BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2699|
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THIRD READING
Bill No: AB 2699
Author: Bass (D)
Amended: 8/27/10 in Senate
Vote: 21
SENATE BUSINESS, PROF & ECON DEVELOP COMM : 5-1, 6/28/10
AYES: Negrete McLeod, Aanestad, Calderon, Correa, Florez
NOES: Yee
NO VOTE RECORDED: Wyland, Corbett, Walters
ASSEMBLY FLOOR : 67-3, 6/2/10 - See last page for vote
SUBJECT : Healing arts: licensure exemption
SOURCE : Author
DIGEST : This bill exempts, until January 1, 2014, from
state licensure 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.
ANALYSIS : Existing law:
1.Provides that a physician and surgeon or osteopathic
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 in the state
prison, by imprisonment in a county jail not exceeding
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one year, or by both fine and imprisonment.
2.Makes it unlawful for any person to practice as a
dentist, nurse, optometrist, dental hygienist, physician
assistant or vocational nurse without a valid license,
certificate or registration issued by the regulatory
boards that regulate these professionals.
3.Establishes the Chiropractic Initiative Act of California
(Initiative Act), approved by voters on November 7, 1922,
and became effective on December 21, 1922, to regulate
the practice of chiropractors. Provides under the
Initiative Act that the Board of Chiropractic Examiners,
upon receipt of specified fee, to issue a license to any
person licensed to practice chiropractic in another
state, provided that the other state had the same general
requirements as California at the time the license was
issued, and that other state grants reciprocal
registration to chiropractic examiners.
4.Provides that in a state of emergency, as defined, a
health care practitioner licensed in another state that
offers or provides health care for which he or she is
licensed, is exempt from licensure.
5.Establishes reciprocity eligibility requirements for
certain health care practitioners who are licensed in
other states, including physicians and surgeons, nurses,
and dentists.
This bill:
1. Exempts from state licensure, until January 2, 2014,
specified health care practitioners that are licensed or
certified in good standing in another state, district,
territory of the United States and who offer or provide
health care services in California under the following
requirements:
A. Prior to providing those services, he or
she:
1) Obtains authorization from the board
to participate in the sponsored event.
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2) Satisfies the following requirements:
? The health care practitioner
has not committed any act or been convicted
of a crime constituting grounds for denial
of licensure or registration, and is in good
standing in each state in which he or she is
licensed or certified.
? The health care practitioner
has the appropriate education and experience
to participate in a sponsored event, as
determined by the board.
? The health care practitioner
agrees to comply with all applicable
practice requirements.
1) Submits to the board, on a form
prescribed by the board, a request for
authorization to practice without a license,
and pays a nominal fee, in an amount determined
by the board by regulation, to cover the cost
of developing the authorization process and
processing the request.
A. The care is provided under all of the
following circumstances:
1) To uninsured or underinsured persons.
2) On a short-term voluntary basis, not
to exceed a 10-calander-day period per
sponsored event.
3) In association with a sponsoring
entity that complies with specified
requirements.
4) Without charge to the recipient or to
a third party on behalf of the recipient.
1. Allows the Board to deny a health care practitioner
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authorization to practice without a license if the
health care practitioner fails to comply with the
requirements of this section or for any act that would
be grounds for denial of an application for licensure.
2. Requires the sponsoring entity seeking to provide, or
arrange for the provision of, health care services to do
both of the following:
A. Register with each applicable board for which
an out of state health care practitioner is
participating in the sponsored event by completing a
registration form that includes the name of the
sponsoring authority, its officers or organization
officials, specified contact information for the
sponsoring entity and its officers, and, any
additional information required by the licensing
board.
B. Provide the information required above to the
county health department of the county in which the
health care services will be provided, along with
any additional information that may be required by
that department.
3. Requires the sponsoring entity to notify in writing the
licensing board and the county health department of any
change to the information required by #3) above within
30 calendar days of the change.
4. Requires the sponsoring entity additionally do the
following:
A. Within 15 calendar days of the provision of
health care services, it must file a report with the
licensing board and the county health department on
the date, place, type, and general description of
the care provided, along with a listing of the
health care practitioners who participated in
providing that care.
B. Maintain a list of health care practitioners
associated with the provision of health care
services under this bill. Requires the sponsoring
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entity to maintain a copy of each health care
practitioner's current license or certification and
shall require each health care practitioner to
attest in writing that his or her license or
certificate is not suspended or revoked pursuant to
disciplinary proceedings in any jurisdiction. The
sponsoring entity shall maintain these records for a
period of at least five years following the
provision of health care services and shall, upon
request, furnish those records to the licensing
board or any county health department.
5. Prohibits a contract of liability insurance issued,
amended, or renewed in this state on or after January 1,
2011, from excluding coverage of a health care
practitioner or a sponsoring entity that provides, or
arranges for the provision of, health care services
under this bill, provided that the practitioner or
entity complies with the requirements of this bill.
6. States that the exemption from licensure for health care
practitioners shall not be construed to authorize to a
health care practitioner to render care outside the
scope of practice authorized by his or her license or
certificate.
7. Authorizes the board to terminate authorization for a
health care practitioner to provide health care services
pursuant to this bill for failure to comply with the
requirements of this bill.
8. Requires the board provide both the sponsoring entity
and the health care practitioner with a written notice
of termination including the basis for that termination.
The health care practitioner may, within 30 days after
the date of the receipt of notice of termination, file a
written appeal to the board. The appeal shall include
any documentation the health care practitioner wishes to
present to the board.
9. Prohibits a health care practitioner whose authorization
to provide health care services has been terminated from
providing health care services unless and until a
subsequent request for authorization has been approved
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by the board. A health care practitioner who provides
health care services in violation is deemed to be
practicing health care in violation of the law and be
subject to any applicable administrative, civil, or
criminal fines, penalties, and other sanctions.
10.Specifies the provisions of this bill are severable.
11.Defines the following terms: board, sponsoring entity,
and uninsured or underinsured person.
Background
Licensure Requirements . Generally, health care
practitioners, including physician and surgeons,
osteopathic physicians, dentists, physician assistants,
nurses, and dental hygienists must be licensed in
California to practice in the state. There are limited
exemptions to this general rule. For example, health care
practitioners who provide care during a state of emergency
upon request by the Director of Emergency Medical Services
Authority are exempt from licensure. Additionally, a
physician and surgeon who is practicing in another state
may be exempted from licensure when he or she has been
invited by the United States Olympic Committee (Committee)
to provide medical services in in-state events sanctioned
by the Committee, and the services provided are limited to
those sanctioned by the Committee, as specified.
Additionally, licensing boards allow health care
practitioners who are licensed or certified in other states
to practice in California under specified requirements.
Free Health Clinics . Remote Area Medical (RAM) Volunteer
Corps, based in Tennessee, is a non-profit organization
founded in 1985, and has staged hundreds of medical clinics
both in the United States and worldwide. In August 2009,
RAM conducted an eight-day health event in Los Angeles
County. Volunteer health care practitioners, such as
doctors, nurses, dentists, chiropractors and optometrists,
provided various medical services to more than 6,300
uninsured and underinsured residents of the county. On
April 27 to May 3, 2010, RAM conducted its second free
health clinic in Los Angeles. Thousands of people sought
and received treatments but many people had to be turned
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away. Organizers of the event indicated that a shortage of
volunteer health care practitioners hampered their effort,
and if existing law allowed for certain exemption for
health care practitioners at these types of health clinic
events, additional medical volunteers could have been
recruited.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/30/10)
Los Angeles County Board of Supervisors (source)
California Academy of Physician Assistants
Planned Parenthood Los Angeles Advocacy Project
Service Employees International Union
OPPOSITION : (Verified 8/30/10)
American Nurses Association of California
California Nurses Association
ARGUMENTS IN SUPPORT : The Los Angeles County Board of
Supervisors state that current law prohibits out-of-state
health care practitioners from practicing in California
without a license. Thousands of low-income children,
families, and individuals in California are uninsured or
underinsured and do not receive basic health, vision, and
dental care screenings. Lack of basic health services and
preventive care may lead to more serious and costly
problems in the future. In August 2009, the Remote Area
Medical (RAM) Volunteer Corps conducted an eight-day health
event in Los Angeles County. Volunteer medical, dental and
other health care practitioners provided $2.9 million in
free services to over 14,000 patient encounters during the
event. While the event was extremely successful, RAM
experienced a shortage of volunteer health care
professionals because of restrictions in State law which
prohibits volunteer out-of-state licensed medical personnel
from providing short-term services. As a result, thousands
of residents needing services were turned away. Another
RAM event was held at the Los Angeles Sports Arena from
April 27 to May 3, 2010, and over 6,600 uninsured and
underinsured received services, most of which were vision
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and dental.
ARGUMENTS IN OPPOSITION : The California Nurses
Association indicate that this bill does not assure that
practitioners who come to California are competent, and
have passed adequate background checks, and patients who
are injured or harmed by out-of state practitioners would
have little recourse, because the state's healing arts
boards do not have the authority to regulate or enforce
discipline practitioners who are not licensed in
California.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall,
Bill Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Knight, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Nestande, Niello,
Nielsen, V. Manuel Perez, Ruskin, Saldana, Silva,
Skinner, Smyth, Solorio, Torlakson, Torrico, Tran,
Villines, John A. Perez
NOES: Portantino, Salas, Swanson
NO VOTE RECORDED: Tom Berryhill, Jones, Lieu, Monning,
Nava, Norby, Audra Strickland, Torres, Yamada, Vacancy
JA:nl 8/30/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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