BILL ANALYSIS
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|Hearing Date:June 28, 2010 |Bill No:AB |
| |2683 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 2683Author:Hernandez
As Amended:June 14, 2010 Fiscal: Yes
SUBJECT: Optometry.
SUMMARY: Authorizes optometrists to practice in long term care
settings such as skilled nursing facilities (nursing homes),
psychiatric hospitals, and intermediate care facilities.
Existing law:
1)Licenses and regulates the practice of optometry by the California
Board of Optometry (Board) within the Department of Consumer Affairs
(DCA).
2)Requires an optometrist to notify the Board in writing of the address
or addresses where he or she is to engage, or intends to engage, in
the practice of optometry.
3)Exempts an optometrist from notifying the Board if he or she engages
in temporary practice which is limited to 7 calendar days during a
30-day period and 54 days during the calendar year at any the
following settings:
a) A facility licensed by the State Department of Public Health.
b) A public institution, including, but not limited to, a school,
community college, or correctional facility.
c) A mobile unit operated by a governmental agency or nonprofit
or charitable organization.
d) The home of a non-ambulatory patient.
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e) The practice location of a licensed optometrist who is absent
for a reason approved by the Board.
4)Authorizes an assistant in the office of a physician and surgeon or
optometrist under the direct responsibility and supervision of a
physician and surgeon or optometrist to fit prescription lenses.
5)Specifies additional duties that an assistant may perform in the
office of, and under the direct supervision of, an ophthalmologist
or optometrist.
This bill:
1)Authorizes an optometrist to engage in the practice of optometry at
any health facility or residential care facility, provided the
optometrist:
a) Maintains a primary business office, separate from the health
facility or residential care facility, that meets all of the
following requirements:
i) Is open to the public during normal business hours by
telephone and for purposes of billing services or access to
patient records.
ii) Is licensed to the optometrist or the employer of the
optometrist as a local business with the city or county in
which it is located.
iii) Is registered by the optometrist with the Board.
iv) Is owned or leased by the optometrist or by the
employer of the optometrist.
v) Is not a residential dwelling.
b) Maintains or discloses patient records in the following
manner:
i) Records are maintained and made available to the patient
in such a way that the type and extent of services provided to
the patient are conspicuously disclosed. The disclosure of
records shall be made at or near the time services are rendered
and shall be maintained at the primary business office;
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ii) The optometrist complies with all federal and state
laws and regulations regarding the maintenance and protection
of medical records, including, but not limited to, the federal
Health Insurance Portability and Accountability (HIPA) Act of
1996;
iii) The optometrist keeps all necessary records for a
minimum of seven years from the date of service. Any
information shall be certified by the optometrist as being
true, accurate, and complete;
iv) Records shall be maintained for each prescription as
part of the patient's chart, including the optometrist's name
and license number, the place of practice or primary business
office, and the description of the goods and services for which
the patient is charged and the amount charged;
v) A copy of any referral or order requesting optometric
services for a patient from the health facility's or
residential care facility's administrator, director of social
services, the attending physician and surgeon, the patient, or
a family member shall be kept in the patient's medical record.
c) Possesses and appropriately uses the instruments and equipment
required for all optometric services and procedures performed
within the health facility or residential care facility.
2)Exempts an optometrist from providing notification to the Board of
each health facility or residential care facility, provided all
requirements are met.
3)Defines certain terms for purposes of the above provisions,
including:
a) Health facility as specified in the Health and Safety Code,
exclusive of a hospital, as defined.
b) Residential care facility as any facility licensed by the
State Department of Social Services caring for persons who cannot
live alone but who do not need extensive services.
4)Authorizes an assistant to fit prescription lenses and perform those
additional duties in any setting where optometry or ophthalmology is
practiced, under the direct responsibility and supervision of a
physician and surgeon, optometrist, or ophthalmologist,
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respectively.
5)Defines "setting" for purposes of Item # 4 above, to include, but not
be limited to, any facility licensed by the State Department of
Public Health or the State Department of Social Services.
6)Makes technical, clarifying and conforming changes.
FISCAL EFFECT: The Assembly Appropriations Committee analysis, dated
May 5, 2010 indicates absorbable fee-supported special fund costs to
the California Board of Optometry to increase oversight of a small
group of professionals addressed by the bill
COMMENTS:
1.Purpose. This bill is sponsored by Board of Optometry (Board) in
order to authorize optometrists to practice optometry at a health
facility or residential care facility, upon meeting specified
requirements.
According to the Author, "California laws are vague and do not
adequately address notification, standard of practice and record
keeping requirements for optometrists who practice in health
facilities. A definition of optometric care in non-traditional
settings is needed in order to allow optometrists to provide this
type of care in a way that will protect the public and increase
access to care. Furthermore, due to low overhead costs and
potentially high profit margins, increasing numbers of optometrists
are providing this type of care either part-time or as a sole mode
of practice.
"Additionally, over the next several years and decades, Californian's
and the nations' baby boom generation are reaching age 65 and
represent among the fastest growing population in the state and in
the nation. It is projected that the number of elderly patients who
live in assisted living facilities, traditional nursing homes, and
various tiers of intermediate care is expected to double by year
2030. The concomitant expectation is that a great number of
professional services, such as optometric services will be rendered
for a non-ambulatory, or relatively immobile, percentage of the
population. The Board wants to ensure that optometric services
rendered to patients in these settings are provided in a manner as
consistent as possible with the level of care that would be provided
by the practitioner in his/her regular practice location."
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2.Background. Optometrists diagnose and treat vision problems and eye
diseases and write prescriptions for eyeglasses, contact lenses, and
medications. Optometrists are required to complete at least three
years of study at an accredited college or university before
beginning specialized optometry training. The specialized training
is four years in duration and the optometry student must then pass
written and clinical state board examinations prior to licensure.
Currently, more than 6,500 optometrists practice in California.
In 2007, AB 986 authorized optometrists to practice at temporary
locations in a similar fashion to statutes that authorize dentists
to work at temporary practice locations, such as nursing homes,
schools, and other public institutions. However, those provisions
only authorized a limited term timeframe for the practice of
optometry at these temporary locations; 7 calendar days during a
30-day period and 54 days during the calendar year.
According to the Author and Sponsor, current law provides inadequate
regulatory safeguards for optometrists who practice in long-term
care facilities. This bill increases those safeguards. The Author
indicates the number of professionals practicing in these patient
settings will increase as the proportion of elderly Californians
continues to increase.
3.Use of Assistants. This bill was amended on May 17, at the request
of the California Medical Association to clarify that assistants
under the direct oversight of an ophthalmologist or optometrist may
carry out certain tasks and functions in any setting where
ophthalmology or optometry is practiced. Formerly, the law
specified that these assistants may carry out these functions in the
office of a physician and surgeon or optometrist.
Writing in support of these amendments, the Chairman of the UC Davis
Eye Center states that ophthalmology practices have traditionally
employed specialized ophthalmic technicians who are not usually
formally trained as medical assistants, but have training that is
specifically relevant to eye care. In order to provide efficient
and affordable health care, amendments were made by SB 929 in 2000,
which authorized assistants to administer medications under the
direct supervision of a physician and surgeon or optometrist. Since
that time, however, the Department of Public Health has interpreted
that amendment as not applying to practice operating in
hospital-based clinics, which are under its licensing jurisdiction.
Prohibiting supervised technicians from administering drops under
direct supervision "greatly impairs our ability to render care in an
efficient and cost-effective manner. Moreover, the nature of the
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practice in academic health centers which often care for larger
numbers of patients with more serious health problems seriously
impairs out ability to care effectively."
"The care delivery activities involved in practicing ophthalmology and
optometry are no different when performed in a hospital-based clinic
compared with a private office. Given that technicians have been
administering these medications for decades in private offices (and
indeed in hospital-based clinics for nearly that long until the
recent DPH challenge) without known issue, this clarification in law
only serves to restore what had reasonably been intended in the
first place."
4.Prior Legislation. AB 986 (Eng, Chapter 276, Statutes of 2007)
allowed the practice of optometry at temporary locations under
certain conditions, established a retention period for optometrists
to maintain patient records, and increased licensing fees.
SB 929 (Polanco, Chapter 676, Statutes of 2000), among other things,
authorized assistants working in the office of an optometrist or
ophthalmologist, and under the direct supervision of an optometrist
or ophthalmologist, to perform a number of optometric tests and
procedures.
5.Arguments in Support. The Board of Optometry in sponsoring the bill
states that optometrists who practice in a variety of
non-traditional settings, such as long-term health care facilities,
skilled nursing facilities, psychiatric facilities, and intermediate
care facilities, have asked the Board to set minimum standards and
clarify what is required for optometrists who work in these
settings. Additionally, due to low overhead costs and high profit
margins, increasing numbers of optometrists are providing this type
of care either part-time or as a sole mode of practice. According
to the Board, California laws are vague and do not adequately
address notification, standard of practice and record keeping
requirements for optometrists who practice in health facilities. As
a consumer protection agency, the Board feels it is necessary to
establish guidelines in order to prevent any possible abuse by
licensees regarding billing and services provided.
Advanced Eyecare, Inc . argues that many residents of health care
facilities have health or behavioral issues making them not readily
transportable to a doctor's office, "in house" care is often the
only way these patients may receive vision services. However, under
existing law, providing "in-house" optometric vision services the
residents of a care facility is at best cumbersome and at worst a
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crime. "In fact, the State's largest vision insurance company,
which also administers some Medi-Cal vision benefits is preventing
its panel doctors from providing "in-house" care to nursing home
residents. This bill would allow optometrists to care for these
facility residents while requiring certain criteria prior to
providing in house services.
Vision Service Plan believes that the proper vision health care is
extremely important to enhance the quality of life for all persons,
and supports the ability for qualified optometrists to provide
on-site vision care to his or her geriatric patients residing in
health and residential care facilities.
6.Clarifying Amendments. Committee staff has worked with the Sponsors
to clarify and focus certain provisions of the bill. The following
clarifying amendments will be offered as Author's amendments in
Committee:
a) Clarify the definition of "residential care facility."
Revise page 4, line 36 through page 5, line 3 to read:
(2) "Residential care facility" means any facility licensed by
the State Department of Social Services caring for persons who
cannot live alone but who do not need extensive medical services.
The services provided in these facilities vary according to the
needs of the individual, but typically include help with
medications and assistance with personal hygiene, dressing, and
grooming. Residential care facilities include, as defined in
subsection (1) of paragraph (a) of Section 1502 of the Health and
Safety Code (a) (1), including but are not limited to, the
following:
b) Clarify the requirements of a primary business office.
Revise page 5, line 26 to read: "Is not located in or connected
with a residential dwelling."
c) Specify that both the place of practice and the primary
business office must be included in the information maintained by
an optometrist.
Revise page 6, line 12 to read: "The place of practice or and
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the primary business office."
SUPPORT AND OPPOSITION:
Support:
Board of Optometry (Sponsor)
Advanced Eyecare, Inc.
Chairman, UC Davis Eye Center
Vision Service Plan
Opposition:
None received as of June 21, 2010.
Consultant:G. V. Ayers