Existing law, the Acupuncture Licensure Act, provides for the licensure and regulation of the practice of acupuncture. The act defines various terms for those purposes, including approved educational and training program, which references the Accreditation Commission for Acupuncture and Oriental Medicine.

This bill would define additional terms under the act, including supervising acupuncturist, acupuncture assistant, and basic supportive acupuncture service. The bill would update the reference to the above-described commission, as specified, and would make conforming changes.

Existing law requires the Acupuncture Board, consisting of 7 members, to enforce and administer the act, and repeals this provision on January 1, 2024. Under existing law, that repeal renders the board subject to review by the appropriate policy committees of the Legislature. Existing law makes the protection of the public the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions. Existing law authorizes the board, by and with the approval of the Director of Consumer Affairs, to appoint an executive officer who is exempt from the State Civil Service Act, and repeals this provision on January 1, 2024.

This bill would reorganize and make other nonsubstantive changes to these provisions. The bill would repeal these provisions on January 1, 2028. The bill would additionally authorize the board, or its designee, upon complaint, to inspect specified premises, places of practice, or clinics. The bill would require specified records to be open to inspection by the board, or its designee, during an investigation initiated in response to a complaint that a licensee has violated any law or regulation that constitutes grounds for disciplinary action or issuance of a citation and fine by the board. The bill would require a copy of the above-described records to be provided to the board immediately upon request.

Existing law requires an acupuncturist to obtain and post a wall license at each place of practice. Existing law establishes that an acupuncturist is responsible for the acupuncture, Asian massage services, or any other specified practice rendered pursuant to the license of the acupuncturist in each place of practice maintained by the acupuncturist.

This bill would delete the requirement that the acupuncturist be responsible for Asian massage services in the provision described above.

Existing law, the Acupuncture Licensure Act, provides for the licensure and regulation of the practice of acupuncture. The act defines various terms for those purposes, including approved educational and training program, which references the Accreditation Commission for Acupuncture and Oriental Medicine.

This bill would define additional terms under the act, including supervising acupuncturist, acupuncture assistant, and basic supportive acupuncture service. The bill would update the reference to the above-described commission, as specified, and would make conforming changes.

Existing law requires the Acupuncture Board, consisting of 7 members, to enforce and administer the act, and repeals this provision on January 1, 2024. Under existing law, that repeal renders the board subject to review by the appropriate policy committees of the Legislature. Existing law makes the protection of the public the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions. Existing law authorizes the board, by and with the approval of the Director of Consumer Affairs, to appoint an executive officer who is exempt from the State Civil Service Act, and repeals this provision on January 1, 2024.

This bill would reorganize and make other nonsubstantive changes to these provisions. The bill would repeal these provisions on January 1, 2028. The bill would additionally authorize the board, or its designee, upon complaint, to inspect specified premises, places of practice, or clinics. The bill would require specified records to be open to inspection by the board, or its designee, during an investigation initiated in response to a complaint that a licensee has violated any law or regulation that constitutes grounds for disciplinary action or issuance of a citation and fine by the board. The bill would require a copy of the above-described records to be provided to the board immediately upon request.

Existing law requires an acupuncturist to obtain and post a wall license at each place of practice. Existing law establishes that an acupuncturist is responsible for the acupuncture, Asian massage services, or any other specified practice rendered pursuant to the license of the acupuncturist in each place of practice maintained by the acupuncturist.

This bill would delete the requirement that the acupuncturist be responsible for Asian massage services in the provision described above.

Existing law, the Acupuncture Licensure Act, provides for the licensure and regulation of the practice of acupuncture. The act defines various terms for those purposes, including approved educational and training program, which references the Accreditation Commission for Acupuncture and Oriental Medicine.

This bill would define additional terms under the act, including supervising acupuncturist, acupuncture assistant, and basic supportive acupuncture service. The bill would update the reference to the above-described commission, as specified, and would make conforming changes.

Existing law requires the Acupuncture Board, consisting of 7 members, to enforce and administer the act, and repeals this provision on January 1, 2024. Under existing law, that repeal renders the board subject to review by the appropriate policy committees of the Legislature. Existing law makes the protection of the public the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions. Existing law authorizes the board, by and with the approval of the Director of Consumer Affairs, to appoint an executive officer who is exempt from the State Civil Service Act, and repeals this provision on January 1, 2024.

This bill would reorganize and make other nonsubstantive changes to these provisions. The bill would repeal these provisions on January 1, 2028. The bill would additionally authorize the board, or its designee, upon complaint, to inspect specified premises, places of practice, or clinics. The bill would require specified records to be open to inspection by the board, or its designee, during an investigation initiated in response to a complaint that a licensee has violated any law or regulation that constitutes grounds for disciplinary action or issuance of a citation and fine by the board. The bill would require a copy of the above-described records to be provided to the board immediately upon request.

Existing law requires an acupuncturist to obtain and post a wall license at each place of practice. Existing law establishes that an acupuncturist is responsible for the acupuncture, Asian massage services, or any other specified practice rendered pursuant to the license of the acupuncturist in each place of practice maintained by the acupuncturist.

This bill would delete the requirement that the acupuncturist be responsible for Asian massage services in the provision described above.

Existing law, the Acupuncture Licensure Act, provides for the licensure and regulation of the practice of acupuncture. Existing The act defines various terms for those purposes, including approved educational and training program, which references the Accreditation Commission for Acupuncture and Oriental Medicine.

Existing law requires the Acupuncture Board, consisting of 7 members, to enforce and administer the act, and repeals this provision on January 1, 2024. Under existing law, that repeal renders the board subject to review by the appropriate policy committees of the Legislature. Existing law makes the protection of the public the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions. Existing law authorizes the board, by and with the approval of the Director of Consumer Affairs, to appoint an executive officer who is exempt from the State Civil Service Act, and repeals this provision on January 1, 2024.

This bill would reorganize and make other nonsubstantive changes to these provisions. The bill would repeal these provisions on January 1, 2028.

Existing law, the Acupuncture Licensure Act, provides for the licensure and regulation of the practice of acupuncture. Existing law requires the Acupuncture Board, consisting of 7 members, to enforce and administer the act, and repeals this provision on January 1, 2024. Under existing law, that repeal renders the board subject to review by the appropriate policy committees of the Legislature. Existing law makes the protection of the public the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions. Existing law authorizes the board, by and with the approval of the Director of Consumer Affairs, to appoint an executive officer who is exempt from the State Civil Service Act, and repeals this provision on January 1, 2024.

This bill would reorganize and make other nonsubstantive changes to these provisions.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1264

Author:(Berman)

As Amended Ver:July 5, 2023

Majority vote

SUMMARY

Extends the sunset date for the California Acupuncture Board (CAB) until January 1, 2028, authorizes acupuncturists to supervise acupuncture assistants, as specified, and makes other changes.

Senate Amendments

1. Authorize the CAB, or its designee, upon complaint, to inspect premises where acupuncture is practice.
2. Require licensee records to be readily open to inspection during an investigations.

COMMENTS

Background. The CAB is a licensing entity within the Department of Consumer Affairs (DCA). The CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists.

An acupuncture license authorizes the holder:

To engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.

Specifically, the Acupuncture Licensing Act defines the following:

1. "Acupuncture" is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."
2. A "Magnet" is a mineral or metal that produces a magnetic field without the application of an electric current.
3. "Plant, animal, and mineral products" are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
4. "Dietary supplement" has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

The CAB is the agency responsible for administering and enforcing the act. The CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

The CAB's mission statement, as stated in its 2018–2022 Strategic Plan, is:

To protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act

According to the Author

Each year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development hold joint sunset review oversight hearings to review the licensing boards under the Department of Consumer Affairs (DCA). The DCA boards are responsible for protecting consumers and the public and regulating the professionals they license. The sunset review process provides an opportunity for the Legislature, DCA, boards, and stakeholders to discuss the performance of the boards and make recommendations for improvements.

Each board subject to review has an enacting statute that has a repeal date, which means each board requires an extension before the repeal date. This bill is one of the "sunset" bills that are intended to extend the repeal date of the boards undergoing sunset review, as well as include the recommendations from the sunset review oversight hearings.

This year, there are four sunset review bills authored by the Assembly Committee on Business and Professions and four sunset review bills authored by the Chair of the Senate Business, Professions and Economic Development Committee.

Arguments in Support

The California Acupuncture Board writes in support:

The four-year extension of the Board by [this bill] allows the Board to continue to operate and to protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act. This is a benefit to the licensed acupuncturists and most of all, consumers of California.

The bill's establishment of acupuncture assistants and the scope of procedures permitted under basic supportive acupuncture services helps guide the profession on the qualifications and standards when an acupuncturist chooses to engage these services. These amendments provide a framework for these services to occur with public safety in mind.

The bill is not establishing a review or approval process for these individuals to provide basic supportive acupuncture services. Therefore, an increase in workload related to licensing, examination, or education oversight is not anticipated. It is possible the Board could receive an insignificant increase in complaints due to the establishment of acupuncture assistants. However, whatever workload increase the Board may see would likely be absorbable within the Board's existing staffing and budget resources. As such, the Board supports [this bill].

Arguments in Opposition

None on file

FISCAL COMMENTS

According to the Senate Appropriations Committee, the 2023-24 Budget Act provides approximately $3.99 million (Acupuncture Fund) and 12.0 positions to support the continued operation of CAB's licensing and enforcement activities.

CAB reports total ongoing costs of approximately $4,000 to review supervising acupuncturist cases involving disciplinary action. CAB notes that while there may be an increase in complaints due to the changes proposed by this bill related to acupuncture assistants and supervising acupuncturists, adjustments and case review costs will likely be minor and absorbable.

VOTES:

ASM BUSINESS AND PROFESSIONS: 16-0-2

YES: Berman, Flora, Alanis, Alvarez, Bonta, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting

ABS, ABST OR NV: Chen, McCarty

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 77-0-3

YES: Addis, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie‑Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

ABS, ABST OR NV: Aguiar-Curry, Mathis, Papan

SENATE FLOOR: 39-0-1

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Caballero

UPDATED

VERSION: July 5, 2023

CONSULTANT: Vincent Chee / B. & P. / (916) 319-3301 FN: 0002042

 THIRD READING  

Bill No: AB 1264

Author: Berman (D), et al.

Amended: 7/5/23 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 12-0, 7/10/23

AYES: Roth, Nguyen, Alvarado-Gil, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Smallwood-Cuevas, Wahab

NO VOTE RECORDED: Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 77-0, 5/25/23 - See last page for vote

SUBJECT: Acupuncture

SOURCE: Author

DIGEST:

This bill authorizes acupuncturists to supervise acupuncture assistants, as specified; authorizes the California Acupuncture Board (Board of CAB), or its designee, upon complaint, to inspect premises, places of practice, or clinics, as specified; subjects the Board to legislative review on or before January 1, 2028; and, makes other technical changes.

ANALYSIS:

Existing law:

1. Regulates the practice of acupuncture under the Acupuncture Licensure Act. (Business and Professions Code (BPC) §§ 4925-4934)
2. Defines “acupuncture” as the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control for the treatment of certain diseases or dysfunctions of the body, and includes the techniques of electroacupuncture, cupping, and moxibustion. (BPC § 4927(d))
3. Establishes the CAB, and Authorizes the CAB to appoint an executive officer until January 1, 2024, to administer and enforce the act. (BPC §§ 4928, 4934)
4. Defines “approved educational and training program” as a school or college offering education and training in the practice of an acupuncturist that meets specified requirements, including accreditation or other pre-accreditation status by the Accreditation Commission for Acupuncture and Oriental Medicine. (BPC § 4927.5)

This bill:

1. Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
2. Defines “supervising acupuncturist” as a person who meets the following conditions:
3. Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
4. Has practiced as a licensed acupuncturist in this state for at least five years.
5. Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
6. Defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
7. Requires supervising acupuncturists to do the following:
8. Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
9. Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
10. Ensure the acupuncture assistant meets the following:
11. Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice or has completed an approved educational and training program.
12. Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program’s Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
13. Defines “basic supportive acupuncture service” as any of the following:
14. Needle removal.
15. Cupping.
16. Moxibustion.
17. Gua sha.
18. The use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
19. Excludes from the definition of “basic supportive acupuncture service” diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
20. Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
21. Permits the Board to inspect the following upon complaint:
22. Any premise in which acupuncture services, as defined, are provided or reasonably suspected of being provided.
23. Any place of practice registered with the board for which a wall license has been issued as defined.
24. Any clinic owned and operated by a school with an approved educational and training program, as defined.
25. Any premise in which acupuncture services, as defined, are provided under a tutorial program, as defined.
26. Requires all records required by law to be kept by an acupuncturist, including, but not limited to, records pertaining to the provision of services to patients, and be open to inspection by the board, or its designee, during an investigation initiated in response to a complaint against a licensee, as specified. A copy of records must be provided to the board immediately upon request.
27. States nothing in 8) or 9) above grants the board jurisdiction over the practice of medicine.
28. Makes other technical and conforming changes.

Background

In early 2023, the Senate Business, Professions and Economic Development Committee and the Assembly Committee on Business and Professions (Committees) began their comprehensive sunset review oversight of eight regulatory entities including the Board. The Committees conducted two oversight hearings in March of this year. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees, and which are reflected in the Background Papers prepared by Committee staff for each agency and program reviewed this year.

The Board is a licensing entity within the DCA. The CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists. An acupuncture license authorizes the holder: To engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health. Specifically, the Acupuncture Licensing Act defines the following:

• “Acupuncture” is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."

• A “Magnet” is a mineral or metal that produces a magnetic field without the application of an electric current.
• “Plant, animal, and mineral products” are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
• “Dietary supplement” has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

The CAB is the agency responsible for administering and enforcing the act. The CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

Currently, the Acupuncture Licensure Act limits the entirety of the practice of acupuncture to licensed acupuncturists unless the unlicensed person is engaged in an acupuncture course or tutorial program or participating in a post-graduate review course. As a result, acupuncturists are not allowed to hire or train acupuncture students in a typical practice. Some stakeholders have requested the authority to supervise senior acupuncture students as “acupuncture assistants,” allowing assistants to perform low-level, non-invasive acupuncture functions in an acupuncture practice, such as the removal of needles or checking pulse or blood pressure. This would be similar to the use of supervised assistants in other professions, such as physical therapy assistants, occupational therapy assistants, and dental assistants, among numerous others. This bill defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.

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

According to the Senate Appropriations Committee, the 2023-24 Budget Act provides approximately $3.99 million and 12.0 positions to support the continued operation of CAB’s licensing and enforcement activities. CAB reports total ongoing costs of approximately $4,000 to review supervising acupuncturist cases involving disciplinary action. CAB notes that while there may be an increase in complaints due to the changes proposed by this bill related to acupuncture assistants and supervising acupuncturists, adjustments and case review costs will likely be minor and absorbable.

SUPPORT: (Verified 9/1/23)

California Acupuncture Board

California Acupuncture Legislative Group

OPPOSITION: (Verified 9/1/23)

None received

ARGUMENTS IN SUPPORT: The California Acupuncture Legislative Group notes that this bill “would add a new position for acupuncture students to work under the direct supervision and instruction of a licensed acupuncturist. The benefits include helping the acupuncturists remove needles, cupping, moxibustion, guasha or other services as listed in the practice act. We feel this is a positive direction for students of acupuncture and East Asian Medicine schools, and for job growth and development.”

CAB notes that “The four-year extension of the Board by AB 1264 allows the Board to continue to operate and to protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act. This is a benefit to the licensed acupuncturists and most of all, consumers of California. The bill’s establishment of acupuncture assistants and the scope of procedures permitted under basic supportive acupuncture services helps guide the profession on the qualifications and standards when an acupuncturist chooses to engage these services. These amendments provide a framework for these services to occur with public safety in mind. The bill is not establishing a review or approval process for these individuals to provide basic supportive acupuncture services. Therefore, an increase in workload related to licensing, examination, or education oversight is not anticipated. It is possible the Board could receive an insignificant increase in complaints due to the establishment of acupuncture assistants. However, whatever workload increase the Board may see would likely be absorbable within the Board’s existing staffing and budget resources.”

ASSEMBLY FLOOR: 77-0, 5/25/23

AYES: Addis, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Aguiar-Curry, Mathis, Papan

Prepared by: Sarah Mason / B., P. & E.D. /

9/2/23 15:01:44

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1264 (Berman) - Acupuncture

Bill Summary:

AB 1264 extends the operation of the California Acupuncture Board (CAB) to January 1, 2028 and makes changes recommended during the joint sunset review of CAB, as specified.

Fiscal Impact:

The 2023-24 Budget Act provides approximately $3.99 million (Acupuncture Fund) and 12.0 positions to support the continued operation of CAB’s licensing and enforcement activities.

CAB reports total ongoing costs of approximately $4,000 to review supervising acupuncturist cases involving disciplinary action. CAB notes that while there may be an increase in complaints due to the changes proposed by this bill related to acupuncture assistants and supervising acupuncturists, adjustments and case review costs will likely be minor and absorbable.

Background:

The CAB is a licensing entity within the Department of Consumer Affairs (DCA). CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The Act is the chapter of laws that establish CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists. CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

An acupuncture license authorizes the holder: to engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health. Specifically, the Acupuncture Licensing Act defines the following:

• “Acupuncture” is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."
• A “Magnet” is a mineral or metal that produces a magnetic field without the application of an electric current.
• “Plant, animal, and mineral products” are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
• “Dietary supplement” has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

Proposed Law:

• Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
• Defines “supervising acupuncturist” as a person who meets the following conditions:
  • Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
  • Has practiced as a licensed acupuncturist in this state for at least five years.
  • Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
• Defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
• Requires supervising acupuncturists to do the following:
  • Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
  • Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
  • Ensure the acupuncture assistant meets the following:
    • Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice or has completed an approved educational and training program.
    • Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program’s Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
• Defines “basic supportive acupuncture service” as any of the following: needle removal; cupping, moxibustion; gua sha; or the use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
• Excludes from the definition of “basic supportive acupuncture service” diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
• Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
• Permits the CAB to inspect the following upon complaint:
  • Any premise in which acupuncture services, as defined, are provided or reasonably suspected of being provided.
  • Any place of practice registered with the board for which a wall license has been issued as defined.
  • Any clinic owned and operated by a school with an approved educational and training program, as defined.
  • Any premise in which acupuncture services, as defined, are provided under a tutorial program, as defined.
• Requires all records required by law to be kept by an acupuncturist, including, but not limited to, records pertaining to the provision of services to patients, and be open to inspection by the CAB, or its designee, during an investigation initiated in response to a complaint against a licensee, as specified. A copy of records must be provided to the board immediately upon request.
• Specifies that CAB does not have jurisdiction over the practice of medicine.
• Makes other technical and conforming changes.

Related Legislation:

SB 812 (Roth, 2023) is the California Tax Education Council sunset bill. SB 812 is pending in Assembly Appropriations Committee.

SB 813 (Roth, 2023) is the Structural Pest Control Board sunset bill. SB 813 is pending in Assembly Appropriations Committee.

SB 814 (Roth, 2023) is the Bureau of Household Goods and Services sunset bill. SB 814 is pending in Assembly Appropriations Committee.

SB 815 (Roth, 2023) is the Medical Board of California sunset bill. SB 815 is pending in Assembly Appropriations Committee.

AB 1257 (Berman, 2023) is the Dental Hygiene Board of California sunset bill. AB 1257 is pending in this committee.

AB 1262 (Berman, 2023) is the Professional Fiduciaries Bureau sunset bill. AB 1262 is pending in this committee.

AB 1263 (Berman, 2023) is the Bureau of Automotive Repair sunset bill. AB 1263 is pending in this committee.

Staff Comments:

The boards and bureaus within the DCA are special fund agencies whose activities are funded by regulatory and license fees and generally receive no support from the General Fund. New legislative mandates, even those modest in scope, may in totality create new cost pressures and impact the entity’s operating costs, future budget requests, or license fees.

According the Background Paper for the CAB, during the CAB’s last sunset review, the CAB’s reserve was declining due to an operational budget deficit. Subsequently, the CAB completed a fee study in August 2019. The fee study observed revenue losses among all of the CAB’s fees and also identified workload that was not supported by the existing fee structure.

In response to the study, the CAB pursued legislation to update its fees during the 2020-21 Legislative Session. Those fees were included in the DCA-supported fee bill, AB 3330 (Calderon, Chapter 359, Statutes of 2020). Since then, the CAB has spent less than its revenue and its reserve appears stable. The CAB currently estimates a reserve of $3.9 million at the end of FY 2023-24, approximately 11.3 months.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1264 (Berman) - Acupuncture

Bill Summary:

AB 1264 extends the operation of the California Acupuncture Board (CAB) to January 1, 2028 and makes changes recommended during the joint sunset review of CAB, as specified.

Fiscal Impact:

The 2023-24 Budget Act provides approximately $3.99 million (Acupuncture Fund) and 12.0 positions to support the continued operation of CAB’s licensing and enforcement activities.

CAB reports total ongoing costs of approximately $4,000 to review supervising acupuncturist cases involving disciplinary action. CAB notes that while there may be an increase in complaints due to the changes proposed by this bill related to acupuncture assistants and supervising acupuncturists, adjustments and case review costs will likely be minor and absorbable.

Background:

The CAB is a licensing entity within the Department of Consumer Affairs (DCA). CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The Act is the chapter of laws that establish CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists. CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

An acupuncture license authorizes the holder: to engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health. Specifically, the Acupuncture Licensing Act defines the following:

• “Acupuncture” is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."
• A “Magnet” is a mineral or metal that produces a magnetic field without the application of an electric current.
• “Plant, animal, and mineral products” are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
• “Dietary supplement” has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

Proposed Law:

• Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
• Defines “supervising acupuncturist” as a person who meets the following conditions:
  • Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
  • Has practiced as a licensed acupuncturist in this state for at least five years.
  • Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
• Defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
• Requires supervising acupuncturists to do the following:
  • Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
  • Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
  • Ensure the acupuncture assistant meets the following:
    • Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice or has completed an approved educational and training program.
    • Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program’s Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
• Defines “basic supportive acupuncture service” as any of the following: needle removal; cupping, moxibustion; gua sha; or the use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
• Excludes from the definition of “basic supportive acupuncture service” diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
• Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
• Permits the CAB to inspect the following upon complaint:
  • Any premise in which acupuncture services, as defined, are provided or reasonably suspected of being provided.
  • Any place of practice registered with the board for which a wall license has been issued as defined.
  • Any clinic owned and operated by a school with an approved educational and training program, as defined.
  • Any premise in which acupuncture services, as defined, are provided under a tutorial program, as defined.
• Requires all records required by law to be kept by an acupuncturist, including, but not limited to, records pertaining to the provision of services to patients, and be open to inspection by the CAB, or its designee, during an investigation initiated in response to a complaint against a licensee, as specified. A copy of records must be provided to the board immediately upon request.
• Specifies that CAB does not have jurisdiction over the practice of medicine.
• Makes other technical and conforming changes.

Related Legislation:

SB 812 (Roth, 2023) is the California Tax Education Council sunset bill. SB 812 is pending in Assembly Appropriations Committee.

SB 813 (Roth, 2023) is the Structural Pest Control Board sunset bill. SB 813 is pending in Assembly Appropriations Committee.

SB 814 (Roth, 2023) is the Bureau of Household Goods and Services sunset bill. SB 814 is pending in Assembly Appropriations Committee.

SB 815 (Roth, 2023) is the Medical Board of California sunset bill. SB 815 is pending in Assembly Appropriations Committee.

AB 1257 (Berman, 2023) is the Dental Hygiene Board of California sunset bill. AB 1257 is pending in this committee.

AB 1262 (Berman, 2023) is the Professional Fiduciaries Bureau sunset bill. AB 1262 is pending in this committee.

AB 1263 (Berman, 2023) is the Bureau of Automotive Repair sunset bill. AB 1263 is pending in this committee.

Staff Comments:

The boards and bureaus within the DCA are special fund agencies whose activities are funded by regulatory and license fees and generally receive no support from the General Fund. New legislative mandates, even those modest in scope, may in totality create new cost pressures and impact the entity’s operating costs, future budget requests, or license fees.

According the Background Paper for the CAB, during the CAB’s last sunset review, the CAB’s reserve was declining due to an operational budget deficit. Subsequently, the CAB completed a fee study in August 2019. The fee study observed revenue losses among all of the CAB’s fees and also identified workload that was not supported by the existing fee structure.

In response to the study, the CAB pursued legislation to update its fees during the 2020-21 Legislative Session. Those fees were included in the DCA-supported fee bill, AB 3330 (Calderon, Chapter 359, Statutes of 2020). Since then, the CAB has spent less than its revenue and its reserve appears stable. The CAB currently estimates a reserve of $3.9 million at the end of FY 2023-24, approximately 11.3 months.

-- END --

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Richard Roth, Chair

2023 - 2024 Regular

Bill No: AB 1264 Hearing Date: July 10, 2023

Subject: Acupuncture

SUMMARY:

Authorizes acupuncturists to supervise acupuncture assistants, as specified; authorizes the California Acupuncture Board (Board of CAB), or its designee, upon complaint, to inspect premises, places of practice, or clinics, as specified; subjects the Board to legislative review on or before January 1, 2028; and, makes other technical changes.

Existing law:

1. Regulates the practice of acupuncture under the Acupuncture Licensure Act. (Business and Professions Code (BPC) §§ 4925-4934)
2. Defines “acupuncture” as the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control for the treatment of certain diseases or dysfunctions of the body, and includes the techniques of electroacupuncture, cupping, and moxibustion. (BPC § 4927(d))
3. Establishes the CAB, and Authorizes the CAB to appoint an executive officer until January 1, 2024, to administer and enforce the act. (BPC §§ 4928, 4934)
4. Defines “approved educational and training program” as a school or college offering education and training in the practice of an acupuncturist that meets specified requirements, including accreditation or other pre-accreditation status by the Accreditation Commission for Acupuncture and Oriental Medicine. (BPC § 4927.5)

This bill:

1. Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
2. Defines “supervising acupuncturist” as a person who meets the following conditions:
3. Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
4. Has practiced as a licensed acupuncturist in this state for at least five years.
5. Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
6. Defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
7. Requires supervising acupuncturists to do the following:
8. Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
9. Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
10. Ensure the acupuncture assistant meets the following:
11. Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice or has completed an approved educational and training program.
12. Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program’s Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
13. Defines “basic supportive acupuncture service” as any of the following:
14. Needle removal.
15. Cupping.
16. Moxibustion.
17. Gua sha.
18. The use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
19. Excludes from the definition of “basic supportive acupuncture service” diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
20. Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
21. Permits the Board to inspect the following upon complaint:
22. Any premise in which acupuncture services, as defined, are provided or reasonably suspected of being provided.
23. Any place of practice registered with the board for which a wall license has been issued as defined.
24. Any clinic owned and operated by a school with an approved educational and training program, as defined.
25. Any premise in which acupuncture services, as defined, are provided under a tutorial program, as defined.
26. Requires all records required by law to be kept by an acupuncturist, including, but not limited to, records pertaining to the provision of services to patients, and be open to inspection by the board, or its designee, during an investigation initiated in response to a complaint against a licensee, as specified. A copy of records must be provided to the board immediately upon request.
27. States nothing in 8) or 9) above grants the board jurisdiction over the practice of medicine.
28. Makes other technical and conforming changes.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Appropriations Committee, “CAB will need to review supervising acupuncturists in the case of disciplinary action, which would require about 40 program analyst hours and about four hours of a member of the CAB’s time to review cases, at a cost of $4,000 (Acupuncture Fund). CAB notes this bill could potentially cause an increase in complaints, however CAB expects adjustments and case review costs will be minor and absorbable. It projects there will need to be on-going special fund costs of approximately $4 million annually (Acupuncture Fund) to extend the sunset date of CAB until January 1, 2028. This fund is fully self-supporting with fee revenue.”

COMMENTS:

1. Purpose. The Author is the Sponsor of this bill. This bill is a result of the joint committee sunset review process.
2. Background.

Oversight Hearings and Sunset Review of Licensing Boards and Programs. In early 2023, the Senate Business, Professions and Economic Development Committee and the Assembly Committee on Business and Professions (Committees) began their comprehensive sunset review oversight of eight regulatory entities including the Board. The Committees conducted two oversight hearings in March of this year. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees, and which are reflected in the Background Papers prepared by Committee staff for each agency and program reviewed this year.

The California Acupuncture Board (CAB or Board). The Board is a licensing entity within the DCA. The CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists. An acupuncture license authorizes the holder: To engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health. Specifically, the Acupuncture Licensing Act defines the following:

• “Acupuncture” is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."

• A “Magnet” is a mineral or metal that produces a magnetic field without the application of an electric current.
• Plant, animal, and mineral products” are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
• “Dietary supplement” has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law. The CAB is the agency responsible for administering and enforcing the act. The CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists. The CAB’s mission statement, as stated in its 2018–2022 Strategic Plan, is:

To protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act.

Review of CAB. CAB was last reviewed as part of the sunset review program in 2018. Due to the constraints of the COVID-19 pandemic on legislative business, the legislature extended the Board’s sunset date by one year, in order to allow for a comprehensive review. The following are some of the issues pertaining to the Board along with background information concerning particular issues. Recommendations noted by Committee staff regarding the particular issue areas that needed to be addressed include the following:

• 1. Sunset Issue # 8: Acupuncture Assistants.

Background.

Currently, the Acupuncture Licensure Act limits the entirety of the practice of acupuncture to licensed acupuncturists unless the unlicensed person is engaged in an acupuncture course or tutorial program or participating in a post-graduate review course. As a result, acupuncturists are not allowed to hire or train acupuncture students in a typical practice. Some stakeholders have requested the authority to supervise senior acupuncture students as “acupuncture assistants,” allowing assistants to perform low-level, non-invasive acupuncture functions in an acupuncture practice, such as the removal of needles or checking pulse or blood pressure. This would be similar to the use of supervised assistants in other professions, such as physical therapy assistants, occupational therapy assistants, and dental assistants, among numerous others.

Recommendation and Proposed Statutory Change. The CAB should update the Committees on any discussions it may have had on the topic and whether there are any immediate patient safety concerns. This bill would define “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.

• 1. Sunset Issue # 10: Technical Changes.

Background.

There may be technical changes necessary to the Acupuncture Licensure Act to help the CAB perform its duties or streamline its processes. For example, the Acupuncture Licensure Act still refers specifically to the entity that approves schools as the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), but in 2021, the entity changed its name to the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM).

Recommendation and Proposed Statutory Change. The CAB should continue to work with the Committees and suggest any technical clean-up that may be needed. This bill will update the name to reflect the current organization approving schools and add language, which would allow for a successor organization to replace if necessary. In addition, this bill will permit the CAB, upon a complaint, to inspect any premise where acupuncture services are provided, any place of practice that has been issued a wall license; any clinic owned and operated by a school with an approved educational and training program, or any premise in which acupuncture services are provided under a tutorial program.

• 1. Sunset Issue # 11: Sunset Extension.

Background.

The CAB continues to work well with the Legislature in implementing its consumer protection mission. This is demonstrated by the CAB’s recent completion of its fee study, occupational analysis, and ongoing improvements consistent with its Strategic Plan, including balancing its budget. While the COVID-19 pandemic created understandable challenges, the CAB should continue to implement its CE auditing processes and monitor the needs of the acupuncture community, such as the availability of affordable and effective CE.

Recommendation and Proposed Statutory Change. The CAB’s regulation of acupuncturists should be continued and reviewed again on a future date to be determined. This bill would extend the date for legislative review to January 1, 2028.

1. Arguments in Support. The California Acupuncture Legislative Group writes in support: “The “California Acupuncture Legislative Group” would like to submit a formal position of “In-Support of” AB 1264 for the following reasons:

“This bill will continue the California Acupuncture Board’s role in consumer protection until January 1, 2028. The CA Acup. Leg. Group fully supports the CAB, and their role in consumer protection and oversight of the acupuncture profession.

The CA Acupuncture Legislative Group agrees to the deletion of the word “Asian Massage Services” as described in Section 8 f (1) of practice act. This is a “repeat” list of words which is already specified in acupuncture practice act, section 4937. The Ca Acup. Leg Group supports this deletion, as long as this deletion does not change the current acupuncture practice act.”

…The proposed bill would add a new position for acupuncture students to work under the direct supervision and instruction of a licensed acupuncturist. The benefits include helping the acupuncturists remove needles, cupping, moxibustion, guasha or other services as listed in the practice act. We feel this is a positive direction for students of acupuncture and East Asian Medicine schools, and for job growth and development.”

CAB notes that “The four-year extension of the Board by AB 1264 allows the Board to continue to operate and to protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act. This is a benefit to the licensed acupuncturists and most of all, consumers of California. The bill’s establishment of acupuncture assistants and the scope of procedures permitted under basic supportive acupuncture services helps guide the profession on the qualifications and standards when an acupuncturist chooses to engage these services. These amendments provide a framework for these services to occur with public safety in mind. The bill is not establishing a review or approval process for these individuals to provide basic supportive acupuncture services. Therefore, an increase in workload related to licensing, examination, or education oversight is not anticipated. It is possible the Board could receive an insignificant increase in complaints due to the establishment of acupuncture assistants. However, whatever workload increase the Board may see would likely be absorbable within the Board’s existing staffing and budget resources.”

SUPPORT AND OPPOSITION:

Support:

California Acupuncture Board

California Acupuncture Legislative Group

Opposition:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1264

Author:(Committee on Business and Professions)

As Amended Ver:April 20, 2023

Majority vote

SUMMARY

Extends the sunset date for the California Acupuncture Board (CAB) until January 1, 2028, authorizes acupuncturists to supervise acupuncture assistants, as specified, and makes other technical changes.

Major Provisions

1. Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
2. Defines "supervising acupuncturist" as a person who meets the following conditions:
   1. Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
   2. Has been practiced as a licensed acupuncturist in this state for at least five years.
   3. Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
3. Defines "acupuncture assistant" as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
4. Requires supervising acupuncturists to do the following:
   1. Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
   2. Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
   3. Ensure the acupuncture assistant meets the following:
      1. Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice.
      2. Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program's Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
5. Defines "basic supportive acupuncture service" as any of the following:
   1. Needle removal.
   2. Cupping.
   3. Moxibustion.
   4. Gua sha.
   5. The use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
6. Excludes from the definition of "basic supportive acupuncture service" diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
7. Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
8. Makes other technical and conforming changes.

COMMENTS

Background. The CAB is a licensing entity within the Department of Consumer Affairs (DCA). The CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists.

An acupuncture license authorizes the holder:

To engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.

Specifically, the Acupuncture Licensing Act defines the following:

1. "Acupuncture" is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."
2. A "Magnet" is a mineral or metal that produces a magnetic field without the application of an electric current.
3. "Plant, animal, and mineral products" are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
4. "Dietary supplement" has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

The CAB is the agency responsible for administering and enforcing the act. The CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

The CAB's mission statement, as stated in its 2018–2022 Strategic Plan, is:

To protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act.

According to the Author

Each year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development hold joint sunset review oversight hearings to review the licensing boards under the Department of Consumer Affairs (DCA). The DCA boards are responsible for protecting consumers and the public and regulating the professionals they license. The sunset review process provides an opportunity for the Legislature, DCA, boards, and stakeholders to discuss the performance of the boards and make recommendations for improvements.

Each board subject to review has an enacting statute that has a repeal date, which means each board requires an extension before the repeal date. This bill is one of the "sunset" bills that are intended to extend the repeal date of the boards undergoing sunset review, as well as include the recommendations from the sunset review oversight hearings.

This year, there are four sunset review bills authored by the Assembly Committee on Business and Professions and four sunset review bills authored by the Chair of the Senate Business, Professions and Economic Development Committee.

Arguments in Support

None on file

Arguments in Opposition

None on file

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. CAB will need to review supervising acupuncturists in the case of disciplinary action, which would require about 40 program analyst hours and about four hours of a member of the CAB's time to review cases, at a cost of $4,000 (Acupuncture Fund). CAB notes this bill could potentially cause an increase in complaints, however CAB expects adjustments and case review costs will be minor and absorbable.
2. On-going special fund costs of approximately $4 million annually (Acupuncture Fund) to extend the sunset date of CAB until January 1, 2028. This fund is fully self-supporting with fee revenue.

VOTES

ASM BUSINESS AND PROFESSIONS: 16-0-2

YES: Berman, Flora, Alanis, Alvarez, Bonta, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting

ABS, ABST OR NV: Chen, McCarty

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: April 20, 2023

CONSULTANT: Vincent Chee / B. & P. / (916) 319-3301 FN: 0000509

Date of Hearing: May 17, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1264

Author:(Committee on Business and Professions) – As Amended Ver:April 20, 2023

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

SUMMARY:

This bill extends the sunset date for the California Acupuncture Board (CAB) until January 1, 2028, defines “supervising acupuncturist,” “acupuncture assistant,” “basic supportive acupuncture service,” and “approved educational and training program,” authorizes acupuncturists to supervise acupuncture assistants, and makes other technical changes. 

FISCAL EFFECT:

1. CAB will need to review supervising acupuncturists in the case of disciplinary action, which would require about 40 program analyst hours and about four hours of a member of the CAB’s time to review cases, at a cost of $4,000 (Acupuncture Fund). CAB notes this bill could potentially cause an increase in complaints, however CAB expects adjustments and case review costs will be minor and absorbable.
2. On-going special fund costs of approximately $4 million annually (Acupuncture Fund) to extend the sunset date of CAB until January 1, 2028. This fund is fully self-supporting with fee revenue.

COMMENTS:

1. Purpose. Each year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development hold joint sunset review oversight hearings to review the licensing boards under the Department of Consumer Affairs (DCA). The DCA boards are responsible for protecting consumers and the public and regulating the professionals they license. The sunset review process provides an opportunity for the Legislature, DCA, boards, and stakeholders to discuss the performance of the boards and make recommendations for improvements.
   
   Each board subject to review has an enacting statute with a repeal date, which means each board requires an extension before the repeal date. This bill is one of the “sunset” bills that are intended to extend the repeal date of the boards undergoing sunset review, as well as include the recommendations from the sunset review oversight hearings.
   
2. Background. CAB is a licensing entity within DCA. CAB is responsible for administering and enforcing the Acupuncture Licensing Act (act). The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists. An acupuncture license authorizes the holder to engage in the practice of acupuncture, perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
   
3. Sunset Extension. According to the Assembly Committee on Business and Professions, CAB continues to work well with the Legislature in implementing its consumer protection mission. This is demonstrated by CAB’s recent completion of its fee study, occupational analysis, and ongoing improvements consistent with its strategic plan, including balancing its budget. While the COVID-19 pandemic created challenges, CAB should continue to implement its auditing processes and monitor the needs of the acupuncture community.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

ABPCA Bill Id:AB 1264

Author:(Committee on Business and Professions) – As Amended Ver:April 20, 2023

SUBJECT: Acupuncture.

SUMMARY: Extends the sunset date for the California Acupuncture Board (CAB) until January 1, 2028, authorizes acupuncturists to supervise acupuncture assistants, as specified, and makes other technical changes.

EXISTING LAW:

1. Regulates the practice of acupuncture under the Acupuncture Licensure Act. (Business and Professions Code (BPC) §§ 4925-4934)
2. Defines “Acupuncture” as the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control for the treatment of certain diseases or dysfunctions of the body, and includes the techniques of electroacupuncture, cupping, and moxibustion. (BPC § 4927(d))
3. Establishes the CAB, until January 1, 2024, to administer and enforce the act. (BPC § 4928)
4. Authorizes the CAB, until January 1, 2024, to appoint an executive officer. (BPC § 4934)
5. Defines “approved educational and training program” as a school or college offering education and training in the practice of an acupuncturist that meets specified requirements, including accreditation or other pre-accreditation status by the Accreditation Commission for Acupuncture and Oriental Medicine. (BPC § 4927.5)

THIS BILL:

1. Extends the CAB and the authority to appoint an executive officer until January 1, 2028.
2. Defines “supervising acupuncturist” as a person who meets the following conditions:
   1. Is licensed to practice acupuncture in this state and that license is current, valid, and has not been suspended, revoked, or otherwise subject to formal disciplinary action unless approved by the CAB.
   2. Has been practiced as a licensed acupuncturist in this state for at least five years.
   3. Is in compliance with local laws substantially related to the qualifications, functions, or duties of an acupuncturist.
3. Defines “acupuncture assistant” as a person who, without a license, may perform basic supportive acupuncture procedures under the supervision and order of an acupuncturist.
4. Requires supervising acupuncturists to do the following:
   1. Be physically present and available in the place of practice during the performance of any ordered basic supportive acupuncture procedures.
   2. Be responsible for the training and overall competency of the acupuncture assistant, including the ability to perform any specific basic supportive acupuncture service.
   3. Ensure the acupuncture assistant meets the following:
      1. Is enrolled in an approved education and training program and has completed at least a minimum of 700 hours of clinical practice.
      2. Holds a certificate in Clean Needle Technique issued by the Council of Colleges of Acupuncture and Herbal Medicine, or its successor entity, or has completed an approved educational and training program’s Clean Needle Technique course using the Council of Colleges of Acupuncture and Herbal Medicine Clean Needle Technique, 7th edition, revised 1/2016.
5. Defines “basic supportive acupuncture service” as any of the following:
   1. Needle removal.
   2. Cupping.
   3. Moxibustion.
   4. Gua sha.
   5. The use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.
6. Excludes from the definition of “basic supportive acupuncture service” diagnosis, point location, needle insertion, electrical stimulation, rendering advice to patients, or any other procedure requiring a similar degree of judgment or skill.
7. Replaces references to the Accreditation Commission for Acupuncture and Oriental Medicine to the Accreditation Commission for Acupuncture and Herbal Medicine, or its successor entity.
8. Makes other technical and conforming changes.

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

COMMENTS:

Purpose. Each year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development hold joint sunset review oversight hearings to review the licensing boards under the Department of Consumer Affairs (DCA). The DCA boards are responsible for protecting consumers and the public and regulating the professionals they license. The sunset review process provides an opportunity for the Legislature, DCA, boards, and stakeholders to discuss the performance of the boards and make recommendations for improvements.

Each board subject to review has an enacting statute that has a repeal date, which means each board requires an extension before the repeal date. This bill is one of the “sunset” bills that are intended to extend the repeal date of the boards undergoing sunset review, as well as include the recommendations from the sunset review oversight hearings.

This year, there are four sunset review bills authored by the Assembly Committee on Business and Professions and four sunset review bills authored by the Chair of the Senate Business, Professions and Economic Development Committee.

Background. The CAB is a licensing entity within the Department of Consumer Affairs (DCA). The CAB is responsible for administering and enforcing the Acupuncture Licensing Act. The act is the chapter of laws that establish the CAB and outlines the regulatory framework for the practice, licensing, education, and discipline of acupuncturists.

An acupuncture license authorizes the holder:

To engage in the practice of acupuncture [and] perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.

Specifically, the Acupuncture Licensing Act defines the following:

• “Acupuncture” is "the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion."
• A “Magnet” is a mineral or metal that produces a magnetic field without the application of an electric current.
• “Plant, animal, and mineral products” are "naturally occurring substances of plant, animal, or mineral origin, except that it does not include synthetic compounds, controlled substances or dangerous drugs."
• “Dietary supplement” has the meaning as under federal law, except that dietary supplement does not include controlled substances or dangerous drugs as defined under state law.

The CAB is the agency responsible for administering and enforcing the act. The CAB is also authorized to establish and clarify licensing procedures and practice standards through administrative rulemaking (the process for issuing regulations). For fiscal year (FY) 2021-22, the CAB reported a total of 11,819 actively licensed acupuncturists.

The CAB’s mission statement, as stated in its 2018–2022 Strategic Plan, is:

To protect the people of California by upholding acupuncture practice standards through the oversight and enforcement of the Acupuncture Licensure Act.

Current Related Legislation. AB 1257 (Business and Professions Committee), which is pending in this committee, is the sunset bill for the Dental Hygiene Board of Califonria and extends the Dental Hygiene Board of California until January 1, 2028, and makes other changes raised during sunset review.

AB 1262 (Business and Professions Committee), which is pending in this committee, is the sunset bill for the Professional Fiduciaries Bureau and extends the sunset date for the Professional Fiduciaries Bureau until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the bureau’s sunset review oversight process.

AB 1263 (Business and Professions Committee), which is pending in this committee, is the sunset bill for the Bureau of Automotive Repair and extends the sunset date for the Bureau of Automotive Repair until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the bureau’s sunset review oversight process.

SB 812 (Roth), which is pending in the Senate, is the sunset review bill for the California Tax Education Council and would council to post a notice of specified claims and links the California Board of Accountancy, the State Bar of California, and the Internal Revenue Service on its social media accounts, to the extent feasible, as specified.

SB 813 (Roth), which is pending in the Senate, is the sunset review bill for the Structural Pest Control Board and requires a registered company to notify the registrar in writing within seven business days when the licensed operator ceases to be connected with the company.

SB 814 (Roth), which is pending in the Senate, is the sunset review bill for the Bureau of Household Goods and Services and would require the Director of Consumer Affairs to conduct spot check investigations, as described above, no less than twice per year.

SB 815 (Roth), which is pending in the Senate, is the sunset review bill for the Medical Board of California and currently makes technical changes.

Prior Related Legislation. AB 3142 (Low), Chapter 596, Statutes of 2018, extended the CAB and the CAB's authority to appoint an executive officer by four years and made various changes to the Acupuncture Licensure Act raised during sunset review.

AB 2190 (Salas), Chapter 667, Statutes of 2016, extended the operation of the CAB and the CAB's authority to appoint an executive officer until January 1, 2019, established processes for the CAB to assess the educational equivalency of license applicants who received their education outside the United States, and made clarifying changes.

SB 1246 (Lieu), Chapter 397, Statues of 2014, extended the CAB and the CAB’s authority to appoint an executive officer until January 1, 2017, and revised acupuncture program approval requirements, including removing the CAB's ability to perform site visits and added national programmatic accreditation as a requirement for acupuncture schools.

SB 1236 (Price), Chapter 332, Statutes of 2012, extended the sunset date for the CAB and other boards under the DCA and the term of the CAB’s executive officer by two years, until January 1, 2015, and made technical and clarifying changes to statutes governing CAB-approved acupuncture training programs.

ARGUMENTS IN SUPPORT:

None on file

ARGUMENTS IN OPPOSITION:

None on file

SUNSET ISSUES FOR CONSIDERATION:

In preparation for the sunset hearings, committee staff public background papers that identify outstanding issues relating to the entity being reviewed. The background paper is available on the Committee’s website: https://abp.assembly.ca.gov/jointsunsethearings. While all of the issues identified in the background paper remain available for discussion, the following are currently being addressed in the amendments to this bill or otherwise actively discussed:

1. Issue #8: Acupuncture Assistants. Currently, the Acupuncture Licensure Act limits the entirety of the practice of acupuncture to licensed acupuncturists unless the unlicensed person is engaged in an acupuncture course or tutorial program or participating in a post-graduate review course. As a result, acupuncturists are not allowed to hire or train acupuncture students in a typical practice.

Some stakeholders have requested the authority to supervise senior acupuncture students as “acupuncture assistants,” allowing assistants to perform low-level, non-invasive acupuncture functions in an acupuncture practice, such as the removal of needles or checking pulse or blood pressure. This would be similar to the use of supervised assistants in other professions, such as physical therapy assistants, occupational therapy assistants, and dental assistants, among numerous others.

Staff Recommendation: The CAB should update the Committees on any discussions it may have had on the topic and whether there are any immediate patient safety concerns.

Board Response:

The Board has not discussed this item in the last 15 years. It appears that this was an item of interest for the Joint Committee on Boards, Commissions, and Consumer Protection as Business and Professions Code section 4934.2(a) required the Board to research and report to said Committee by September 1, 2004 a comprehensive study of the use of unlicensed acupuncture assistants and the need to license and regulate those assistants.

In the examples provided in the background paper for what an assistant could be doing, the only challenge would be for unlicensed individuals removing needles. Board staff have identified possible patient safety concerns from unsupervised practice that may manifest during needle removal or because of inadequate infection control practices.

BPC section 4937 lists modalities that are not solely within an acupuncturist’s scope such that if those assistants have the appropriate training in those modalities, they can carry out those treatments.

CCR section 1399.434(h) does afford an acupuncture student attending an approved educational and training program to earn 25% of their clinical hours in an externship at a private clinic. The supervisor in this environment would be required to be a licensed acupuncturist with at least five years of licensed clinical experience in acupuncture and Asian medicine and have an agreement with an educational and training program. Acupuncture trainees, in an approved acupuncture tutorial program, would also be allowed to work in an acupuncture clinic, under the responsibility of the tutorial program supervisor.

The Board encourages the acupuncture profession to work with acupuncture educational and training programs for hiring qualified externship students, or engaging training tutorial students as a tutorial supervisor, if it is seeking to engage the assistance of individuals who have training in acupuncture prior to licensure.

The Board would need greater details from the profession on what specific practices they are seeking to have acupuncture assistants carry out to ensure that public safety concerns are addressed.

Committee Recommendation: Based on CAB’s response, this bill authorizes the use of acupuncture assistants to provide services provided by acupuncture stakeholders so long as the assistants are supervised students who have clinical experience equivalent to the final year of a terminal degree and have completed infection control training. The specific procedures authorized are:

• 1. Needle removal after placement by the supervising acupuncturist.
  2. Cupping, which is the use of cups on the skin to create suction.
  3. Moxibustion, which is the use of lit mugwart to warm points on the body.
  4. Gua sha, which is the use of a smooth-edged tool to gently scrape skin.
  5. The use of massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health.

1. Issue #10: Technical Changes. There may be technical changes that can be made to the Acupuncture Licensure Act to help the CAB perform its duties or streamline its processes.

For example, the Acupuncture Licensure Act still refers specifically to the entity that approves schools as the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), but in 2021 the entity changed its name to the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM). It would clarify the act to update the name and language allowing for a successor organization.

Staff Recommendation: The CAB should continue to work with the Committees and suggest any technical clean-up that may be needed.

Board Response: The Board requests the Committees’ example to align the current association name, Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM).

In BPC section 4961(f)(1), the Board requests that, “,Asian massage services,” be removed as it is already called out as part of an acupuncturist’s scope in BPC section 4937.

Committee Recommendation: This bill contains the CAB’s recommended technical changes.

1. Sunset Extension. The CAB continues to work well with the Legislature in implementing its consumer protection mission. This is demonstrated by the CAB’s recent completion of its fee study, occupational analysis, and ongoing improvements consistent with its Strategic Plan, including balancing its budget.

While the COVID-19 pandemic created understandable challenges, the CAB should continue to implement its CE auditing processes and monitor the needs of the acupuncture community, such as the availability of affordable and effective CE.

Staff Recommendation: The CAB’s regulation of acupuncturists should be continued and reviewed again on a future date to be determined.

Board Response: Yes, continued regulation and licensure of the practice of Acupuncture by the Board will provide for greater public safety.

Committee Recommendation: This bill extends the CAB by four years.

REGISTERED SUPPORT:

None on file

REGISTERED OPPOSITION:

None on file

Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301