BILL ANALYSIS
SB 112
Page 1
Date of Hearing: June 16, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
SB 112 (Oropeza) - As Amended: June 3, 2009
SENATE VOTE : 37-0
SUBJECT : Hemodialysis technicians.
SUMMARY : Revises the training requirements for certified
hemodialysis technicians (CHT). Specifically, this bill :
1)Prohibits an individual from providing services as a
hemodialysis technician (HT) without being certified by the
Department of Public Health (department) as a CHT, as
specified.
2)Requires an individual to meet the following requirements to
become a CHT:
a) Have a high school diploma or equivalency, or have
greater than four years of work experience in dialysis as
of October 14, 2008;
b) Have successfully completed a training program that is
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, and communication and interpersonal skills, including
patient sensitivity training and care of difficult
patients; and,
c) Successfully accomplish either of the following:
i) Pass a standardized test that is approved by the
department and that covers, at a minimum, specified
subjects; or,
ii) Successfully pass an examination offered by a
national, commercially available certification program
for hemodialysis technicians which is approved for this
purpose by the Centers for Medicare and Medicaid
Services.
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3)Requires a training program to include 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; and,
h) Dialyzer reprocessing, if applicable.
4)States that a community or corporate-based training program,
or a training program offered by an educational institution,
is acceptable if the program meets the applicable
requirements.
5)Permits an individual employed as HT by a hemodialysis clinic
or unit for more than two years as of October 14, 2008, who
does not have documentation showing successful completion of a
qualified training program to be deemed to be in compliance
by:
a) Passing a written exam, offered by a hemodialysis clinic
or unit, covering the subjects listed above; and,
b) Passing a skills checklist through observation by a
registered nurse of the technician's skills.
6)Requires the department to adopt regulations to implement this
bill.
7)Permits current HTs to retain their certifications until April
15, 2010.
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8)Is an urgency statute, and becomes inoperative on July 1,
2010, and, as of January 1, 2011, is repealed, unless a later
enacted statute deletes or extends the dates on which it
becomes inoperative and is repealed.
9)Permits 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.
10)Requires each hemodialysis unit or clinic to have information
available for inspection by the department survey teams which
verifies that the HTs employed at the unit or clinic meet the
certification requirements.
11)Defines "standardized test" as an examination certified by
faculty of the University of California to validly and
reliably measure the knowledge required to demonstrate
competency in the areas being tested.
12)Makes Legislative findings and declarations.
EXISTING LAW :
1)Establishes the Hemodialysis Technicians Training Act which
prescribes minimum requirements for HTs.
2)Defines a HT 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 HT 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.
5)Requires the Department of Public Health (DPH) to certify HTs
and requires the certification to include one or more of the
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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; or,
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 DPH.
6)Requires a hemodialysis technician to obtain 30 hours of
in-service training or continuing education in dialysis care
from specified sources.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "SB 112
will bring California's hemodialysis technician certification
program into compliance with the [Centers for Medicare and
Medicaid Services' (CMS)] Conditions for Coverage (CfC) [of
End-Stage Renal Disease facilities] so that our program can be
granted approval by CMS, thus allowing an alternative pathway to
certification for California's CHTs."
Background . On April 15, 2008, CMS established new CfCs for
dialysis facilities. CfCs are the minimum health and safety
standards that providers and suppliers must meet in order to be
Medicare and Medicaid certified. According to the U.S.
Department of Health and Human Services, the new conditions
update CMS standards for delivering safe, high-quality care to
dialysis patients. The revised regulations are patient-centered;
reflect improvements in clinical standards of care, the use of
more advanced technology, and, most notably, a framework to
incorporate performance measures viewed by the scientific and
medical community to be related to the quality of care provided
to dialysis patients. The conditions also established specific
standards which include the certification of "Patient Care
Technicians," known in California as Certified Hemodialysis
Technicians.
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According to the author's office, there are over 5,000 CHTs
currently in California, and all must be recertified to be in
compliance with the new CfC prior to April 15, 2010. CMS has
only approved three private certification programs, so this bill
modifies California's state certification program as an
alternative pathway.
REGISTERED SUPPORT / OPPOSITION :
Support
California Dialysis Council (sponsor)
The American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
DaVita (Dialysis) Inc.
National Kidney Foundation
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301