The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and establishes specific requirements for licensure and renewal. That act generally requires that an application for a certificate be accompanied by the fee required by the act, but requires the waiver of the fee for a physician and surgeon residing in California who certifies to the board that the license is for the sole purpose of providing voluntary, unpaid service. The act establishes a parallel fee waiver requirement for the renewal of a physician and surgeons certificate.

This bill would remove from those application and renewal fee waiver provisions the requirement that a physician and surgeon reside in California.

The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and establishes specific requirements for licensure and renewal. That act generally requires that an application for a certificate be accompanied by the fee required by the act, but requires the waiver of the fee for a physician and surgeon residing in California who certifies to the board that the license is for the sole purpose of providing voluntary, unpaid service. The act establishes a parallel fee waiver requirement for the renewal of a physician and surgeons certificate.

This bill would remove from those application and renewal fee waiver provisions the requirement that a physician and surgeon reside in California.

Existing law provides for the licensure and regulation of various healing arts practitioners by boards within the Department of Consumer Affairs. Existing law provides an exemption from these requirements for a health care practitioner licensed in another state who offers or provides health care for which he or she is licensed during a state of emergency, as defined, and upon request of the Director of the Emergency Medical Services Authority, as specified.

Existing law provides, until January 1, 2018, an exemption from the licensure and regulation requirements for a health care practitioner, as defined, licensed or certified in good standing in another state or states, who offers or provides health care services for which he or she is licensed or certified through a sponsored event, as defined, (1) to uninsured or underinsured persons, (2) on a short-term voluntary basis, (3) in association with a sponsoring entity that registers with the applicable healing arts board, as defined, and provides specified information to the county health department of the county in which the health care services will be provided, and (4) without charge to the recipient or a 3rd party on behalf of the recipient, as specified. Existing law also requires an exempt health care practitioner to obtain prior authorization to provide these services from the applicable licensing board, as defined, and to satisfy other specified requirements, including payment of a fee as determined by the applicable licensing board.

This bill would provide an exemption similar to that sponsored event exemption to be administered by the Medical Board of California, applicable only to a physician, defined as a person licensed or certified in good standing in another jurisdiction of the United States, who offers or provides health care services for which he or she is licensed or certified, and who engages in acts that are subject to licensure or regulation under the Medical Practice Act. That exemption would be for health care services that are provided through free clinics, as defined, rather than through sponsored events. Such a physician would be authorized to volunteer for up to 60 days in a calendar year, which need not be consecutive.

Date of Hearing: August 3, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 1261

Author:(Stone) – As Amended Ver:May 3, 2016

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

SUMMARY:

This bill removes the requirement that a physician and surgeon reside in California in order to receive a license fee waiver, when the license is for the sole purpose of providing voluntary and unpaid services.

FISCAL EFFECT:

There is the potential for minor revenue loss to the Contingent Fund of the Medical Board associated with expanding the availability of fee waiver for volunteer physicians, but this loss is expected to be so small as to be negligible.

COMMENTS:

Purpose. Currently, it is prohibited for a licensed doctor out-of-state to practice in California for an extended period of time. This bill seeks to allow licensed doctors, who are in good standing in their own state and are visiting California, to volunteer their services at free clinics with a two year limited license issued by the MBC through an existing program. The bill would allow the fee waiver for such a license to be available to persons primarily residing outside California.

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

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Rudy Salas, Chair

SBPCA Bill Id:

Author:() – As Ver:

SENATE VOTE:

SUBJECT:

SUMMARY: Removes the requirement from application and renewal fee waivers that a physician and surgeon reside in California in order to provide voluntary and unpaid services.

EXISTING LAW:

1. Establishes the Medical Board of California (MBC), to regulate the practice of medicine in California. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the Osteopathic Medical Board (OMBC) to enforce provisions of law related to osteopathic physicians and surgeons. (BPC § 2450)
3. Provides that a physician and surgeon who practices or attempts to practice medicine in California without a license or certificate is guilty of a public offense punishable by a fine not exceeding $10,000, by imprisonment, or by both fine and imprisonment. (BPC § 2052)
   
4. Exempts health care practitioners licensed in another state or territory from California licensure during a state of emergency, as specified. (BPC § 900)
   
5. Authorizes the MBC and the OMBC to establish reciprocity provisions for those individuals holding an unlimited license to practice medicine or osteopathic medicine in another state, as specified. (BPC §§ 2135, 2153.5)
   
6. Exempts from California licensure, until January 1, 2018, out of state health care practitioners who voluntarily participate in “sponsored events” for uninsured or underinsured individuals for no more than ten calendar days, as specified.
   (BPC § 901)

THIS BILL:

1. Removes the requirement from application and renewal fee waivers that a physician and surgeon reside in California in order to provide voluntary and unpaid services.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, this bill will result in negligible state costs.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author, “In parts of the state, including parts of the 28^th Senate District, many semi-retired doctors flock to the region during the winter time. According to many of the health clinics in those regions, they receive numerous requests for doctors looking to volunteer. Current law limits out of state doctors to only practice at specified events when in California. The amount of time these doctors are allowed to practice at these events is only 10 days. SB 1261 allows licensed doctors, who are in good standing in their own state but are visiting California, to volunteer and help alleviate the doctor shortage at health clinics in California by simply expanding a program that is already offered to retired California doctors that are practicing on a volunteer basis.”

Background. Prior to 2010, health care practitioners, including physician and surgeons, osteopathic physicians, dentists, physician assistants, nurses, and dental hygienists were required to be licensed in California in order to practice in the state for any length of time and in any setting. The only exemptions included health care practitioners who provided care during a state of emergency upon request by the Director of Emergency Medical Services Authority, or if a physician and surgeon who was practicing in another state had been invited by the United States Olympic Committee to provide medical services during in-state events sanctioned by the Committee.

In 2010, AB 2699 (Bass) Chapter 270, Statutes of 2010, established that health care professionals who were licensed or certified outside of California were permitted to provide health care services to underinsured and uninsured Californians at health care events. These professionals could only provide these services for up to 10 days. In 2013, AB 512 (Rendon) Chapter 111, Statutes of 2013, extended the sunset date of AB 2699 from January 1, 2014 to January 1, 2018.

Patient Protection Provisions. Current law includes a number of provisions to ensure patient safety including:

For health care practitioners:

1. The practitioner must obtain authorization from the respective California licensing or certifying board to participate in the sponsored event.
2. The practitioner must be in good standing in each state in which the practitioner is licensed or certified.
3. The practitioner must not have committed any act or been convicted of a crime constituting grounds for denial of licensure or certification.
4. The practitioner must have the appropriate education and experience to participate in a sponsored event.
5. The practitioner whose authorization to provide health care services has been terminated and is deemed to be practicing health care in violation of the law is subject to any applicable administrative, civil, and criminal fines, penalties and other sanctions.

For the Sponsors of Health Care Events:

1. Requires the sponsoring entity seeking to provide, or arrange for the provision of, health care services to do both of the following:
2. Register with each applicable licensing or certifying board for which an out of state health care practitioner is participating in the sponsored event by completing a registration form.
3. Provide the information on the registration form to the county health department of the county in which the health care services will be provided.
4. Requires the sponsoring entity to notify in writing the licensing or certifying board and the county health department of any change to the information on the registration form within 30 calendar days of the change.
5. Within 15 calendar days of the provision of health care services, the sponsoring entity must file a report with the licensing or certifying board and the county health department on the date, place, type and general description of the care provided, along with a listing of the health care practitioners who participated in providing services.
6. Requires the sponsoring entity to maintain a copy of each health care practitioner’s current license or certification and shall require each health care practitioner to attest in writing that his or her license or certificate is not suspended or revoked pursuant to disciplinary proceedings in any jurisdiction. The sponsoring entity shall maintain these records for a period of at least five years following the provision of health care services and shall, upon request, furnish those records to the licensing or certifying board or any county health department.

For the licensing or certifying boards:

1. Authorizes the board to terminate authorization for a health care practitioner to provide health care services pursuant to this bill for failure to comply with the requirements of this bill.
2. Requires the board provide both the sponsoring entity and the health care practitioner with a written notice of termination including the basis for that termination.
3. Allows the board to deny a health care practitioner authorization to practice without a license if the health care practitioner fails to comply with the requirements or for any act that would be grounds for denial of an application for licensure or certification.

Free Health Clinics. Since 2010, there have been several events held across the state. The Remote Area Medical Volunteer Corps is a non-profit organization that has staged hundreds of medical clinics both in the United States and worldwide. Over the past seven years, RAM conducted health events in Los Angeles County where volunteer health care practitioners, such as doctors, nurses, dentists, chiropractors and optometrists provided various medical services to over 19,000 uninsured and underinsured residents of the county. Additionally, more than 7,000 people received free medical, vision and dental care during a 2013 four day CareNow clinic event held at the Los Angeles Memorial Coliseum.

Currently, it is prohibited for a licensed out of state doctor to practice in California for an extended period of time. This bill seeks to allow licensed doctors, who are in good standing in their own state, and are visiting California, to volunteer their services at free clinics with a two year limited license issued by the MBC.

Prior Related Legislation. AB 512 (Rendon) Chapter 111, Statutes of 2013, extended the sunset date, from January 2014, to January 2018, on existing law permitting qualified, out-of-state health care practitioners to volunteer their services on a limited basis at health care events designed to provide free services for underinsured and uninsured individuals in California.

AB 2699 (Bass) Chapter 270, Statutes of 2010, exempted from state licensure, until January 1, 2014, specified health care practitioners who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California, as specified.

REGISTERED SUPPORT:

None on file.

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Le Ondra Clark Harvey, Ph.D. / B. & P. / (916) 319-3301

 THIRD READING  

Bill No: SB 1261

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 4/18/16

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

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT:

SOURCE: Author

DIGEST: This bill deletes the residency requirement for physicians and surgeons’ eligibility for license fee waivers due to charity work.

ANALYSIS:

Existing law:

1. Establishes the Medical Board of California (MBC), to regulate the practice of medicine in California. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the Osteopathic Medical Board to enforce provisions of law related to osteopathic physicians and surgeons. (BPC § 2450)
3. Requires that license fees be waived for a physician and surgeon residing in California who certifies to the MBC that the issuance of the license is for the sole purpose of providing voluntary, unpaid service. (BPC § 2083)
4. Requires that license renewal fees be waived for a physician and surgeon residing in California who certifies to the MBC that the issuance of the license is for the sole purpose of providing voluntary, unpaid service. (BPC § 2442)

This bill deletes the California residency requirement for an initial and renewal license fee waiver for physicians who certify to the MBC that the issuance of the license is for the sole purpose of providing voluntary, unpaid service.

Background

This bill was heard in a different form in the Senate Business, Professions, and Economic Development Committee; this bill’s prior contents would have authorized physicians licensed out of state to work in California free clinics for up to 60 days a year, as specified, which the author stated was important because there is currently a shortage of doctors practicing at clinics across California and it is good public policy to allow licensed doctors, who are in good standing in their own state but are visiting California, to volunteer and help alleviate that shortage

This bill was substantially amended in the Senate Appropriations Committee.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 5/18/16)

None received

OPPOSITION: (Verified 5/18/16)

None received

Prepared by:

5/18/16 16:28:01

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2015 - 2016 Regular

Bill No: Hearing Date: April 18, 2016

Subject:

SUMMARY:

Authorizes physicians licensed out of state to work in California free clinics for up to 60 days a year, as specified.

Existing law:

1. Establishes the Medical Board of California (MBC), to regulate the practice of medicine in California. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the Osteopathic Medical Board (OMBC) to enforce provisions of law related to osteopathic physicians and surgeons. (BPC § 2450)
3. Provides that a physician and surgeon who practices or attempts to practice medicine in California without a license or certificate is guilty of a public offense punishable by a fine not exceeding $10,000, by imprisonment, or by both fine and imprisonment. (BPC § 2052)
   
4. Exempts health care practitioners licensed in another state or territory from California licensure during a state of emergency, as specified. (BPC § 900)
   
5. Authorizes the MBC and the OMBC to establish reciprocity provisions for those individuals holding an unlimited license to practice osteopathic medicine in another state, as specified. (BPC §§ 2135, 2153.5)
   
6. Exempts from California licensure, until January 1, 2018, out of state health care practitioners who voluntarily participate in “sponsored events” for uninsured or underinsured individuals for no more than ten calendar days, as specified.
   (BPC § 901)

This bill:

1. Defines “board” as the MBC.
2. Defines a “free clinic” as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, bequests, gifts, grants, government funds or contributions, that may be in the form of money, goods, or services. In a free clinic there shall be no charges directly to the patient for services rendered or for drugs, medicines, appliances, or apparatuses furnished.
3. Defines a “uninsured or underinsured person” as a person who does not have health care coverage, including private coverage or coverage through a program funded in whole or in part by a governmental entity, or a person who has health care coverage, but the coverage is not adequate to obtain those health care services offered by the physician.
4. Exempts a physician who offers or provides health care services at a free clinic from California licensure if all of the following are met:
   1. The physician obtains authorization from the MBC to participate in a free clinic after submitting a copy of his or her valid license or certificate from each state in which he or she holds licensure or certification and a photographic identification. The MBC shall notify the free clinic, within 20 calendar days of receiving a request for authorization, whether that request is approved or denied.
   2. The physician has not committed any act or been convicted of a crime constituting grounds for denial of licensure or registration, as specified, and is in good standing in each state in which he or she holds licensure or certification.
   3. The physician has the appropriate education and experience to participate in a free clinic, as determined by the MBC.
   4. The physician agrees to comply with all applicable California practice requirements.
   5. The services are provided under all of the following circumstances:
      1. To uninsured or underinsured persons;
      2. On voluntary basis, for a total of days not to exceed 60 days in a calendar year. The 60 days need not be consecutive.
      3. In association with a free clinic enrolled in the Medi–Cal program.
      4. Without charge to the recipient or to a third party on behalf of the recipient.
5. Requires the free clinic seeking to provide, or arrange for the provision of, health care services under this section to register with the MBC and the county health department of the county in which the health care services were provided, as specified.
6. Requires the free clinic to maintain a list of physicians associated with the provision of health care services and maintain a copy of each physician’s current license or certification and to require each physician to attest in writing that his or her license or certificate is not suspended or revoked pursuant to disciplinary proceedings in any jurisdiction.
7. Prohibits a contract of liability insurance issued, amended, or renewed in this state on or after January 1, 2017, from excluding coverage of a physician or a free clinic that provides, or arranges for the provision of, health care services, provided that the practitioner or free clinic complies with current law.
8. Authorizes the MBC to terminate authorization for a physician to provide health care services for failure to comply with the law, as specified, and provides for an appeals process for the physician.
9. States that the provisions of this law are severable, and that if any provision of this bill or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

FISCAL EFFECT:

Unknown. This bill is keyed “fiscal” by the Legislative Counsel.

COMMENTS:

1. Purpose. This bill is sponsored by the Author. According to the Author, “Currently, it is prohibited for a licensed out of state doctor to practice medicine in California for an extended period of time. In parts of the state like Palm Springs, many semi-retired doctors flock to the region during the winter time. According to many of the health clinics in that region, they receive numerous requests for doctors looking to volunteer.

The current law limits out of state doctors to only practice at specified events when in California. There is currently a shortage of doctors practicing at these clinics across California. It is good public policy to allow licensed doctors, who are in good standing in their own state but are visiting California, to volunteer and help alleviate that shortage.”

1. Background. This bill is modeled after current law which exempts a broad range of health care practitioners from California licensure requirements to participate in free sponsored healthcare events for up to ten days. The authorizing bill, AB 2699 (Bass, Chapter 270, Statutes of 2010), was enacted to facilitate programs provided by such entities as Remote Area Medical Volunteer Corps and CareNow, which provide multi-day health fairs that provide services for thousands of un- and underinsured individuals.

If the Author’s office is concerned about the lack of primary care services for un- and underinsured individuals, the Author may consider instead exploring other ways to advance practice opportunities for currently licensed California healthcare providers without compromising state oversight for our most vulnerable populations.

1. Prior Legislation. AB 512 (Rendon, Chapter 111, Statutes of 2013) extended the sunset date, from January 2014, to January 2018, on existing law permitting qualified, out-of-state health care practitioners to volunteer their services on a limited basis at health care events designed to provide free services for underinsured and uninsured individuals in California.

AB 2699 (Bass, Chapter 270, Statutes of 2010) exempted from state licensure, until January 1, 2014, specified health care practitioners who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California, as specified.

1. Policy Considerations. This bill exempts only physicians and surgeons from California licensure requirements for the purpose of serving in free clinics. The Author’s office did not clarify why other healthcare licensees, especially other primary care providers such as nurse practitioners and physicians assistants, are not included. Justification for the exemption also lacks basic evidence of necessity, explanation for 60 days of unlicensed practice, how many clinics may be affected, and whether the licensing boards affected, which should also include the OMBC, are in favor of such a change.

SUPPORT AND OPPOSITION:

Support: None on file as of April 12, 2016.

Opposition: None on file as of April 12, 2016.

-- END --