Version:

Existing law, the Dental Practice Act, provides for the licensure and regulation of registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice by the Dental Hygiene Committee of California. Existing law authorizes a registered dental hygienist in alternative practice to practice pursuant to specified provisions of law as, among other things, an independent contractor or an employee of a specified clinic. Existing law, the Moscone-Knox Professional Corporation Act, prohibits a professional corporation from rendering professional services in this state without a currently effective certificate of registration issued by the governmental agency regulating the profession in which the corporation is or proposes to be engaged and excepts any professional corporation rendering professional services by persons duly licensed by specified state entities from that requirement. Existing law authorizes specified healing arts licensees to be shareholders, officers, directors, or professional employees of a designated professional corporation, subject to certain limitations relating to ownership of shares. However, existing law specifies that it does not limit employment by a designated professional corporation to only those healing arts licensees and authorizes any healing arts licensee to be employed to render professional services by a designated professional corporation.

This bill would additionally except any professional corporation rendering professional services by persons duly licensed by the Dental Hygiene Committee of California from the certificate of registration requirement. The bill would authorize registered dental assistants, licensed dentists, registered dental hygienists, and registered dental hygienists in extended functions to be shareholders, officers, directors, or professional employees of a registered dental hygienist in alternative practice corporation. The bill would, in the Dental Practice Act, authorize a registered dental hygienist in alternative practice to practice as an employee of a professional corporation, as specified. The bill would make it unprofessional conduct to violate, attempt to violate, assist in or abet the violation of, or conspire to violate, specified provisions regarding registered dental hygienists in alternative practice corporations, the Moscone-Knox Professional Corporation Act, or any regulations adopted under those laws. The bill would require a licensee employed by, or practicing in, a registered dental hygienist in alternative practice corporation to practice within the scope of their license and be subject to all applicable licensure provisions in their respective practice act. The bill would require the bylaws of a registered dental hygienist in alternative practice corporation to include a provision requiring the capital stock of a disqualified or deceased person to be sold to specified parties within a specified period of time. The bill would also require such a corporation to provide security for claims by patients.

This bill would additionally except any professional corporation rendering professional services by persons duly licensed by the Dental Hygiene Committee of California from the certificate of registration requirement. The bill would authorize dental assistants and assistants, licensed dentists dentists, registered dental hygienists, and registered dental hygienists in extended functions to be shareholders, officers, directors, or professional employees of a registered dental hygienist in alternative practice corporation. The bill would, in the Dental Practice Act, authorize a registered dental hygienist in alternative practice to practice as an employee of a professional corporation, as specified. The bill would make it unprofessional conduct to violate, attempt to violate, assist in or abet the violation of, or conspire to violate, specified provisions regarding registered dental hygienists in alternative practice corporations, the Moscone-Knox Professional Corporation Act, or any regulations adopted under those laws. The bill would require the bylaws of a registered dental hygienist in alternative practice corporation to include a provision requiring the capital stock of a disqualified or deceased person to be sold to specified parties within a specified period of time. The bill would also require such a corporation to provide security for claims by patients.

(1)Existing

Existing law, the Dental Practice Act, provides for the licensure and regulation of registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice by the Dental Hygiene Committee of California. Existing law authorizes a registered dental hygienist in alternative practice to practice pursuant to specified provisions of law as, among other things, an independent contractor or an employee of a specified clinic. Existing law, the Moscone-Knox Professional Corporation Act, prohibits a professional corporation from rendering professional services in this state without a currently effective certificate of registration issued by the governmental agency regulating the profession in which the corporation is or proposes to be engaged and excepts any professional corporation rendering professional services by persons duly licensed by specified state entities from that requirement. Existing law authorizes specified healing arts practitioners licensees to be shareholders, officers, directors, or professional employees of a designated professional corporation, subject to certain limitations relating to ownership of shares. However, existing law specifies that it does not limit employment by a designated professional corporation to only those healing arts licensees and authorizes any healing arts licensee to be employed to render professional services by a designated professional corporation.

This bill would additionally except any professional corporation rendering professional services by persons duly licensed by the Dental Hygiene Committee of California from the certificate of registration requirement. The bill would authorize dental assistants and licensed dentists to be shareholders, officers, directors, or professional employees of a registered dental hygienist in alternative practice corporation. The bill would, in the Dental Practice Act, authorize a registered dental hygienist in alternative practice to practice as an employee of a professional corporation, as specified. The bill would make it unprofessional conduct to violate, attempt to violate, assist in or abet the violation of, or conspire to violate, specified provisions regarding registered dental hygienists in alternative practice corporations, the Moscone-Knox Professional Corporation Act, or any regulations adopted under those laws. The bill would require the bylaws of a registered dental hygienist in alternative practice corporation to include a provision requiring the capital stock of a disqualified or deceased person to be sold to specified parties within a specified period of time. The bill would also require such a corporation to provide security for claims by patients.

(2)Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides certain standards that govern health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services.

This bill would require health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to provide specified reimbursement for registered dental hygienists in alternative practice performing dental hygiene services that may lawfully be performed by registered dental hygienists and that are reimbursable under the contracts or policies. The bill would also require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and registered dental hygienists in alternative practice. Because a willful violation of the bills provisions by a health care service plan covering dental services or a specialized health care service plan covering dental services would be a crime, it would impose a state-mandated local program.

(3)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law authorizes a registered dental hygienist in alternative practice to perform various duties in specified settings, including dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development.

This bill would provide that an alternative dental hygiene practice established within a certified shortage area is not required to close due to the removal of the dental health professional shortage area designation if the registered dental hygienist in alternative practice meets certain requirements.

(2)

(1)Existing law, the Dental Practice Act, provides for the licensure and regulation of registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice by the Dental Hygiene Committee of California. Existing law, the Moscone-Knox Professional Corporation Act, prohibits a professional corporation from rendering professional services in this state without a currently effective certificate of registration issued by the governmental agency regulating the profession in which the corporation is or proposes to be engaged and excepts any professional corporation rendering professional services by persons duly licensed by specified state entities from that requirement. Existing law authorizes specified healing arts practitioners to be shareholders, officers, directors, or professional employees of a designated professional corporation, subject to certain limitations relating to ownership of shares.

(3)

(4)

This bill would provide that no reimbursement is required by this act for a specified reason.

(2)Existing law, the Moscone-Knox Professional Corporation Act, prohibits a professional corporation from rendering professional services in this state without a currently effective certificate of registration issued by the governmental agency regulating the profession in which the corporation is or proposes to be engaged and excepts any professional corporation rendering professional services by persons duly licensed by specified state entities from that requirement. Existing law authorizes specified healing arts practitioners to be shareholders, officers, directors, or professional employees of a designated professional corporation, subject to certain limitations relating to ownership of shares.

(3)Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides certain standards that govern health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services.

(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would require an alternative dental hygiene practice established within a certified shortage area to continue regardless of certification.

This bill would require health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse provide specified reimbursement for registered dental hygienists in alternative practice for performing dental hygiene services that may lawfully be performed by registered dental hygienists and that are reimbursable under the contracts or policies. The bill would also require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and registered dental hygienists in alternative practice. Because a willful violation of the bills provisions by a health care service plan covering dental services or a specialized health care service plan covering dental services would be a crime, it would impose a state-mandated local program.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would require an alternative dental hygiene practice established within a certified shortage area to continue regardless of certification.

Existing law authorizes a registered dental hygienist in alternative practice to provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state. However, under existing law, if the registered dental hygienist in alternative practice provides services to a patient 18 months or more after the first date that he or she provides services to a patient, he or she is required to obtain written verification, including a prescription for dental hygiene services, that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state.

This bill would delete that written verification and prescription requirement.

This bill would require health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse registered dental hygienists in alternative practice for performing dental hygiene services that may lawfully be performed by registered dental hygienists and that are reimbursable under the contracts or policies. The bill would also require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and registered dental hygienists in alternative practice. Because a willful violation of the bills provisions by a health care service plan covering dental services or a specialized health care service plan covering dental services would be a crime, it would impose a state-mandated local program.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would require an alternative dental hygiene practice established within a certified shortage area to continue regardless of certification.

This bill would delete that written verification and prescription requirement.

This bill would require health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse registered dental hygienists in alternative practice for performing dental hygiene services that may lawfully be performed by registered dental hygienists and that are reimbursable under the contracts or policies. The bill would also require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and registered dental hygienists in alternative practice. Because a willful violation of the bills provisions by a health care service plan covering dental services or a specialized health care service plan covering dental services would be a crime, it would impose a state-mandated local program.

This bill would provide that no reimbursement is required by this act for a specified reason.

Version:

The people of the State of California do enact as follows:SECTION 1.Section 1925 of the Business and Professions Code is amended to read:1925.

A registered dental hygienist in alternative practice may practice, pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, subdivisions (a) and (b) of Section 1910, Section 1910.5, and Section 1926.05 as an employee of a dentist or of another registered dental hygienist in alternative practice, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, as an employee of a primary care clinic or specialty clinic that is licensed pursuant to Section 1204 of the Health and Safety Code, as an employee of a primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code, as an employee of a clinic owned or operated by a public hospital or health system, as an employee of a clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the countys role under Section 17000 of the Welfare and Institutions Code, or as an employee of a professional corporation under the Moscone-Knox Professional Corporation Act (commencing with Section 13400) of Part 4 of Division 3 of Title 1 of the Corporations Code.

SEC. 2.Article 9.1 (commencing with Section 1967) is added to Chapter 4 of Division 2 of the Business and Professions Code, to read:9.1.Registered Dental Hygienist in Alternative Practice Corporations1967.

A registered dental hygienist in alternative practice corporation is a professional corporation that is authorized to render professional services, as defined in Section 13401 of the Corporations Code, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Professional Corporation Act (commencing with Section 13400) of Part 4 of Division 3 of Title 1 of the Corporations Code, this article, and all other statutes and regulations now or hereafter adopted pertaining to the professional corporation and the conduct of its affairs. With respect to a registered dental hygienist in alternative practice corporation, the governmental agency referred to in the Moscone-Knox Professional Corporation Act is the Dental Hygiene Committee of California.

1967.1.

It shall constitute unprofessional conduct and a violation of this article for any person licensed under this article to violate, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term of this article, the Moscone-Knox Professional Corporation Act, or any regulations duly adopted under those laws.

1967.2.

A licensee employed by, or practicing in, a registered dental hygienist in alternative practice corporation pursuant to Section 13401.5 of the Corporations Code shall practice within the scope of their license and shall be subject to all applicable licensure provisions in their respective practice act.

1967.3.

The income of a registered dental hygienist in alternative practice corporation attributable to professional services rendered while a shareholder is a disqualified person, as defined in subdivision (e) of Section 13401 of the Corporations Code, shall not in any manner accrue to the benefit of such shareholder or his or her shares in the registered dental hygienist in alternative practice corporation.

1967.4.

(a)The bylaws of a registered dental hygienist in alternative practice corporation shall include a provision whereby the capital stock of the professional corporation owned by a disqualified person, as defined in subdivision (e) of Section 13401 of the Corporations Code, or a deceased person, shall be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.

(b)A registered dental hygienist in alternative practice corporation shall provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.

SEC. 3.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

(a)Professional services means any type of professional services that may be lawfully rendered only pursuant to a license, certification, or registration authorized by the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act.

(b)Professional corporation means a corporation organized under the General Corporation Law or pursuant to subdivision (b) of Section 13406 that is engaged in rendering professional services in a single profession, except as otherwise authorized in Section 13401.5, pursuant to a certificate of registration issued by the governmental agency regulating the profession as herein provided and that in its practice or business designates itself as a professional or other corporation as may be required by statute. However, any professional corporation or foreign professional corporation rendering professional services by persons duly licensed by the Medical Board of California or any examining committee under the jurisdiction of the board, the Osteopathic Medical Board of California, the Dental Board of California, the Dental Hygiene Committee of California, the California State Board of Pharmacy, the Veterinary Medical Board, the California Architects Board, the Court Reporters Board of California, the Board of Behavioral Sciences, the Speech-Language Pathology and Audiology Board, the Board of Registered Nursing, or the State Board of Optometry shall not be required to obtain a certificate of registration in order to render those professional services.

(c)Foreign professional corporation means a corporation organized under the laws of a state of the United States other than this state that is engaged in a profession of a type for which there is authorization in the Business and Professions Code for the performance of professional services by a foreign professional corporation.

(d)Licensed person means any natural person who is duly licensed under the provisions of the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act to render the same professional services as are or will be rendered by the professional corporation or foreign professional corporation of which he or she is, or intends to become, an officer, director, shareholder, or employee.

(e)Disqualified person means a licensed person who for any reason becomes legally disqualified (temporarily or permanently) to render the professional services that the particular professional corporation or foreign professional corporation of which he or she is an officer, director, shareholder, or employee is or was rendering.

SEC. 4.Section 13401.5 of the Corporations Code is amended to read:13401.5.

Notwithstanding subdivision (d) of Section 13401 and any other provision of law, the following licensed persons may be shareholders, officers, directors, or professional employees of the professional corporations designated in this section so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation so designated herein, and so long as the number of those licensed persons owning shares in the professional corporation so designated herein does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. This section does not limit employment by a professional corporation designated in this section to only those licensed professionals listed under each subdivision. Any person duly licensed under Division 2 (commencing with Section 500) of the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act may be employed to render professional services by a professional corporation designated in this section.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Registered dental assistants.

(2)Licensed dentists.

(3)Registered dental hygienists.

(4)Registered dental hygienists in extended functions.

The people of the State of California do enact as follows:SECTION 1.Section 1925 of the Business and Professions Code is amended to read:1925.

1967.1.

1967.2.

1967.3.

1967.4.

SEC. 3.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 4.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Registered dental assistants.

(2)Licensed dentists.

(3)Registered dental hygienists.

(4)Registered dental hygienists in extended functions.

The people of the State of California do enact as follows:SECTION 1.Section 1925 of the Business and Professions Code is amended to read:1925.

1967.1.

1967.2.

A registered dental hygienist in alternative practice corporation shall not do or fail to do any act the doing of which or the failure to do would constitute unprofessional conduct under any statute or regulation, now or hereafter adopted. In the conduct of its practice, it shall observe and be bound by such statutes and regulations to the same extent as a person holding a license under Article 9 (commencing with Section 1900).

1967.2.

1967.3.

1967.4.

SEC. 3.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 4.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental Registered dental assistants.

(2)Licensed dentists.

(3)Registered dental hygienists.

(4)Registered dental hygienists in extended functions.

The people of the State of California do enact as follows:SECTION 1.Section 1925 of the Business and Professions Code is amended to read:1925.

1967.1.

1967.2.

1967.3.

1967.4.

SEC. 3.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 4.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

(3)Registered dental hygienists.

(4)Registered dental hygienists in extended functions.

The people of the State of California do enact as follows:SECTION 1.Section 1925 of the Business and Professions Code is amended to read:1925.

A registered dental hygienist in alternative practice may practice, pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, subdivisions (a) and (b) of Section 1910, Section 1910.5, and Section 1926.05 as an employee of a dentist or of another registered dental hygienist in alternative practice, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, as an employee of a primary care clinic or specialty clinic that is licensed pursuant to Section 1204 of the Health and Safety Code, as an employee of a primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code, as an employee of a clinic owned or operated by a public hospital or health system, or as an employee of a clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the countys role under Section 17000 of the Welfare and Institutions Code. Code, or as an employee of a professional corporation under the Moscone-Knox Professional Corporation Act (commencing with Section 13400) of Part 4 of Division 3 of Title 1 of the Corporations Code.

1967.1.

1967.2.

1967.3.

1967.4.

SECTION 1.SEC. 3.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 2.SEC. 4.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 3.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

(a)This section shall only apply to a health care service plan contract covering dental services or a specialized health care service plan contract covering dental services issued, amended, or renewed on or after January 1, 2016.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health care service plan covering dental services or a specialized health care service plan covering dental services.

(c)If a health care service plan contract covering dental services or a specialized health care service plan contract covering dental services provides reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that plan contract to a contracted provider, or to an enrollee if out-of-network services are covered, shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

(d)(1)Nothing in this section shall preclude a health care service plan contract covering dental services or a specialized health care service plan contract covering dental services from setting different fee schedules for different services provided by different providers.

(2)A health care service plan contract covering dental services or a specialized health care service plan contract covering dental services shall use the same fee schedule for dental hygiene services whether the services are performed by a registered dental hygienist or a registered dental hygienist in alternative practice.

SEC. 4.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(a)This section shall only apply to a health insurance policy covering dental services or a specialized health insurance policy covering dental services issued, amended, or renewed on or after January 1, 2016.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

(c)If a health insurance policy covering dental services or a specialized health insurance policy covering dental services provides for reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that policy to a contracted provider, or to an insured if out-of-network services are covered, shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

(d)(1)Nothing in this section shall preclude a health insurance policy covering dental services or a specialized health insurance policy covering dental services from setting different fee schedules for different services provided by different providers.

(2)A health insurance policy covering dental services or a specialized health insurance policy covering dental services shall use the same fee schedule for dental hygiene services whether the services are performed by a registered dental hygienist or a registered dental hygienist in alternative practice.

SEC. 5.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

The people of the State of California do enact as follows:SECTION 1.Section 1926 of the Business and Professions Code is amended to read:1926.

A registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:

(a)Residences of the homebound.

(b)Schools.

(c)Residential facilities and other institutions.

(d)Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. An alternative dental hygiene practice established within a certified shortage area shall not be required to close due to the removal of the dental health professional shortage area designation if the registered dental hygienist in alternative practice continues to serve those patients that lack or have limited access to dental care including, but not limited to, Medi-Cal program patients, and at least 40 percent of the total patient population of the alternative dental hygiene practice is comprised of underserved populations.

SEC. 2.SECTION 1.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 3.SEC. 2.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 4.SEC. 3.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

SEC. 5.SEC. 4.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

SEC. 6.SEC. 5.

The people of the State of California do enact as follows:SECTION 1.Section 1926 of the Business and Professions Code is amended to read:1926.

(a)Residences of the homebound.

(b)Schools.

(c)Residential facilities and other institutions.

SEC. 2.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 3.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 4.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

SEC. 5.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

SEC. 6.

The people of the State of California do enact as follows:SECTION 1.Section 1926 of the Business and Professions Code is amended to read:1926.

(a)Residences of the homebound.

(b)Schools.

(c)Residential facilities and other institutions.

(d)Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. An alternative dental hygiene practice established within a certified shortage area shall continue regardless of certification. An alternative dental hygiene practice established within a certified shortage area shall not be required to close due to the removal of the dental health professional shortage area designation if the registered dental hygienist in alternative practice continues to serve those patients that lack or have limited access to dental care including, but not limited to, Medi-Cal program patients, and at least 40 percent of the total alternative dental hygiene practice serves those underserved populations.

SEC. 2.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

SEC. 3.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 4.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

SEC. 5.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

SEC. 6.

The people of the State of California do enact as follows:SECTION 1.Section 1924 of the Business and Professions Code is amended to read:1924.

A person licensed as a registered dental hygienist who has completed the prescribed classes through the Health Manpower Pilot Project (HMPP) and who has established an independent practice under the HMPP by June 30, 1997, shall be deemed to have satisfied the licensing requirements under Section 1922, and shall be authorized to continue to operate the practice he or she presently operates, so long as he or she follows the functions as specified in Sections 1922, 1925, 1926, 1927, 1928, and 1930, and subdivision (b) of Section 1929, and as long as he or she continues to personally practice and operate the practice or until he or she sells the practice to a licensed dentist.

SEC. 2.SECTION 1.Section 1926 of the Business and Professions Code is amended to read:1926.

(a)Residences of the homebound.

(b)Schools.

(c)Residential facilities and other institutions.

SEC. 3.Section 1931 of the Business and Professions Code is amended to read:1931.

A registered dental hygienist in alternative practice may provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state.

SEC. 4.SEC. 2.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

(d)Licensed person means any natural person who is duly licensed under the provisions of the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act to render the same professional services as are or will be rendered by the professional corporation or foreign professional corporation of which he or she is is, or intends to become, an officer, director, shareholder, or employee.

SEC. 5.SEC. 3.Section 13401.5 of the Corporations Code is amended to read:13401.5.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 6.SEC. 4.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

(c)If a health care service plan contract covering dental services or a specialized health care service plan contract covering dental services provides reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that plan contract shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

SEC. 7.SEC. 5.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

(c)If a health insurance policy covering dental services or a specialized health insurance policy covering dental services provides for reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that policy shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

SEC. 8.SEC. 6.

The people of the State of California do enact as follows:SECTION 1.Section 1924 of the Business and Professions Code is amended to read:1924.

A person licensed as a registered dental hygienist who has completed the prescribed classes through the Health Manpower Pilot Project (HMPP) and who has established an independent practice under the HMPP by June 30, 1997, shall be deemed to have satisfied the licensing requirements under Section 1922, and shall be authorized to continue to operate the practice he or she presently operates, so long as he or she follows the requirements for prescription and functions as specified in Sections 1922, 1925, 1926, 1927, 1928, and 1930, and 1931, and subdivision (b) of Section 1929, and as long as he or she continues to personally practice and operate the practice or until he or she sells the practice to a licensed dentist.

SEC. 2.Section 1926 of the Business and Professions Code is amended to read:1926.

(a)Residences of the homebound.

(b)Schools.

(c)Residential facilities and other institutions.

SEC. 3.Section 1931 of the Business and Professions Code is amended to read:1931.

(a)(1)A registered dental hygienist in alternative practice may provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state.

(2)If the dental hygienist in alternative practice provides services to a patient 18 months or more after the first date that he or she provides services to a patient, he or she shall obtain written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state. The verification shall include a prescription for dental hygiene services as described in subdivision (b).

(b)A registered dental hygienist in alternative practice may provide dental hygiene services for a patient who presents to the registered dental hygienist in alternative practice a written prescription for dental hygiene services issued by a dentist or physician and surgeon licensed to practice in this state. The prescription shall be valid for a time period based on the dentists or physician and surgeons professional judgment, but not to exceed two years from the date it was issued.

(c)(1)The committee may seek to obtain an injunction against any registered dental hygienist in alternative practice who provides services pursuant to this section, if the committee has reasonable cause to believe that the services are being provided to a patient who has not received a prescription for those services from a dentist or physician and surgeon licensed to practice in this state.

(2)Providing services pursuant to this section without obtaining a prescription in accordance with subdivision (b) shall constitute unprofessional conduct on the part of the registered dental hygienist in alternative practice, and reason for the committee to revoke or suspend the license of the registered dental hygienist in alternative practice pursuant to Section 1947.

SEC. 4.Section 13401 of the Corporations Code is amended to read:13401.

As used in this part:

(d)Licensed person means any natural person who is duly licensed under the provisions of the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act to render the same professional services as are or will be rendered by the professional corporation or foreign professional corporation of which he or she is or intends to become, an officer, director, shareholder, or employee.

SEC. 5.Section 13401.5 of the Corporations Code is amended to read:13401.5.

Notwithstanding subdivision (d) of Section 13401 and any other provision of law, the following licensed persons may be shareholders, officers, directors, or professional employees of the professional corporations designated in this section so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation so designated herein, and so long as the number of those licensed persons owning shares in the professional corporation so designated herein does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. This section does not limit employment by a professional corporation designated in this section of to only those licensed professionals listed under each subdivision. Any person duly licensed under Division 2 (commencing with Section 500) of the Business and Professions Code, the Chiropractic Act, or the Osteopathic Act may be employed to render professional services by a professional corporation designated in this section.

(a)Medical corporation.

(1)Licensed doctors of podiatric medicine.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(12)Licensed physical therapists.

(b)Podiatric medical corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed physical therapists.

(c)Psychological corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Registered nurses.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed chiropractors.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(d)Speech-language pathology corporation.

(1)Licensed audiologists.

(e)Audiology corporation.

(1)Licensed speech-language pathologists.

(f)Nursing corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Licensed optometrists.

(5)Licensed marriage and family therapists.

(6)Licensed clinical social workers.

(7)Licensed physician assistants.

(8)Licensed chiropractors.

(9)Licensed acupuncturists.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(g)Marriage and family therapist corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(h)Licensed clinical social worker corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed marriage and family therapists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(8)Licensed professional clinical counselors.

(i)Physician assistants corporation.

(1)Licensed physicians and surgeons.

(2)Registered nurses.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(j)Optometric corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Naturopathic doctors.

(k)Chiropractic corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed acupuncturists.

(9)Naturopathic doctors.

(10)Licensed professional clinical counselors.

(l)Acupuncture corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed psychologists.

(4)Registered nurses.

(5)Licensed optometrists.

(6)Licensed marriage and family therapists.

(7)Licensed clinical social workers.

(8)Licensed physician assistants.

(9)Licensed chiropractors.

(10)Naturopathic doctors.

(11)Licensed professional clinical counselors.

(m)Naturopathic doctor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Registered nurses.

(4)Licensed physician assistants.

(5)Licensed chiropractors.

(6)Licensed acupuncturists.

(7)Licensed physical therapists.

(8)Licensed doctors of podiatric medicine.

(9)Licensed marriage and family therapists.

(10)Licensed clinical social workers.

(11)Licensed optometrists.

(12)Licensed professional clinical counselors.

(n)Dental corporation.

(1)Licensed physicians and surgeons.

(2)Dental assistants.

(3)Registered dental assistants.

(4)Registered dental assistants in extended functions.

(5)Registered dental hygienists.

(6)Registered dental hygienists in extended functions.

(7)Registered dental hygienists in alternative practice.

(o)Professional clinical counselor corporation.

(1)Licensed physicians and surgeons.

(2)Licensed psychologists.

(3)Licensed clinical social workers.

(4)Licensed marriage and family therapists.

(5)Registered nurses.

(6)Licensed chiropractors.

(7)Licensed acupuncturists.

(8)Naturopathic doctors.

(p)Physical therapy corporation.

(1)Licensed physicians and surgeons.

(2)Licensed doctors of podiatric medicine.

(3)Licensed acupuncturists.

(4)Naturopathic doctors.

(5)Licensed occupational therapists.

(6)Licensed speech-language therapists.

(7)Licensed audiologists.

(8)Registered nurses.

(9)Licensed psychologists.

(10)Licensed physician assistants.

(q)Registered dental hygienist in alternative practice corporation.

(1)Dental assistants.

(2)Licensed dentists.

SEC. 6.Section 1374.196 is added to the Health and Safety Code, to read:1374.196.

(c)If a health care service plan contract covering dental services or a specialized health care service plan contract covering dental services provides reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that plan contract shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

SEC. 7.Section 10120.4 is added to the Insurance Code, to read:10120.4.

(b)A registered dental hygienist in alternative practice, licensed pursuant to Section 1922 of the Business and Professions Code, may submit or allow to be submitted on his or her behalf any claim for dental hygiene services performed as authorized pursuant to Article 9 (commencing with Section 1900) of Chapter 4 of Division 2 of the Business and Professions Code to a health insurer covering dental services or a specialized health insurer covering dental services.

(c)If a health insurance policy covering dental services or a specialized health insurance policy covering dental services provides for reimbursement for dental hygiene services that may lawfully be performed by a registered dental hygienist, licensed pursuant to Section 1917 of the Business and Professions Code, reimbursement under that policy shall not be denied when the service is performed by a registered dental hygienist in alternative practice.

SEC. 8.

Date	Status
Sep 8, 2015	Read second time. Ordered to third reading.
Jul 7, 2015	From committee: Do pass and re-refer to Com. on HEALTH with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (July 6). Re-referred to Com. on HEALTH.
Jul 7, 2015	Re-referred to Com. on APPR.
Jul 7, 2015	Withdrawn from committee.
Jul 16, 2015	From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on APPR.
Aug 17, 2015	From committee: Be placed on second reading file pursuant to Senate Rule 28.8 and ordered to consent calendar.
Aug 18, 2015	Read second time. Ordered to Consent Calendar.
Aug 20, 2015	From Consent Calendar.
Aug 20, 2015	Ordered to third reading.
Sep 4, 2015	Read third time and amended. Ordered to second reading.
Jun 29, 2015	From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B., P. & E.D.
Sep 10, 2015	In Assembly. Concurrence in Senate amendments pending.
Sep 10, 2015	Read third time. Passed. Ordered to the Assembly.
Sep 10, 2015	Read third time. Passed. Ordered to the Assembly. (Ayes 40. Noes 0. Page 2713.).
Sep 11, 2015	Senate amendments concurred in. To Engrossing and Enrolling.
Sep 11, 2015	Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 3140.).
Sep 11, 2015	Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0.).
Sep 23, 2015	Enrolled and presented to the Governor at 4 p.m.
Oct 6, 2015	Approved by the Governor.
Oct 6, 2015	Chaptered by Secretary of State - Chapter 516, Statutes of 2015.
May 4, 2015	Re-referred to Com. on APPR.
Feb 24, 2015	From printer. May be heard in committee March 26.
Mar 5, 2015	Referred to Coms. on B. & P. and HEALTH.
Apr 15, 2015	From committee: Amend, and do pass as amended and re-refer to Com. on HEALTH. (Ayes 10. Noes 4.) (April 14).
Apr 16, 2015	Read second time and amended.
Apr 20, 2015	Re-referred to Com. on HEALTH.
Apr 22, 2015	From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
Apr 23, 2015	Re-referred to Com. on HEALTH.
Apr 29, 2015	From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 7.) (April 28).
Apr 30, 2015	Read second time and amended.
Feb 23, 2015	Read first time. To print.
May 13, 2015	From committee: Do pass. (Ayes 13. Noes 3.) (May 13).
May 14, 2015	Read second time. Ordered to third reading.
Jun 2, 2015	Read third time and amended. Ordered to third reading.
Jun 2, 2015	Read third time and amended. Ordered to third reading. (Page 1761.)
Jun 4, 2015	In Senate. Read first time. To Com. on RLS. for assignment.
Jun 4, 2015	Read third time. Passed. Ordered to the Senate.
Jun 4, 2015	Read third time. Passed. Ordered to the Senate. (Ayes 80. Noes 0. Page 1907.)
Jun 18, 2015	Referred to Coms. on B., P. & E.D. and HEALTH.
Jun 19, 2015	In committee: Hearing postponed by committee.

Date	Description	Location	Votes
Sep 11, 2015	AB 502 CHAU Concurrence in Senate Amendments	Assembly Floor	79 0 1 Passed
Sep 10, 2015	Assembly 3rd Reading AB502 Chau By Hill	Senate Floor	40 0 0 Passed
Jul 6, 2015	Do pass, but first be re-referred to the Committee on [Health] with the recommendation: To Consent Calendar	Senate Standing Committee on Business, Professions and Economic Development	9 0 0 Passed
Jun 4, 2015	AB 502 CHAU Assembly Third Reading	Assembly Floor	80 0 0 Passed
May 13, 2015	Do pass.	Assembly Standing Committee on Appropriations	13 3 1 Passed
Apr 28, 2015	Do pass as amended and be re-referred to the Committee on [Appropriations]	Assembly Standing Committee on Health	11 7 1 Passed
Apr 14, 2015	Do pass as amended and be re-referred to the Committee on [Health]	Assembly Standing Committee on Business and Professions	10 4 0 Passed

Key

Pro

Against

Did Not Vote

This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.

Positions by individuals are not included.

* Testimony in a hearing

** Position recorded in bill analysis

*** Position recorded in written testimony

Organization	Position	Date
13 RDHAPs	** Support	Apr 28, 2015
California Dental Association	** Support	Sep 10, 2015
California Dental Hygienists Association	* Support	May 13, 2015
Dental Hygiene Committee of California	** Support	Sep 10, 2015

* Testimony in a hearing

** Position recorded in bill analysis

*** Position recorded in written testimony

Concurrence in Senate Amendments analysis 1 @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 12pt; font-family: "Times New Roman", serif } p.cjk { font-size: 12pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; orphans: 2; background: transparent; page-break-after: avoid } h1.western { font-size: 12pt; font-family: "Times New Roman", serif } h1.cjk { font-family: "Times New Roman", serif; font-size: 12pt } h1.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA }

AB 502

Page 3

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 502

Author:(Chau)

As Amended Ver:September 4, 2015

Majority vote

ASSEMBLY:

80-0

(June 4, 2015)

SENATE:

40-0

(September 10, 2015)

Original Committee Reference: B. & P.

SUMMARY: Authorizes the creation of and establishes rules of governance for a registered dental hygienist in alternative practice (RDHAP) corporation.

The Senate amendments:

Authorize an RDHAP to practice as an employee of a professional corporation under the Moscone-Knox Professional Corporation Act.
State that an RDHAP corporation is a professional corporation that is authorized to render professional services, as specified, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Professional Corporation Act and other applicable laws and regulations.
Declare the violation of, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term laws and regulations relating to the practice of an RDHAP to be unprofessional conduct.
Specify that a licensee employed by, or practicing in, an RDHAP corporation shall practice within the scope of his or her license.
Prohibit a shareholder who is disqualified from providing professional services from deriving benefit from an RDHAP corporation attributable to professional services rendered while a shareholder is a disqualified person.
Require the bylaws of an RDHAP corporation to include a provision whereby the capital stock owned by a disqualified person or a deceased person be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.
Require an RDHAP to provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.
Exempt a professional corporation rendering professional services by persons licensed by the Dental Hygiene Committee of California (DHCC) from any requirement to obtain a certificate of registration in order to render those professional services.
Authorize registered dental hygienists and registered dental hygienists in extended functions to serve as a shareholder, officer, director, or professional employee of an RDHAP corporation.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS:

Purpose. This bill is sponsored by the California Dental Hygienists' Association. According to the author, "[The BPC] authorizes RDHAPs to incorporate. Corporation law would protect the RDHAP's business, however, there is not language in the Corporations Code authorizing RDHAPs to establish corporations, leaving them without critical protections. [This bill] would address these issues and ensure that the public has access to quality dental hygiene services."

Background. In 1986, the Office of Statewide Health Planning and Development (OSHPD) created the RDHAP. In 1993, the professional designation was made permanent in statute. An RDHAP must have been engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including educational settings and public health settings, for a minimum of 2,000 hours during the immediately preceding 36 months, complete 150 additional hours of education courses, and pass a written exam. An RDHAP has a unique distinction in that they can work for a dentist or as an employee of another RDHAP as an independent contractor, as a sole proprietor of an alternative hygiene practice, or other locations such as residences of the homebound, schools, residential facilities, and in underserved dental shortage areas, as determined by OSHPD. They may also operate a mobile dental clinic or operate an independent office or offices.

As a result, RDHAPs may practice in settings outside of the traditional dental office, and allow patients to receive the same type of professional preventive care they would receive in a dental office in schools, skilled and residential care facilities, hospitals, private homes, and in some instances in an RDHAP's own office. A 2009 survey of California RDHAPs found that more than two-thirds of their patients had no other source of oral health care. RDHAPs also struggle to find referrals to dentists for patients in need of more advanced care and charge lower fees than dentists.

The DHCC licenses and regulates approximately 509 RDHAPs.

Professional Corporations. A professional corporation is an organization made up of individuals of the same trade or profession. The Moscone-Knox Professional Corporations Act of 1968 authorized the formation of professional corporations to obtain certain benefits of the corporate form of doing business, such as limited legal liability. At that time, only medical, law and dental professional corporations were envisioned; there are now 15 authorized healing arts professional corporations. Current law specifies which healing arts licensees may be shareholders, officers, directors or professional employees of professional corporations controlled by a differing profession if the sum of all shares owned by those licensed persons does not exceed 49% of the total shares of the professional corporation.

Business and Professions Code Section 1962 authorizes an association, partnership, corporation, or group of three or more registered RDHAPs to practice under an assumed or fictitious name if the association, partnership, corporation, or group holds a permit issued by the DHCC authorizing the holder to use that name connection with the holder's practice, as specified. According to the sponsors, this section was intended to allow RDHAPs to incorporate to gain the protections afforded by corporation law, most importantly, protection against personal liability. However, conforming changes were not made to the Corporations Code. This bill would authorize the creation of an RDHAP professional corporation and provide that a dental assistant, licensed dentist, registered dental hygienist, or registered dental hygienist in extended functions may be a shareholder, officer, director, or professional employee of the RDHAP corporation, and would establish rules of governance for that corporation.

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301 FN: 0002385

SENATE RULES COMMITTEE - SENATE FLOOR ANALYSIS @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 14pt; font-family: "Times New Roman", serif } p.cjk { font-size: 14pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; page-break-inside: avoid; orphans: 2; background: transparent; page-break-after: avoid } h1.western { font-size: 12pt; font-family: "Times New Roman", serif } h1.cjk { font-size: 12pt; font-family: "Times New Roman", serif } h1.ctl { font-weight: bold; font-size: 14pt; font-family: "Times New Roman", serif; so-language: ar-SA } a:link { color: #0000ff; text-decoration: underline } a.western:link { font-weight: bold } a.cjk:link { font-weight: bold }

AB 502

Page 6

SENATE RULES COMMITTEE

Office of Senate Floor Analyses

(916) 651-1520 Fax: (916) 327-4478

AB 502

THIRD READING

Bill No: AB 502

Author: Chau (D)

Amended: 9/4/15 in Senate

Vote: 21

SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 7/6/15

AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 80-0, 6/4/15 - See last page for vote

SUBJECT: Dental hygiene

SOURCE: California Dental Hygienists’ Association

DIGEST: This bill authorizes the creation of and establishes rules of governance for a registered dental hygienist in alternative practice (RDHAP) corporation.

Senate Floor Amendments of 9/4/15 (1) reaffirm that any professional licensee hired by a RDHAP corporation is required to practice within the scope of his or her practice act and is subject to all applicable licensure provisions; and (2) make a technical change.

ANALYSIS:

Existing law:

Establishes the Dental Hygiene Committee of California (DHCC) within the jurisdiction of the Dental Board of California (DBC) to administer laws pertaining to dental hygienists. (Business and Professions Code (BPC) § 1901(a))

Authorizes the DHCC to license a person as a RDHAP who demonstrates satisfactory performance on an examination in California law and meets certain requirements. (BPC § 1922)

Authorizes a RDHAP to perform all functions that may be performed by a registered dental assistant; dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan; oral health education; counseling; health screenings; preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planing; and application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease in the following settings:

Residences of the homebound.

Schools.

Residential facilities and other institutions.

Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. (BPC § 1926)

Authorizes an association, partnership, corporation, or group of three or more RDHAPs to practice if it obtains a permit issued by the DHCC. (BPC § 1962)

Establishes the Moscone-Knox Professional Corporation Act (Moscone-Knox Act) which regulates the formation and operation of professional corporations, and defines a professional corporation as a corporation organized under the general corporation law, as specified, or a corporation that is engaged in rendering professional services in a single profession. (Corporations Code (CORP) §§ 13400 et seq.)

Specifies in the Moscone-Knox Act that certain licensed persons may be shareholders, officers, directors or professional employees of professional corporations controlled by licensed persons of a different profession so long as the sum of all shares owned by those certain licensed persons does not exceed 49% of the total number of shares of the professional corporation, and so long as the number of those certain licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. (CORP § 13401.5)

Specifies that the Moscone-Knox Act does not limit employment by a professional corporation of only those licensed professionals listed. Any healing arts licensee may be employed to render professional services by a professional corporation designated, as specified. (CORP § 13401.5)

This bill:

Authorizes a RDHAP to practice as an employee of a professional corporation under the Moscone-Knox Act.

States that a RDHAP corporation is a professional corporation that is authorized to render professional services, as specified, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Act and other applicable laws and regulations.

Declares the violation of, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term laws and regulations relating to the practice of a RDHAP to be unprofessional conduct.

Prohibits a RDHAP from doing or failing to do anything that would constitute unprofessional conduct, as specified.

Prohibits a shareholder who is disqualified from providing professional services from deriving benefit from a RDHAP corporation attributable to professional services rendered while a shareholder is a disqualified person.

Requires the bylaws of a RDHAP corporation to include a provision whereby the capital stock owned by a disqualified person or a deceased person be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.

Requires a RDHAP to provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.

Exempts a professional corporation rendering professional services by persons licensed by the DHCC from any requirement to obtain a certificate of registration in order to render those professional services.

Authorizes the creation of a RDHAP professional corporation and states that a dental assistant, licensed dentist, registered dental hygienist, or registered dental hygienist in extended functions may be a shareholder, officer, director, or professional employee of the professional corporations so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation, and so long as the number of those licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation.

States that any professional licensee hired by a RDHAP corporation is required to practice within the scope of his or her practice act and is subject to all applicable licensure provisions.

Makes clarifying and technical amendments.

Background

RDHAP. Dental hygienists clean teeth, examine patients for signs of oral diseases such as gingivitis, and provide other preventative dental care. They also educate patients on ways to improve and maintain good oral health.

An RDHAP is dental hygienist who has a baccalaureate degree, completed a DBC-approved continuing education course and passed a state licensure examination to practice independently in underserved settings. These settings are defined as Dental Health Professional Shortage Areas, residences of the homebound, nursing homes, hospitals, residential care facilities, and other public health settings. RDHAPs may independently provide all services that, as a registered dental hygienist, they are licensed to provide under general supervision. RDHAPs must have a “dentist of record” on file with the Dental Hygiene Committee of California to gain licensure. This documented relationship is for referral, consultation, and emergency services.

RDHAPs can provide dental hygiene services to patients for 18 months without involvement of a dentist or physician. If an RDHAP continues to provide services to that patient, he or she is required to obtain written verification that the patient has been examined by a dentist or physician licensed to practice in the state and a prescription for further services. There are currently 508 licensed RDHAPs in California.

Professional corporations. Although existing law appears to authorize RDHAPs to incorporate, DHCC’s Web site explicitly states that they may not because they are not included in the Moscone-Knox Professional Corporations Act of 1968.

A professional corporation is an organization made up of individuals of the same trade or profession. The Moscone-Knox Act authorized the formation of professional corporations to obtain certain benefits of the corporate form of doing business, such as limited legal liability. At that time, only medical, law and dental professional corporations were envisioned. There are now 16 authorized healing arts professional corporations. Existing law specifies which healing arts licensees may be shareholders, officers, directors or professional employees of professional corporations controlled by a differing profession so long as the sum of all shares owned by those licensed persons does not exceed 49% of the total number of shares of the professional corporation.

This bill authorizes the creation of a RDHAP corporation and permits a dental assistant, licensed dentist, registered dental hygienist, or registered dental hygienist in extended functions to be a shareholder, officer, director or professional employee of the professional corporation, as specified.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee, any costs to the California Department of Insurance and the Department of Managed Health Care to assess compliance with this bill’s requirements are expected to be minor and absorbable.

SUPPORT: (Verified 9/4/15)

California Dental Hygienists’ Association (source)

California Dental Association

Dental Hygiene Committee of California

OPPOSITION: (Verified 9/4/15)

None received

ARGUMENTS IN SUPPORT: Supporters believe that RDHAPs have successfully provided dental hygiene care in California for over 15 years and statutes are necessary to be updated to allow for the continuation of that care. Supporters also state that the Corporations Code does not currently recognize the ability authorized in the Business and Professions Code for RDHAPs to legally incorporate, and that this bill will align these two code sections, providing clarity and protection for RDHAPs.

ASSEMBLY FLOOR: 80-0, 6/4/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

Prepared by: Sarah Huchel / B., P. & E.D. / (916) 651-4104

9/8/15 15:27:24

**** END ****

SENATE RULES COMMITTEE - SENATE FLOOR ANALYSIS @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 14pt; font-family: "Times New Roman", serif } p.cjk { font-size: 14pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; page-break-inside: avoid; orphans: 2; background: transparent; page-break-after: avoid } h1.western { font-size: 12pt; font-family: "Times New Roman", serif } h1.cjk { font-size: 12pt; font-family: "Times New Roman", serif } h1.ctl { font-weight: bold; font-size: 14pt; font-family: "ヒラギノ角ゴ Pro W3", "MS Mincho"; so-language: ar-SA } a:link { color: #0000ff; text-decoration: underline } a.western:link { font-weight: bold } a.cjk:link { font-weight: bold }

AB 502

Page 7

SENATE RULES COMMITTEE

Office of Senate Floor Analyses

(916) 651-1520 Fax: (916) 327-4478

AB 502

THIRD READING

Bill No: AB 502

Author: Chau (D)

Amended: 7/16/15 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 7/6/15

AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 80-0, 6/4/15 - See last page for vote

SUBJECT: Dental hygiene

SOURCE: California Dental Hygienists’ Association

DIGEST: This bill authorizes the creation of and establishes rules of governance for a registered dental hygienist in alternative practice (RDHAP) corporation.

ANALYSIS:

Existing law:

Establishes the Dental Hygiene Committee of California (DHCC) within the jurisdiction of the Dental Board of California (DBC) to administer laws pertaining to dental hygienists. (Business and Professions Code (BPC) § 1901(a))

Authorizes the DHCC to license a person as a RDHAP who demonstrates satisfactory performance on an examination in California law and meets either of the following requirements:

Holds a current California license as a registered dental hygienist and meets the following requirements:

Has been engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including, but not limited to, educational settings and public health settings, for a minimum of 2,000 hours during the immediately preceding 36 months.

Has successfully completed a bachelor’s degree or its equivalent, as specified, and a minimum of 150 hours of additional educational requirements.

Has received a letter of acceptance into the employment utilization phase of the Health Manpower Pilot Project No. 155 established by the Office of Statewide Health Planning and Development. (BPC § 1922)

Authorizes a RDHAP to perform all functions that may be performed by a registered dental assistant; dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan; oral health education; counseling; health screenings; preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planing; and application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease in the following settings:

Residences of the homebound.

Schools.

Residential facilities and other institutions.

Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. (BPC § 1926)

Authorizes a RDHAP to operate a mobile dental hygiene clinic. (BPC §§ 1926.1, 1926.2)

Authorizes a RDHAP to bill insurance and hire other RDHAPs and dental assistants. (BPC §§ 1928, 1929)

Authorizes an association, partnership, corporation, or group of three or more RDHAPs to practice if it obtains a permit issued by the DHCC. (BPC § 1962)

Authorizes a RDHAP to provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state. (BPC § 1931 (a)(1))

Establishes the Moscone-Knox Professional Corporation Act (Moscone-Knox Act) which regulates the formation and operation of professional corporations, and defines a professional corporation as a corporation organized under the general corporation law, as specified, or a corporation that is engaged in rendering professional services in a single profession. (Corporations Code (CORP) §§ 13400 et seq.)

Specifies in the Moscone-Knox Act that certain licensed persons may be shareholders, officers, directors or professional employees of professional corporations controlled by licensed persons of a different profession so long as the sum of all shares owned by those certain licensed persons does not exceed 49% of the total number of shares of the professional corporation, and so long as the number of those certain licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. (CORP § 13401.5)

Specifies that the Moscone-Knox Act does not limit employment by a professional corporation of only those licensed professionals listed. Any healing arts licensee may be employed to render professional services by a professional corporation designated, as specified. (CORP § 13401.5)

This bill:

Authorizes a RDHAP to practice as an employee of a professional corporation under the Moscone-Knox Act.

States that a RDHAP corporation is a professional corporation that is authorized to render professional services, as specified, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Act and other applicable laws and regulations.

Declares the violation of, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term laws and regulations relating to the practice of a RDHAP to be unprofessional conduct.

Prohibits a RDHAP from doing or failing to do anything that would constitute unprofessional conduct, as specified.

Prohibits a shareholder who is disqualified from providing professional services from deriving benefit from a RDHAP corporation attributable to professional services rendered while a shareholder is a disqualified person.

Requires the bylaws of a RDHAP corporation to include a provision whereby the capital stock owned by a disqualified person or a deceased person be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.

Requires a RDHAP to provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.

Exempts a professional corporation rendering professional services by persons licensed by the DHCC from any requirement to obtain a certificate of registration in order to render those professional services.

Authorizes the creation of a RDHAP professional corporation and states that a dental assistant, licensed dentist, registered dental hygienist, or registered dental hygienist in extended functions may be a shareholder, officer, director, or professional employee of the professional corporations so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation, and so long as the number of those licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation.

Makes clarifying and technical amendments.

Background

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/17/15)

California Dental Hygienists’ Association (source)

California Dental Association

Dental Hygiene Committee of California

OPPOSITION: (Verified 8/17/15)

None received

ARGUMENTS IN SUPPORT: The source of this bill, the California Dental Hygienists’ Association support passage of this bill because, “The [RDHAPs] have successfully provided dental hygiene care in California for over 15 years. It’s time to update the statute to address roadblocks to care that have become apparent.”

The California Dental Association states, “The Corporations Code does not currently recognize the ability authorized in the Business and Professions Code for RDHAPs to legally incorporate, and AB 502 will align these two code sections, providing clarity and protection for RDHAPs.”

ASSEMBLY FLOOR: 80-0, 6/04/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O’Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

Prepared by: Sarah Huchel / B., P. & E.D. / (916) 651-4104

8/21/15 9:33:46

**** END ****

SENATE RULES COMMITTEE - SENATE FLOOR ANALYSIS @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 14pt; font-family: "Times New Roman", serif } p.cjk { font-size: 14pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; page-break-inside: avoid; orphans: 2; background: transparent; page-break-after: avoid } h1.western { font-size: 12pt; font-family: "Times New Roman", serif } h1.cjk { font-size: 12pt; font-family: "Times New Roman", serif } h1.ctl { font-weight: bold; font-size: 14pt; font-family: "ヒラギノ角ゴ Pro W3", "MS Mincho"; so-language: ar-SA } a:link { color: #0000ff; text-decoration: underline } a.western:link { font-weight: bold } a.cjk:link { font-weight: bold }

AB 502

Page 7

SENATE RULES COMMITTEE

Office of Senate Floor Analyses

(916) 651-1520 Fax: (916) 327-4478

AB 502

CONSENT

Bill No: AB 502

Author: Chau (D)

Amended: 7/16/15 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 7/6/15

AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 80-0, 6/4/15 - See last page for vote

SUBJECT: Dental hygiene

SOURCE: California Dental Hygienists’ Association

DIGEST: This bill authorizes the creation of and establishes rules of governance for a registered dental hygienist in alternative practice (RDHAP) corporation.

ANALYSIS:

Existing law:

Establishes the Dental Hygiene Committee of California (DHCC) within the jurisdiction of the Dental Board of California (DBC) to administer laws pertaining to dental hygienists. (Business and Professions Code (BPC) § 1901(a))

Authorizes the DHCC to license a person as a RDHAP who demonstrates satisfactory performance on an examination in California law and meets either of the following requirements:

Holds a current California license as a registered dental hygienist and meets the following requirements:

Has been engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including, but not limited to, educational settings and public health settings, for a minimum of 2,000 hours during the immediately preceding 36 months.

Has successfully completed a bachelor’s degree or its equivalent, as specified, and a minimum of 150 hours of additional educational requirements.

Has received a letter of acceptance into the employment utilization phase of the Health Manpower Pilot Project No. 155 established by the Office of Statewide Health Planning and Development. (BPC § 1922)

Authorizes a RDHAP to perform all functions that may be performed by a registered dental assistant; dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan; oral health education; counseling; health screenings; preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planing; and application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease in the following settings:

Residences of the homebound.

Schools.

Residential facilities and other institutions.

Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. (BPC § 1926)

Authorizes a RDHAP to operate a mobile dental hygiene clinic. (BPC §§ 1926.1, 1926.2)

Authorizes a RDHAP to bill insurance and hire other RDHAPs and dental assistants. (BPC §§ 1928, 1929)

Authorizes an association, partnership, corporation, or group of three or more RDHAPs to practice if it obtains a permit issued by the DHCC. (BPC § 1962)

Authorizes a RDHAP to provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state. (BPC § 1931 (a)(1))

Establishes the Moscone-Knox Professional Corporation Act (Moscone-Knox Act) which regulates the formation and operation of professional corporations, and defines a professional corporation as a corporation organized under the general corporation law, as specified, or a corporation that is engaged in rendering professional services in a single profession. (Corporations Code (CORP) §§ 13400 et seq.)

Specifies in the Moscone-Knox Act that certain licensed persons may be shareholders, officers, directors or professional employees of professional corporations controlled by licensed persons of a different profession so long as the sum of all shares owned by those certain licensed persons does not exceed 49% of the total number of shares of the professional corporation, and so long as the number of those certain licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. (CORP § 13401.5)

Specifies that the Moscone-Knox Act does not limit employment by a professional corporation of only those licensed professionals listed. Any healing arts licensee may be employed to render professional services by a professional corporation designated, as specified. (CORP § 13401.5)

This bill:

Authorizes a RDHAP to practice as an employee of a professional corporation under the Moscone-Knox Act.

States that a RDHAP corporation is a professional corporation that is authorized to render professional services, as specified, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Act and other applicable laws and regulations.

Declares the violation of, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term laws and regulations relating to the practice of a RDHAP to be unprofessional conduct.

Prohibits a RDHAP from doing or failing to do anything that would constitute unprofessional conduct, as specified.

Prohibits a shareholder who is disqualified from providing professional services from deriving benefit from a RDHAP corporation attributable to professional services rendered while a shareholder is a disqualified person.

Requires the bylaws of a RDHAP corporation to include a provision whereby the capital stock owned by a disqualified person or a deceased person be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.

Requires a RDHAP to provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.

Exempts a professional corporation rendering professional services by persons licensed by the DHCC from any requirement to obtain a certificate of registration in order to render those professional services.

Authorizes the creation of a RDHAP professional corporation and states that a dental assistant, licensed dentist, registered dental hygienist, or registered dental hygienist in extended functions may be a shareholder, officer, director, or professional employee of the professional corporations so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation, and so long as the number of those licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation.

Makes clarifying and technical amendments.

Background

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/17/15)

California Dental Hygienists’ Association (source)

California Dental Association

Dental Hygiene Committee of California

OPPOSITION: (Verified 8/17/15)

None received

ASSEMBLY FLOOR: 80-0, 6/04/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O’Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

Prepared by: Sarah Huchel / B., P. & E.D. / (916) 651-4104

8/19/15 20:39:03

**** END ****

SENATE HEALTH @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 12pt; font-family: "Arial", sans-serif } p.cjk { font-size: 12pt; font-family: "Times New Roman", serif } p.ctl { font-size: 12pt; font-family: "Arial", sans-serif; so-language: ar-SA } h1 { direction: ltr; widows: 2; color: #000000; orphans: 2; text-align: center; border-top: 1.50pt solid #000000; border-bottom: none; border-left: none; border-right: none; padding-top: 0.01in; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; background: transparent } h1.western { font-family: "Arial", sans-serif; font-weight: bold; font-size: 14pt } h1.cjk { font-weight: bold; font-size: 14pt; font-family: "Times New Roman", serif } h1.ctl { font-weight: bold; font-family: "Arial", sans-serif; font-size: 14pt; so-language: ar-SA } h2 { direction: ltr; color: #000000; widows: 2; orphans: 2; background: transparent } h2.western { font-weight: bold; font-size: 12pt; font-family: "Arial", sans-serif } h2.cjk { font-weight: bold; font-size: 12pt; font-family: "Times New Roman", serif } h2.ctl { font-family: "Arial", sans-serif; font-size: 12pt; so-language: ar-SA } a:link { color: #0000ff; text-decoration: underline }

AB 502 (Chau) Page 5 of 5

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2015 - 2016 Regular

Bill No: AB 502 Hearing Date: July 6, 2015

Author:	Chau
Version:	June 29, 2015
Urgency:	No	Fiscal:	Yes
Consultant:	Sarah Huchel

Subject: Dental hygiene.

SUMMARY:

Authorizes the creation of and establishes rules of governance for a registered dental hygienist in alternative practice (RDHAP) corporation.

Existing law:

Establishes the Dental Hygiene Committee of California (DHCC) within the jurisdiction of the Dental Board of California (DBC) to administer laws pertaining to dental hygienists. (Business and Professions Code (BPC) § 1901(a))

Authorizes the DHCC to license a person as a RDHAP who demonstrates satisfactory performance on an examination in California law and meets either of the following requirements:

Holds a current California license as a registered dental hygienist and meets the following requirements:

Has been engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including, but not limited to, educational settings and public health settings, for a minimum of 2,000 hours during the immediately preceding 36 months.

Has successfully completed a bachelor’s degree or its equivalent, as specified, and a minimum of 150 hours of additional educational requirements.

Has received a letter of acceptance into the employment utilization phase of the Health Manpower Pilot Project No. 155 established by the Office of Statewide Health Planning and Development. (BPC § 1922)

Authorizes a RDHAP to perform all functions that may be performed by a registered dental assistant; dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan; oral health education; counseling; health screenings; preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planing; and application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease in the following settings:

Residences of the homebound.

Schools.

Residential facilities and other institutions.

Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. (BPC § 1926)

Authorizes a RDHAP to operate a mobile dental hygiene clinic. (BPC §§ 1926.1, 1926.2)

Authorizes a RDHAP to bill insurance and hire other RDHAPs and dental assistants. (BPC §§ 1928, 1929)

Authorizes an association, partnership, corporation, or group of three or more RDHAPs to practice if it obtains a permit issued by the DHCC. (BPC § 1962)

Authorizes a RDHAP to provide services to a patient without obtaining written verification that the patient has been examined by a dentist or physician and surgeon licensed to practice in this state. (BPC § 1931 (a)(1))

Establishes the Moscone-Knox Professional Corporation Act (Moscone-Knox Act) which regulates the formation and operation of professional corporations, and defines a professional corporation as a corporation organized under the general corporation law, as specified, or a corporation that is engaged in rendering professional services in a single profession. (Corporations Code (CORP) §§ 13400 et seq.)

Specifies in the Moscone-Knox Act that certain licensed persons may be shareholders, officers, directors or professional employees of professional corporations controlled by licensed persons of a different profession so long as the sum of all shares owned by those certain licensed persons does not exceed 49% of the total number of shares of the professional corporation, and so long as the number of those certain licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation. (CORP § 13401.5)

Specifies that the Moscone-Knox Act does not limit employment by a professional corporation of only those licensed professionals listed. Any healing arts licensee may be employed to render professional services by a professional corporation designated, as specified. (CORP § 13401.5)

This bill:

Authorizes a RDHAP to practice as an employee of a professional corporation under the Moscone-Knox Professional Corporation Act.

States that a RDHAP corporation is a professional corporation that is authorized to render professional services, as specified, so long as that professional corporation and its shareholders, officers, directors, and professional employees rendering professional services are in compliance with the Moscone-Knox Professional Corporation Act and other applicable laws and regulations.

Declares the violation of, attempt to violate, directly or indirectly, assist in or abet the violation of, or conspire to violate any provision or term laws and regulations relating to the practice of a RDHAP to be unprofessional conduct.

Prohibits a RDHAP from doing or failing to do anything that would constitute unprofessional conduct, as specified.

Prohibits a shareholder who is disqualified from providing professional services from deriving benefit from a RDHAP corporation attributable to professional services rendered while a shareholder is a disqualified person.

Requires the bylaws of a RDHAP corporation to include a provision whereby the capital stock owned by a disqualified person or a deceased person be sold to the professional corporation or to the remaining shareholders of the professional corporation not later than 90 days after disqualification, if the shareholder becomes a disqualified person, or not later than six months after death, if the shareholder becomes deceased.

Requires a RDHAP to provide adequate security by insurance or otherwise for claims against it by its patients arising out of the rendering of professional services.

Exempts a professional corporation rendering professional services by persons licensed by the DHCC from any requirement to obtain a certificate of registration in order to render those professional services.

Authorizes the creation of a RDHAP professional corporation and states that a dental assistant or licensed dentist may be a shareholder, officer, director, or professional employee of the professional corporations so long as the sum of all shares owned by those licensed persons does not exceed 49 percent of the total number of shares of the professional corporation, and so long as the number of those licensed persons owning shares in the professional corporation does not exceed the number of persons licensed by the governmental agency regulating the designated professional corporation.

Makes clarifying and technical amendments.

FISCAL EFFECT:

This bill has been keyed “fiscal” by the Legislative Counsel. According to an analysis by the Assembly Appropriations Committee dated May 13, 2014, any costs to the California Department of Insurance and the Department of Managed Health Care to assess compliance with this bill's requirements are expected to be minor and absorbable.

COMMENTS:

Purpose. This bill is sponsored by the California Dental Hygienists’ Association. According to the Author’s office, “Even though BPC 1962 authorizes RDHAPs to incorporate, the DHCC does not have enough regulatory and oversight authority to ensure that consumers are protected from RDHAP corporations. Currently other boards, such as the Physical Therapy Board of California and the Dental Board of California have statutory authority to regulate and impose oversight of Physical Therapy Corporations or Dental Corporations. AB 502 would provide the DHCC with the same type of regulatory and oversight authority as other California Boards.”

RDHAP. Dental hygienists clean teeth, examine patients for signs of oral diseases such as gingivitis, and provide other preventative dental care. They also educate patients on ways to improve and maintain good oral health.

An RDHAP is dental hygienist who has a baccalaureate degree, completed a DBC-approved continuing education course and passed a state licensure examination to practice independently in underserved settings. These settings are defined as Dental Health Professional Shortage Areas, residences of the homebound, nursing homes, hospitals, residential care facilities, and other public health settings. RDHAPs may independently provide all services that, as an RDH, they are licensed to provide under general supervision. RDHAPs must have a “dentist of record” on file with the Dental Hygiene Committee of California to gain licensure. This documented relationship is for referral, consultation, and emergency services.

Professional Corporations. Although existing law appears to authorize RDHAPs to incorporate, DHCC’s website explicitly states that they may not because they are not included in the Moscone-Knox Professional Corporations Act of 1968.

A professional corporation is an organization made up of individuals of the same trade or profession. The Moscone-Knox Professional Corporations Act authorized the formation of professional corporations to obtain certain benefits of the corporate form of doing business, such as limited legal liability. At that time, only medical, law and dental professional corporations were envisioned. There are now 16 authorized healing arts professional corporations. Current law specifies which healing arts licensees may be shareholders, officers, directors or professional employees of professional corporations controlled by a differing profession so long as the sum of all shares owned by those licensed persons does not exceed 49% of the total number of shares of the professional corporation.

This bill would authorize the creation of a RDHAP corporation and would permit dental assistants and licensed dentists to be shareholders, officers, directors or professional employees of the professional corporation, as specified.

Prior Related Legislation. AB 1174 (Bocanegra, Chapter 662, Statutes of 2014) authorized RDHAPs to determine which radiographs to perform and to place protective restorations.

AB 123, (Cohn, Chapter 549, Statutes of 2003) provided that physicians and surgeons, dental assistants, registered dental assistants, registered dental assistants in extended functions, registered dental hygienists, registered dental hygienists in extended functions, or RDHAPs may be shareholders, officers, directors, or professional employees of dental corporations.

SB 853 (Perata, Chapter 31, Statutes of 2008) created the DHCC as the separate body within the DBC to oversee the practice of dental hygiene.

Arguments in Support. The sponsors of this bill, the California Dental Hygienists’ Association support passage of this bill because, “The [RDHAPs] have successfully provided dental hygiene care in California for over 15 years. It’s time to update the statute to address roadblocks to care that have become apparent.”

Policy Consideration. The bill currently states that a RDHAP corporation must provide “adequate security” for claims. It is recommended that DHCC use its existing authority to promulgate regulations further defining this term in order to protect the public against financial harm.

SUPPORT AND OPPOSITION:

Support:

California Dental Hygienists’ Association (Sponsor)

California Dental Association

Dental Hygiene Committee of California

Opposition:

None on file as of June 30, 2015.

-- END --

Assembly Third Reading analysis @page { size: 8.5in 11in; margin-left: 1in; margin-right: 0.75in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 12pt; font-family: "Times New Roman", serif } p.cjk { font-size: 12pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; orphans: 2; background: transparent; page-break-after: avoid } h1.western { font-size: 12pt; font-family: "Times New Roman", serif } h1.cjk { font-family: "Times New Roman", serif; font-size: 12pt } h1.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA }

AB 502

Page 3

ASSEMBLY THIRD READING

ATR Bill Id:AB 502

Author:(Chau)

As Amended Ver:June 2, 2015

Majority vote

Committee	Votes	Ayes	Noes
Business & Professions	10-4	Bonilla, Jones, Bloom, Campos, Dodd, Eggman, Holden, Mullin, Ting, Wood	Baker, Chang, Gatto, Wilk
Health	11-7	Bonta, Bonilla, Burke, Chiu, Gomez, Nazarian, Ridley-Thomas, Rodriguez, Santiago, Thurmond, Wood	Maienschein, Chávez, Gonzalez, Lackey, Patterson, Steinorth, Waldron
Appropriations	13-3	Gomez, Bloom, Bonta, Calderon, Daly, Eggman, Eduardo Garcia, Holden, Jones, Quirk, Rendon, Wagner, Weber	Bigelow, Chang, Gallagher

SUMMARY: Requires insurance companies to reimburse registered dental hygienists in alternative practice (RDHAPs) for dental hygiene care legally provided and covered by insurance, and clarifies that RDHAPs are authorized to establish corporations. Specifically, this bill:

Exempts professional corporations, rendering professional services by persons duly licensed by the Dental Hygiene Committee of California (DHCC), from the requirement to obtain a certificate of registration in order to render those professional services, and specifies that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.
Requires health care service plan contracts covering dental services, specialized health care service plan contracts covering dental services, health insurance policies covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse RDHAPs for performing dental hygiene services that may lawfully be performed by registered dental hygienists (RDH) and that are reimbursable under the contracts or policies, and would require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and RDHAP.
Makes other clarifying and conforming changes.

FISCAL EFFECT: According to the Assembly Appropriations Committee, any costs to the California Department of Insurance and the Department of Managed Health Care to assess compliance with this bill's requirements are expected to be minor and absorbable.

COMMENTS:

Purpose. This bill is sponsored by the California Dental Hygienists' Association. According to the author, "A number of situations reduce access to RDHAPs... [M]any dental insurance companies recognize dentists in a dental practice as the billable provider of dental hygiene services and even though RDHAPs provide the same billable services that an RDH provide, billed by the dentist, the insurance companies are denying RDHAP's reimbursement for services. This forces patients who cannot easily access care in a traditional dental office to pay out of pocket for the services of a RDHAP or not receive the care due to finances… [The BPC] authorizes RDHAPs to incorporate. Corporation law would protect the RDHAP's business, however, there is not language in the Corporations Code authorizing RDHAPs to establish corporations, leaving them without critical protections. [This bill] would address these issues and ensure that the public has access to quality dental hygiene services."

The DHCC licenses and regulates approximately 509 RDHAPs.

Reimbursement for Services. Currently, many dental insurance companies recognize dentists in a dental practice as the billable provider of dental hygiene services and even though RDHAPs provide the same billable services that an RDH provide, billed by the dentist, the insurance companies are denying RDHAP's reimbursement for services. In its 2014 Sunset Review Report, the DHCC identified as a barrier to RDHAP practice the inability for RDHAPs to collect payment for services rendered. The DHCC noted that RDHAPs have difficulty collecting payment for services from insurance companies based outside of California. This is because not all states have the RDHAP provider status making them ineligible for reimbursement. As a result, some patients who cannot easily access care in a traditional dental office are forced to pay out of pocket for the services of a RDHAP or not receive care due to financial constraints.

Business and Professions Code Section 1962 authorizes an association, partnership, corporation, or group of three or more registered RDHAPs to practice under an assumed or fictitious name if the association, partnership, corporation, or group holds a permit issued by the DHCC authorizing the holder to use that name connection with the holder's practice, as specified. According to the sponsors, this section was intended to allow RDHAPs to incorporate to gain the protections afforded by corporation law, most importantly, protection against personal liability. However, conforming changes were not made to the Corporations Code. This bill would specify that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and specify that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301 FN: 0000884

AB 502

Page 4

ASSEMBLY THIRD READING

ATR Bill Id:AB 502

Author:(Chau)

As Amended Ver:April 30, 2015

Majority vote

Committee	Votes	Ayes	Noes
Business & Professions	10-4	Bonilla, Jones, Bloom, Campos, Dodd, Eggman, Holden, Mullin, Ting, Wood	Baker, Chang, Gatto, Wilk
Health	11-7	Bonta, Bonilla, Burke, Chiu, Gomez, Nazarian, Ridley-Thomas, Rodriguez, Santiago, Thurmond, Wood	Maienschein, Chávez, Gonzalez, Lackey, Patterson, Steinorth, Waldron
Appropriations	13-3	Gomez, Bloom, Bonta, Calderon, Daly, Eggman, Eduardo Garcia, Holden, Jones, Quirk, Rendon, Wagner, Weber	Bigelow, Chang, Gallagher

SUMMARY: Authorizes registered dental hygienists in alternative practice (RDHAPs), who established practices within certified dental shortage areas, to continue their practice when the shortage area designation is removed; requires insurance companies to reimburse RDHAPs for dental hygiene care legally provided and covered by insurance; and clarifies that RDHAPs are authorized to establish corporations. Specifically, this bill:

Authorizes an alternative dental hygiene practice established within a certified shortage area to continue to operate if the certification is removed if the RDHAP continues to serve those patients that lack or have limited access to dental care, and at least 40% of the total patient population is comprised of underserved populations.
Exempts professional corporations, rendering professional services by persons duly licensed by the Dental Hygiene Committee of California (DHCC), from the requirement to obtain a certificate of registration in order to render those professional services, and specifies that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.
Requires health care service plan contracts covering dental services, specialized health care service plan contracts covering dental services, health insurance policies covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse RDHAPs for performing dental hygiene services that may lawfully be performed by registered dental hygienists (RDH) and that are reimbursable under the contracts or policies, and would require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and RDHAP.
Makes other clarifying and conforming changes.

COMMENTS:

Purpose. This bill is sponsored by the California Dental Hygienists' Association. According to the author, "A number of situations reduce access to RDHAPs. First, California law allows [RDHs]to open practice in geographic areas where people have no access to regular preventive oral care due to an absence or shortage of dentists. However, under current law, RDHAPs who practice in dental health shortage areas can no longer practice in those areas once they are no longer designated a dental shortage area. Second, many dental insurance companies recognize dentists in a dental practice as the billable provider of dental hygiene services and even though RDHAPs provide the same billable services that an RDH provide, billed by the dentist, the insurance companies are denying RDHAP’s reimbursement for services. This forces patients who cannot easily access care in a traditional dental office to pay out of pocket for the services of a RDHAP or not receive the care due to finances. Additionally, any patient who goes directly to an RDHAP for preventative services must obtain a dentist's or doctor's prescription to continue those services once they pass 18 months of service with the RDHAP. This is problematic in areas where dentists are in short supply creating a barrier for patients to obtain much needed services. Finally, the [BPC] authorizes RDHAPs to incorporate. Corporation law would protect the RDHAP’s business, however, there is not language in the Corporations Code authorizing RDHAPs to establish corporations, leaving them without critical protections. [This bill] would address these issues and ensure that the public has access to quality dental hygiene services."

The DHCC licenses and regulates approximately 509 RDHAPs.

Prescription Requirements. Business and Professions Code Section 1931 allows a RDHAP to provide dental hygiene services to a patient without referral by a dentist for up to 18 months. However, after 18 months a patient needs to have a prescription from a dentist or a physician and surgeon in order to continue dental hygiene services with the RDHAP. The prescription is valid for up to two years. According to the author, this is problematic in areas where dentists are in short supply creating a barrier for patients to obtain much needed basic preventive care services.

According to the author, RDHAPs have proven to be safe providers who refer patients to dentists when major dental issues arise outside of their scope of practice to treat. There is no precedent for requiring a practice agreement for licensure, nor for services delivered within a professional's own scope of practice. This is unique in that most restrictions requiring a prescription of one provider to another are for specialty care, not for primary preventive health care services. In practice, this is simply an administrative hurdle, time consuming for providers, and has not been shown to contribute to positive patient outcomes. The author indicates that patients should have their choice of dental hygiene care provider, and the public should not need a prescription to receive basic preventive care. According to the sponsors, an RDHAP is the only oral health care provider a patient has access to, and if a prescription is not obtained, the patient cannot even continue to receive preventative dental hygiene care, even though the need for and benefits of that care still exist.

Dental Health Professional Shortage Areas (DHPSAs). According to OSHPD, DHPSAs are based on the evaluation of criteria established through federal regulation to identify geographic areas or population groups with a shortage of dental providers. The federal DHPSA designation identifies areas as having a shortage of dental providers on the basis of availability of dentists and other dental auxiliaries. To qualify for designation as a DHPSA, an area must be: 1) a rational service area; have a population to general practice dentist ratio of 5,000:1 or 4,000:1 plus population features demonstrating "unusually high need"; and 2) a lack of access to dental care in surrounding areas because of excessive distance, overutilization, or access barriers. According to OSHPD, there are 53 DHPSAs. Approximately 5% of Californians live in a DHPSA.

The DHCC noted in their 2014 Sunset Review Report that problems have arisen when the shortage area in which an RDHAP sets up a practice is redesignated as a non-shortage area. Existing law requires the RDHAP to close down the practice when this occurs. The DHCC views this as "counterproductive...as the closure of the practice would leave patients with no access to dental hygiene services." According to the sponsors, when a DHPSA in San Luis Obispo was faced with losing its designation status, RDHAPs in that area fought to keep the designation area so that patients could continue to be served. This bill seeks to prevent patients from losing access to established dental care should an area lose its DHPSA.

Business and Professions Code Section 1962 authorizes an association, partnership, corporation, or group of three or more registered RDHAPs to practice under an assumed or fictitious name if the association, partnership, corporation, or group holds a permit issued by the DHCC authorizing the holder to use that name connection with the holder's practice, as specified. According to the sponsors, this section was intended to allow RDHAPs to incorporate to gain the protections afforded by corporation law, most importantly, protection against personal liability. However, conforming changes were not made to the Corporations Code. This bill would specify that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and specify that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.

Policy Issues:

DHPSAs. The sponsors assert that it is necessary to allow RDHAPs who have established practices in DHPSAs to be able to continue that practice, even if that designation is later removed. However, while there is anecdotal evidence that this is a concern, it does not appear that any DHPSA has in fact been un-designated as a shortage area.

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301 FN: 0000413

Assembly Bill Fiscal Committee Analysis @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 12pt; font-family: "Times New Roman", serif } p.cjk { font-size: 12pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; orphans: 2; text-align: center; background: transparent; page-break-after: avoid } h1.western { font-family: "Times New Roman", serif; font-size: 12pt } h1.cjk { font-family: "Times New Roman", serif; font-size: 12pt } h1.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA }

AB 502

Page 2

Date of Hearing: May 13, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 502

Author:(Chau) – As Amended Ver:April 30, 2015

Policy Committee:	Business and Professions	Vote:	10 - 4
	Health		11 - 7

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill makes several adjustments to statutes governing dental hygienists. Specifically, this bill:

Allows an alternative dental hygiene practice established within a certified dental health professional shortage area (DHPSA) to continue to operate upon removal of the DHPSA certification.
Prohibits health care service plans and health insurance policies that cover dental services issued, amended, or renewed after January 1, 2016, from denying reimbursement to a contracted provider, or to an enrollee if out-of-network services are covered, when the service is performed by a registered dental hygienist in alternative practice (RDHAP). Requires the same fee schedule be used for dental hygiene services, whether services are performed by a registered dental hygienist (RDH) or an RDHAP.
Clarifies RDHAPs are authorized to establish professional corporations.

FISCAL EFFECT:

Any costs to the California Department of Insurance and the Department of Managed Health Care to assess compliance with this bill's requirements are expected to be minor and absorbable.

COMMENTS:

Purpose. The author states this bill will remove barriers in existing law for RDHAPs to practice and increase public access to quality dental hygiene services. These barriers include: (1) Currently, RDHAPs cannot practice in an DHPSAs once they lose certification; (2) RDHAPs are not currently provided with proper financial incentives to provide services, as health plans and insurers are denying reimbursement for RDHAP services; and (3) there are no current business protections for RDHAPs in statute, though existing law authorizes them to incorporate.
Background. RDHAPs are RDHs in the state of California with bachelor’s degrees (or equivalent certifications), who have completed a continuing education course in independent practice dental hygiene and passed a licensing examination administered by the Dental Hygiene Committee of California (DHCC). Once licensed, DHCC requires RDHAPs to designate a “dentist of record” for referrals, consultations, or emergencies, after which RDHAPs are able to provide dental hygiene services without the supervision of a dentist to underserved populations in "alternative practice" settings, which are schools, residential and other institutions, residences of the homebound, and dental health professional shortage areas. According to DHCC, there are currently 563 RDHAPs licensed to practice in specified alternative settings.
Opposition. The California Dental Association is opposed to this bill, citing concerns about oversight of RDHAPs who continue to practice after DHPSA certification is revoked, and lack of evidence or data to support this proposal.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Assembly Bill Policy Committee Analysis @page { size: 8.5in 11in; margin-left: 1in; margin-right: 1in; margin-top: 0.5in; margin-bottom: 0.5in } p { color: #000000; widows: 2; margin-bottom: 0.1in; orphans: 2; line-height: 115%; direction: ltr; background: transparent } p.western { font-size: 12pt; font-family: "Times New Roman", serif } p.cjk { font-size: 12pt; font-family: "Times New Roman", serif } p.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA } h1 { direction: ltr; color: #000000; widows: 2; orphans: 2; text-align: center; background: transparent; page-break-after: avoid } h1.western { font-family: "Times New Roman", serif; font-size: 12pt } h1.cjk { font-family: "Times New Roman", serif; font-size: 12pt } h1.ctl { font-size: 10pt; font-family: "Times New Roman", serif; so-language: ar-SA }

AB 502

Page 6

Date of Hearing: April 28, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 502

Author:Chau – As Amended Ver:April 22, 2015

SUBJECT: Dental hygiene.

SUMMARY: Allows alternative dental hygiene practices to continue to operate and provide care within a certified shortage area, as specified, regardless of whether or not that area maintains a designation as a dental health professional shortage area (DHPSA) in the future. Allows registered dental hygienists in alternative practice (RDHAPs) to submit claims for dental hygiene services and requires health plans and insurers to provide reimbursement, as specified. Specifically, this bill:

Prohibits an alternative dental hygiene practice from being forced to close owing to a loss of its surrounding location’s designation as a DHPSA under the following circumstances:
1. The RDHAPs continue to serve patients that have no or limited access to dental care, including Medi-Cal program patients; and,
2. At least 40% of the total alternative dental hygiene practice serves those underserved populations.
Allows licensed dentists and dental assistants to be part of professional corporations of RDHAPs.
Requires health plans and policies that cover dental services, including specialized health plans and policies, to do the following:
1. Allow RDHAPs to submit any claim for dental hygiene services;
2. Reimburse an RDHAP for dental hygiene services that can be performed by a registered dental hygienist (RDH) if the plan or policy provides reimbursement for dental hygiene services; and,
3. Use the same payment rates for RDHAPs as are provided to RDHs.

EXISTING LAW:

Allows the licensure and regulation of registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice by the Dental Hygiene Committee of California (DHCC).
Allows an RDHAP to perform various duties in specified settings, including DHPSAs, as certified by the Office of Statewide Health Planning and Development.
Establishes the Knox-Keene Health Care Service Plan Act of 1975 under the administration and enforcement of the Department of Managed Health Care, and requires a health care service plan to reimburse claims, as specified.
Provides for the regulation of health insurers by the California Department of Insurance.
Establishes specified standards for health care service plan contracts covering dental services, health insurance policies covering dental services, specialized health care service plan contracts covering dental services, and specialized health insurance policies covering dental services.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

PURPOSE OF THIS BILL. The author states RDHAPs provide necessary professional preventive dental care to patients who typically have limited or no access to these services. The author states existing law limits access to RDHAPs by preventing those who practice in DHPSAs from continuing practice in those areas once they lose certification. In addition, the author contends RDHAPs are not currently provided with proper financial incentives to provide services, as health plans and insurers are denying reimbursement for RDHAP services, despite the services being equivalent to those billable services provided by an RDH. Finally, the author asserts there are no current business protections for RDHAPs in statute, though existing law authorizes them to incorporate. The author states this bill will remove barriers in existing law for RDHAPs to practice and increase public access to quality dental hygiene services.
BACKGROUND.
1. California Health Benefits Review Program (CHBRP) Analysis. At the request of the Legislature, CHBRP, within the University of California, provides independent analyses of medical, financial, and public health impacts of proposed legislation regarding health insurance benefit mandates and repeals. The following background is based on the CHBRP review for this bill.
  1. RDHAPs. RDHAPs are a subset of RDHs who are authorized to practice in specified underserved areas, including residences of homebound individuals, schools, residential facilities, and DHPSAs. Although RDHAPs and RDHs share the same scope of practice, RDHs may not practice dental hygiene in the absence of an on-site dentist whereas RDHAPs, through additional schooling and a licensing process, may provide dental hygiene services without the supervision of a dentist. Once licensed, RDHAPs are able to administer dental hygiene services in designated alternative practice settings without the supervision of a dentist, provided that they identify a dentist for referrals, consultations, or emergencies.

CHBRP estimates that RDHAPs annually provide dental hygiene services to approximately 598,400 patients. In a 2009 survey, RDHAPs estimated that, on average, about a tenth of their patients were privately insured, a third were uninsured, and over half were covered through public assistance programs, such as Medi-Cal.

Current barriers to practice. According to DHCC, there are currently 563 licensed RDHAPs (524 of which are practicing) throughout California, as compared with approximately 31,000 licensed RDHs. Due to their small numbers, unique designation, and barriers to participation in some networks, RDHAPs often experience difficulty gaining recognition as providers from payers and receiving compensation for their services. In a 2009 descriptive survey of the RDHAP workforce, 82% of practicing RDHAPs reported maintaining employment in a traditional dental office setting for an average of three days per week in order to support two days of alternative practice, citing significant administrative barriers to receiving consistent reimbursement for services delivered under their RDHAP licensure. Accordingly, in 2009, RDHAPs identified administrative hassle as a significant impediment (4.0 on a 5-point scale) to providing direct patient care and reported spending approximately one-third of RDHAP practice time on administrative activities.
Policies in other states. There are currently 37 states, including California, that are direct-access states for dental hygienists, meaning that a dental hygienist can initiate treatment based on his or her assessment of patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and can maintain a provider-patient relationship. These services are generally provided in settings such as Head Start centers, schools, federally qualified health centers (FQHCs), and long-term care facilities. In 16 states, there is statutory or regulatory language allowing the state Medicaid program to directly reimburse dental hygienists for services rendered.

Federal criteria for DHPSAs. A geographic area will be designated as having a dental professional shortage if the following three criteria are met:
1. The area is a rational area for the delivery of dental services;
2. One of the following conditions prevails in the area:
  1. The area has a population to full-time-equivalent dentist ratio of at least 5,000:1; or,
  2. The area has a population to full-time-equivalent dentist ratio of less than 5,000:1 but greater than 4,000:1 and has unusually high needs for dental services or insufficient capacity of existing dental providers.
3. Dental professionals in contiguous areas are overutilized, excessively distant, or inaccessible to the population of the area under consideration.

Populations with unusually high needs for dental services are defined as those where more than 20% of the population has incomes below the poverty level, or areas where the majority of the population does not have a fluoridated water supply.

Legislative oversight hearing. On March 17, 2014, the Senate Committee on Business, Professions, and Economic Development and the Assembly Committee on Business, Professions, and Consumer Protections held a joint oversight hearing to discuss a Sunset Review Report on the DHCC. The report discussed at the hearing identified barriers to RDHAP practice, including the closure of a dental practice when the area no longer meets criteria as a DHPSA, and the ability for DHAPs to collect payment for services rendered. The staff recommendation examined at the joint hearing included amending existing law to reduce these two specific barriers.
Denti-Cal State Audit. On December 11, 2014, the California State Auditor issued a report titled “California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care.” The report stated that insufficient number of dental providers willing to participate in Medi-Cal, low reimbursement rates and a failure to adequately monitor the program, led to limited access to care and low utilization rates for Medi-Cal beneficiaries across the state. The Audit found that 16 counties either have no active providers or do not have providers willing to accept new Medi-Cal patients, and 16 other counties have an insufficient number of providers.

Recent changes in federal and state laws that have expanded Medi-Cal coverage could increase the number of children and adults who can receive additional covered dental services from 2.7 million to as many as 6.4 million, bringing into question the state's ability to provide timely and adequate care to beneficiaries.

Impact of this bill. The CHBRP analysis anticipates multiple impacts on the dental coverage of patients, and utilization rates for RDHAPs.

There are currently no RDHAPs that participate as contracted network providers in DHMOs (dental health maintenance organizations) or DPPOs (dental preferred provider organizations) in the state. It is not anticipated that RDHAPs will become participating providers in either type of dental insurance plan under this bill due to their scope of practice and network participation requirements.

Additionally, RDHAPs are already allowed to submit claims as out-of-network providers to DPPO plans, however the rate of reimbursement and likelihood of having the claim paid varies by plan, service, and the certification requirements of each plan. This bill is likely to increase the likelihood of claims being paid and RDHAPs being recognized by DPPOs as out-of-network providers only.

Finally, reduced paperwork, changes to professional corporation requirements and staffing, certification requirements, and barriers to providing and being reimbursed for care will not change the out-of-network nature of RDHAP care or the limitations on where they can practice. However, it could increase the number and/or amount of time spent by RDHAPs practicing independently in DHPSAs and alternative practice settings.

SUPPORT. The California Dental Hygienists’ Association, the sponsor of the bill, and supporters state this bill improves access to dental hygiene care for vulnerable populations that cannot easily access traditional dental offices by strengthening the RDHAP practice in current law. Supporters state RDHAPs are recognized dental providers that provide the healthcare system with innovative services essential to expanding dental services to patients throughout California. Supporters argue this bill removes current barriers to RDHAP practice and improves the ability of RDHAPs to take dental hygiene care to patients.
OPPOSITION. The California Dental Association states in opposition, on a prior version of the bill, the primary reason for the development of the RDHAP license is to bring dental hygiene services to dentally underserved populations and into underserved communities. According to the opposition, it is not aware of any existing problems with DHPSAs that have lost, or are in danger of losing, their designations and potentially reducing access to care, and that it is unclear what effect a DHPSA reclassification would have on the surrounding community. The opposition concludes that should guidelines should be placed into statute for RDHAPs who work in reclassified DHPSAs to ensure the practice retains the intent of the law to increase dental services to underserved populations.
PREVIOUS LEGISLATION.
1. AB 1174 (Bocanegra), Chapter 662, Statutes of 2014, authorizes certain allied dental professionals, including RDHs and RDHAPs, to perform additional activities using telehealth.
2. AB 1334 (Salinas), Chapter 850, Statutes of 2006, RDHAPs to provide services to patients without a prescription from a dentist or a physician and surgeon for the first 18 months after the first date of service.
POLICY COMMENT. At the time of this analysis, there do not appear to be records of existing DHPSAs within California losing their designation. The Committee may wish to consider the need for immediate action on these specific provisions of this bill, since the future needs and services provided for dental care of vulnerable populations may have changed by the time any DHPSAs lose their designation.
TECHNICAL AMENDMENT. This bill allows RDHAPs to continue to provide services in DHPSAs which have lost their classification, on the condition that they continue to provide services to patients who have limited or no access to dental care, and at least 40% of the practice serves those underserved populations. The current language is unclear as to whether the 40% requirement applies to the percentage of practicing providers who must serve an underserved population, or the percentage of clientele which must be underserved. The author has indicated the intent was to require the latter option in the bill; therefore the Committee may suggest the clarifying, technical amendment:

In Section 1926 of the Business and Professions Code:

(d) Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines. An alternative dental hygiene practice established within a certified shortage area shall not be required to close due to the removal of the dental health professional shortage area designation if the registered dental hygienist in alternative practice continues to serve those patients that lack or have limited access to dental care including, but not limited to, Medi-Cal program patients, and at least 40 percent of the total patient population of the alternative dental hygiene practice ~~serves those~~ is comprised of those underserved populations.

REGISTERED SUPPORT / OPPOSITION:

Support

California Dental Hygienists’ Association (sponsor)
Several individuals (prior version)

Opposition

California Dental Association (prior version)

Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097

AB 502

Page 8

Date of Hearing: April 14, 2015

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Susan Bonilla, Chair

ABPCA Bill Id:AB 502

Author:(Chau) – As Introduced Ver:February 23, 2015

NOTE: Double Referral This bill is double referred, and if passed by this Committee, it will be referred to the Assembly Health Committee.

SUBJECT: Dental hygiene.

SUMMARY: Authorizes registered dental hygienists in alternative practice (RDHAPs), who established practices within certified dental shortage areas, to continue their practice when the shortage area designation is removed; requires insurance companies to reimburse RDHAPs for dental hygiene care legally provided and covered by insurance; deletes the requirement for patients to obtain a prescription for dental hygiene care provided by an RDHAP, and clarifies that RDHAPs are authorized to establish corporations.

EXISTING LAW

Licenses and regulates registered dental hygienists in extended functions (RDHEF) by the Dental Hygiene Committee of California (DHCC) under the Dental Board of California (DBC) within the Department of Consumer Affairs (DCA). (Business and Professions Code (BPC) Section 1900 et seq.)
Authorizes an RDHAP to perform all duties that may be performed by a registered dental assistant and all of the functions of a registered dental hygienist (RDH) including dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan, including oral health education, counseling, and health screenings; preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planning; and application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease in the following settings: (BPC Section 1926)
1. Residences of the homebound;
2. Schools;
3. Residential facilities and other institutions; and
4. Dental health professional shortage areas (DHPSAs), as certified by the Office of Statewide Health Planning and Development (OSHPD) in accordance with existing office guidelines.
Further authorizes an RDHAP to determine which radiographs to perform on a patient who has not received an initial examination by the supervising dentist for the specific purpose of the dentist making a diagnosis and treatment plan for the patient, and to place protective restorations, under general supervision by a dentist, to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment in the following settings: (BPC Section 1926.05)
Requires an RDHAP to meet the following requirements in order to obtain licensure: (BPC Section 1922)
1. Holds a current California license as a registered dental hygienist and is engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including, but not limited to, educational settings and public health settings, for a minimum of 2,000 hours and during the immediately preceding 36 months has;
2. Successfully completed a bachelor’s degree or its equivalent from a college or institution of higher education that is accredited by a national or regional accrediting agency recognized by the United States Department of Education, and a minimum of 150 hours of additional educational requirements, as prescribed by the DHCC by regulation, that are consistent with good dental and dental hygiene practice, as specified;
3. Received a letter of acceptance into the employment utilization phase of the Health Manpower Pilot Project No. 155 established by the (OSHPD); and
4. Passed an examination in California law and ethics.
Requires an RDHAP to provide to the DHCC documentation of an existing relationship with at least one dentist for referral, consultation, and emergency services. (BPC Section 1930)
Requires an RDHAP who provides services for 18 months or longer to obtain written verification that the patient has been examined by a dentist or physician and surgeon, and requires that verification, to be valid for up to two years, to include a prescription for dental hygiene services. (BPC Section 1931(a),(b))
Authorizes the DHCC to seek to obtain an injunction against any RDHAP if the DHCC has reasonable cause to believe that the services are being provided without a prescription, and specifies that providing services without a written prescription on the part of a RDHAP shall constitute unprofessional practice and reason for the DHCC to revoke or suspend the license of the RDHAP. (BPC Section 1931(c))
Authorizes an association, partnership, corporation, or group of three or more registered RDHAPs engaging in practice under a name, that would be in violation of a prohibition against practicing under an assumed or fictitious name, to practice under that name if the association, partnership, corporation, or group holds an unexpired, unsuspended, and unrevoked permit issued by the DHCC authorizing the holder to use a name specified in the permit in connection with the holder's practice, as specified. (BPC Section 1962)
Establishes the Moscone-Knox Professional Corporation Act, which regulates the formation and operation of professional corporations, and defines a professional corporation as a corporation organized under the general corporation law, as specified, or a corporation that is engaged in rendering professional services in a single profession. (Corporations Code (CC) Section 13400 et seq.)
Authorizes an RDHAP to submit, or allow to be submitted, any insurance or third-party claims for patient services performed as authorized by relevant sections of the BPC, as specified. (BPC Section 1928)

THIS BILL

Permits an alternative dental hygiene practice established within a certified shortage area to continue regardless of certification.
Eliminates the requirement for an RDHAP to obtain written verification, including a prescription for dental hygiene services, that his or her patient has been examined by a dentist or physician and surgeon.
Exempts professional corporations, rendering professional services by persons duly licensed by the DHCC, from the requirement to obtain a certificate of registration in order to render those professional services, and specifies that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.
Requires health care service plan contracts covering dental services, specialized health care service plan contracts covering dental services, health insurance policies covering dental services, and specialized health insurance policies covering dental services issued, amended, or renewed on or after January 1, 2016, to reimburse RDHAPs for performing dental hygiene services that may lawfully be performed by registered dental hygienists (RDH) and that are reimbursable under the contracts or policies, and would require the plan or insurer to use the same fee schedule for reimbursing both registered dental hygienists and RDHAP.
Makes other clarifying and conforming changes.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.

COMMENTS

Purpose. This bill is sponsored by the California Dental Hygienists' Association. According to the author, "A number of situations reduce access to RDHAPs. First, California law allows [RDHs]to open practice in geographic areas where people have no access to regular preventive oral care due to an absence or shortage of dentists. However, under current law, RDHAPs who practice in dental health shortage areas can no longer practice in those areas once they are no longer designated a dental shortage area. Second, many dental insurance companies recognize dentists in a dental practice as the billable provider of dental hygiene services and even though RDHAPs provide the same billable services that an RDH provide, billed by the dentist, the insurance companies are denying RDHAP’s reimbursement for services. This forces patients who cannot easily access care in a traditional dental office to pay out of pocket for the services of a RDHAP or not receive the care due to finances. Additionally, any patient who goes directly to an RDHAP for preventative services must obtain a dentist’s or doctor’s prescription to continue those services once they pass 18 months of service with the RDHAP. This is problematic in areas where dentists are in short supply creating a barrier for patients to obtain much needed services. Finally, the [BPC] authorizes RDHAPs to incorporate. Corporation law would protect the RDHAP’s business, however, there is not language in the Corporations Code authorizing RDHAPs to establish corporations, leaving them without critical protections. [This bill] would address these issues and ensure that the public has access to quality dental hygiene services."
Background. In 1986, the OSHPD created the RDHAP. In 1993, the professional designation was made permanent in statute. An RDHAP must have been engaged in the practice of dental hygiene as a registered dental hygienist in any setting, including educational settings and public health settings, for a minimum of 2,000 hours during the immediately preceding 36 months, complete 150 additional hours of education courses, and pass a written exam. An RDHAP has a unique distinction in that they can work for a dentist or as an employee of another RDHAP as an independent contractor, as a sole proprietor of an alternative hygiene practice, or other locations such as residences of the homebound, schools, residential facilities, and in underserved dental shortage areas, as determined by OSHPD. They may also operate a mobile dental clinic or operate an independent office or offices.

As a result, RDHAPs may practice in settings outside of the traditional dental office, and allow patients to receive the same type of professional preventive care they would receive in a dental office in schools, skilled and residential care facilities, hospitals, private homes, and in some instances in an RDHAP’s own office. A 2009 survey of California RDHAPs found that more than two thirds of their patients had no other source of oral health care. RDHAPs also struggle to find referrals to dentists for patients in need of more advanced care and charge lower fees than dentists.

The DHCC licenses and regulates approximately 509 RDHAPs.

Prescription Requirements. BPC Section 1931 allows a RDHAP to provide dental hygiene services to a patient without referral by a dentist for up to 18 months. However, after 18 months a patient needs to have a prescription from a dentist or a physician and surgeon in order to continue dental hygiene services with the RDHAP. The prescription is valid for up to 2 years. According to the author, this is problematic in areas where dentists are in short supply creating a barrier for patients to obtain much needed basic preventive care services.

According to the author, RDHAPs have proven to be safe providers who refer patients to dentists when major dental issues arise outside of their scope of practice to treat. There is no precedent for requiring a practice agreement for licensure, nor for services delivered within a professional’s own scope of practice. This is unique in that most restrictions requiring a prescription of one provider to another are for specialty care, not for primary preventive health care services. In practice, this is simply an administrative hurdle, time consuming for providers, and has not been shown to contribute to positive patient outcomes. The author indicates that patients should have their choice of dental hygiene care provider, and the public should not need a prescription to receive basic preventive care. According to the sponsors, an RDHAP is the only oral health care provider a patient has access to, and if a prescription is not obtained, the patient cannot even continue to receive preventative dental hygiene care, even though the need for and benefits of that care still exist.

Dental Health Professional Shortage Areas (DHPSAs). According to OSHPD, DHPSAs are based on the evaluation of criteria established through federal regulation to identify geographic areas or population groups with a shortage of dental providers. The federal DHPSA designation identifies areas as having a shortage of dental providers on the basis of availability of dentists and other dental auxiliaries. To qualify for designation as a DHPSA, an area must be: 1) a rational service area; have a population to general practice dentist ratio of 5,000:1 or 4,000:1 plus population features demonstrating "unusually high need"; and 3) a lack of access to dental care in surrounding areas because of excessive distance, overutilization, or access barriers. According to OSHPD, there are 53 DHPSAs. Approximately 5% of Californians live in a DHPSA.

The DHCC noted in their 2014 Sunset Review Report that problems have arisen when the shortage area in which an RDHAP sets up a practice is redesignated as a non-shortage area. Existing law requires the RDHAP to close down the practice when this occurs. The DHCC views this as “counterproductive...as the closure of the practice would leave patients with no access to dental hygiene services.” According to the sponsors, when a DHPSA in San Luis Obispo was faced with losing its designation status, RDHAPs in that area fought to keep the designation area so that patients could continue to be served. This bill seeks to prevent patients from losing access to established dental care should an area lose its DHPSA.

Reimbursement for Services. Currently, many dental insurance companies recognize dentists in a dental practice as the billable provider of dental hygiene services and even though RDHAPs provide the same billable services that an RDH provide, billed by the dentist, the insurance companies are denying RDHAP’s reimbursement for services. In its 2014 Sunset Review Report, the DHCC identified as a barrier to RDHAP practice the inability for RDHAPs to collect payment for services rendered. The DHCC noted that RDHAPs have difficulty collecting payment for services from insurance companies based outside of California. This is because not all states have the RDHAP provider status making them ineligible for reimbursement. As a result, some patients who cannot easily access care in a traditional dental office are forced to pay out of pocket for the services of a RDHAP or not receive care due to financial constraints.

Professional Corporations. A professional corporation is an organization made up of individuals of the same trade or profession. The Moscone-Knox Professional Corporations Act of 1968 authorized the formation of professional corporations to obtain certain benefits of the corporate form of doing business, such as limited legal liability. At that time, only medical, law and dental professional corporations were envisioned; there are now 15 authorized healing arts professional corporations. Current law specifies which healing arts licensees may be shareholders, officers, directors or professional employees of professional corporations controlled by a differing profession if the sum of all shares owned by those licensed persons does not exceed 49% of the total shares of the professional corporation.

BPC Section 1962 authorizes an association, partnership, corporation, or group of three or more registered RDHAPs to practice under an assumed or fictitious name if the association, partnership, corporation, or group holds a permit issued by the DHCC authorizing the holder to use that name connection with the holder's practice, as specified. According to the sponsors, this section was intended to allow RDHAPs to incorporate to gain the protections afforded by corporation law, most importantly, protection against personal liability. However, conforming changes were not made to the Corporations Code. This bill would specify that RDHAPs may be shareholders, officers, or directors of an RDHAP corporation, and specify that licensed dentists and dental assistants may be professional employees of an RDHAP corporation.

Prior Related Legislation. AB 1174 (Bocanegra), Chapter 662, Statutes of 2014, authorized, among others, RDHAPs to determine which radiographs to perform and to place protective restorations, as specified, and provided that face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for teledentistry, as specified.

AB 1245 (Lieu), Chapter 395, Statutes of 2014, extended the operation of the DHCC until January 1, 2019.

SB 1202 (Leno), Chapter 331, Statutes of 2012, among other things, authorized, instead of require, the DHCC to seek an injunction against an RDHAPs who provides dental hygiene services to a patient for longer than 18 months without obtaining a prescription for dental hygiene services from a dentist or physician and surgeon, and specified that a violation by an RDHAPs of that requirement is reason for the DHCC to revoke or suspend his or her license.

AB 1334 (Salinas), Chapter 850, Statutes of 2006, authorized an RDHAP to provide services to patients without a prescription from a dentist or a physician and surgeon for the first 18 months after the first date of service, and made that prescription valid for a period not to exceed two years. AB 1334 also made failure to comply with those provisions unprofessional conduct.

AB 123, Chapter 549, Statutes of 2003, provided that physicians and surgeons, dental assistants, registered dental assistants, registered dental assistants in extended functions, registered dental hygienists, registered dental hygienists in extended functions, or registered dental hygienists in alternative practice may be shareholders, officers, directors, or professional employees of dental corporations.

SB 853 (Perata), Chapter 31, Statutes of 2008, created the DHCC as the separate body within the DBC to oversee the practice of dental hygiene.

ARGUMENTS IN SUPPORT

The California Dental Hygienists' Association (CDHA) writes in support, "[This bill]…would strengthen access to dental hygiene care in underserved areas of the state. RDHAPs…have more education and training than [RDHs] and provide dental hygiene care unsupervised and outside of the traditional dental office in order to reach populations who have difficulty accessing care through a traditional dental setting or lack dentists in their area. RDHAPs take dental hygiene care to the patient. RDHAPs work in skilled nursing facilities, homes of the disabled or homebound, in schools or in [DHPSAs]. RDHAPs can have offices or mobile units. RDHAPs are recognized dental providers and have their own National Provider Identification (NPI) number. DentiCal recognizes RDHAPs as billable providers. [This bill] improves access to dental hygiene care for vulnerable populations that cannot easily access a dental office by strengthening the RDHAP practice, thereby improving the RDHAP's ability to take dental hygiene care to patients.”

ARGUMENTS IN OPPOSITION

The California Dental Association (CDA) writes in opposition, "Over the last several years, CDA has been working on a number of initiatives to improve access to dental care and understands the need for innovation and non-traditional approaches. Unfortunately, [CDA] believe the approach [this bill] takes, to remove the requirement for a dentist or physician examination to continue with dental hygiene-specific services after an 18-month time period, is a fundamentally flawed approach to solving access to care concerns. Further, the prescription requirement in current law supports connection between dental team members and promotes the patient to seek the diagnostic and restorative care of a dentist – services that are critical and cannot be provided by a hygienist. Approval for continued hygiene care is the safeguard afforded to protect both patients and hygienists from conditions that may lead to supervised neglect, whereby, despite hygienic-specific care, the patient's health deteriorates over time from untreated dental disease.”

"…The primary reason for the development of the RDHAP license is to bring dental hygiene services to dentally underserved populations and into underserved communities. Should a DHPSA lose its designation, [CDA] believes that guidelines should be in place that describe the circumstances under which an RDHAP can continue operating an established practice to ensure that the practice retains the intent of the law to increase dental services to underserved populations."

POLICY ISSUES

DHPSAs. The sponsors assert that it is necessary to allow RDHAPs who have established practices in DHPSAs to be able to continue that practice, even if that designation is later removed. However, while there is anecdotal evidence that this is a concern, it does not appear that any DHPSA has in fact been un-designated as a shortage area.

Considering that the reason for a RDHAPs expanded scope of practice is to increase access to the most underserved populations, should this bill pass this Committee, the author should consider language that would ensure that this purpose is adhered to. Specifically, the author should include language in the bill that would specify that RDHAPs shall continue to serve those that lack or have limited access to care. For example, the author might require that a RDHAP who continues to practice in an area after it is no longer classified as a DHPSA, provide services to a specified percentage of Medi-Cal patients.

Prescription Requirements for RDHAP Services. RDHAPs play an important role in providing critical dental hygiene services to underserved populations by providing services within their scope of practice independently. However, while the statutory scheme enacting the RDHAP licensure envisioned much freedom for an RDHAP, it still envisioned the RDHAP as part of a dental team. Under existing law, hygienists are required to refer any screened patients with possible oral abnormalities to a dentist for a comprehensive examination, diagnosis, and treatment plan. Additionally, BPC Section 1930 requires the RDHAP to provide to the DHCC documentation of an existing relationship with at least one dentist for referral, consultation, and emergency services. This is because while RDHAPs may assess dental hygiene and develop, plan, and implement a dental hygiene care plan, including oral health education, counseling, and health screenings, it does not include a complete dental diagnosis or comprehensive treatment planning, which may only be performed by a dentist. In addition, RDHAPs are prohibited from inferring that he or she is in any way able to provide dental services or make any type of dental diagnosis beyond evaluating a patient's dental hygiene status. Only dentists are allowed to diagnose oral health problems, plan treatment, and prescribe medication.

Existing law requires RDHAPs to obtain a prescription for dental hygiene services from a dentist or a physician and surgeon to provide services for longer than an 18 month period, and that prescription is valid for up to two years. As a result, a patient would only have to obtain one prescription for services within the first prescription period of 42 months, or 3 and 1/2 years.

RDHAPs practice in extremely underserved areas and treat vulnerable populations, specifically persons in schools, residential facilities and other institutions, the homebound, and persons in DHPSAs. As a result, this population may be most in need of a periodic examination, by either a dentist or a physician and surgeon, which allows for a diagnosis of the patient's condition and the development of a treatment plan for a full range of care, if necessary. If this requirement were removed, this more comprehensive diagnosis or examination may not occur.

While the sponsors assert that the prescription requirement poses a barrier to care, it is unclear the extent to which patients of RDHAPs have been unable to obtain the necessary prescription requirement. In addition, with the advent of new means of increasing care, such as through the Virtual Dental Home that uses telehealth services to provide access to care, removing the requirement for a more complete diagnosis or examination appears to move away from increasing access to care. As a result, it is recommended that the author strike this provision until it is clearer the extent to which this requirement imposes a barrier to care and the extent to which removing this requirement will benefit, instead of potentially harm, a vulnerable patient is clear.

SUGGESTED AUTHOR’S AMENDMENTS

Strike Sections 1 and 3 of the bill inclusive.

REGISTERED SUPPORT / OPPOSITION:

Support

California Dental Hygienists' Association (sponsor)

13 RDHAPs

Opposition

California Dental Association

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301

Discussed in Hearing

1MIN

Authors shown for version:
Chaptered (10/6/2015)

AB 502: Dental hygiene.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 502

THIRD READING

Bill No: AB 502

THIRD READING

Bill No: AB 502

CONSENT

Bill No: AB 502

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

SUMMARY:

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COMMENTS:

SUPPORT AND OPPOSITION:

ASSEMBLY THIRD READING

ATR Bill Id:AB 502

ASSEMBLY THIRD READING

ATR Bill Id:AB 502

ASSEMBLY COMMITTEE ON APPROPRIATIONS

ABPCA Bill Id:AB 502

ASSEMBLY COMMITTEE ON HEALTH

ABPCA Bill Id:AB 502

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

ABPCA Bill Id:AB 502

Assembly Floor

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Assembly Standing Committee on Appropriations

Assembly Standing Committee on Health