 4 of ? 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. SB 1478 (Committee on Business, Professions and Economic Development) Page 5 of ? 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. SB 1478 (Committee on Business, Professions and Economic Development) Page 6 of ? 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 SB 1478 (Committee on Business, Professions and Economic Development) Page 7 of ? 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 SB 1478 (Committee on Business, Professions and Economic Development) Page 8 of ? 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 SB 1478 (Committee on Business, Professions and Economic Development) Page 9 of ? 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. SB 1478 (Committee on Business, Professions and Economic Development) Page 10 of ? -- END --