BILL ANALYSIS                                                                                                                                                                                                    �



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          Date of Hearing:   April 17, 2012

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER 
                                     PROTECTION
                                 Mary Hayashi, Chair
                    AB 1976 (Logue) - As Amended:  April 11, 2012
           
          SUBJECT  :   Professions and vocations: licensure and 
          certification requirements: military experience.

           SUMMARY  :   Establishes the Veterans Health Care Workforce Act of 
          2012 and imposes specified requirements on healing arts boards 
          within the Department of Consumer Affairs (DCA) and on the 
          Department of Public Health (DPH) to facilitate the licensing or 
          certification of veterans with appropriate health-care related 
          education, training, or practical experience.  Specifically, 
           this bill  :  

          1)Requires healing arts boards within DCA to, upon the 
            presentation of satisfactory evidence by an applicant for 
            licensure, accept the education, training, and practical 
            experience completed by an applicant as a member of the United 
            States (U.S.) Armed Forces or Military Reserves of the U.S., 
            the national guard of any state, the military reserves of any 
            state, or the naval militia of any state, toward the 
            qualifications and requirements to receive a license issued by 
            that board unless the board determines that the education, 
            training, or practical experience is not substantially 
            equivalent to the standards of the board.

          2)Requires, by July 1, 2014, any DCA healing arts board that 
            accredits or otherwise approves schools offering educational 
            course credit for meeting licensing qualifications and 
            requirements to require those schools seeking accreditation or 
            approval to have procedures in place to fully accept an 
            applicant's military education, training, and practical 
            experience toward the completion of an educational program 
            that would qualify a person to apply for licensure.

          3)Requires each DCA healing arts board to determine whether it 
            is necessary to adopt regulations to implement the above 
            provisions.  If a board determines it is necessary to adopt 
            regulations, the board shall adopt those regulations not later 
            than January 1, 2014.  









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          4)If a board determines it is not necessary to adopt 
            regulations, the board shall, not later than January 1, 2014, 
            submit to the Governor and the Legislature a written report 
            explaining why such regulations are not necessary. This 
            provision becomes inoperative on January 1, 2017.

          5)Requires the California Department of Veterans Affairs (CDVA) 
            to provide technical assistance to DCA healing arts boards and 
            the DCA director with respect to complying with the above 
            requirements, including the determination of substantial 
            equivalency between the education, training, or practical 
            experience of an applicant and the board's standards, and 
            obtaining state, federal, or private funds to support 
            compliance with this bill's requirements.








          6)Requires the DCA director to submit a written report to the 
            Governor and the Legislature by January 1, 2016, on the 
            progress of DCA healing arts boards toward compliance with 
            this bill's provisions, as specified.  This provision becomes 
            inoperative on January 1, 2017.

          7)Establishes identical provisions as outlined above for DPH, 
            for applicants for licensure or certification in any of the 
            following professions:

             a)   Medical Laboratory Technician (MLT);

             b)   Clinical Laboratory Scientist (CLS);

             c)   Radiologic Technologist (RT);

             d)   Nuclear Medicine Technologist (NMT);

             e)   Certified Nurse Assistant (CNA);

             f)   Certified Home Health Aide (HHA);

             g)   Certified Hemodialysis Technician (CHT); and,








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             h)   Nursing Home Administrator (NHA). 

          8)States findings and declarations.

           EXISTING LAW  

          1)Provides for the licensure and regulation of various healing 
            arts professions by boards within DCA.

          2)Requires the rules and regulations of these healing arts 
            boards to provide for methods of evaluating education, 
            training, and experience obtained in military service if such 
            training is applicable to the requirements of the particular 
            profession or vocation regulated by the board.

          3)Authorizes DPH to license or certify a number of healing arts 
            professionals.

          4)Specifies that CDVA has specified powers and duties relating 
            to various programs serving veterans.

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author, "In order to 
          honor the service of our nation's returning heroes and address 
          California's healthcare workforce needs, this bill would ensure 
          that veterans with healthcare education, training, and practical 
          experience are expedited into civilian employment as healthcare 
          professionals.

          "This bill would break down barriers facing returning veterans, 
          by requiring state entities that license healthcare 
          professionals to establish policies that recognize the 
          education, training, and practical experience of a veteran 
          applicant.  It would also require these entities to work with 
          the college programs they accredit to ensure that the colleges 
          have procedures in place so that veteran applicants are not 
          forced to retake classes they have already completed at a 
          military institute, and so that veterans are able to quickly 
          complete the additional coursework necessary for licensure."

           Background  .  Current law requires DCA's healing arts boards to 








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          provide for methods of evaluating education, training, and 
          experience obtained in military service if such training is 
          applicable to the requirements of the particular profession or 
          vocation regulated by the board.  This requirement is based on 
          the policy that, consistent with high quality health care 
          services, persons with skills, knowledge and experience obtained 
          in the armed services of the United States should be permitted 
          to apply such learning and contribute to the health manpower 
          needs of the state at the maximum level of responsibility and 
          skill for which they are qualified.

          Although DPH is not subject to a similar statutory requirement, 
          DPH reports having procedures in place to evaluate education, 
          training, and experience obtained in military service for the 
          professions of MLT, CLS, RT, NMT and CNA.  There are currently 
          no procedures in place for HHAs, CHTs, NHAs.  

          DPH approves 120 schools for the purposes of training for CLS.  
          The current procedure requires a laboratory scientist trainee 
          license for any military applicant who needs further training to 
          obtain a California CLS license.  In issuing this trainee 
          license, DPH has procedures in place to evaluate military 
          training and experience of applicants.  The schools accept the 
          scientist trainee license as qualification to enter their 
          program.
            
          DPH approves 643 CNA training programs, 267 HHA training 
          programs and 498 Certified CHT training programs.  DPH, not the 
          schools, would approve training, education and experience 
          equivalency.  DPH currently has procedures in place to evaluate 
          military training, education and experience for CNA applicants, 
          but not for HHA or CHT applicants.

          There are no school programs for NHAs seeking initial licensure. 
           DPH does approve NHA courses for continuing education 
          requirements after the individual is licensed.  CDPH does not 
          currently have procedures in place for evaluating military 
          training, experience, or education for NHA applicants.
            
          CDPH does not have statutory authority to approve NMT schools.  
          The Joint Review Committee on Educational Programs in Nuclear 
          Medicine Technology (JRCNMT) accredits these programs.  JRCNMT 
          is the only programmatic accrediting agency recognized to 
          accredit NMT educational programs offered through traditional 
          and distance education formats in the U.S. and its territories.  








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          The JRCNMT holds recognition from the Council for Higher 
          Education Accreditation.

          The Radiologic Health Branch (RHB) within DPH is responsible for 
          the inspection of RT schools.  However, the three branches of 
          the military have programs for RTs and NMTs.  These programs are 
          accredited by the Joint Review Committee on Education in 
          Radiologic Technology (JRCERT), a private accrediting 
          organization recognized by the U.S. Department of Education for 
          the accreditation of educational programs in the radiological 
          sciences.  The American Registry of Radiologic Technologists 
          (ARRT) is a private certifying organization that accepts 
          graduates from schools accredited by JRCERT.  An RT or NMT 
          completing the military's programs is qualified to take ARRT's 
          examination.  If a veteran takes and passes the ARRT's 
          examination, the veteran can then apply to DPH-RHB to obtain the 
          applicable authorization without taking the DPH examination, 
          since they have already passed the ARRT's examination.  The 
          veteran is not required to attend an RHB-approved school since 
          they completed the required training program in the military.  
          Therefore, schools do not need to have a procedure to accept an 
          already qualified veteran who participated in and passed a 
          military RT or NMT program.  This bill could apply if someone 
          from the military, who had been attending a JRCERT accredited 
          program, left service before completing the program.  If he/she 
          were to apply to finish his/her RT courses, all 41 schools have 
          procedures in place to assess out of state, out of country, and 
          military education received to identify what classes would be 
          needed in order to graduate and become certified.  

          DPH has no record of any applicants for licensure or 
          certification for any of the professions specified in the bill 
          being denied because DPH did not accept the applicant's military 
          education, training or practical experience toward the 
          requirements for licensure or certification.  

          Similar, comprehensive information for DCA's health care boards 
          was not available at the time this analysis was written.  
          However, according to the Medical Board of California (MBC), the 
          MBC does not accredit U.S. medical schools.  The requirement is 
          that applicants must be graduates of a medical school accredited 
          by the Liaison Committee on Medical Education (LCME), which is 
          the nationally recognized accrediting authority for medical 
          education programs leading to the MD degree in U.S. and Canadian 
          medical schools.  The LCME is sponsored by the Association of 








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          American Medical Colleges and the American Medical Association.

          DCA's boards and bureaus that would be affected by this bill 
          include the Acupuncture Board, the Board of Behavioral Sciences, 
          the Board of Occupational Therapy, the Board of Optometry, the 
          Board of Pharmacy, the Board of Podiatric Medicine, the Board of 
          Psychology, the Board of Registered Nursing, the Board of 
          Vocational Nursing and Psychiatric Technicians, the Dental 
          Board, the MBC, the Osteopathic Medical Board, the Physical 
          Therapy Board, the Respiratory Care Board, the Speech-Language 
          Pathology and Audiology Board, and the Veterinary Medical Board.

          The Post-9/11 GI Bill provides financial support for education 
          and housing to individuals with at least 90 days of aggregate 
          service after September 10, 2001, or individuals discharged with 
          a service-connected disability after 30 days.  Veterans must 
          receive an honorable discharge to be eligible for the Post-9/11 
          GI Bill, which went into effect August 1, 2009.  Approved 
          training under the Post-9/11 GI Bill includes graduate and 
          undergraduate degrees, vocational/technical training, on-the-job 
          training, flight training, correspondence training, licensing 
          and national testing programs, entrepreneurship training, and 
          tutorial assistance.  All training programs must be approved for 
          GI Bill benefits.

          According to a September 2011 New York Times editorial by 
          Hollister K. Petraeus, assistant director for service members 
          affairs at the U.S. Consumer Financial Protection Bureau, 
          veterans are increasingly being targeted and exploited by 
          private educational institutions that provide little academic, 
          administrative, or counseling support after students enroll.  
          She states, in part: "Vast sums are involved: between 2006 and 
          2010, the money received in military education benefits by just 
          20 for-profit companies soared to an estimated $521.2 million 
          from $66.6 million?The schools have a strong incentive to enroll 
          service members and veterans, in large part because of the 
          "90-10 rule" created by the 1998 amendments to the Higher 
          Education Act.  Put simply, the rule says that a for-profit 
          college must obtain at least 10% of its revenue from a source 
          other than Title IV education funds, the primary source of 
          federal student aid.  Funds from Tuition Assistance and the G.I. 
          Bill are not defined as Title IV funds, so they count toward the 
          10% requirement, just like private sources of financing."

          "Therein lies a problem.  For every service member or veteran 








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          (or spouse or child, in the case of the post-9/11 G.I. Bill) 
          enrolled at a for-profit college and paying with military 
          education funds, that college can enroll nine others who are 
          using nothing but Title IV money.  This gives for-profit 
          colleges an incentive to see service members as nothing more 
          than dollar signs in uniform, and to use aggressive marketing to 
          draw them in and take out private loans, which students often 
          need because the federal grants are insufficient to cover the 
          full cost of tuition and related expenses.

          "A number of for-profit colleges have questionable academic 
          credentials or lack accreditation accepted by other 
          institutions.  This makes it very difficult for students to 
          transfer credits to other schools.  Not surprisingly, for-profit 
          colleges also tend to have a higher-than-average student loan 
          default rate, which means that, in the end, the college 
          experience there may hinder, rather than help, the careers and 
          financial prospects of their graduates."

          At the same time, according to an April 10, 2012, report by 
          National Public Radio, "Offices serving former military have 
          popped up at colleges and universities nationwide in response to 
          the growing number of veterans making the transition to student 
          life."

          According to "U.S. Military and California Health Personnel: 
          Select Comparisons,"
          a 2008 report by the Center for the Health Professions at the 
          University of California, San Francisco, "As California faces 
          workforce shortages and geographic mal-distribution in many of 
          the health care professions, policy makers are looking to 
          expanding educational programs, rethinking practice models and 
          improving recruitment and retention efforts among existing and 
          new pools of workers.  One potential pool of health care workers 
          includes former military personnel returning from active duty or 
          retiring with years available for service in the civilian labor 
          force.

          "Individuals with military training or experience in health care 
          may be well-positioned to meet civilian health care needs upon 
          their separation from service.  Most of the military training is 
          nationally accredited and/or of documented high quality, and a 
          serviceperson retiring from military duty may still want to work 
          for many years in the civilian sector.  However, current rules 
          and regulations may present unnecessary challenges.  To 








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          facilitate smooth transitions between military and civilian 
          work, civilian policy makers and educators might want to explore 
          better alignment of accreditation, certification and licensure 
          standards."

           Related legislation  .  AB 1932 (Cook) requires healing arts 
          boards within DCA to issue a written report to CDVA detailing 
          the methods of evaluating the education, training, and 
          experience obtained in military service and whether that 
          education, training, and experience is applicable to the boards' 
          requirements for licensure, by January 1, 2014.  This bill is 
          pending in Assembly Veterans Affairs Committee.

           Double-referred  .  This bill is double-referred to Assembly 
          Veterans Affairs Committee.

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California State Rural Health Association (sponsor)
          American Legion - Department of California
          AMVETS - Department of California
          California Association of County Veterans Service Officers
          California State Commanders Veterans Council
          Vietnam Veterans of America - California State Council

           Opposition 
           
          None on file
           
          Analysis Prepared by  :    Angela Mapp / B.,P. & C.P. / (916) 
          319-3301