BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 562
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          Date of Hearing:   June 25, 2013

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                              Richard S. Gordon, Chair
                    SB 562 (Galgiani) - As Amended:  June 18, 2013

           SENATE VOTE  :   32-0
           
          SUBJECT  :   Dentists:  mobile or portable dental units.

           SUMMARY  :   Establishes a framework for "portable dental units"  
          to be regulated by the Dental Board of California (DBC) and  
          deletes restrictions limiting dentists to operating only one  
          mobile dental clinic.  Specifically,  this bill  :   

          1)Requires a portable dental unit to be registered and operated  
            in accordance with regulations to be established by DBC, and  
            prohibits the regulations from preventing or lessening  
            competition in service areas.  

          2)Deletes the restriction on a licensed dentist operating only  
            one mobile dental clinic or unit registered as a dental office  
            or facility.

          3)Permits the regulations to include, but not be limited to,  
            requirements for availability of follow-up and emergency care,  
            maintenance and availability of provider and patient records,  
            and treatment information to be provided to patients and other  
            appropriate parties.  

          4)Exempts portable dental units from requirements related to  
            additional offices, clinics operated by federal entities,  
            federally recognized Indian tribes or tribal organizations,  
            intermittent clinics, and mobile service units, as specified.

          5) Defines the following terms:

             a)   "Mobile dental unit" means a self-contained facility in  
               which dentistry will be practiced that may be moved, towed,  
               or transported from one location to another; and,

             b)   "Portable dental unit" means dental equipment housed in  
               a self-contained unit used for providing dental treatment  
               which is routinely is transported to, and used on a  








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               temporary basis at, a non-dental office location.

          6)Makes other technical or clarifying changes. 

           EXISTING LAW  :

          1)Authorizes the DBC to license and regulate those engaged in  
            the practice of dentistry.  (Business and Professions Code  
            (BPC) Section 1601.1) 

          2)Authorizes a dentist to operate a mobile dental clinic or unit  
            that is registered according to regulations adopted by the  
            DBC.  (BPC 1657)

          3)Specifies the following requirements for a mobile dental  
            clinic:

             a)   There is a written procedure for emergency follow-up  
               care for patients treated in the mobile dental clinic and  
               that such procedure includes arrangements for treatment in  
               a dental facility which is permanently established in the  
               area;

             b)   The mobile dental clinic has communication facilities  
               which will enable the operator thereof to contact necessary  
               parties in the event of a medical or dental emergency;

             c)   The mobile dental clinic conforms to all applicable  
               federal, state and local laws, regulations and ordinances  
               dealing with radiographic equipment, flammability,  
               construction, sanitation and zoning, and the applicant  
               possesses all applicable county and city licenses or  
               permits to operate the unit; 

             d)   The driver of the unit possesses a valid California  
               driver's license;

             e)   Each mobile dental clinic shall have ready access to a  
               ramp or lift if services are provided to disabled persons;  
               and, 

             f)   Have ready access to toilet facilities.  (16 California  
               Code of Regulations Section 1049(c)) 

          4)Defines a "mobile service unit" or "mobile unit" as a special  








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            purpose commercial coach or a commercial coach that meets any  
            of the following criteria: 

             a)   Is approved by the Department of Public Health (DPH) as  
               a service of a licensed health facility;

             b)   Is licensed by the DPH as a clinic; or,

             c)   Is licensed as an "other" type of approved mobile unit  
               by DPH.

          5)States that a "mobile service unit" or "mobile unit" does not  
            mean a modular, relocatable or transportable unit that is  
            designed to be placed on a foundation when it reaches its  
            destination.  (HSC 1765.105) 

          6)Requires the following for a mobile service unit:

             a)   The mobile unit shall be of sufficient size and shall be  
               arranged in a manner that is appropriate for the provision  
               of those health care services that it is licensed to  
               provide;

             b)   The mobile unit shall be equipped with appropriate  
               utilities for the comfort and safety of patients, and the  
               Office of Statewide Health Planning and Development shall  
               review and approve hospital-provided utility connections  
               for mobile units that require utility hookups with general  
               acute care hospitals;

             c)   The mobile unit shall be maintained in good repair and  
               in a clean and sanitary manner;

             d)   All proposed modifications to previously approved  
               services and procedures shall be reviewed and approved by  
               DPH before they are implemented; and, 

             e)   Modifications to the mobile service unit shall be  
               approved by the Department of Housing and Community  
               Development.  (HSC 1765.150)

          7)Requires a licensee using mobile services to maintain written  
            transfer agreements that shall include, but shall not be  
            limited to, provisions for communication with, and  
            transportation to, one or more nearby hospitals and other  








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            health facilities as needed to meet medical emergencies.  (HSC  
            1765.160 (c)) 

           FISCAL EFFECT  :  Unknown    

           COMMENTS  :    

           1)Purpose of this bill  .  This bill updates current law to  
            provide for the regulation of portable dental units, which are  
            collapsible, suitcase-sized dental practice sites.  This bill  
            is sponsored by the California Dental Association. 

           2)Author's statement  .  According to the author, "[Current law]  
            provides authority for the Dental Board of California to  
            regulate 'mobile dental units,' but did not envision the use  
            of portable equipment, as the statutory language does not  
            appear flexible enough to provide the same authority over  
            'portable dental units.'  As Californians rely on the Dental  
            Board of California to ensure proper consumer protections  
            through regulations - regardless of the location or manner in  
            which those services are provided - it is imperative to update  
            the statute to extend the board's authority over all manner of  
            current practice."

           3)Nontraditional dental practice settings  .  California regulates  
            the practice of dentistry in many settings beyond the  
            traditional brick-and-mortar office:  

              a)   Mobile service unit  .  A mobile service unit is basically  
               a primary clinic on wheels, typically in a specialized  
               commercial coach.  These units are approved by the  
               Department of Public Health and may provide dental  
               services, in addition to other procedures, but are not  
               regulated by DBC. 

              b)   Mobile dental clinic .  A mobile dental clinic, or mobile  
               dental unit, is a commercial coach, trailer, van, or other  
               self-contained unit that may appear similar to a mobile  
               service unit, but only provides dental services.  A mobile  
               dental clinic is regulated by DBC, and may be operated by a  
               dentist after receiving a permit from DBC and proving that  
               the unit complies with existing health and safety  
               regulations.  

              c)   Portable dental unit  .  A portable dental unit consists  








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               of portable dental chair and suitcase-like container  
               housing a collection of dental tools which may be set up to  
               enable a dental professional to perform dental services at  
               various field sites.  This bill allows DBC to regulate  
               these units in the same manner as mobile dental clinics.     
                

           4)Operation of multiple mobile and portable dental units  .  This  
            bill also deletes the restriction on dentists operating only  
            one mobile dental unit at a time.  This restriction is no  
            longer relevant, as dentists are permitted to have multiple  
            traditional dental offices, and a dentist is required to  
            register each mobile unit with the board and follow all  
            relevant laws and regulations.  

            According to the sponsor, "Lifting the numerical restriction  
            will encourage access to care by allowing dentists to cover  
            multiple sites with multiple mobile and/or portable units,  
            either themselves or through general supervision of dental  
            hygienists."  
                
            5)Previous legislation .  SB 1202 (Leno), Chapter 331, Statutes  
            of 2011, authorized a registered dental hygienist in  
            alternative practice to operate a mobile dental hygiene clinic  
            under certain circumstances. 

            AB 2390 (Reyes), Chapter 347, Statutes of 2003, exempted  
            certain mobile service units from the provisions of the Dental  
            Practice Act that regulate mobile dental clinics, or units and  
            additional places of practice, among other provisions.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Dental Association (sponsor)
          California Academy of Physician Assistants
          California Primary Care Association
          The Children's Partnership
           
            Opposition 
           
          None on file.

           Analysis Prepared by  :    Sarah Huchel / B.,P. & C.P. / (916)  








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          319-3301