BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 1083
Author: Pavley (D)
Amended: 8/18/14
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 9-0, 4/21/14
AYES: Lieu, Wyland, Berryhill, Block, Corbett, Galgiani,
Hernandez, Hill, Padilla
SENATE FLOOR : 36-0, 4/28/14 (Consent)
AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett,
Correa, De Le�n, DeSaulnier, Evans, Fuller, Gaines, Galgiani,
Hancock, Hernandez, Hill, Hueso, Huff, Jackson, Knight, Lara,
Leno, Lieu, Liu, Mitchell, Monning, Morrell, Nielsen, Padilla,
Pavley, Roth, Steinberg, Vidak, Walters, Wolk, Wyland
NO VOTE RECORDED: Calderon, Torres, Wright, Yee
ASSEMBLY FLOOR : 79-0, 8/25/14 - See last page for vote
SUBJECT : Physician assistants: disability certifications
SOURCE : California Academy of Physician Assistants
DIGEST : This bill amends the Physician Assistant Practice Act
to authorize a physician assistant (PA) to certify claims for
disability insurance (DI), after performance of a physical
examination by the PA and under the supervision of a physician
and surgeon; expands the definition of "practitioner" to include
PAs; and requires the Employment Development Department (EDD) to
implement these provisions on or before January 1, 2017.
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Assembly Amendments require EDD to implement the provisions of
this bill by January 1, 2017.
ANALYSIS :
Existing law:
1. Authorizes the Physician Assistant Board to license and
regulate the practice of PAs.
2. Specifies the delegation of services agreement for a PA
including ordering durable medical equipment, approving,
signing, modifying or, after consultation with a supervising
physician, adding to a plan of treatment or care.
3. Allows a PA or nurse practitioner (NP), under the supervision
of a physician, to carry out the initial report for and
authorize temporary disability for no more than three
calendar days.
4. Prohibits a PA or NP from prescribing permanent DI.
5. Allows the claimant to apply for DI by having a doctor's note
that certifies the claimant's illness, injury, or pregnancy,
or that of a family member that is under the claimant's care.
If the claimant requires more DI after the first period of
DI is over, they can continue to file for DI using the
original doctor's note.
6. Defines a "doctor's note" as a medical document that
certifies the claimant's illness, injury, or pregnancy based
on the physician or practitioner's medical knowledge, a
physical examination, and the claimant's medical history.
The note must also include the physician or practitioner's
recommendation for the claimant's leave from work and their
reception of DI.
7. Defines "practitioner" as a person duly licensed or certified
in California acting within the scope of his/her license or
certification who is a dentist, podiatrist, or an NP, and in
the case of an NP, after performance of a physical
examination by an NP and collaboration with a physician and
surgeon, or as to normal pregnancy or childbirth, a midwife
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or nurse midwife, or NP.
This bill:
1.Permits PAs to certify disability under the supervision of a
physician and surgeon.
2.Expands the definition of "practitioner" to include PAs who
have performed a physical examination under the supervision of
a physician and surgeon.
3.Requires EDD to implement these provisions on or before
January 1, 2017.
4.Requires funds appropriated to cover costs of this bill to
come from the Unemployment Compensation Disability Fund.
Background
PA roles and training . A PA is a licensed and highly skilled
health care professional trained to provide patient evaluation,
education, and health care services. A PA works with a
physician to provide medical care and guidance needed by a
patient.
A PA must attend a specialized medical training program
associated with a medical school that includes classroom studies
and clinical experience. An academic degree and/or certificate
is awarded upon graduation. Most PA training programs require
prior health care experience. Many PAs have two or four-year
academic degrees before entering a PA training program.
Authorization to sign forms . Existing law permits PAs to sign
corresponding certificates or forms for the purpose of issuing
disabled person placards, certify licensees to drive standard
commercial vehicles, school buses, general public transportation
vehicles, and farm labor vehicles. PAs are also authorized to
conduct physical examinations and sign corresponding forms or
certificates for those seeking employment in school districts or
with the county superintendent of schools.
Under existing law, PAs can certify some claims of temporary
disability including Paid Family Leave (PFL). The PFL insurance
provides up to six weeks of benefits for individuals who must
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take time off to care for a seriously ill child, spouse, parent,
or registered domestic partner, or to bond with a new child.
State Disability Insurance (SDI) programs . According to
information obtained from EDD, SDI programs offer affordable,
short-term benefits to eligible workers who suffer a loss of
wages when they are unable to work due to a non-work-related
injury or due to pregnancy or childbirth. SDI eligible workers
must not have been able to perform their daily work tasks for at
least eight consecutive days.
Anyone who is considered under California law as a
"practitioner" can sign SDI forms via EDD's online system. A
"practitioner" is defined as any person who has been licensed or
certified in California as a dentist, podiatrist, or NP who
collaborates with a physician and surgeon. In the case of
signing forms for an individual who is determined to have a
normal pregnancy or childbirth; a midwife, nurse midwife, or NP
can perform a physical examination to determine whether or not
the patient is eligible for SDI. Additionally, a medical
officer of a U.S. Government facility, chiropractor, or
psychologist is also authorized to certify claims for SDI.
However, because PAs are not recognized as a practitioner, they
are not permitted to certify claims for SDI.
Comments
According to the author, "Physician assistants are licensed
health care professionals who practice medicine as members of a
physician-led team, delivering a broad range of medical and
surgical services to diverse populations in rural, urban and
suburban settings?SB 1083 would include physician assistants as
recognized practitioners who may certify disability insurance
with EDD." The author believes,"?this bill closes a loophole in
the law that currently allows PAs to certify some claims of
temporary disability, such as Paid Family Leave, but not others
such as claims for disability insurance with the EDD."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee:
One-time contract costs to EDD of approximately $4 million to
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modify and test existing Information Technology (IT) systems
(Unemployment Compensation Disability Fund). Ongoing costs
are likely minor. EDD indicates in order to comply with this
bill, it will need to reprogram several systems, and that
programming also requires testing to ensure all interfaces
work properly.
Minor costs, likely under $100,000 annually, to Department of
Consumer Affairs to update an existing interface with EDD to
share PA licensure data (Physician Assistant Fund).
SUPPORT : (Verified 8/26/14)
California Academy of Physician Assistants (source)
Kaiser Permanente
Medical Board of California
Physician Assistant Board
ARGUMENTS IN SUPPORT : The bill's sponsor, the California
Academy of Physician Assistants, notes, "The restrictions
related to EDD forms are inconsistent with the scope of practice
of a physician assistant, which allows them to act as an agent
of their supervising physician in performing medical
examinations as well as most other medical services. The law
pertaining to DI is also inconsistent with a physician
assistants' ability to certify other claims of temporary
disability, such as Paid Family Leave under the Family Medical
Leave Act and the California Family Rights Act, but not claims
for Disability Insurance."
Kaiser Permanente writes, "This bill would align PA's scope of
practice with authority nurse practitioners gained under SB 819
(Yee) in 2009. Kaiser Permanente supports this bill as it would
reduce confusion, expand the pool of medical professionals who
can certify disability, and ensure appropriate physician
supervision."
ASSEMBLY FLOOR : 79-0, 8/25/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hern�ndez,
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Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Vacancy
MW:de 8/26/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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