BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2300
A
AUTHOR: Emmerson
B
AMENDED: June 17, 2010
HEARING DATE: June 23, 2010
2
CONSULTANT:
3
Hansel
0
0
SUBJECT
Genetic counselors
SUMMARY
Requires the Department of Public Health (DPH) to license
genetic counselors who are credentialed by, and in good
standing with, the American Board of Genetic Counseling
(ABGC). Requires DPH to issue a temporary genetic
counselor license to a person who meets the requirements
for licensure except for passing the certification
examination, but who has applied to take the exam, or
intends to take the exam, as specified.
CHANGES TO EXISTING LAW
Existing law:
Provides for administration of various genetic screening
programs by the Department of Public Health, including a
prenatal testing program and a newborn screening program.
Requires DPH to designate prenatal diagnosis centers to
provide prenatal testing and genetic counseling for genetic
and birth defects.
Continued---
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Requires DPH to establish regulations and standards for the
licensure of master level genetic counselors and doctoral
level geneticists.
Provides that no person shall use the title of genetic
counselor unless they have received a license from DPH.
Establishes requirements for licensure, including that the
person has received a master's degree or above from a
program specializing in or having substantial course
content in genetics, and has passed a competency
examination administered by the department.
This bill:
Requires DPH, until it adopts regulations, to license
genetic counselors who are credentialed by, and in good
standing with, the American Board of Genetic Counseling
(ABGC), and have no history of disciplinary actions by
ABGC.
Allows DPH to revoke the license of a genetic counselor if
the person loses ABGC credentialing or is placed on
probationary status by the ABGC, or has been convicted of,
or plead guilty to, a felony charge substantially related
to the qualifications, functions, and duties of a genetic
counselor.
Requires DPH to issue a temporary counselor license that is
valid for 24 months to a person who meets the requirements
for licensure except for passing the certification
examination, who has applied for the first available
certification exam offered by ABGC, or who meets the
requirements to apply for the exam and certifies that they
plan to apply to take the exam the following year.
Provides that a temporary license shall not be extended or
renewed.
Provides that a temporary license shall expire at the
earliest of the following: (1) Upon the issuance of a
regular license; (2) Thirty days after the temporary
licensee has failed the certification exam; or (3) Upon the
expiration of the temporary license.
Requires a person holding a temporary genetic counselor
license to work under the supervision of a licensed genetic
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counselor or physician.
Allows DPH to revoke the temporary license of a genetic
counselor if the person loses ABGC credentialing or is
placed on probationary status by the ABGC, or has been
convicted of or plead guilty to, a felony charge
substantially related to the qualifications, functions, and
duties of a genetic counselor.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, AB 2300 would result in
fee-supported special fund workload in the range of $50,000
for DPH to administer temporary licenses for genetic
counselors.
BACKGROUND AND DISCUSSION
According to the author, despite the fact that legislation
passed in 2000 to provide for licensure of genetic
counselors, two problems have prevented the legislation
from being implemented. First, DPH, which is currently
charged with responsibility for administering the licensing
provisions, has not issued regulations necessary to begin
issuing licenses, including regulations setting out
procedures and requirements for the certification exam
which is required for licensure. Second, the original
legislation did not establish a temporary license category
for genetic counselors, under which persons with genetic
counseling degrees could work in California under the
supervision of a licensed genetic counselor or physician
until they take the certification exam.
The author states that there are potential harms to the
public resulting from this profession remaining
unregulated, including unqualified providers ordering
unnecessary tests or incorrect tests, and misinterpreting
tests. The author cites statistics that only 25 percent of
physicians without the type of training that genetic
counselors receive rate themselves as having good or better
knowledge of genetics.
The role of genetic counselors
According to the Human Genome Project (HGP), genetic
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counselors are health professionals with specialized
degrees and experience in the areas of medical genetics and
counseling. Genetic counselors practice as part of a
health care team, providing information and support to
families who have members with birth defects or genetic
disorders, and who may be at risk of inherited conditions.
According the HGP, genetic counselors work in a variety of
capacities, including in clinical settings, with biotech
companies, and in laboratories.
People may seek genetic counseling at various times,
including before or during pregnancy to discuss factors
that may increase the chance of having a child with a birth
defect or genetic condition, or during adulthood, to
discuss the likelihood of developing conditions that are
hereditary and that occur later in life.
According to the ABGC, genetic counselors work as members
of a health care team, providing information and support to
families who have members with birth defects or genetic
disorders and to families who may be at risk for a variety
of inherited conditions. They identify families at risk,
investigate the problem present in the family, interpret
information about the disorder, analyze inheritance
patterns and risks of recurrence, and review available
options with the family.
Genetic counselors also provide supportive counseling to
families, serve as patient advocates, and refer individuals
and families to community or state support services. They
serve as educators and resource people for other health
care professionals and for the general public. Some
counselors also work in administrative capacities. Many
engage in research activities related to the field of
medical genetics and genetic counseling.
The ABGC currently certifies genetic counselors. To be
certified, applicants must demonstrate competency in
several defined areas. ABGC also has accredited 32
graduate programs in genetic counseling in the U.S.,
including 3 in California, which produce 20 to 25 graduates
per year. According to the ABGC, about 300 genetic
counselors currently practice in California, in areas that
include prenatal, pediatric, metabolic, cancer, cardiology,
neurology, adult-onset disorder, preconception, and
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infertility genetics as well as general and other genetic
testing. Employers of genetic counselors include academic
centers, private laboratories, public hospitals, and
private physician groups. Some genetic counselors work in
private practice.
Several states, including Illinois, Massachusetts, Utah,
and Washington have enacted licensure statutes for genetic
counselors and many others are considering legislation to
do so. All currently have provisions for temporary
licenses.
DPH Regulations
SB 1364 (Johnston) Chapter 941, Statutes of 2000, created a
licensing program for genetic counselors in California,
administered by the Department of Health Services (now
Department of Public Health). The legislation established
basic requirements for licensure, among them a master's
degree or above focusing on genetics, and passage of a
competency exam. It was expected that the department would
issue regulations to implement the licensing program. To
date, the regulations have not been developed, although DPH
expects to complete them by January 1, 2014.
Prenatal Screening Program and Newborn Screening Program
The DPH Prenatal Screening Program screens pregnant women
for several birth defects, including open neural tube
defects, abdominal wall defects, and Down syndrome. The
program provides women who are at high risk, based on the
screening test results, free follow-up services at
state-approved Prenatal Diagnosis Centers. Services offered
at these centers include genetic counseling, ultrasound,
and amniocentesis. Participation in the screening testing
and follow-up services is voluntary.
The State of California began its Newborn Screening Program
in 1966 with the testing for phenylketonuria (PKU). Since
then, several disorders and conditions have been added to
the program, including galactosemia, primary congenital
hypothyroidism, sickle cell disease, congenital adrenal
hyperplasia, cystic fibrosis and biotinidase deficiency.
Disorders screened for by the program have varying degrees
of severity. If identified early, many of these conditions
can be treated before they cause serious health programs.
Positive test results are immediately telephoned to one of
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several designated Newborn Screening Area Service Centers
throughout the state, which make arrangements for repeat
testing and assist with referrals to special care clinics.
Arguments in support
The National Society of Genetic Counselors states without
AB 2300 graduates of California's three genetic counseling
training programs would be forced to seek employment
outside the state if they wished to work immediately upon
completing their degree, making it difficult for entities
that use genetic counselors to attract new graduates.
These circumstances place California at a disadvantage
relative to other states.
The American College of Medical Genetics states that AB
2300 is necessary for California to be able to recruit and
retain appropriately qualified genetic counselors.
Related bills
AB 549 (Furutani) requires DPH to issue a clinical
biochemical geneticist license to applicants who meet
specified requirements. In Senate Business, Professions,
and Economic Development Committee.
Prior Legislation
SB 1364 (Johnston) Chapter 941, Statutes of 2000
establishes a licensing program for genetic counselors in
California, administered by the Department of Health
Services (now Department of Public Health).
PRIOR ACTIONS
Assembly Business, Professions and Consumer Protection:
11-0
Assembly Appropriations: 15-0
Assembly Floor: 74
COMMENTS
1. Sunset on interim licensing provisions. As drafted, AB
2300, would require DPH to license persons who meet ABGC
accreditation standards until it finalizes regulations to
establish permanent licensing requirements. A suggested
amendment would be to sunset these provisions on January 1,
2014 to ensure that these interim provisions do not
STAFF ANALYSIS OF ASSEMBLY BILL 2300 (Emmerson) Page
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continue indefinitely and to encourage regulations to be
adopted in a reasonable time period.
2. Suggested technical amendments:
a. On page 2, lines 21 - 40 and on page 3, lines 1 - 13,
amend as follows:
124982. (a) On and after July 1, 2011, the department
shall issue a temporary genetic counselor license valid for
one year to a person to practice as a licensed genetic
counselor who meets both of the following:
(1) The requirements for licensure set forth in
subdivision (b) of Section 124981, except passing the
certification examination as required by paragraph (2) of
subdivision (b) of Section 124981.
(2) Either of the following requirements:
(A) The person meets the requirements for and has
applied for the first available certification examination
offered. The department may require an applicant for a
temporary genetic counselor license to provide
documentation of acceptance for the examination.
(B) The person meets the requirements to apply for the
examination and certifies that he or she plans to apply to
sit for the examination in the coming year following the
year of the first available examination. The department may
require an applicant to provide documentation showing
registration for the examination when it is received by the
applicant shall require documentation that the applicant
took the examination.
(b) A temporary genetic counselor license shall be valid
for 24 months and shall not be extended or renewed.
(c) Notwithstanding subdivision (a), a temporary license
issued pursuant to this section shall expire upon any of
the following events, whichever occurs earlier:
(1) The issuance of a license pursuant to Section
124981.
(2) Thirty days after notification of the department
that an applicant has failed the certification examination ,
or on the date that the applicant applies and is granted an
additional temporary license pursuant to subdivision (b).
(3) The expiration date on the temporary license.
POSITIONS
Support: American College of Medical Genetics
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American Society of Human Genetics
National Society of Genetic Counselors
National Urea Cycle Disorders Foundation
Quest Diagnostics
An individual
Oppose: None received
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