BILL ANALYSIS
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|Hearing Date:March 23, 2009 |Bill No:SB |
| |112 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC
DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 112Author:Oropeza
As Amended:March 4, 2009 Fiscal: Yes
SUBJECT: Hemodialysis technicians (Urgency).
SUMMARY: An urgency measure which revises existing
requirements for the certification of hemodialysis
technicians under the Hemodialysis Technicians Training
Act.
Existing law:
1)Establishes the Hemodialysis Technicians Training Act
which prescribes minimum requirements for hemodialysis
technicians.
2)Defines a hemodialysis technician as an unlicensed health
care provider who is employed by a hemodialysis clinic or
unit for the purpose of participating in the direct
treatment of patients undergoing hemodialysis.
3)Specifies that the treatment of patients by a
hemodialysis technician includes performing venipuncture
and arterial puncture for the purpose of providing
dialysis treatment, administration of local anesthetics,
heparin, and sodium chloride solutions.
4)Requires that the administration of these medications be
pursuant to a protocol established by the medical
director of the hemodialysis unit or clinic and under the
immediate supervision of a licensed physician and surgeon
or a licensed registered nurse.
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5)Requires the Department of Public Health (DPH) to certify
hemodialysis technicians and requires the certification
to include one or more of the following requirements:
a) Certification by the Board of Nephrology
Examination for Nurses and Technicians.
b) Completion of a DPH-approved training and testing
program in a hemodialysis clinic or unit.
c) Certification by DPH as being a graduate of a local
training and testing program operated by an accredited
college, or accredited university approved by the DPH,
or a graduate of a private training program approved
by DPR.
6)Specifies that a hemodialysis technician certificate is
valid for four years.
7)Requires a hemodialysis technician to obtain 30 hours of
in-service training or continuing education in dialysis
care from specified sources.
This bill:
1)Revises the requirements for the certification of
hemodialysis technicians under the Hemodialysis
Technicians Training Act to require all of the following:
a) Have a high school diploma or an equivalent, or
have greater than four years of work experience in
dialysis as of October 14, 2008.
b) Completion of a training program approved by the
medical director and governing body of a hemodialysis
clinic or unit, under the direction of a registered
nurse, focused on the operation of kidney dialysis
equipment and machines; providing direct patient care,
communication and interpersonal skills, including
patient sensitivity training and care of difficult
patients. Defines "successfully completes a training
program" as completing all didactic portions of the
program and demonstrating competency in the knowledge
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and skills provided by the program.
c) Passage of a standardized examination that is
either approved by DPH and that covers specified
subjects or offered by a national commercially
available certification program for hemodialysis
technicians, which is approved for this purpose by the
Centers for Medicaid and Medicare Services (CMS).
Requires the DPH-approved standardized examination to
be administered in a proctored environment by an
independent examiner. Specifies that independent
examiners may include representatives appointed by
End-Stage Renal Disease Network 17, End-Stage Renal
Disease Network 18, the California Dialysis Council or
any private testing organization approved by DPH.
2)Requires the training program specified in item #1) of b)
above to include all of the following subjects:
a) Principles of dialysis.
b) Care of patients with kidney failure, including
interpersonal skills.
c) Dialysis procedures and documentation, including
initiation, proper cannulation techniques, monitoring,
and termination of dialysis.
d) Possible complications of dialysis.
e) Water treatment and dialysate preparation.
f) Infection control.
g) Safety.
h) Dialyzer reprocessing, if applicable.
3)Accepts a community or corporate-based training program,
or a training program offered by an educational
institution to satisfy the training program requirements
specified in item #1) of b) above if such program meets
the certification requirements specified in this bill.
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4)Specifies that a person employed as a hemodialysis
technician by a hemodialysis clinic or unit for more than
two years as of October 14, 2008, who does not have
documentation of having successfully completed the
training program specified in this bill, is deemed to be
in compliance with the training requirements by doing
both of the following:
a) Passing a written exam, offered by a hemodialysis
clinic or unit, covering the subjects specified in
item #2) above.
b) Passing a skills checklist through observation by a
registered nurse of the technician's skills.
5)Specifies that the prohibition on a hemodialysis
technician providing hemodialysis services, unless
certified by DPH, does not apply to a person certified by
DPH as a hemodialysis technician as of the operative date
of this bill. Indicates instead that the certificate of
such a hemodialysis technician is valid until April 15,
2010, and must, on or before that date, obtain a new
certificate in a manner prescribed by DPH. Sunsets this
provision on July 1, 2010 and as of January 1, 2010 is
repealed unless a later enacted statute extends this
date.
6)Allows an expired certification to be renewed at any time
within two years after its expiration on the filing of an
application for renewal and documentation of the required
in-service education.
7)Makes legislative findings and declarations on the need
to revise the state requirements for hemodialysis
technicians.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal"
by Legislative Counsel.
COMMENTS:
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1.Purpose. According to the sponsor of this bill, the
California Dialysis Council (Council), this measure will
bring California's hemodialysis technician certification
program into compliance with recent guidelines adopted by
CMS for Conditions for Coverage of End-Stage Renal
Disease facilities (CMS guidelines). The CMS guidelines
establish conditions that dialysis facilities must meet
to be certified as health care providers under the
Medicare Program. According to the Council, there are
currently 5,000 certified hemodialysis technicians in
California who must be re-certified to be in compliance
with the new CMS guidelines by April 15, 2010. Thus, the
Council argues, it is important that California's
certification requirements be modified to allow
hemodialysis technicians that currently hold state
certification to continue to be certified.
2.Background.
a. Certification of Hemodialysis Technicians. Current
law requires that DPH adopt rules and regulations
prescribing minimum training standards for
hemodialysis technicians. Under the Hemodialysis
Technicians Training Act, hemodialysis technicians
must be certified by DPH, complete a
department-approved training and testing program in a
hemodialysis clinic or unit, and graduate from an
accredited training and testing program that is
approved by DPH. Hemodialysis technician functions
include performing venipuncture and arterial puncture
for the purpose of providing dialysis treatment,
administration of local anesthetics, heparin, and
sodium chloride solutions. Current law requires that
the administration of these medications be pursuant to
a protocol established by the medical director of the
hemodialysis unit or clinic and under the immediate
supervision of a licensed physician and surgeon or a
licensed registered nurse.
b. Conditions for Coverage of End-Stage Renal Disease
facilities. On April 15, 2008, CMS established new
conditions for coverage for dialysis facilities to be
certified under the Medicare program. Certification
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under the Medicare program is important for facilities
accepting payments from Medicare. The conditions
established specific standards which include the
certification of "Patient Care Technicians," known in
California as Certified Hemodialysis Technicians. The
current regulations require patient care technicians
to meet the following:
i. Meet all applicable state requirements for
education, training, credentialing, competency,
standards of practice, certification, and licensure
in the State in which he or she is employed as a
dialysis technician.
ii. Have a high school diploma or equivalency.
iii. Have completed a training program that is
approved by the medical director and governing body,
under the direction of a registered nurse, focused
on the operation of kidney dialysis equipment and
machines, providing direct patient care, and
communication and interpersonal skills, including
patient sensitivity training and care of difficult
patients.
iv. The training program must include those
subjects specified in item # 2) of this bill above.
v. Be certified under a state certification
program or a national commercially available
certification program, as follows:
(1) For newly employed patient care
technicians, within 18 months of being hired as a
dialysis patient care technician, or
(2) For patient care technicians employed on
October 14, 2008, within 18 months after such
date.
CMS also requires that the state or national
certification program require patient care technicians
to take a standardized test developed and tested to
validly and reliably measure the knowledge required to
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demonstrate competency in this area.
CMS also recognizes that there are some experienced
patient care technicians working in dialysis
facilities as of the effective date of the new rules
who may not have evidence of high school diploma or
equivalency. Patient care technicians with four years
work experience in dialysis as of October 14, 2008 who
lack evidence of a high school diploma may use their
work experience in lieu of the requirement for high
school diploma.
c. DPH letter to certified hemodialysis technicians,
dialysis clinics and hemodialysis training programs.
On November 3, 2008, DPH sent a letter to hemodialysis
technicians, end-stage renal disease clinics, and
hemodialysis training programs indicating that
effective October 14, 2008, hemodialysis technicians
are required to obtain certification from one of three
national commercially-available certification
programs: Nephrology Nursing Certification
Commission, Board of Nephrology Examiners for Nursing
and Technology and National Nephrology Certification
Organization examination. Hemodialysis technicians
working on October 14, 2008, who are not yet certified
under an approved program must be certified before
April 15, 2010. Hemodialysis technicians hired after
October 14, 2008 must be certified within 18 months of
their hire date. DPH further points out that if a
hemodialysis technician who is not certified changes
jobs from one dialysis facility to another, the time
he/she was employed in the first facility will count
towards the 18-month deadline for certification,
unless the gap in employment as a dialysis technicians
is more than 18 months.
3.Arguments in Support. Supporters, including the American
Federation of State, County, and Municipal Employees , and
DaVita indicate that this bill ensures that hemodialysis
technicians meet the requirements of the CfC so that
dialysis facilities in this state may continue to employ
hemodialysis technicians.
4.Technical Amendments. The author wishes to correct a
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drafting error referencing a subsection in the bill
relating to the certification requirements of
hemodialysis technicians. On page 5, line 38, delete
Section 1247.6 and insert Section 1247.61.
SUPPORT AND OPPOSITION:
Support:
American Federation of State, County, and Municipal
Employees
DaVita
Opposition:
None on file as of March 17, 2009.
Consultant:Rosielyn Pulmano