BILL ANALYSIS
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UNFINISHED BUSINESS
Bill No: SB 112
Author: Oropeza (D), et al
Amended: 8/27/09
Vote: 27 - Urgency
SEN. BUS., PROF. & ECON. DEV. COMMITTEE : 10-0, 3/23/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett, Correa,
Florez, Oropeza, Romero, Walters, Yee
SENATE APPROPRIATIONS COMMITTEE : 11-0, 4/20/09
AYES: Kehoe, Cox, Corbett, Denham, DeSaulnier, Hancock,
Leno, Runner, Walters, Wolk, Yee
NO VOTE RECORDED: Oropeza, Wyland
SENATE FLOOR : 37-0, 4/23/09 (Consent)
AYES: Aanestad, Alquist, Ashburn, Benoit, Calderon,
Cedillo, Cogdill, Corbett, Correa, Cox, Denham,
DeSaulnier, Dutton, Florez, Hancock, Hollingsworth, Huff,
Kehoe, Leno, Liu, Lowenthal, Maldonado, Negrete McLeod,
Oropeza, Padilla, Pavley, Romero, Runner, Simitian,
Steinberg, Strickland, Walters, Wiggins, Wolk, Wright,
Wyland, Yee
NO VOTE RECORDED: Ducheny, Harman, Vacancy
ASSEMBLY FLOOR : 74-0, 8/31/09 - See last page for vote
SUBJECT : Hemodialysis technicians
SOURCE : California Dialysis Council
CONTINUED
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DIGEST : This bill revises existing requirements for the
certification of hemodialysis technicians under the
Hemodialysis Technicians Training Act.
Assembly Amendments define the term "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 and specify that a training program must be
submitted to the Department of Public Health for approval
prior to implementation.
ANALYSIS :
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.
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.
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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 DPH, or a graduate of a private training program
approved by DPH.
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. Requires, following approval by the medical
director and governing body, the training program be
submitted to DPH for approval prior to
implementation. The training program shall be
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
and skills provided by the program.
C. Passage of a standardized test that is either
approved by DPH and that covers specified subjects or
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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 test 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-State Renal Disease Network 18, the
California Dialysis Council or any private testing
organization approved by DPH.
2.Requires the training program specified in #1(B) above to
include all of the following subjects at a minimum:
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 requires
specified in #1(B) above if such program meets the
certification requirements specified in this bill.
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
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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, or a community or corporate-based
training program covering the subjects specified in
#2 above.
B. Passing a skills checklist through observation by
a registered nurse of the skills listed ion #2 above.
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.Defines "standardized test" as an examination certified
by the faculty of the University of California to validly
and reliably measure the knowledge required to
demonstrate competency in the areas of being tested.
8.Makes legislative findings and declarations on the need
to revise the state requirements for hemodialysis
technicians.
Background
1. 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,
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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.
2. Conditions for Coverage of End-State Renal Disease
Facilities . On April 15, 2008, CMS established new
conditions for coverage for dialysis facilities to be
certified under the Medicare program. Certification
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:
A. 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.
B. Have a high school diploma or equivalency.
C. 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.
D. The training program must include those subjects
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specified in #2 above.
E. 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
demonstrate competency in this area.
CMA 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 of 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.
3. DPH letter to certified hemodialysis technicians,
dialysis clinics and hemodialysis training programs . On
November 3, 2008, DPH sent a letter to hemodialysis
technicians, end-state 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.
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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 technicians
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 technician is more than 18 months.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
DPH Regulations $69 $117
$69 Special*
*State Department of Public Health Licensing and
Certification Program
Fund
SUPPORT : (Verified 9/1/09)
California Dialysis Council (source)
American Federation of State, County and Municipal
Employees, AFL-CIO
DaVita (Dialysis) Inc.
National Kidney Foundation of No. California and No. Nevada
ARGUMENTS IN SUPPORT : According to the sponsor of this
bill, the California Dialysis Council (Council), this bill
will bring California's hemodialysis technician
certification program into compliance with recent
guidelines adopted by CMS for Conditions for Coverage of
End-State 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
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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 the California's
certification requirements be modified to allow
hemodialysis technicians that currently hold state
certification to continue to be certified.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, 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, Jones, Krekorian, Lieu, Logue,
Bonnie Lowenthal, Ma, Mendoza, Miller, Monning, Nava,
Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Ruskin, Salas, Saldana, Silva, Smyth, Solorio,
Audra Strickland, Swanson, Torlakson, Torres, Torrico,
Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Davis, Duvall, Knight, Portantino,
Skinner, Vacancy
JJA:cm 9/1/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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