The Medical Practice Act requires the Medical Board of California to adopt and administer standards for the continuing education of licensed physicians and surgeons and requires the board to require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at specified intervals. The act requires the board, in determining its continuing education requirements, to consider including courses on specified matters.

This bill would require the board to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

The Medical Practice Act requires the Medical Board of California to adopt and administer standards for the continuing education of licensed physicians and surgeons and requires the board to require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at specified intervals. The act requires the board, in determining its continuing education requirements, to consider including courses on specified matters.

This bill would require the board to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

The Medical Practice Act requires the Medical Board of California to adopt and administer standards for the continuing education of licensed physicians and surgeons and requires the board to require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at specified intervals. The act requires the board, in determining its continuing education requirements, to consider including courses on specified matters.

This bill would require the board to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

The Medical Practice Act requires the Medical Board of California to adopt and administer standards for the continuing education of licensed physicians and surgeons and requires the board to require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at specified intervals. The act requires the board, in determining its continuing education requirements, to consider including courses on specified matters.

This bill would require the board to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

The Medical Practice Act requires the Medical Board of California to adopt and administer standards for the continuing education of licensed physicians and surgeons and requires the board to require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at specified intervals. The act requires the board, in determining its continuing education requirements, to consider including courses on specified matters.

This bill would require the board to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1340

Author:(Maienschein)

As Amended Ver:August 30, 2017

Majority vote

Original Committee Reference: B. & P.

SUMMARY: Requires the Medical Board of California (MBC) to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

The Senate amendments move the bill's requirements to a new standalone section in the code rather than as an addition to an existing section.

EXISTING LAW:

1. Establishes the MBC, under to Department of Consumer Affairs (DCA), to regulate the practice of medicine. (Business and Professions Code (BPC) Section 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing education of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC Section 2190 et seq.)
3. Specifies that the continuing medical education standards may be met by educational activities that meet the standards of the Division of Licensing and that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. These may include, but are not limited to, educational activities that meet any of the following criteria:
   1. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
   2. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
   3. Concern bioethics or professional ethics.
   4. Are designed to improve the physician-patient relationship.
4. Specifies that on and after July 1, 2006, all continuing medical education courses shall contain curriculum that includes cultural and linguistic competency in the practice of medicine.
5. States that a continuing medical education course dedicated solely to research or other issues that does not include a direct patient care component or a course offered by a continuing medical education provider that is not located in this state is not required to contain curriculum that includes cultural and linguistic competency in the practice of medicine.
6. Directs associations that accredit continuing medical education courses to develop standards before July 1, 2006, for compliance with the requirements of 5) above. The associations may update these standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.
7. Specifies that educational activities that are not directed toward the practice of medicine, or are directed primarily toward the business aspects of medical practice, including, but not limited to, medical office management, billing and coding, and marketing shall not be deemed to meet the continuing medical education standards for licensed physicians and surgeons.
8. Indicates that educational activities that meet the content standards created by the MBC and are accredited by the California Medical Association or the Accreditation Council for Continuing Medical Education (CME) may be deemed by the Division of Licensing to meet its CME standards.
9. Permits the Division of Licensing to establish criteria that providers of continuing medical education shall follow to ensure attendance by licensees throughout the entire course. (BPC Section 2190.2)
10. Requires all general internists and family physicians who have a patient population of which over 25% are 65 years of age or older to complete at least 20% of all mandatory continuing education hours in a course in the field of geriatric medicine or the care of older patients. (BPC Section 2190.3)
11. Requires all physicians and surgeons to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC Section 2190.5)
12. Permits the MBC, by regulatory action, to exempt physicians and surgeons by practice status category from CME requirements, as specified, if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
13. Specifies that certain requirements for CME shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
14. Requires the MBC, in determining its continuing education requirements, to consider including course in: (BPC Section 2191)
    1. Human sexuality as defined in Section 2090 and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
    2. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
    3. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
    4. Nutrition, for every physician and surgeon, as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
    5. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
    6. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
    7. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
    8. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
    9. Pain management.
    10. Geriatric care for emergency room physicians and surgeons.
    11. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
        1. Pain and symptom management.
        2. The psycho-social dynamics of death.
        3. Dying and bereavement.
        4. Hospice care.

FISCAL EFFECT: According to the May 23, 2017 Assembly Appropriations Committee, this bill will result in negligible costs.

COMMENTS:

Purpose. This bill is sponsored by the Steinberg Institute. According to the author, "This bill would establish an optional continuing medical education (CME) training on mental health issues in a primary care setting for medical professionals.

In the era of integrated health care, it is imperative that all medical professionals are trained in recognizing the early signs of mental health issue in children and young adults. This is especially important for Pediatricians and general practitioners to ensure they are fully supported in identifying mental health concerns and appropriately treating them.

In fact, in the United States, approximately 60% of mental health care visits are directed to a primary care physician. Considering that 50% of all cases of mental illness begin by age 14 and by age 24 the rate is 75%, the need to equip physicians with the tools and knowledge to meet the demands of these young people is paramount.

Pediatricians and general practitioners need to be supported in their work and provided with robust evidence-based practices and training around early intervention for mental health issues in their patients. This bill is a critical first step in helping to train these providers and provide better care to patients."

Background. According to information obtained from the MBC, existing law requires physicians and surgeons to complete at least 50 hours of approved CME during each two-year license renewal cycle. Currently, physicians and surgeons only have a mandatory one-time CME requirement of 12 hours in the subject of pain management and the treatment of the terminally ill. There is also a mandate in existing law that requires general internists and family physicians who have a patient population of which over 25% are 65 years of age or older to complete at least 20% of all mandatory CME in a course in the field of geriatric medicine or the care of older patients.

Existing CME courses approved by the MBC's Licensing Program include:

1. Programs accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA), the American Medical Association (AMA), and the Accreditation Council for Continuing Medical Education (ACCME) that qualify for AMA PRA Category 1 Credit(s)™;
2. Programs that qualify for prescribed credit from the American Academy of Family Physicians (AAFP); and,
3. Other programs offered by other organizations and institutions acceptable to the MBC.

This bill does not require a course in integrating mental and physical health care in primary care settings, as specified, but instead recommends the MBC to consider a course in this topic when determining its continuing education requirements.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301 FN: 0001745

 THIRD READING  

Bill No: AB 1340

Author:

: 8/30/17

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/12/17

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 77-0, 5/11/17 (Consent) - See last page for vote

SUBJECT:

SOURCE: Steinberg Institute

DIGEST:

This bill requires the Medical Board of California (MBC), in determining its continuing education requirements for licensed physicians and surgeons, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

Senate Floor Amendments of 8/30/17 eliminate chaptering conflicts with SB 798 (Hill) by creating a new code section rather than amending a current code section in the Medical Practice Act.

ANALYSIS:

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC). (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CME course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
10. Requires the MBC, in determining its continuing education requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. Pain management.
20. Geriatric care for emergency room physicians and surgeons.
21. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.

This bill requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

Background

CME Requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

Comments

According to the author, “Unfortunately, many children’s mental health needs go unmet, often for years resulting in avoidable negative outcomes for the individual and leading to families in crisis. The need to address mental health issues in the primary care setting is clear; in the U.S., approximately 60% of mental health care visits are directed to a primary care physician. The diagnosis and treatment of mental health is often identified too late. AB 1340 would allow any medical professional seeking to fulfill their Continuing Medical Education requirement the additional option of studying mental health. According to the Centers for Disease Control, for the first time, suicide has become the leading cause of death for children between the ages of 10 through 14. Our efforts will ensure that pediatricians and general practitioners are trained in recognizing the early signs of mental health issues in children and young adults.”

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 8/30/17)

Steinberg Institute (source)

California Access Coalition

California Council of Community Behavioral Health Agencies

California Psychiatric Association

March of Dimes Foundation

OPPOSITION: (Verified 8/30/17)

None received

ARGUMENTS IN SUPPORT: Supporters believe that the integration of physical and mental health has proven itself invaluable in producing positive outcomes in both the physical and mental health of patients. Effective integration both saves money and provides a higher quality of life for those afflicted with both physical and mental health diagnoses. Supporters call this bill a common sense approach to meeting the increasing demand for mental health services and ensuring practicing physicians have the expertise to treat their patients appropriately and effectively.

ASSEMBLY FLOOR: 77-0, 5/11/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Dahle, O'Donnell, Patterson

Prepared by:

8/31/17 16:11:03

**** END ****

 THIRD READING  

Bill No: AB 1340

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/12/17

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 77-0, 5/11/17 (Consent) - See last page for vote

SUBJECT:

SOURCE: Steinberg Institute

DIGEST:

This bill requires the Medical Board of California (MBC), in determining its continuing education requirements for licensed physicians and surgeons, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

ANALYSIS:

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC). (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CME course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
10. Requires the MBC, in determining its continuing education requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. Pain management.
20. Geriatric care for emergency room physicians and surgeons.
21. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.

This bill requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

Background

CME Requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

Comments

According to the author, “Unfortunately, many children’s mental health needs go unmet, often for years resulting in avoidable negative outcomes for the individual and leading to families in crisis. The need to address mental health issues in the primary care setting is clear; in the U.S., approximately 60% of mental health care visits are directed to a primary care physician. The diagnosis and treatment of mental health is often identified too late. AB 1340 would allow any medical professional seeking to fulfill their Continuing Medical Education requirement the additional option of studying mental health. According to the Centers for Disease Control, for the first time, suicide has become the leading cause of death for children between the ages of 10 through 14. Our efforts will ensure that pediatricians and general practitioners are trained in recognizing the early signs of mental health issues in children and young adults.”

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 7/12/17)

Steinberg Institute (source)

California Access Coalition

California Council of Community Behavioral Health Agencies

California Psychiatric Association

March of Dimes Foundation

OPPOSITION: (Verified 7/12/17)

None received

ARGUMENTS IN SUPPORT: Supporters believe that the integration of physical and mental health has proven itself invaluable in producing positive outcomes in both the physical and mental health of patients. Effective integration both saves money and provides a higher quality of life for those afflicted with both physical and mental health diagnoses. Supporters call this bill a common sense approach to meeting the increasing demand for mental health services and ensuring practicing physicians have the expertise to treat their patients appropriately and effectively.

ASSEMBLY FLOOR: 77-0, 5/11/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Dahle, O'Donnell, Patterson

Prepared by:

7/12/17 15:43:56

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: AB 1340 Hearing Date: June 12, 2017

Subject: Continuing medical education: mental and physical health care integration

SUMMARY: Requires the Medical Board of California (MBC), in determining its continuing education requirements for licensed physicians and surgeons, to consider including

a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC). (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CME course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of
   12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
10. Requires the MBC, in determining its continuing education requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. Pain management.
20. Geriatric care for emergency room physicians and surgeons.
21. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.

This bill requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated May 3, 2017, this bill will result in negligible state fiscal effect.

COMMENTS:

1. Purpose. The Steinberg Institute is the Sponsor of this measure. According to the Author, “Unfortunately, many children’s mental health needs go unmet, often for years resulting in avoidable negative outcomes for the individual and leading to families in crisis. The need to address mental health issues in the primary care setting is clear; in the U.S., approximately 60% of mental health care visits are directed to a primary care physician. The diagnosis and treatment of mental health is often identified too late. AB 1340 would allow any medical professional seeking to fulfill their Continuing Medical Education requirement the additional option of studying mental health. According to the Centers for Disease Control, for the first time, suicide has become the leading cause of death for children between the ages of 10 through 14. Our efforts will ensure that pediatricians and general practitioners are trained in recognizing the early signs of mental health issues in children and young adults.”
2. Continuing Medical Education (CME) Requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

1. Related Legislation This Year. AB 89 (Levine) requires an applicant for licensure as a psychologist to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention. (Status: This bill is currently pending in the Senate Committee on Appropriations.)

AB 326 (Salas) requires an applicant for licensure by the Board of Barbering and Cosmetology to take one-hour training in physical and sexual abuse awareness as part of a BBC- approved course developed through regulations. (Status: This bill will also be heard before the Committee on June 12, 2017.)

1. Arguments in Support. California Access Coalition and California Council of Community Behavioral Health Agencies believe that “the integration of physical and mental health has proven itself invaluable in producing positive outcomes in both the physical and mental health of patients. Effective integration both saves money and provides a higher quality of life for those afflicted with both physical and mental health diagnoses.”

The Steinberg Institute, the bill’s Sponsor, states that AB 1340 is a common sense approach to meeting the increasing demand for mental health services and ensuring practicing physicians have the expertise to treat their patients appropriately and effectively.

According to the California Psychiatric Association, continuing education in primary care psychiatry provides a means of increasing the “psychiatric quotient” of primary care providers. CPA states that this education will allow primary care providers to screen and identify at risk individuals in the early stages of developing a mental illness and target evidence-based treatment to those experiencing signs or symptoms of mental illness.

The March of Dimes Foundation states that this bill is aligned with the goal of increasing the capacity of all health care providers to screen and direct women to treatment options, discussed as part of the organization’s participation on the Task Force on the Status of Maternal Mental Health Care

1. MBC Position. The MBC adopted a neutral position on the bill, noting that it requires consideration of a CME course on integrating mental and physical health care in primary care settings and that the MBC does not track employment information for physicians so would not know which licensees practice in primary care settings. MBC advised that as means of encouraging attendance in the types of CME courses outlined by this bill, MBC could include an article in its Newsletter or put information on its website.
2. Proposed Author’s Amendments. The Author received comments from First 5 California (California Children and Families Commission) regarding the impacts of failure to address trauma in children, specifically the potential illness for mental illness later in life and that the exposure to trauma and mental illness commonly go hand in hand. According to First 5, oftentimes, children who live in a household where they are abused may begin to exhibit signs of post traumatic stress disorder, or parents who suffer from mental illness may also expose their children to certain traumas. First 5 noted that certain mental illnesses have been found to be hereditary and thus requested an amendment, intended to be preventive, to add “exposure to trauma” to the language currently contained in the bill.

On page 3, in line 21 after “issues” insert “and exposure to trauma”

18 (l) In determining its continuing education requirements, the

19 board shall consider including a course in integrating mental and

20 physical health care in primary care settings, especially as it

21 pertains to early identification of mental health issues and exposure to trauma in children

22 and young adults and their appropriate care and treatment.

SUPPORT AND OPPOSITION:

Support:

California Access Coalition

California Council of Community Behavioral Health Agencies

California Psychiatric Association

March of Dimes Foundation

Steinberg Institute

Neutral:

Medical Board of California

Opposition:

None on file as of June 7, 2017.

-- END --

Date of Hearing: May 3, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1340

Author:(Maienschein) – As Introduced Ver:February 17, 2017

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

SUMMARY:

This bill requires the Medical Board of California (MBC) to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it applies to children and youth.

FISCAL EFFECT:

Negligible state fiscal effect.

COMMENTS:

1. Purpose. This bill is sponsored by the Steinberg Institute in order to encourage medical professionals to be trained in recognizing the early signs of mental health issues in children and young adults.
2. Background. Current law requires physicians and surgeons licensed by the board to complete at least 50 hours of approved Continuing Medical Education (CME) during each two-year license renewal cycle. This bill does not require a course in integrating mental and physical health care in primary care settings, as specified, but instead recommends the MBC to consider a course in this topic when determining its continuing education requirements.

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

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 1340

Author:(Maienschein) – As Introduced Ver:February 17, 2017

SUBJECT: Continuing medical education: mental and physical health care integration.

SUMMARY: Requires the Medical Board of California (MBC) to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

EXISTING LAW:

1. Establishes the MBC, under to Department of Consumer Affairs (DCA), to regulate the practice of medicine. (BPC § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing education of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190 et seq.)
3. Specifies that the continuing medical education standards may be met by educational activities that meet the standards of the Division of Licensing and that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. These may include, but are not limited to, educational activities that meet any of the following criteria:
   1. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
   2. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
   3. Concern bioethics or professional ethics.
   4. Are designed to improve the physician-patient relationship.
4. Specifies that on and after July 1, 2006, all continuing medical education courses shall contain curriculum that includes cultural and linguistic competency in the practice of medicine.
5. States that a continuing medical education course dedicated solely to research or other issues that does not include a direct patient care component or a course offered by a continuing medical education provider that is not located in this state is not required to contain curriculum that includes cultural and linguistic competency in the practice of medicine.
6. Directs associations that accredit continuing medical education courses to develop standards before July 1, 2006, for compliance with the requirements of 5) above. The associations may update these standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.
7. Specifies that educational activities that are not directed toward the practice of medicine, or are directed primarily toward the business aspects of medical practice, including, but not limited to, medical office management, billing and coding, and marketing shall not be deemed to meet the continuing medical education standards for licensed physicians and surgeons.
8. Indicates that educational activities that meet the content standards created by the MBC and are accredited by the California Medical Association or the Accreditation Council for Continuing Medical Education (CME) may be deemed by the Division of Licensing to meet its CME standards.
9. Permits the Division of Licensing to establish criteria that providers of continuing medical education shall follow to ensure attendance by licensees throughout the entire course. (BPC § 2190.2)
10. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory continuing education hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
11. Requires all physicians and surgeons to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
12. Permits the MBC, by regulatory action, to exempt physicians and surgeons by practice status category from CME requirements, as specified, if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
13. Specifies that certain requirements for CME shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
14. Requires the MBC, in determining its continuing education requirements, to consider including course in: (BPC § 2191)
    1. Human sexuality as defined in Section 2090 and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
    2. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
    3. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
    4. Nutrition, for every physician and surgeon, as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
    5. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
    6. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
    7. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
    8. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
    9. Pain management.
    10. Geriatric care for emergency room physicians and surgeons.
    11. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
        1. Pain and symptom management.
        2. The psycho-social dynamics of death.
        3. Dying and bereavement.
        4. Hospice care.

THIS BILL:

1. Requires the MBC, in determining its continuing education requirements, to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

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

COMMENTS:

Purpose. This bill is sponsored by the Steinberg Institute. According to the author, “This bill would establish an optional continuing medical education (CME) training on mental health issues in a primary care setting for medical professionals.

In the era of integrated health care, it is imperative that all medical professionals are trained in recognizing the early signs of mental health issue in children and young adults. This is especially important for Pediatricians and general practitioners to ensure they are fully supported in identifying mental health concerns and appropriately treating them.

In fact, in the U.S., approximately 60 percent of mental health care visits are directed to a primary care physician. Considering that 50 percent of all cases of mental illness begin by age 14 and by age 24 the rate is 75 percent, the need to equip physicians with the tools and knowledge to meet the demands of these young people is paramount.

Pediatricians and general practitioners need to be supported in their work and provided with robust evidence-based practices and training around early intervention for mental health issues in their patients. AB 1340 is a critical first step in helping to train these providers and provide better care to patients.”

Background. According to information obtained from the MBC, existing law requires physicians and surgeons to complete at least 50 hours of approved CME during each two-year license renewal cycle. Currently, physicians and surgeons only have a mandatory one-time CME requirement of 12 hours in the subject of pain management and the treatment of the terminally ill. There is also a mandate in existing law that requires general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME in a course in the field of geriatric medicine or the care of older patients.

Existing CME courses approved by the MBC’s Licensing Program include:

• Programs accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA), the American Medical Association (AMA), and the Accreditation Council for Continuing Medical Education (ACCME) that qualify for AMA PRA Category 1 Credit(s)™;
• Programs that qualify for prescribed credit from the American Academy of Family Physicians (AAFP); and,
• Other programs offered by other organizations and institutions acceptable to the MBC.

This bill does not require a course in integrating mental and physical health care in primary care settings, as specified, but instead recommends the MBC to consider a course in this topic when determining its continuing education requirements.

Current Related Legislation. AB 89 (Levine) of the current Legislative Session requires, on January 1, 2020, an applicant for licensure as a psychologist to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention, as specified; and also requires an applicant for renewal to complete a one-time requirement of a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention. STATUS: This bill is currently pending referral in the Senate Committee on Rules.

AB 326 (Salas) of the current Legislative Session requires an applicant for licensure under the Board of Barbering and Cosmetology to take a one-hour training on domestic violence and sexual assault awareness as part of their educational requirements, as specified. STATUS: This bill is currently pending in the Assembly Committee on Appropriations.

Prior Related Legislation. AB 2198 (Levine) of 2014, would have required a psychologist, marriage and family therapist, educational psychologist, professional clinical counselor and clinical social worker, who began graduate study on or after January 1, 2016, to complete a minimum of 15 hours of coursework on suicide prevention, before being issued a license. In addition, it would have commencing January 1, 2016, require a person licensed in these professions who began graduate study prior to January 1, 2016, to take a six-hour continuing education course on suicide prevention in order to renew a license. NOTE: This bill was vetoed by the Governor Brown. In his message he states. “California has an extensive regulatory scheme that aims to ensure that California physicians, psychologists and counselors are skilled in the healing arts to which they have committed their lives. Rather than further legislating in this field, I would ask our licensing boards to evaluate the issues which this bill raises and take whatever actions are needed."

AB 2435 (Lowenthal), Chapter 552, Statutes of 2010, requires psychologists, LMFTs, LCSWs, and LPCCs to have instruction and training in the recognition and reporting of suspected elder and dependent adult abuse as requirements for licensure.

POLICY ISSUES:

Will This Measure Achieve its Intended Goal? The goal of this legislation is laudable. It is imperative that health professionals be provided with training in the detection and treatment of mental illness in children and young adult populations. However, this bill does not require that physicians take a course in mental health treatment; rather, it mandates that the MBC consider accepting CME courses on this topic. However, the MBC already has the authority to consider CME providers that offer course on mental health treatment. For example, there is a one-time requirement that physicians and surgeons complete 12 hours of CME covering treating patients with mental illness. Further, psychiatrists, physicians who specialize in the treatment of mental illness, are subject to CME requirements and take CME courses in their area of expertise. Therefore, it is unclear why legislation is needed to reiterate the MBC’s existing authority. Similar to other directives in the Medical Practice Act on CME topics, it merely asks the MBC to consider these providers which it already has authority to do.

REGISTERED SUPPORT:

Steinberg Institute (sponsor)

California Access Coalition

California Council of Community Behavioral Health Agencies

March of Dimes Foundation

REGISTERED OPPOSITION:

None on file.

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