BILL ANALYSIS �
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|Hearing Date:June 18, 2012 |Bill No:AB |
| |1896 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: AB 1896Author:Chesbro
As Amended:March 27, 2012Fiscal: No
SUBJECT: Healing arts: Tribal health programs: health care
practitioners.
SUMMARY: Aligns California law with the provisions of federal law
which exempt a health care practitioner licensed in any state who
practices as part of the tribal health program from the licensure
requirements of the state in which the tribal health program is
located.
Existing California law:
1) Provides for the licensure and regulation of health care
practitioners by various healing arts boards within the Department
of Consumer Affairs.
2) Exempts a person practicing a profession or rendering services from
any state licensure requirements if they are practicing as an
employee of a department, bureau, office, division, or similarly
constituted agency of the federal government, and provides medical
services exclusively on a federal reservation or at any facility
wholly supported by and maintained by the United States Government.
(Business and Professions Code (BPC) � 715)
Existing Federal Law:
1) Defines "tribal health program" as an Indian tribe or tribal
organization that operates any health program, service, function,
activity, or facility funded, in whole or part, by the Indian
Health Service. (25 U.S.C. � 450 et seq.)
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2) Defines a "health profession" as: allopathic medicine, family
medicine, internal medicine, pediatrics, geriatric medicine,
obstetrics and gynecology, podiatric medicine, nursing, public
health nursing, dentistry, psychiatry, osteopathy, optometry,
pharmacy, psychology, public health, social work, marriage and
family therapy, chiropractic medicine, environmental health and
engineering, an allied health profession, or any other health
profession. (25 U.S.C. � 1603(n))
3) Authorizes a health care professional credentialed and privileged
at a federal health care institution or location designated by the
Secretary of Defense to practice at any location, regardless of
where the health care professional or the patient are located, so
long as the practice is within the scope of the authorized federal
duties. (H.R. 1540 � 1094(d))
4) Establishes, under the Patient Protection and Affordable Care Act
(PPACA), that licensed health professionals employed by a tribal
health program shall be exempt, if licensed in any state, from the
licensing requirement of the state in which the tribal health
program performs the services described in the contract or compact
of the tribal health program under the Indian Self-Determination
and Education Assistance Act (ISDEAA). (25 U.S.C. � 450 et seq.)
This bill: Specifies that a person who is licensed as a health care
practitioner in any other state and is employed by a tribal health
program is exempt from any state licensing requirement with respect to
acts authorized under the person's license where the tribal health
program performs specified services.
FISCAL EFFECT: This bill has been keyed "non-fiscal" by Legislative
Counsel.
COMMENTS:
1. Purpose. This bill is sponsored by the California Rural Indian
Health Board (CRIHB). According to the Author, this bill would
amend the current California law to conform with the requirements
specified in the PPACA (Public Law 111-148). Historically, the
Tribal Health Programs experience shortages in doctors, dentists,
nurses and other providers. The Author states that according to
the Federal Indian Health Service's Workforce report, the vacancy
rates range from 10 to 25 percent depending on the type of provider
and this is primarily attributed to the remoteness of many of the
facilities. Aligning California law with federal law in this
manner will enable the Tribal Health Programs to more readily hire
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health care providers and continue to provide care to the patients
that they serve.
2. Background. Indian Health Care. The National Indian Health Board
(NIHB) represents Tribal governments, both those that operate their
own health care delivery systems through contracting and
compacting, and those receiving health care directly from the
Indian Health Service (IHS). According to the NIHB, the system for
delivering health care services to Indians is unique: "It was
designed by the federal government to carry out the federal trust
responsibility for Indian health. In addition, federal policy
dictates that the federal government interacts with Indian tribes
on a government-to-government basis."
Treaties between the U.S. Government and Indian Tribes frequently
call for the provision of medical services, the services of
physicians, or the provision of hospitals for the care of Indian
people. Even before these treaties, the U.S. Constitution
specifically addressed the federal government's primacy role in
dealing with Indians in the commerce and treaty clauses. Supreme
Court cases, such as Cherokee Nation v. Georgia (1831),
specifically address the relationship between Tribes, states, and
the federal government. Out of this case and others, the
guardian/ward relationship was created that forms the basis of the
trust relationship.
Indian Health Services (IHS). The IHS, an agency within the
Department of Health and Human Services, is responsible for
providing federal health services to American Indians and Alaska
Natives. The provision of health services to members of
federally-recognized tribes grew out of the special
government-to-government relationship between the federal
government and Indian tribes. This relationship, established in
1787, is based on Article I, Section 8 of the Constitution, and has
been given form and substance by numerous treaties, laws, Supreme
Court decisions, and Executive Orders. The IHS is the principal
federal health care provider and health advocate for Indian people
and its goal is to raise their health status to the highest
possible level. The IHS provides a comprehensive health service
delivery system for approximately 1.9 million American Indians and
Alaska Natives who belong to 564 federally recognized tribes in 35
states.
Patient Protection and Affordable Care Act (PPACA). The original
version of the Indian Health Care Improvement Act (IHCIA) was
passed by Congress in 1976. The authorization of appropriations
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for the IHCIA expired in 2000. The Patient Protection and
Affordable Care Act reauthorized the IHCIA, and authorizes the
director of IHS to:
Facilitate advocacy and promote consultation on matters
relating to Indian health within the Department of Health and
Human Services.
Provide authorization for hospice, assisted living,
long-term, and home- and community-based care.
Extend the ability to recover costs from third parties
to tribally operated facilities.
Update current law regarding collection of
reimbursements from Medicare, Medicaid, and CHIP (Children's
Health Insurance Program) by Indian health facilities.
Allow tribes and tribal organizations to purchase health
benefits coverage for IHS beneficiaries.
Authorize IHS to enter into arrangements with the
Departments of Veterans Affairs and Defense to share medical
facilities and services.
Allow a tribe or tribal organization carrying out a
program under the Indian Self-Determination and Education
Assistance Act and an urban Indian organization carrying out a
program under Title V of IHCIA to purchase coverage for its
employees from the Federal Employees Health Benefits Program.
Authorize the establishment of a Community Health
Representative program for urban Indian organizations to train
and employ Indians to provide health care services.
Direct the IHS to establish comprehensive behavioral
health, prevention, and treatment programs for Indians.
The PPACA also includes provisions for health care services
provided to Indians through Tribal Health Programs. The Act
indicates that professionals who are employed by tribal health
programs shall be considered exempt from the licensing requirements
of the state in which the tribal health program performs services
under the ISDEAA (25 U.S.C. � 450 et seq.).
1. Arguments in Support. The CRIHB as the sponsor of this measure
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indicate that this bill will assist Tribal Health Programs to hire
needed health care providers. They state that California's 31
Tribal Health Programs operate 57 ambulatory clinics and have
difficulty hiring and retaining providers to work in the
facilities. These critically important safety net facilities serve
over 130,000 American Indian patients and non-Indian Medi-Cal
patients on an annual basis. CRIHB further indicates that by
aligning California and federal law the bill will enable the Tribal
Health Programs to more readily hire health care providers and
continue to provide care to the patients that they serve.
SUPPORT AND OPPOSITION:
Support: California Rural Indian Health Board Inc. (Sponsor)
Opposition: None received as of June 13, 2012.
Consultant:Le Ondra Clark