SB 1451: Professions and vocations.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2024-09-22
Current Status:
Passed
(2024-09-22: Chaptered by Secretary of State. Chapter 481, Statutes of 2024.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
What does this bill do?
This bill changes licensing and practice rules for many professions and affects individual license applicants, health care providers, and certain businesses and tribes. Notable updates include clarifying "applicant" means individuals; waiving temporary‑license fees for some military spouses; shortening initial physician licenses to 26 months and tying renewals to postgraduate training; expanding nurse practitioner scope and transition rules; extending pharmacists' authority to furnish oral COVID‑19 drugs to 2026 and adding veterinary drug paperwork; allowing certain LVNs to perform respiratory tasks with training through 2028; and letting federally recognized tribes obtain bureau licenses without Secretary of State filings.
The summary is provided by generative AI which can make mistakes. For original language, please view the details in the table below.
(1)Existing law establishes the Department of Consumer Affairs, which is composed of boards that license and regulate various professions. Existing law imposes certain requirements on those boards to expedite licensure processes, waive specified licensing fees, or issue temporary licenses, depending on the criteria that the applicant satisfies. One of those provisions requires, among other things, the applicant to be, or to have been, an active duty member of the Armed Forces of the United States, as specified. Another provision requires that the applicant hold an out-of-state license in that profession or vocation and be married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. Under a third provisions criteria, the applicant must have been admitted to the United States as a refugee, have been granted asylum, or have a special immigrant visa, as specified.
This bill would specify that the term applicant, for purposes of the above-described provisions, refers to an applicant for an individual license and does not refer to applicants for business or entity licenses. The bill would prohibit a board from charging a fee for the issuance of a temporary license for an applicant who holds an out-of-state license in that profession or vocation and who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. The bill would make conforming changes.
(2)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law requires the dental hygiene board to submit recommendations regarding dental hygiene scope of practice issues to the Dental Board of California for approval, modification, or rejection, and authorizes the dental hygiene board to request the dental board to provide its reasons in writing for rejecting or significantly modifying the recommendation. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would delete the provision requiring the Dental Board of California to approve, modify, or reject, and, if requested by the dental hygiene board, to provide reasons for rejecting or significantly modifying, the above-described recommendations submitted by the dental hygiene board. The bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed and the registered dental hygienist in alternative practice annually provides specified information to certain patients.
(3)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law sets the expiration for a physicians and surgeons license at 12 midnight on the last day of the month in which the license was issued during the second year of a two-year term commencing from the date of issuance. Existing law requires a physician and surgeon issued a license on or after January 1, 2022, at the time of initial license renewal, to show evidence that the licensee has received at least 36 months of board-approved postgraduate training. Existing law authorizes the board to grant an additional 60 days to the expiration date of that initial license.
This bill would instead require an initial physicians and surgeons license issued on or after January 1, 2025, to be for a period of 26 months. The bill would also authorize a physicians and surgeons certificate issued on or after January 1, 2022, to be renewed for the first time if the board receives evidence that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires, and would require evidence at the time of their second renewal that the licensee has received credit for at least 36 months of board-approved postgraduate training. The bill would require the relevant postgraduate training program director to report to the board within 30 days if a licensee who renews their license for the first time pursuant to these provisions is disenrolled from their training program, as specified.
Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O. By expanding the scope of a crime, this bill would impose a state-mandated local program. The bill would also authorize certain persons to use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.
(4)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(5)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to nurse practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner in direct patient care for 3 full-time equivalent years or 4,600 hours within the last 5 years, as indicated on the application, to have satisfied this requirement. The bill would require proof of completion of one transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner practicing under those provisions to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring the nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(6)Existing law, the Pharmacy Law, establishes the California State Board of Pharmacy to license and regulate the practice of pharmacy. Existing law authorizes a pharmacist to provide consultation to a patient about, among other things, drug therapy, disease management, and disease prevention. Existing law, until January 1, 2025, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements.
This bill would require a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs. The bill would extend the operation of the provisions authorizing a pharmacist to furnish COVID-19 oral therapeutics until January 1, 2026.
(7)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the licensed vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(8)Existing law, the Massage Therapy Act, until January 1, 2027, provides for the voluntary certification of massage therapists by the California Massage Therapy Council, a private nonprofit entity. The council is governed by a board of directors composed of 13 members, of which 10 members are appointed by various organizations and associations, as specified. The appointing entities are not required to exercise the right to appoint. The 10 appointed members, at a duly held board meeting in accordance with the boards bylaws, are required to appoint 3 additional members with specified qualifications. Board member terms are 4 years.
This bill would modify those terms to be for 4 years and until the appointment and qualification of a board members successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served 2 terms would not be eligible for reappointment to the board regardless of the appointing authority. The bill would require a board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, to vacate their appointment no later than July 1, 2025. Under the bill, a decision to change the appointing authority of any member appointed to the board would not be effective unless the current member has completed their term under these provisions or the appointment is vacant. The bill would provide that a board member may be removed only by their appointing authority under prescribed conditions.
This bill would move the repeal date of the act to January 1, 2026.
(9)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(10)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(11)Existing law, the Automotive Repair Act, establishes the Bureau of Automotive Repair under the supervision and control of the Director of Consumer Affairs for the registration and regulation of automotive repair dealers. Existing law defines terms for purposes of the act, including defining automotive repair dealer to mean a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees. The act further defines person to include a firm, partnership, association, limited liability company, or corporation. A violation of the act is a crime.
This bill would require the bureau to license a federally recognized tribe, as defined, that applies for licensure and is otherwise compliant with the act for the purpose of engaging in a business regulated by the act. The bill would expand the term person to include a participating tribe and would further define participating tribe to mean a federally recognized tribe that formally applies for licensure from the bureau pursuant to the bill. The bill would exempt a participating tribe from any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement.
(12)Existing law, the Household Movers Act, provides for the licensure and regulation of household movers by the Division of Household Movers within the Bureau of Household Goods and Services. The act prohibits a household mover from engaging in the business of specified transportation of used household goods and personal effects by motor vehicle in the state without a permit issued by the bureau. The act also prohibits a household mover from engaging in the business of the interstate transportation of those items into or out of this state without a valid operating authority issued by the Federal Motor Carrier Safety Administration. The act prohibits the issuance of a permit unless the applicant establishes their knowledge and ability to engage in business as a household mover by examination. The act requires a permit applicant to meet certain residence requirements, as specified.
This bill would exempt an applicant whose principal place of business is not in this state from the residency requirements but would require that the applicant file with the bureau a designation of persons upon whom court or agency process may be served in this state made pursuant to specified federal regulations. The bill would exempt an applicant from examination if they only conduct interstate household moves, but would require the applicant to file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state. The bill would require the bureau to identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
(13)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the Department of Consumer Affairs, which is composed of boards that license and regulate various professions. Existing law imposes certain requirements on those boards to expedite licensure processes, waive specified licensing fees, or issue temporary licenses, depending on the criteria that the applicant satisfies. One of those provisions requires, among other things, the applicant to be, or to have been, an active duty member of the Armed Forces of the United States, as specified. Another provision requires that the applicant hold an out-of-state license in that profession or vocation and be married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. Under a third provisions criteria, the applicant must have been admitted to the United States as a refugee, have been granted asylum, or have a special immigrant visa, as specified.
This bill would specify that the term applicant, for purposes of the above-described provisions, refers to an applicant for an individual license and does not refer to applicants for business or entity licenses. The bill would prohibit a board from charging a fee for the issuance of a temporary license for an applicant who holds an out-of-state license in that profession or vocation and who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. The bill would make conforming changes.
(2)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law requires the dental hygiene board to submit recommendations regarding dental hygiene scope of practice issues to the Dental Board of California for approval, modification, or rejection, and authorizes the dental hygiene board to request the dental board to provide its reasons in writing for rejecting or significantly modifying the recommendation. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would delete the provision requiring the Dental Board of California to approve, modify, or reject, and, if requested by the dental hygiene board, to provide reasons for rejecting or significantly modifying, the above-described recommendations submitted by the dental hygiene board. The bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed and the registered dental hygienist in alternative practice annually provides specified information to certain patients.
(3)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law sets the expiration for a physicians and surgeons license at 12 midnight on the last day of the month in which the license was issued during the second year of a two-year term commencing from the date of issuance. Existing law requires a physician and surgeon issued a license on or after January 1, 2022, at the time of initial license renewal, to show evidence that the licensee has received at least 36 months of board-approved postgraduate training. Existing law authorizes the board to grant an additional 60 days to the expiration date of that initial license.
This bill would instead require an initial physicians and surgeons license issued on or after January 1, 2025, to be for a period of 26 months. The bill would also authorize a physicians and surgeons certificate issued on or after January 1, 2022, to be renewed for the first time if the board receives evidence that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires, and would require evidence at the time of their second renewal that the licensee has received credit for at least 36 months of board-approved postgraduate training. The bill would require the relevant postgraduate training program director to report to the board within 30 days if a licensee who renews their license for the first time pursuant to these provisions is disenrolled from their training program, as specified.
Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O. By expanding the scope of a crime, this bill would impose a state-mandated local program. The bill would also authorize certain persons to use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.
(4)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(5)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to nurse practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner in direct patient care for 3 full-time equivalent years or 4,600 hours within the last 5 years, as indicated on the application, to have satisfied this requirement. The bill would require proof of completion of one transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner practicing under those provisions to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring the nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(6)Existing law, the Pharmacy Law, establishes the California State Board of Pharmacy to license and regulate the practice of pharmacy. Existing law authorizes a pharmacist to provide consultation to a patient about, among other things, drug therapy, disease management, and disease prevention. Existing law, until January 1, 2025, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements.
This bill would require a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs. The bill would extend the operation of the provisions authorizing a pharmacist to furnish COVID-19 oral therapeutics until January 1, 2026.
(7)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the licensed vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(8)Existing law, the Massage Therapy Act, until January 1, 2027, provides for the voluntary certification of massage therapists by the California Massage Therapy Council, a private nonprofit entity. The council is governed by a board of directors composed of 13 members, of which 10 members are appointed by various organizations and associations, as specified. The appointing entities are not required to exercise the right to appoint. The 10 appointed members, at a duly held board meeting in accordance with the boards bylaws, are required to appoint 3 additional members with specified qualifications. Board member terms are 4 years.
This bill would modify those terms to be for 4 years and until the appointment and qualification of a board members successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served 2 terms would not be eligible for reappointment to the board regardless of the appointing authority. The bill would require a board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, to vacate their appointment no later than July 1, 2025. Under the bill, a decision to change the appointing authority of any member appointed to the board would not be effective unless the current member has completed their term under these provisions or the appointment is vacant. The bill would provide that a board member may be removed only by their appointing authority under prescribed conditions.
This bill would move the repeal date of the act to January 1, 2026.
(9)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(10)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(11)Existing law, the Automotive Repair Act, establishes the Bureau of Automotive Repair under the supervision and control of the Director of Consumer Affairs for the registration and regulation of automotive repair dealers. Existing law defines terms for purposes of the act, including defining automotive repair dealer to mean a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees. The act further defines person to include a firm, partnership, association, limited liability company, or corporation. A violation of the act is a crime.
This bill would require the bureau to license a federally recognized tribe, as defined, that applies for licensure and is otherwise compliant with the act for the purpose of engaging in a business regulated by the act. The bill would expand the term person to include a participating tribe and would further define participating tribe to mean a federally recognized tribe that formally applies for licensure from the bureau pursuant to the bill. The bill would exempt a participating tribe from any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement.
(12)Existing law, the Household Movers Act, provides for the licensure and regulation of household movers by the Division of Household Movers within the Bureau of Household Goods and Services. The act prohibits a household mover from engaging in the business of specified transportation of used household goods and personal effects by motor vehicle in the state without a permit issued by the bureau. The act also prohibits a household mover from engaging in the business of the interstate transportation of those items into or out of this state without a valid operating authority issued by the Federal Motor Carrier Safety Administration. The act prohibits the issuance of a permit unless the applicant establishes their knowledge and ability to engage in business as a household mover by examination. The act requires a permit applicant to meet certain residence requirements, as specified.
This bill would exempt an applicant whose principal place of business is not in this state from the residency requirements but would require that the applicant file with the bureau a designation of persons upon whom court or agency process may be served in this state made pursuant to specified federal regulations. The bill would exempt an applicant from examination if they only conduct interstate household moves, but would require the applicant to file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state. The bill would require the bureau to identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
(13)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the Department of Consumer Affairs, which is composed of boards that license and regulate various professions. Existing law imposes certain requirements on those boards to expedite licensure processes, waive specified licensing fees, or issue temporary licenses, depending on the criteria that the applicant satisfies. One of those provisions requires, among other things, the applicant to be, or to have been, an active duty member of the Armed Forces of the United States, as specified. Another provision requires that the applicant hold an out-of-state license in that profession or vocation and be married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. Under a third provisions criteria, the applicant must have been admitted to the United States as a refugee, have been granted asylum, or have a special immigrant visa, as specified.
This bill would specify that the term applicant, for purposes of the above-described provisions, refers to an applicant for an individual license and does not refer to applicants for business or entity licenses. The bill would prohibit a board from charging a fee for the issuance of a temporary license for an applicant who holds an out-of-state license in that profession or vocation and who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. The bill would make conforming changes.
(2)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law requires the dental hygiene board to submit recommendations regarding dental hygiene scope of practice issues to the Dental Board of California for approval, modification, or rejection, and authorizes the dental hygiene board to request the dental board to provide its reasons in writing for rejecting or significantly modifying the recommendation. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would delete the provision requiring the Dental Board of California to approve, modify, or reject, and, if requested by the dental hygiene board, to provide reasons for rejecting or significantly modifying, the above-described recommendations submitted by the dental hygiene board. The bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed and the registered dental hygienist in alternative practice annually provides specified information to certain patients.
(3)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law sets the expiration for a physicians and surgeons license at 12 midnight on the last day of the month in which the license was issued during the second year of a two-year term commencing from the date of issuance. Existing law requires a physician and surgeon issued a license on or after January 1, 2022, at the time of initial license renewal, to show evidence that the licensee has received at least 36 months of board-approved postgraduate training. Existing law authorizes the board to grant an additional 60 days to the expiration date of that initial license.
This bill would instead require an initial physicians and surgeons license issued on or after January 1, 2025, to be for a period of 26 months. The bill would also authorize a physicians and surgeons certificate issued on or after January 1, 2022, to be renewed for the first time if the board receives evidence that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires, and would require evidence at the time of their second renewal that the licensee has received credit for at least 36 months of board-approved postgraduate training. The bill would require the relevant postgraduate training program director to report to the board within 30 days if a licensee who renews their license for the first time pursuant to these provisions is disenrolled from their training program, as specified.
Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O. By expanding the scope of a crime, this bill would impose a state-mandated local program. The bill would also authorize certain persons to use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.
(4)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(5)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to nurse practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner in direct patient care for 3 full-time equivalent years or 4,600 hours within the last 5 years, as indicated on the application, to have satisfied this requirement. The bill would require proof of completion of one transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner practicing under those provisions to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring the nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(6)Existing law, the Pharmacy Law, establishes the California State Board of Pharmacy to license and regulate the practice of pharmacy. Existing law authorizes a pharmacist to provide consultation to a patient about, among other things, drug therapy, disease management, and disease prevention. Existing law, until January 1, 2025, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements.
This bill would require a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs. The bill would extend the operation of the provisions authorizing a pharmacist to furnish COVID-19 oral therapeutics until January 1, 2026.
(7)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the licensed vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(8)Existing law, the Massage Therapy Act, until January 1, 2027, provides for the voluntary certification of massage therapists by the California Massage Therapy Council, a private nonprofit entity. The council is governed by a board of directors composed of 13 members, of which 10 members are appointed by various organizations and associations, as specified. The appointing entities are not required to exercise the right to appoint. The 10 appointed members, at a duly held board meeting in accordance with the boards bylaws, are required to appoint 3 additional members with specified qualifications. Board member terms are 4 years.
This bill would modify those terms to be for 4 years and until the appointment and qualification of a board members successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served 2 terms would not be eligible for reappointment to the board regardless of the appointing authority. The bill would require a board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, to vacate their appointment no later than July 1, 2025. Under the bill, a decision to change the appointing authority of any member appointed to the board would not be effective unless the current member has completed their term under these provisions or the appointment is vacant. The bill would provide that a board member may be removed only by their appointing authority under prescribed conditions.
This bill would move the repeal date of the act to January 1, 2026.
(9)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(10)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(11)Existing law, the Automotive Repair Act, establishes the Bureau of Automotive Repair under the supervision and control of the Director of Consumer Affairs for the registration and regulation of automotive repair dealers. Existing law defines terms for purposes of the act, including defining automotive repair dealer to mean a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees. The act further defines person to include a firm, partnership, association, limited liability company, or corporation. A violation of the act is a crime.
This bill would require the bureau to license a federally recognized tribe, as defined, that applies for licensure and is otherwise compliant with the act for the purpose of engaging in a business regulated by the act. The bill would expand the term person to include a participating tribe and would further define participating tribe to mean a federally recognized tribe that formally applies for licensure from the bureau pursuant to the bill. The bill would exempt a participating tribe from any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement.
(12)Existing law, the Household Movers Act, provides for the licensure and regulation of household movers by the Division of Household Movers within the Bureau of Household Goods and Services. The act prohibits a household mover from engaging in the business of specified transportation of used household goods and personal effects by motor vehicle in the state without a permit issued by the bureau. The act also prohibits a household mover from engaging in the business of the interstate transportation of those items into or out of this state without a valid operating authority issued by the Federal Motor Carrier Safety Administration. The act prohibits the issuance of a permit unless the applicant establishes their knowledge and ability to engage in business as a household mover by examination. The act requires a permit applicant to meet certain residence requirements, as specified.
This bill would exempt an applicant whose principal place of business is not in this state from the residency requirements but would require that the applicant file with the bureau a designation of persons upon whom court or agency process may be served in this state made pursuant to specified federal regulations. The bill would exempt an applicant from examination if they only conduct interstate household moves, but would require the applicant to file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state. The bill would require the bureau to identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
(13)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law establishes the Department of Consumer Affairs, which is composed of boards that license and regulate various professions. Existing law imposes certain requirements on those boards to expedite licensure processes, waive specified licensing fees, or issue temporary licenses, depending on the criteria that the applicant satisfies. One of those provisions requires, among other things, the applicant to be, or to have been, an active duty member of the Armed Forces of the United States, as specified. Another provision requires that the applicant hold an out-of-state license in that profession or vocation and be married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. Under a third provisions criteria, the applicant must have been admitted to the United States as a refugee, have been granted asylum, or have a special immigrant visa, as specified.
This bill would specify that the term applicant, for purposes of the above-described provisions, refers to an applicant for an individual license and does not refer to applicants for business or entity licenses. The bill would prohibit a board from charging a fee for the issuance of a temporary license for an applicant who holds an out-of-state license in that profession or vocation and who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces, as specified. The bill would make conforming changes.
(1)(2)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law requires the dental hygiene board to submit recommendations regarding dental hygiene scope of practice issues to the Dental Board of California for approval, modification, or rejection, and authorizes the dental hygiene board to request the dental board to provide its reasons in writing for rejecting or significantly modifying the recommendation. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would delete the provision requiring the Dental Board of California to approve, modify, or reject, and, if requested by the dental hygiene board, to provide reasons for rejecting or significantly modifying, the above-described recommendations submitted by the dental hygiene board. The bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed and the registered dental hygienist in alternative practice annually provides specified information to certain patients.
(2)(3)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law makes sets the expiration for a physicians and surgeons license at 12 midnight on the last day of the month in which the license was issued during the second year of a two-year term commencing from the date of issuance. Existing law requires a physician and surgeon issued a license on or after January 1, 2022, at the time of initial license renewal, to show evidence that the licensee has received at least 36 months of board-approved postgraduate training. Existing law authorizes the board to grant an additional 60 days to the expiration date of that initial license.
This bill would instead require an initial physicians and surgeons license issued on or after January 1, 2025, to be for a period of 26 months. The bill would also authorize a physicians and surgeons certificate issued on or after January 1, 2022, to be renewed for the first time if the board receives evidence that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires, and would require evidence at the time of their second renewal that the licensee has received credit for at least 36 months of board-approved postgraduate training. The bill would require the relevant postgraduate training program director to report to the board within 30 days if a licensee who renews their license for the first time pursuant to these provisions is disenrolled from their training program, as specified.
Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O. By expanding the scope of a crime, this bill would impose a state-mandated local program. The bill would also authorize certain persons to use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.
(3)(4)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(4)(5)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to nurse practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner in direct patient care for 3 full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, indicated on the application, to have satisfied this requirement. The bill would require proof of completion of one transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner practicing under those provisions to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring the nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(5)(6)Existing law, the Pharmacy Law, establishes the California State Board of Pharmacy to license and regulate the practice of pharmacy. Existing law authorizes a pharmacist to provide consultation to a patient about, among other things, drug therapy, disease management, and disease prevention. Existing law, until January 1, 2025, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements.
This bill would require a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs. The bill would extend the operation of the provisions authorizing a pharmacist to furnish COVID-19 oral therapeutics until January 1, 2026.
(6)(7)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the licensed vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(8)Existing law, the Massage Therapy Act, until January 1, 2027, provides for the voluntary certification of massage therapists by the California Massage Therapy Council, a private nonprofit entity. The council is governed by a board of directors composed of 13 members, of which 10 members are appointed by various organizations and associations, as specified. The appointing entities are not required to exercise the right to appoint. The 10 appointed members, at a duly held board meeting in accordance with the boards bylaws, are required to appoint 3 additional members with specified qualifications. Board member terms are 4 years.
This bill would modify those terms to be for 4 years and until the appointment and qualification of a board members successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served 2 terms would not be eligible for reappointment to the board regardless of the appointing authority. The bill would require a board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, to vacate their appointment no later than July 1, 2025. Under the bill, a decision to change the appointing authority of any member appointed to the board would not be effective unless the current member has completed their term under these provisions or the appointment is vacant. The bill would provide that a board member may be removed only by their appointing authority under prescribed conditions.
This bill would move the repeal date of the act to January 1, 2026.
(7)(9)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(8)(10)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(11)Existing law, the Automotive Repair Act, establishes the Bureau of Automotive Repair under the supervision and control of the Director of Consumer Affairs for the registration and regulation of automotive repair dealers. Existing law defines terms for purposes of the act, including defining automotive repair dealer to mean a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees. The act further defines person to include a firm, partnership, association, limited liability company, or corporation. A violation of the act is a crime.
This bill would require the bureau to license a federally recognized tribe, as defined, that applies for licensure and is otherwise compliant with the act for the purpose of engaging in a business regulated by the act. The bill would expand the term person to include a participating tribe and would further define participating tribe to mean a federally recognized tribe that formally applies for licensure from the bureau pursuant to the bill. The bill would exempt a participating tribe from any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement.
(12)Existing law, the Household Movers Act, provides for the licensure and regulation of household movers by the Division of Household Movers within the Bureau of Household Goods and Services. The act prohibits a household mover from engaging in the business of specified transportation of used household goods and personal effects by motor vehicle in the state without a permit issued by the bureau. The act also prohibits a household mover from engaging in the business of the interstate transportation of those items into or out of this state without a valid operating authority issued by the Federal Motor Carrier Safety Administration. The act prohibits the issuance of a permit unless the applicant establishes their knowledge and ability to engage in business as a household mover by examination. The act requires a permit applicant to meet certain residence requirements, as specified.
This bill would exempt an applicant whose principal place of business is not in this state from the residency requirements but would require that the applicant file with the bureau a designation of persons upon whom court or agency process may be served in this state made pursuant to specified federal regulations. The bill would exempt an applicant from examination if they only conduct interstate household moves, but would require the applicant to file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state. The bill would require the bureau to identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
(9)(13)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed. removed and the registered dental hygienist in alternative practice annually provides specified information to certain patients.
(2)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O.. D.O. By expanding the scope of a crime, this bill would impose a state-mandated local program. The bill would also authorize certain persons to use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.
(3)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(4)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to Nurse Practitioners. nurse practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner in direct patient care for 3 full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, to have satisfied this requirement. The bill would require proof of completion of a one transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner practicing under those provisions to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring a the nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(5)Existing law, the Pharmacy Law, establishes the California State Board of Pharmacy to license and regulate the practice of pharmacy. Existing law authorizes a pharmacist to provide consultation to a patient about, among other things, drug therapy, disease management, and disease prevention.
This bill would require a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
(5)(6)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the license licensed vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(6)(7)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(7)(8)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(8)(9)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed.
(2)Existing law, the Medical Practice Act, establishes the Medical Board of California for the licensure and regulation of physicians and surgeons. Existing law makes it a misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.
This bill would add the initials D.O. to the list of prohibited terms under that provision. The bill would also prohibit a person from using the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that the person is a licensed M.D. or D.O.. By expanding the scope of a crime, this bill would impose a state-mandated local program.
(2)(3)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(4)Existing law establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the board on matters relating to Nurse Practitioners. Existing law requires the board, by regulation, to define minimum standards for transition to practice, as defined, and provides that clinical experience may include experience obtained before January 1, 2021, if the experience meets requirements established by the board.
This bill would specify that, for purposes of transition to practice, clinical experience shall not be limited to experience in a single category in which a nurse practitioner may practice, as specified, and would prohibit experience obtained before a person is certified as a nurse practitioner from being considered clinical experience for purposes of transition to practice requirements.
Existing law authorizes a nurse practitioner to perform specified functions without standardized procedures if the nurse practitioner satisfies certain requirements, including having completed a transition to practice in California of 3 full-time equivalent years of practice, or 4,600 hours.
This bill would deem a nurse practitioner who has been practicing as a nurse practitioner for 3 full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, to have satisfied this requirement. The bill would require proof of completion of a transition to practice to be provided to the board as an attestation from either a licensed physician and surgeon or a nurse practitioner. The bill would prohibit the board from requiring a nurse practitioner to tell a patient that the patient has a right to see a physician and surgeon, and would delete a provision requiring a nurse practitioner to use a certain phrase to inform Spanish language speakers that the nurse practitioner is not a physician and surgeon.
(3)(5)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the license vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(4)(6)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(5)(7)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(8)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the Dental Practice Act, establishes the Dental Hygiene Board of California to license and regulate dental hygienists. Existing law authorizes a registered dental hygienist in alternative practice to perform specified duties in dental health professional shortage areas, as certified by the Department of Health Care Access and Information, in accordance with specified guidelines.
This bill would authorize a registered dental hygienist in alternative practice with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if certification by the department is removed.
(2)Existing law, the Nursing Practice Act, provides for the licensure and certification of nurse practitioners by the Board of Registered Nursing. Existing law requires the Office of Professional Examination Services in the Department of Consumer Affairs, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing specified functions, and requires the board and the office to assess the alignment of competencies tested in the national nurse practitioner certification examination with the occupational analysis.
This bill would make the provision requiring the assessment of the alignment of competencies inapplicable to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)Existing law, the Respiratory Care Practice Act, establishes the Respiratory Care Board of California to license and regulate the practice of respiratory care. Existing law authorizes a licensed vocational nurse who is employed by a home health agency to perform respiratory tasks and services identified by the board if, on or before January 1, 2025, the licensed vocational nurse has completed patient-specific training satisfactory to their employer, and, on and after January 1, 2025, the licensed vocational nurse has completed that training in accordance with guidelines promulgated by the Respiratory Care Board of California, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
This bill would extend those dates to January 1, 2028. The bill, on and after January 1, 2028, would also authorize a licensed vocational nurse to perform respiratory care services identified by the board while practicing in certain settings identified in the bill if the license vocational nurse has completed patient-specific training satisfactory to their employer and holds a current and valid certification of competency for each respiratory task to be performed, as specified.
(4)Existing law, the Barbering and Cosmetology Act, establishes the State Board of Barbering and Cosmetology to license and regulate barbering and cosmetology, and establishes a hairstylist application and examination fee of $50 or a fee determined by the board, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination.
This bill would instead require the hairstylist application and examination fee to be the actual cost to the board for developing, purchasing, grading, and administering the examination, and would establish that an initial licensee fee for a hairstylist shall be not more than $50.
(5)Existing law establishes the Structural Pest Control Board in the Department of Consumer Affairs to license and regulate structural pest control operators, structural pest control field representatives, and structural pest control applicators. Existing law requires those licensees, as a condition of license renewal, to submit proof to the board that they have informed themselves of the developments in the field of pest control by completing continuing education courses or equivalent activity approved by the board, or taking and completing an examination given by the board, as specified.
This bill would delete the authorization for a licenseholder to take and complete an examination given by the board to satisfy that requirement.
(a)Notwithstanding any other law, on and after July 1, 2016, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant has served as an active duty member of the Armed Forces of the United States and was honorably discharged.
(b)Notwithstanding any other law, on and after July 1, 2024, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant is an active duty member of a regular component of the Armed Forces of the United States enrolled in the United States Department of Defense SkillBridge program as authorized under Section 1143(e) of Title 10 of the United States Code.
(c)A board may adopt regulations necessary to administer this section in accordance with the provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 2.Section 115.5 of the Business and Professions Code is amended to read:115.5.(a)A board within the department shall expedite the licensure process and waive the licensure application fee and the initial or original license fee charged by the board for an applicant who meets both of the following requirements:
(1)Supplies evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)Holds a current license in another state, district, or territory of the United States in the profession or vocation for which the applicant seeks a license from the board.
(b)A board may adopt regulations necessary to administer this section.
(c)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 3.Section 115.6 of the Business and Professions Code is amended to read:115.6.(a)(1)Except as provided in subdivision (j), a board within the department shall, after appropriate investigation, issue a temporary license to practice a profession or vocation to an applicant who meets the requirements set forth in subdivisions (c) and (d).
(2)Revenues from fees for temporary licenses issued by the California Board of Accountancy shall be credited to the Accountancy Fund in accordance with Section 5132.
(b)The board may conduct an investigation of an applicant for purposes of denying or revoking a temporary license issued pursuant to this section. This investigation may include a criminal background check.
(c)An applicant seeking a temporary license pursuant to this section shall meet the following requirements:
(1)The applicant shall supply evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)The applicant shall hold a current, active, and unrestricted license that confers upon the applicant the authority to practice, in another state, district, or territory of the United States, the profession or vocation within the same scope for which the applicant seeks a temporary license from the board.
(3)The applicant shall submit an application to the board that shall include a signed affidavit attesting to the fact that the applicant meets all of the requirements for the temporary license, and that the information submitted in the application is accurate, to the best of the applicants knowledge. The application shall also include written verification from the applicants original licensing jurisdiction stating that the applicants license is in good standing in that jurisdiction.
(4)The applicant shall not have committed an act in any jurisdiction that would have constituted grounds for denial, suspension, or revocation of the license under this code at the time the act was committed. A violation of this paragraph may be grounds for the denial or revocation of a temporary license issued by the board.
(5)The applicant shall not have been disciplined by a licensing entity in another jurisdiction and shall not be the subject of an unresolved complaint, review procedure, or disciplinary proceeding conducted by a licensing entity in another jurisdiction.
(6)(A)The applicant shall, upon request by a board, furnish a full set of fingerprints for purposes of conducting a criminal background check.
(B)The board shall request a fingerprint-based criminal history information check from the Department of Justice in accordance with subdivision (u) of Section 11105 of the Penal Code and the Department of Justice shall furnish state or federal criminal history information in accordance with subdivision (p) of Section 11105 of the Penal Code.
(d)The applicant shall pass a California law and ethics examination if otherwise required by the board for the profession or vocation for which the applicant seeks licensure.
(e)Except as specified in subdivision (g), a board shall issue a temporary license pursuant to this section within 30 days of receiving documentation that the applicant has met the requirements specified in subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(f)(1)A temporary license issued pursuant to this section may be immediately terminated upon a finding that the temporary licenseholder failed to meet any of the requirements described in subdivision (c) or (d) or provided substantively inaccurate information that would affect the persons eligibility for temporary licensure. Upon termination of the temporary license, the board shall issue a notice of termination that shall require the temporary licenseholder to immediately cease the practice of the licensed profession upon receipt.
(2)Notwithstanding any other law, if, after notice and an opportunity to be heard, a board finds that a temporary licenseholder engaged in unprofessional conduct or any other act that is a cause for discipline by the board, the board shall revoke the temporary license.
(g)An applicant seeking a temporary license as a civil engineer, geotechnical engineer, structural engineer, land surveyor, professional geologist, professional geophysicist, certified engineering geologist, or certified hydrogeologist pursuant to this section shall successfully pass the appropriate California-specific examination or examinations required for licensure in those respective professions by the Board for Professional Engineers, Land Surveyors, and Geologists. The board shall issue a temporary license pursuant to this subdivision within 30 days of receiving documentation that the applicant has met the requirements specified in this subdivision and subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(h)A temporary license issued pursuant to this section is nonrenewable and shall expire 12 months after issuance, upon issuance or denial of a standard license, upon issuance or denial of a license by endorsement, or upon issuance or denial of an expedited license pursuant to Section 115.5, whichever occurs first.
(i)A board shall submit to the department for approval, if necessary to implement this section, draft regulations necessary to administer this section. These regulations shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(j)(1)This section shall not apply to a board that has a process in place by which an out-of-state licensed applicant in good standing who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States is able to receive expedited, temporary authorization to practice while meeting state-specific requirements for a period of at least one year or is able to receive an expedited license by endorsement with no additional requirements superseding those described in subdivisions (c) and (d).
(2)This section shall apply only to the extent that it does not amend an initiative or violate constitutional requirements.
(k)An applicant for a temporary license pursuant to this section shall not be required to provide, and no board shall collect, a fee for the application or issuance of a temporary license.
(l)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 4.Section 135.4 of the Business and Professions Code is amended to read:135.4.(a)Notwithstanding any other law, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that they have been admitted to the United States as a refugee under Section 1157 of Title 8 of the United States Code, have been granted asylum by the Secretary of Homeland Security or the Attorney General of the United States pursuant to Section 1158 of Title 8 of the United States Code, or they have a special immigrant visa (SIV) that has been granted a status under Section 1244 of Public Law 110-181, under Public Law 109-163, or under Section 602(b) of Title VI of Division F of Public Law 111-8.
(b)Nothing in this section shall be construed as changing existing licensure requirements. A person applying for expedited licensure under subdivision (a) shall meet all applicable statutory and regulatory licensure requirements.
(c)A board may adopt regulations necessary to administer this section.
(d)For purposes of this section, applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 5.Section 1905.2 of the Business and Professions Code is repealed.SEC. 6.Section 1926 of the Business and Professions Code is amended to read:1926.In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services, and shall annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
(e)Dental offices.
SEC. 7.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that the person is entitled to practice hereunder, or who represents or holds themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(4)A person holding a current and active license under this division or any initiative act referred to in this division, to the extent the use of the title is consistent with the act governing the practice of that license.
(5)A person whose use of the word doctor or the prefix Dr. is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500.
SEC. 8.Section 2097.5 is added to the Business and Professions Code, to read:2097.5.(a)(1)Notwithstanding Section 2097, a physicians and surgeons license may be renewed for the first time if the board receives evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires.
(2)The relevant postgraduate training program director shall report to the board within 30 days, on a form approved by the board, if a licensee who renews their license pursuant to this subdivision is disenrolled from their training program for any reason, including, but not limited to, resignation, termination, or graduation.
(b)If a physicians and surgeons license is initially renewed pursuant to subdivision (a), then, at the time of their second renewal, in addition to any other requirements, the board shall require evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training, pursuant to the attestation of the program director, designated institutional official, or delegated authority for the approved postgraduate training program where the applicant participated. A licensee who fails to meet the requirements of this subdivision shall be automatically placed in delinquent status by the board.
(c)If a physicians and surgeons license is initially renewed pursuant to subdivision (a) and the licensee is disenrolled from the relevant California board-approved postgraduate training program, the board may place the relevant license in delinquent status if the board does not receive evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training. If placed on delinquent status, that license shall be returned to current status upon the board receiving evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program or has received credit for at least 36 months of board-approved postgraduate training before their license changes to canceled status, pursuant to Section 2428. Any license status change made pursuant to this subdivision shall not relieve the licensee of the license renewal requirements of subdivision (b).
(d)(1)Notwithstanding any other law, the board shall issue an initial physicians and surgeons license for a period of 26 months.
(2)A renewed physicians and surgeons license shall be subject to the requirements of Section 2423.
(e)Upon review of supporting documentation, the board, in its discretion, may renew a physicians and surgeons license for an applicant who has demonstrated substantial compliance with this section.
(f)A physician whose license is canceled or who surrenders their license prior to meeting the renewal requirements of either subdivision (b) or (c) is subject to the reinstatement requirements of subdivision (e) of Section 2097.
(g)(1)Except as provided in paragraph (2), this section only applies to individuals who are issued an initial physicians and surgeons license by the board on or after January 1, 2022.
(2)Paragraph (1) of subdivision (d) only applies to individuals who are issued an initial license on or after January 1, 2025.
(h)This section shall not apply to the Osteopathic Medical Board of California.
SEC. 9.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 10.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as indicated on the application, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of one transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation pursuant to this section unless the attestation was produced fraudulently.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 11.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner practicing under this section and not working under standardized procedures shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(i)Subdivision (h) shall not apply to a nurse practitioner if either of the following applies:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 12.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 13.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care-related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 14.Section 4052.04 of the Business and Professions Code is amended to read:4052.04.(a)In addition to the authority provided in Section 4052, a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2, the virus that causes COVID-19.
(b)Prior to furnishing COVID-19 oral therapeutics pursuant to subdivision (a), a pharmacist shall utilize relevant and appropriate evidence-based clinical guidelines published by the federal Food and Drug Administration in providing these patient care services.
(c)A pharmacist who furnishes COVID-19 oral therapeutics shall notify the patients primary care provider, or enter the appropriate information in a patient record system shared with the primary care provider, as permitted by that primary care provider. If the patient does not have a primary care provider, the pharmacist shall provide the patient with a written record of the drugs furnished and advise the patient to consult a physician of the patients choice.
(d)A pharmacist shall document, to the extent possible, the kind and amounts of COVID-19 oral therapeutics furnished pursuant to subdivision (a), as well as information regarding any testing services provided, in the patients record in the record system maintained by the pharmacy. The records shall be maintained for three years and shall be available for inspection by all properly authorized personnel of the board.
(e)For purposes of this section, COVID-19 oral therapeutics means drugs that are approved or authorized by the United States Food and Drug Administration for the treatment of COVID-19 and administered orally.
(f)This section shall remain in effect only until January 1, 2026, and as of that date is repealed.
SEC. 15.Section 4069 is added to the Business and Professions Code, to read:4069.A pharmacist who dispenses or furnishes a dangerous drug, as defined in Section 4022, pursuant to a veterinary prescription shall include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
SEC. 16.Section 4602 of the Business and Professions Code is amended to read:4602.(a)The California Massage Therapy Council, as defined in subdivision (d) of Section 4601, is hereby established and shall carry out the responsibilities and duties set forth in this chapter.
(b)The council may take any reasonable actions necessary to carry out the responsibilities and duties set forth in this chapter, including, but not limited to, hiring staff, entering into contracts, and developing policies, procedures, rules, and bylaws to implement this chapter.
(c)The council may require background checks for all employees, contractors, volunteers, and board members as a condition of their employment, formation of a contractual relationship, or participation in council activities.
(d)The council shall issue a certificate to an individual applicant who satisfies the requirements of this chapter for that certificate.
(e)The council is authorized to determine whether the information provided to the council in relation to the certification of an applicant is true and correct and meets the requirements of this chapter. If the council has any reason to question whether the information provided is true or correct, or meets the requirements of this chapter, the council is authorized to make any investigation it deems necessary to establish that the information received is accurate and satisfies any criteria established by this chapter. The applicant has the burden to prove that they are entitled to certification.
(f)The council shall be governed by a board of directors composed of 13 members who shall be chosen in the following manner:
(1)One member shall be a representative of the League of California Cities, unless that entity chooses not to exercise this right to appoint.
(2)One member shall be a representative of the California Police Chiefs Association, unless that entity chooses not to exercise this right to appoint.
(3)One member shall be a representative of the California State Association of Counties, unless that entity chooses not to exercise this right to appoint.
(4)One member shall be a representative of an anti-human trafficking organization to be determined by the council. This organization shall appoint one member, unless the organization chooses not to exercise this right to appoint.
(5)One member shall be appointed by the Office of the Chancellor of the California Community Colleges, unless that office chooses not to exercise this right to appoint.
(6)One member shall be a member of the public appointed by the Director of the Department of Consumer Affairs, unless the director chooses not to exercise this right to appoint.
(7)One member shall be appointed by the California Association of Private Postsecondary Schools, unless that entity chooses not to exercise this right to appoint.
(8)One member shall be appointed by the American Massage Therapy Association, California Chapter, who shall be a California-certified massage therapist or massage practitioner who is a California resident and who has been practicing massage for at least three years, unless that entity chooses not to exercise this right to appoint.
(9)One member shall be a public health official representing a city, county, city and county, or state health department, to be determined by the council. The city, county, city and county, or state health department chosen, shall appoint one member unless that entity chooses not to exercise this right to appoint.
(10)(A)One member shall be a certified massage therapist or a certified massage practitioner who is a California resident who has practiced massage for at least three years prior to the appointment, selected by a professional society, association, or other entity which membership is composed of massage therapist professionals, and that chooses to participate in the council. To qualify, a professional society, association, or other entity shall have a dues-paying membership in California of at least 1,000 individuals, have been established since 2000, and shall have bylaws that require its members to comply with a code of ethics.
(B)If there is more than one professional society, association, or other entity that meets the requirements of subparagraph (A), the appointment shall rotate based on a four-year term between each of the qualifying entities. The qualifying entity shall maintain its appointment authority during the entirety of the four-year term during which it holds the appointment authority. The order in which a qualifying professional society, association, or other entity has the authority to appoint shall be determined by alphabetical order based on the full legal name of the entity as of January 1, 2014.
(11)The members appointed to the board in accordance with paragraphs (1) to (10), inclusive, shall appoint three additional members, at a duly held board meeting in accordance with the boards bylaws. One of those appointees shall be an attorney licensed by the State Bar of California who has been practicing law for at least three years and who at the time of appointment represents a city, county, or a city and county in the state. One of those appointees shall represent a massage business entity that has been operating in the state for at least three years. The council shall establish in its bylaws a process for appointing an additional member, provided that the member has knowledge of the massage industry or can bring needed expertise to the operation of the council for purposes of complying with Section 4603.
(g)Any decision to change the appointing authority of any member appointed to the board pursuant to paragraphs (1) to (10), inclusive, of subdivision (f) shall not be effective unless the current member has completed their term under subdivision (h) or the appointment is vacant.
(h)(1)Board member terms shall be for four years and until the appointment and qualification of their successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served two terms shall not be eligible for reappointment to the board regardless of the appointing authority. Any board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, shall vacate their appointment no later than July 1, 2025.
(2)A board member may be removed only by their appointing authority under the conditions provided in Section 106.
(i)The board of directors shall establish fees reasonably related to the cost of providing services and carrying out its ongoing responsibilities and duties. Initial and renewal fees for certificates shall be in an amount sufficient to support the functions of the council in the administration of this chapter, but in no event shall exceed three hundred dollars ($300). The renewal fee shall be reassessed biennially by the board.
(j)The meetings of the council shall be subject to the rules of the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). The board may adopt additional policies and procedures that provide greater transparency to certificate holders and the public than required by the Bagley-Keene Open Meeting Act.
(k)Prior to holding a meeting to vote upon a proposal to increase the certification fees, the board shall provide at least 90 days notice of the meeting, including posting a notice on the councils internet website unless at least two-thirds of the board members concur that there is an active threat to public safety and that voting at a meeting without prior notice is necessary. However, the board shall not waive the requirements of subdivision (i).
(l)If the board approves an increase in the certification fees, the council shall update all relevant areas of its internet website and notify all certificate holders and affected applicants by email within 14 days of the boards action.
(m)The council shall assess its contact with non-English speakers. Based on this assessment, the council shall offer and make available all publicly available written and electronic materials provided to certificate holders and applicants in languages other than English that the council determines will be used by a substantial number of non-English speakers who are in contact with the council. This subdivision shall not apply to examinations, denial and disciplinary legal documents, and email communications. The council shall provide a report to the Legislature on the findings of its assessment of contact with non-English speakers on or before January 1, 2019.
SEC. 17.Section 4621 of the Business and Professions Code is amended to read:4621.(a)This chapter shall remain in effect only until January 1, 2026, and as of that date is repealed.
(b)Notwithstanding any other law, the powers and duties of the council shall be subject to review by the appropriate policy committees of the Legislature.
SEC. 18.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 19.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 20.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 21.Section 9880.1 of the Business and Professions Code is amended to read:9880.1.The following definitions apply for the purposes of this chapter:
(a)Automotive repair dealer means a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees.
(b)Automotive technician means an employee of an automotive repair dealer or that dealer, if the employer or dealer repairs motor vehicles and who, for salary or wage, performs repairs of motor vehicles as set forth in subdivision (k).
(c)Bureau means the Bureau of Automotive Repair.
(d)Chief means the Chief of the Bureau of Automotive Repair.
(e)Commercial business agreement means an agreement, whether in writing or oral, entered into between a business or commercial enterprise and an automotive repair dealer, prior to the repair that is requested to be made, that contemplates a continuing business arrangement under which the automotive repair dealer is to repair any motor vehicle covered by the agreement, but does not mean any warranty or extended service agreement normally given by an automotive repair facility to its customers.
(f)Customer means the person presenting a motor vehicle for repair and authorizing the repairs to that motor vehicle. Customer shall not mean the automotive repair dealer providing the repair services or an insurer involved in a claim that includes the motor vehicle being repaired or an employee or agent or a person acting on behalf of the dealer or insurer.
(g)Director means the Director of Consumer Affairs.
(h)Motor vehicle means a passenger vehicle required to be registered with the Department of Motor Vehicles and all motorcycles whether or not required to be registered by the Department of Motor Vehicles.
(i)Person includes a firm, partnership, association, limited liability company, participating tribe, or corporation.
(j)Preventative maintenance services means the following maintenance services: checking tire pressure and adding or relieving pressure, as necessary; rotating tires; changing transmission fluid, transmission filter, engine oil and filter, differential fluid, power steering fluid, and transfer case fluid; changing engine or cabin air filters, and external fuel filters; changing engine coolant; performing a fuel system induction service; replacing belts and windshield wiper blades; replacing light bulbs and restoring headlamps; adding oil or fuel treatments through the designated fill points; and topping off fluids; and all of the listed services include the removal, reinstallation, and replacement of any components necessary to perform each service, and the tapping of damaged threads without removal of any fluid pan.
(k)Repair of motor vehicles means all maintenance of and repairs to motor vehicles performed by an automotive repair dealer, including automotive body repair work, but excluding those repairs made pursuant to a commercial business agreement and roadside services.
(l)Roadside services means the services performed upon a motor vehicle for the purpose of transporting the vehicle or to permit it to be operated under its own power, by, or on behalf of, a motor club holding a certificate of authority pursuant to Chapter 2 (commencing with Section 12160) of Part 5 of Division 2 of the Insurance Code, or by an operator of a tow truck, as defined in Section 615 of the Vehicle Code, that is owned or operated by a person or entity who possesses a valid motor carrier permit, as described in Section 34620 of the Vehicle Code, and is enrolled in the Basic Inspection of Terminals program, as described in Section 34501.12 of the Vehicle Code.
SEC. 22.Section 9880.5 is added to the Business and Professions Code, to read:9880.5.(a)As used in this chapter, the following definitions apply:
(1)Federally recognized tribe means a tribe located in this state and included on the list published in the Federal Register pursuant to the Federally Recognized Indian Tribe List Act of 1994 (25 U.S.C. Sec. 5131) and includes an entity controlled by and established for the benefit of one or more tribes.
(2)Participating tribe means a federally recognized tribe that formally applies for licensure from the bureau pursuant to subdivision (b).
(b)The bureau shall license a federally recognized tribe that applies for licensure and is otherwise compliant with this chapter for the purpose of engaging in a business regulated by this chapter.
(c)Nothing in this chapter is intended to infringe upon or diminish the existing rights, privileges, and immunities of federally recognized tribes as set forth in federal, state, or tribal law, or the jurisdiction of those participating tribes.
(d)Nothing in this chapter, whether express or implied, shall confer upon the bureau or director any rights or authority to regulate any activity within the jurisdiction of a participating tribe.
(e)Any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement shall not apply to a participating tribe.
SEC. 23.Section 19237 of the Business and Professions Code is amended to read:19237.(a)A household mover shall not engage, or attempt to engage, in the business of the transportation of used household goods and personal effects by motor vehicle over any public highway in this state, including by any means or media, advertising, soliciting, offering, arranging as a broker, or entering into an agreement regarding the transportation of used household goods and personal effects, unless both of the following are satisfied:
(1)For transportation of household goods and personal effects within this state, there is in force a permit issued by the bureau authorizing those operations. Permits issued by the Public Utilities Commission pursuant to the former Chapter 7 (commencing with Section 5101) of Division 2 of the Public Utilities Code, that are valid and effective on the operative date of this chapter, shall remain in effect, subject to this chapter, for a period of not more than two years after the operative date of this chapter, or until the time the bureau issues, reissues, renews, suspends, revokes, or otherwise alters or amends the permit, whichever occurs earlier.
(2)(A)For transportation of household goods and personal effects from this state to another state or from another state to this state, there is in force a valid operating authority issued by the Federal Motor Carrier Safety Administration.
(B)An applicant whose principal place of business is not in this state shall not be required to meet the residency requirements pursuant to Section 19239 and shall file with the bureau its designation of persons upon whom court or agency process may be served in this state that the household mover made pursuant to Part 366 of Title 49 of the Code of Federal Regulations.
(C)If the applicant only conducts interstate household moves, the applicant shall not be required to take the examination pursuant to Section 19239 and shall file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state.
(b)A household mover that engages, or attempts to engage, in the business of the transportation of used household goods and personal effects in violation of subdivision (a) shall not enforce any security interest or bring or maintain any action in law or equity to recover any money or property or obtain any other relief from any consignor, consignee, or owner of household goods or personal effects in connection with an agreement to transport, or the transportation of, household goods and personal effects or any related services. A person who utilizes the services of a household mover operating in violation of subdivision (a) may bring an action in any court of competent jurisdiction in this state to recover all compensation paid to that household mover.
(c)The operation of a motor vehicle used in the business of transporting household goods and personal effects by a household mover that does not possess a valid permit or operating authority, as required by subdivision (a), constitutes a public nuisance. Any peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code, may remove any motor vehicle located within the territorial limits in which the officer may act, when the vehicle is found upon a highway and is being used in a manner constituting a public nuisance. At the request of the bureau, the Attorney General, or a district attorney, city attorney, or county counsel, the law enforcement agency may impound the vehicle for a period not to exceed 72 hours to enable the requesting agency to abate the public nuisance, to obtain an order from the superior court of the county in which the vehicle has been impounded to prevent the use of the motor vehicle in violation of law, and to obtain any other remedy available under law as permitted by Section 19282.
(d)Any person having possession or control of used household goods or personal effects, who knows, or through the exercise of reasonable care should know, that a household mover transported those household goods or personal effects in violation of subdivision (a), shall release the household goods and personal effects to the consignor or consignee, as defined in Section 19245, upon the request of the consignor or consignee. If that person fails to release the household goods and personal effects, any peace officer, as defined in subdivision (c), may take custody of the household goods and personal effects and release them to the consignor or consignee.
(e)The bureau shall identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
SEC. 24.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, on and after July 1, 2016, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant has served as an active duty member of the Armed Forces of the United States and was honorably discharged.
(b)Notwithstanding any other law, on and after July 1, 2024, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant is an active duty member of a regular component of the Armed Forces of the United States enrolled in the United States Department of Defense SkillBridge program as authorized under Section 1143(e) of Title 10 of the United States Code.
(c)A board may adopt regulations necessary to administer this section in accordance with the provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 2.Section 115.5 of the Business and Professions Code is amended to read:115.5.(a)A board within the department shall expedite the licensure process and waive the licensure application fee and the initial or original license fee charged by the board for an applicant who meets both of the following requirements:
(1)Supplies evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)Holds a current license in another state, district, or territory of the United States in the profession or vocation for which the applicant seeks a license from the board.
(b)A board may adopt regulations necessary to administer this section.
(c)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 3.Section 115.6 of the Business and Professions Code is amended to read:115.6.(a)(1)Except as provided in subdivision (j), a board within the department shall, after appropriate investigation, issue a temporary license to practice a profession or vocation to an applicant who meets the requirements set forth in subdivisions (c) and (d).
(2)Revenues from fees for temporary licenses issued by the California Board of Accountancy shall be credited to the Accountancy Fund in accordance with Section 5132.
(b)The board may conduct an investigation of an applicant for purposes of denying or revoking a temporary license issued pursuant to this section. This investigation may include a criminal background check.
(c)An applicant seeking a temporary license pursuant to this section shall meet the following requirements:
(1)The applicant shall supply evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)The applicant shall hold a current, active, and unrestricted license that confers upon the applicant the authority to practice, in another state, district, or territory of the United States, the profession or vocation within the same scope for which the applicant seeks a temporary license from the board.
(3)The applicant shall submit an application to the board that shall include a signed affidavit attesting to the fact that the applicant meets all of the requirements for the temporary license, and that the information submitted in the application is accurate, to the best of the applicants knowledge. The application shall also include written verification from the applicants original licensing jurisdiction stating that the applicants license is in good standing in that jurisdiction.
(4)The applicant shall not have committed an act in any jurisdiction that would have constituted grounds for denial, suspension, or revocation of the license under this code at the time the act was committed. A violation of this paragraph may be grounds for the denial or revocation of a temporary license issued by the board.
(5)The applicant shall not have been disciplined by a licensing entity in another jurisdiction and shall not be the subject of an unresolved complaint, review procedure, or disciplinary proceeding conducted by a licensing entity in another jurisdiction.
(6)(A)The applicant shall, upon request by a board, furnish a full set of fingerprints for purposes of conducting a criminal background check.
(B)The board shall request a fingerprint-based criminal history information check from the Department of Justice in accordance with subdivision (u) of Section 11105 of the Penal Code and the Department of Justice shall furnish state or federal criminal history information in accordance with subdivision (p) of Section 11105 of the Penal Code.
(d)The applicant shall pass a California law and ethics examination if otherwise required by the board for the profession or vocation for which the applicant seeks licensure.
(e)Except as specified in subdivision (g), a board shall issue a temporary license pursuant to this section within 30 days of receiving documentation that the applicant has met the requirements specified in subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(f)(1)A temporary license issued pursuant to this section may be immediately terminated upon a finding that the temporary licenseholder failed to meet any of the requirements described in subdivision (c) or (d) or provided substantively inaccurate information that would affect the persons eligibility for temporary licensure. Upon termination of the temporary license, the board shall issue a notice of termination that shall require the temporary licenseholder to immediately cease the practice of the licensed profession upon receipt.
(2)Notwithstanding any other law, if, after notice and an opportunity to be heard, a board finds that a temporary licenseholder engaged in unprofessional conduct or any other act that is a cause for discipline by the board, the board shall revoke the temporary license.
(g)An applicant seeking a temporary license as a civil engineer, geotechnical engineer, structural engineer, land surveyor, professional geologist, professional geophysicist, certified engineering geologist, or certified hydrogeologist pursuant to this section shall successfully pass the appropriate California-specific examination or examinations required for licensure in those respective professions by the Board for Professional Engineers, Land Surveyors, and Geologists. The board shall issue a temporary license pursuant to this subdivision within 30 days of receiving documentation that the applicant has met the requirements specified in this subdivision and subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(h)A temporary license issued pursuant to this section is nonrenewable and shall expire 12 months after issuance, upon issuance or denial of a standard license, upon issuance or denial of a license by endorsement, or upon issuance or denial of an expedited license pursuant to Section 115.5, whichever occurs first.
(i)A board shall submit to the department for approval, if necessary to implement this section, draft regulations necessary to administer this section. These regulations shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(j)(1)This section shall not apply to a board that has a process in place by which an out-of-state licensed applicant in good standing who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States is able to receive expedited, temporary authorization to practice while meeting state-specific requirements for a period of at least one year or is able to receive an expedited license by endorsement with no additional requirements superseding those described in subdivisions (c) and (d).
(2)This section shall apply only to the extent that it does not amend an initiative or violate constitutional requirements.
(k)An applicant for a temporary license pursuant to this section shall not be required to provide, and no board shall collect, a fee for the application or issuance of a temporary license.
(l)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 4.Section 135.4 of the Business and Professions Code is amended to read:135.4.(a)Notwithstanding any other law, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that they have been admitted to the United States as a refugee under Section 1157 of Title 8 of the United States Code, have been granted asylum by the Secretary of Homeland Security or the Attorney General of the United States pursuant to Section 1158 of Title 8 of the United States Code, or they have a special immigrant visa (SIV) that has been granted a status under Section 1244 of Public Law 110-181, under Public Law 109-163, or under Section 602(b) of Title VI of Division F of Public Law 111-8.
(b)Nothing in this section shall be construed as changing existing licensure requirements. A person applying for expedited licensure under subdivision (a) shall meet all applicable statutory and regulatory licensure requirements.
(c)A board may adopt regulations necessary to administer this section.
(d)For purposes of this section, applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 5.Section 1905.2 of the Business and Professions Code is repealed.SEC. 6.Section 1926 of the Business and Professions Code is amended to read:1926.In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services, and shall annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
(e)Dental offices.
SEC. 7.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that the person is entitled to practice hereunder, or who represents or holds themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(4)A person holding a current and active license under this division or any initiative act referred to in this division, to the extent the use of the title is consistent with the act governing the practice of that license.
(5)A person whose use of the word doctor or the prefix Dr. is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500.
SEC. 8.Section 2097.5 is added to the Business and Professions Code, to read:2097.5.(a)(1)Notwithstanding Section 2097, a physicians and surgeons license may be renewed for the first time if the board receives evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires.
(2)The relevant postgraduate training program director shall report to the board within 30 days, on a form approved by the board, if a licensee who renews their license pursuant to this subdivision is disenrolled from their training program for any reason, including, but not limited to, resignation, termination, or graduation.
(b)If a physicians and surgeons license is initially renewed pursuant to subdivision (a), then, at the time of their second renewal, in addition to any other requirements, the board shall require evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training, pursuant to the attestation of the program director, designated institutional official, or delegated authority for the approved postgraduate training program where the applicant participated. A licensee who fails to meet the requirements of this subdivision shall be automatically placed in delinquent status by the board.
(c)If a physicians and surgeons license is initially renewed pursuant to subdivision (a) and the licensee is disenrolled from the relevant California board-approved postgraduate training program, the board may place the relevant license in delinquent status if the board does not receive evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training. If placed on delinquent status, that license shall be returned to current status upon the board receiving evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program or has received credit for at least 36 months of board-approved postgraduate training before their license changes to canceled status, pursuant to Section 2428. Any license status change made pursuant to this subdivision shall not relieve the licensee of the license renewal requirements of subdivision (b).
(d)(1)Notwithstanding any other law, the board shall issue an initial physicians and surgeons license for a period of 26 months.
(2)A renewed physicians and surgeons license shall be subject to the requirements of Section 2423.
(e)Upon review of supporting documentation, the board, in its discretion, may renew a physicians and surgeons license for an applicant who has demonstrated substantial compliance with this section.
(f)A physician whose license is canceled or who surrenders their license prior to meeting the renewal requirements of either subdivision (b) or (c) is subject to the reinstatement requirements of subdivision (e) of Section 2097.
(g)(1)Except as provided in paragraph (2), this section only applies to individuals who are issued an initial physicians and surgeons license by the board on or after January 1, 2022.
(2)Paragraph (1) of subdivision (d) only applies to individuals who are issued an initial license on or after January 1, 2025.
(h)This section shall not apply to the Osteopathic Medical Board of California.
SEC. 9.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 10.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as indicated on the application, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of one transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation pursuant to this section unless the attestation was produced fraudulently.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 11.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner practicing under this section and not working under standardized procedures shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(i)Subdivision (h) shall not apply to a nurse practitioner if either of the following applies:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 12.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 13.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care-related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 14.Section 4052.04 of the Business and Professions Code is amended to read:4052.04.(a)In addition to the authority provided in Section 4052, a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2, the virus that causes COVID-19.
(b)Prior to furnishing COVID-19 oral therapeutics pursuant to subdivision (a), a pharmacist shall utilize relevant and appropriate evidence-based clinical guidelines published by the federal Food and Drug Administration in providing these patient care services.
(c)A pharmacist who furnishes COVID-19 oral therapeutics shall notify the patients primary care provider, or enter the appropriate information in a patient record system shared with the primary care provider, as permitted by that primary care provider. If the patient does not have a primary care provider, the pharmacist shall provide the patient with a written record of the drugs furnished and advise the patient to consult a physician of the patients choice.
(d)A pharmacist shall document, to the extent possible, the kind and amounts of COVID-19 oral therapeutics furnished pursuant to subdivision (a), as well as information regarding any testing services provided, in the patients record in the record system maintained by the pharmacy. The records shall be maintained for three years and shall be available for inspection by all properly authorized personnel of the board.
(e)For purposes of this section, COVID-19 oral therapeutics means drugs that are approved or authorized by the United States Food and Drug Administration for the treatment of COVID-19 and administered orally.
(f)This section shall remain in effect only until January 1, 2026, and as of that date is repealed.
SEC. 15.Section 4069 is added to the Business and Professions Code, to read:4069.A pharmacist who dispenses or furnishes a dangerous drug, as defined in Section 4022, pursuant to a veterinary prescription shall include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
SEC. 16.Section 4602 of the Business and Professions Code is amended to read:4602.(a)The California Massage Therapy Council, as defined in subdivision (d) of Section 4601, is hereby established and shall carry out the responsibilities and duties set forth in this chapter.
(b)The council may take any reasonable actions necessary to carry out the responsibilities and duties set forth in this chapter, including, but not limited to, hiring staff, entering into contracts, and developing policies, procedures, rules, and bylaws to implement this chapter.
(c)The council may require background checks for all employees, contractors, volunteers, and board members as a condition of their employment, formation of a contractual relationship, or participation in council activities.
(d)The council shall issue a certificate to an individual applicant who satisfies the requirements of this chapter for that certificate.
(e)The council is authorized to determine whether the information provided to the council in relation to the certification of an applicant is true and correct and meets the requirements of this chapter. If the council has any reason to question whether the information provided is true or correct, or meets the requirements of this chapter, the council is authorized to make any investigation it deems necessary to establish that the information received is accurate and satisfies any criteria established by this chapter. The applicant has the burden to prove that they are entitled to certification.
(f)The council shall be governed by a board of directors composed of 13 members who shall be chosen in the following manner:
(1)One member shall be a representative of the League of California Cities, unless that entity chooses not to exercise this right to appoint.
(2)One member shall be a representative of the California Police Chiefs Association, unless that entity chooses not to exercise this right to appoint.
(3)One member shall be a representative of the California State Association of Counties, unless that entity chooses not to exercise this right to appoint.
(4)One member shall be a representative of an anti-human trafficking organization to be determined by the council. This organization shall appoint one member, unless the organization chooses not to exercise this right to appoint.
(5)One member shall be appointed by the Office of the Chancellor of the California Community Colleges, unless that office chooses not to exercise this right to appoint.
(6)One member shall be a member of the public appointed by the Director of the Department of Consumer Affairs, unless the director chooses not to exercise this right to appoint.
(7)One member shall be appointed by the California Association of Private Postsecondary Schools, unless that entity chooses not to exercise this right to appoint.
(8)One member shall be appointed by the American Massage Therapy Association, California Chapter, who shall be a California-certified massage therapist or massage practitioner who is a California resident and who has been practicing massage for at least three years, unless that entity chooses not to exercise this right to appoint.
(9)One member shall be a public health official representing a city, county, city and county, or state health department, to be determined by the council. The city, county, city and county, or state health department chosen, shall appoint one member unless that entity chooses not to exercise this right to appoint.
(10)(A)One member shall be a certified massage therapist or a certified massage practitioner who is a California resident who has practiced massage for at least three years prior to the appointment, selected by a professional society, association, or other entity which membership is composed of massage therapist professionals, and that chooses to participate in the council. To qualify, a professional society, association, or other entity shall have a dues-paying membership in California of at least 1,000 individuals, have been established since 2000, and shall have bylaws that require its members to comply with a code of ethics.
(B)If there is more than one professional society, association, or other entity that meets the requirements of subparagraph (A), the appointment shall rotate based on a four-year term between each of the qualifying entities. The qualifying entity shall maintain its appointment authority during the entirety of the four-year term during which it holds the appointment authority. The order in which a qualifying professional society, association, or other entity has the authority to appoint shall be determined by alphabetical order based on the full legal name of the entity as of January 1, 2014.
(11)The members appointed to the board in accordance with paragraphs (1) to (10), inclusive, shall appoint three additional members, at a duly held board meeting in accordance with the boards bylaws. One of those appointees shall be an attorney licensed by the State Bar of California who has been practicing law for at least three years and who at the time of appointment represents a city, county, or a city and county in the state. One of those appointees shall represent a massage business entity that has been operating in the state for at least three years. The council shall establish in its bylaws a process for appointing an additional member, provided that the member has knowledge of the massage industry or can bring needed expertise to the operation of the council for purposes of complying with Section 4603.
(g)Any decision to change the appointing authority of any member appointed to the board pursuant to paragraphs (1) to (10), inclusive, of subdivision (f) shall not be effective unless the current member has completed their term under subdivision (h) or the appointment is vacant.
(h)(1)Board member terms shall be for four years and until the appointment and qualification of their successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served two terms shall not be eligible for reappointment to the board regardless of the appointing authority. Any board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, shall vacate their appointment no later than July 1, 2025.
(2)A board member may be removed only by their appointing authority under the conditions provided in Section 106.
(i)The board of directors shall establish fees reasonably related to the cost of providing services and carrying out its ongoing responsibilities and duties. Initial and renewal fees for certificates shall be in an amount sufficient to support the functions of the council in the administration of this chapter, but in no event shall exceed three hundred dollars ($300). The renewal fee shall be reassessed biennially by the board.
(j)The meetings of the council shall be subject to the rules of the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). The board may adopt additional policies and procedures that provide greater transparency to certificate holders and the public than required by the Bagley-Keene Open Meeting Act.
(k)Prior to holding a meeting to vote upon a proposal to increase the certification fees, the board shall provide at least 90 days notice of the meeting, including posting a notice on the councils internet website unless at least two-thirds of the board members concur that there is an active threat to public safety and that voting at a meeting without prior notice is necessary. However, the board shall not waive the requirements of subdivision (i).
(l)If the board approves an increase in the certification fees, the council shall update all relevant areas of its internet website and notify all certificate holders and affected applicants by email within 14 days of the boards action.
(m)The council shall assess its contact with non-English speakers. Based on this assessment, the council shall offer and make available all publicly available written and electronic materials provided to certificate holders and applicants in languages other than English that the council determines will be used by a substantial number of non-English speakers who are in contact with the council. This subdivision shall not apply to examinations, denial and disciplinary legal documents, and email communications. The council shall provide a report to the Legislature on the findings of its assessment of contact with non-English speakers on or before January 1, 2019.
SEC. 17.Section 4621 of the Business and Professions Code is amended to read:4621.(a)This chapter shall remain in effect only until January 1, 2026, and as of that date is repealed.
(b)Notwithstanding any other law, the powers and duties of the council shall be subject to review by the appropriate policy committees of the Legislature.
SEC. 18.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 19.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 20.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 21.Section 9880.1 of the Business and Professions Code is amended to read:9880.1.The following definitions apply for the purposes of this chapter:
(a)Automotive repair dealer means a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees.
(b)Automotive technician means an employee of an automotive repair dealer or that dealer, if the employer or dealer repairs motor vehicles and who, for salary or wage, performs repairs of motor vehicles as set forth in subdivision (k).
(c)Bureau means the Bureau of Automotive Repair.
(d)Chief means the Chief of the Bureau of Automotive Repair.
(e)Commercial business agreement means an agreement, whether in writing or oral, entered into between a business or commercial enterprise and an automotive repair dealer, prior to the repair that is requested to be made, that contemplates a continuing business arrangement under which the automotive repair dealer is to repair any motor vehicle covered by the agreement, but does not mean any warranty or extended service agreement normally given by an automotive repair facility to its customers.
(f)Customer means the person presenting a motor vehicle for repair and authorizing the repairs to that motor vehicle. Customer shall not mean the automotive repair dealer providing the repair services or an insurer involved in a claim that includes the motor vehicle being repaired or an employee or agent or a person acting on behalf of the dealer or insurer.
(g)Director means the Director of Consumer Affairs.
(h)Motor vehicle means a passenger vehicle required to be registered with the Department of Motor Vehicles and all motorcycles whether or not required to be registered by the Department of Motor Vehicles.
(i)Person includes a firm, partnership, association, limited liability company, participating tribe, or corporation.
(j)Preventative maintenance services means the following maintenance services: checking tire pressure and adding or relieving pressure, as necessary; rotating tires; changing transmission fluid, transmission filter, engine oil and filter, differential fluid, power steering fluid, and transfer case fluid; changing engine or cabin air filters, and external fuel filters; changing engine coolant; performing a fuel system induction service; replacing belts and windshield wiper blades; replacing light bulbs and restoring headlamps; adding oil or fuel treatments through the designated fill points; and topping off fluids; and all of the listed services include the removal, reinstallation, and replacement of any components necessary to perform each service, and the tapping of damaged threads without removal of any fluid pan.
(k)Repair of motor vehicles means all maintenance of and repairs to motor vehicles performed by an automotive repair dealer, including automotive body repair work, but excluding those repairs made pursuant to a commercial business agreement and roadside services.
(l)Roadside services means the services performed upon a motor vehicle for the purpose of transporting the vehicle or to permit it to be operated under its own power, by, or on behalf of, a motor club holding a certificate of authority pursuant to Chapter 2 (commencing with Section 12160) of Part 5 of Division 2 of the Insurance Code, or by an operator of a tow truck, as defined in Section 615 of the Vehicle Code, that is owned or operated by a person or entity who possesses a valid motor carrier permit, as described in Section 34620 of the Vehicle Code, and is enrolled in the Basic Inspection of Terminals program, as described in Section 34501.12 of the Vehicle Code.
SEC. 22.Section 9880.5 is added to the Business and Professions Code, to read:9880.5.(a)As used in this chapter, the following definitions apply:
(1)Federally recognized tribe means a tribe located in this state and included on the list published in the Federal Register pursuant to the Federally Recognized Indian Tribe List Act of 1994 (25 U.S.C. Sec. 5131) and includes an entity controlled by and established for the benefit of one or more tribes.
(2)Participating tribe means a federally recognized tribe that formally applies for licensure from the bureau pursuant to subdivision (b).
(b)The bureau shall license a federally recognized tribe that applies for licensure and is otherwise compliant with this chapter for the purpose of engaging in a business regulated by this chapter.
(c)Nothing in this chapter is intended to infringe upon or diminish the existing rights, privileges, and immunities of federally recognized tribes as set forth in federal, state, or tribal law, or the jurisdiction of those participating tribes.
(d)Nothing in this chapter, whether express or implied, shall confer upon the bureau or director any rights or authority to regulate any activity within the jurisdiction of a participating tribe.
(e)Any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement shall not apply to a participating tribe.
SEC. 23.Section 19237 of the Business and Professions Code is amended to read:19237.(a)A household mover shall not engage, or attempt to engage, in the business of the transportation of used household goods and personal effects by motor vehicle over any public highway in this state, including by any means or media, advertising, soliciting, offering, arranging as a broker, or entering into an agreement regarding the transportation of used household goods and personal effects, unless both of the following are satisfied:
(1)For transportation of household goods and personal effects within this state, there is in force a permit issued by the bureau authorizing those operations. Permits issued by the Public Utilities Commission pursuant to the former Chapter 7 (commencing with Section 5101) of Division 2 of the Public Utilities Code, that are valid and effective on the operative date of this chapter, shall remain in effect, subject to this chapter, for a period of not more than two years after the operative date of this chapter, or until the time the bureau issues, reissues, renews, suspends, revokes, or otherwise alters or amends the permit, whichever occurs earlier.
(2)(A)For transportation of household goods and personal effects from this state to another state or from another state to this state, there is in force a valid operating authority issued by the Federal Motor Carrier Safety Administration.
(B)An applicant whose principal place of business is not in this state shall not be required to meet the residency requirements pursuant to Section 19239 and shall file with the bureau its designation of persons upon whom court or agency process may be served in this state that the household mover made pursuant to Part 366 of Title 49 of the Code of Federal Regulations.
(C)If the applicant only conducts interstate household moves, the applicant shall not be required to take the examination pursuant to Section 19239 and shall file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state.
(b)A household mover that engages, or attempts to engage, in the business of the transportation of used household goods and personal effects in violation of subdivision (a) shall not enforce any security interest or bring or maintain any action in law or equity to recover any money or property or obtain any other relief from any consignor, consignee, or owner of household goods or personal effects in connection with an agreement to transport, or the transportation of, household goods and personal effects or any related services. A person who utilizes the services of a household mover operating in violation of subdivision (a) may bring an action in any court of competent jurisdiction in this state to recover all compensation paid to that household mover.
(c)The operation of a motor vehicle used in the business of transporting household goods and personal effects by a household mover that does not possess a valid permit or operating authority, as required by subdivision (a), constitutes a public nuisance. Any peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code, may remove any motor vehicle located within the territorial limits in which the officer may act, when the vehicle is found upon a highway and is being used in a manner constituting a public nuisance. At the request of the bureau, the Attorney General, or a district attorney, city attorney, or county counsel, the law enforcement agency may impound the vehicle for a period not to exceed 72 hours to enable the requesting agency to abate the public nuisance, to obtain an order from the superior court of the county in which the vehicle has been impounded to prevent the use of the motor vehicle in violation of law, and to obtain any other remedy available under law as permitted by Section 19282.
(d)Any person having possession or control of used household goods or personal effects, who knows, or through the exercise of reasonable care should know, that a household mover transported those household goods or personal effects in violation of subdivision (a), shall release the household goods and personal effects to the consignor or consignee, as defined in Section 19245, upon the request of the consignor or consignee. If that person fails to release the household goods and personal effects, any peace officer, as defined in subdivision (c), may take custody of the household goods and personal effects and release them to the consignor or consignee.
(e)The bureau shall identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
SEC. 24.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, on and after July 1, 2016, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant has served as an active duty member of the Armed Forces of the United States and was honorably discharged.
(b)Notwithstanding any other law, on and after July 1, 2024, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant is an active duty member of a regular component of the Armed Forces of the United States enrolled in the United States Department of Defense SkillBridge program as authorized under Section 1143(e) of Title 10 of the United States Code.
(c)A board may adopt regulations necessary to administer this section in accordance with the provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 2.Section 115.5 of the Business and Professions Code is amended to read:115.5.(a)A board within the department shall expedite the licensure process and waive the licensure application fee and the initial or original license fee charged by the board for an applicant who meets both of the following requirements:
(1)Supplies evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)Holds a current license in another state, district, or territory of the United States in the profession or vocation for which the applicant seeks a license from the board.
(b)A board may adopt regulations necessary to administer this section.
(c)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 3.Section 115.6 of the Business and Professions Code is amended to read:115.6.(a)(1)Except as provided in subdivision (j), a board within the department shall, after appropriate investigation, issue a temporary license to practice a profession or vocation to an applicant who meets the requirements set forth in subdivisions (c) and (d).
(2)Revenues from fees for temporary licenses issued by the California Board of Accountancy shall be credited to the Accountancy Fund in accordance with Section 5132.
(b)The board may conduct an investigation of an applicant for purposes of denying or revoking a temporary license issued pursuant to this section. This investigation may include a criminal background check.
(c)An applicant seeking a temporary license pursuant to this section shall meet the following requirements:
(1)The applicant shall supply evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)The applicant shall hold a current, active, and unrestricted license that confers upon the applicant the authority to practice, in another state, district, or territory of the United States, the profession or vocation within the same scope for which the applicant seeks a temporary license from the board.
(3)The applicant shall submit an application to the board that shall include a signed affidavit attesting to the fact that the applicant meets all of the requirements for the temporary license, and that the information submitted in the application is accurate, to the best of the applicants knowledge. The application shall also include written verification from the applicants original licensing jurisdiction stating that the applicants license is in good standing in that jurisdiction.
(4)The applicant shall not have committed an act in any jurisdiction that would have constituted grounds for denial, suspension, or revocation of the license under this code at the time the act was committed. A violation of this paragraph may be grounds for the denial or revocation of a temporary license issued by the board.
(5)The applicant shall not have been disciplined by a licensing entity in another jurisdiction and shall not be the subject of an unresolved complaint, review procedure, or disciplinary proceeding conducted by a licensing entity in another jurisdiction.
(6)(A)The applicant shall, upon request by a board, furnish a full set of fingerprints for purposes of conducting a criminal background check.
(B)The board shall request a fingerprint-based criminal history information check from the Department of Justice in accordance with subdivision (u) of Section 11105 of the Penal Code and the Department of Justice shall furnish state or federal criminal history information in accordance with subdivision (p) of Section 11105 of the Penal Code.
(d)The applicant shall pass a California law and ethics examination if otherwise required by the board for the profession or vocation for which the applicant seeks licensure.
(e)Except as specified in subdivision (g), a board shall issue a temporary license pursuant to this section within 30 days of receiving documentation that the applicant has met the requirements specified in subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(f)(1)A temporary license issued pursuant to this section may be immediately terminated upon a finding that the temporary licenseholder failed to meet any of the requirements described in subdivision (c) or (d) or provided substantively inaccurate information that would affect the persons eligibility for temporary licensure. Upon termination of the temporary license, the board shall issue a notice of termination that shall require the temporary licenseholder to immediately cease the practice of the licensed profession upon receipt.
(2)Notwithstanding any other law, if, after notice and an opportunity to be heard, a board finds that a temporary licenseholder engaged in unprofessional conduct or any other act that is a cause for discipline by the board, the board shall revoke the temporary license.
(g)An applicant seeking a temporary license as a civil engineer, geotechnical engineer, structural engineer, land surveyor, professional geologist, professional geophysicist, certified engineering geologist, or certified hydrogeologist pursuant to this section shall successfully pass the appropriate California-specific examination or examinations required for licensure in those respective professions by the Board for Professional Engineers, Land Surveyors, and Geologists. The board shall issue a temporary license pursuant to this subdivision within 30 days of receiving documentation that the applicant has met the requirements specified in this subdivision and subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(h)A temporary license issued pursuant to this section is nonrenewable and shall expire 12 months after issuance, upon issuance or denial of a standard license, upon issuance or denial of a license by endorsement, or upon issuance or denial of an expedited license pursuant to Section 115.5, whichever occurs first.
(i)A board shall submit to the department for approval, if necessary to implement this section, draft regulations necessary to administer this section. These regulations shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(j)(1)This section shall not apply to a board that has a process in place by which an out-of-state licensed applicant in good standing who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States is able to receive expedited, temporary authorization to practice while meeting state-specific requirements for a period of at least one year or is able to receive an expedited license by endorsement with no additional requirements superseding those described in subdivisions (c) and (d).
(2)This section shall apply only to the extent that it does not amend an initiative or violate constitutional requirements.
(k)An applicant for a temporary license pursuant to this section shall not be required to provide, and no board shall collect, a fee for the application or issuance of a temporary license.
(l)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 4.Section 135.4 of the Business and Professions Code is amended to read:135.4.(a)Notwithstanding any other law, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that they have been admitted to the United States as a refugee under Section 1157 of Title 8 of the United States Code, have been granted asylum by the Secretary of Homeland Security or the Attorney General of the United States pursuant to Section 1158 of Title 8 of the United States Code, or they have a special immigrant visa (SIV) that has been granted a status under Section 1244 of Public Law 110-181, under Public Law 109-163, or under Section 602(b) of Title VI of Division F of Public Law 111-8.
(b)Nothing in this section shall be construed as changing existing licensure requirements. A person applying for expedited licensure under subdivision (a) shall meet all applicable statutory and regulatory licensure requirements.
(c)A board may adopt regulations necessary to administer this section.
(d)For purposes of this section, applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 5.Section 1905.2 of the Business and Professions Code is repealed.SEC. 6.Section 1926 of the Business and Professions Code is amended to read:1926.In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services, and shall annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
(e)Dental offices.
SEC. 7.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that the person is entitled to practice hereunder, or who represents or holds themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(4)A person holding a current and active license under another chapter of this division or any initiative act referred to in this division, to the extent the use of the title is consistent with the act governing the practice of that license.
(5)A person whose use of the word doctor or the prefix Dr. is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500.
SEC. 8.Section 2097.5 is added to the Business and Professions Code, to read:2097.5.(a)(1)Notwithstanding Section 2097, a physicians and surgeons license may be renewed for the first time if the board receives evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires.
(2)The relevant postgraduate training program director shall report to the board within 30 days, on a form approved by the board, if a licensee who renews their license pursuant to this subdivision is disenrolled from their training program for any reason, including, but not limited to, resignation, termination, or graduation.
(b)If a physicians and surgeons license is initially renewed pursuant to subdivision (a), then, at the time of their second renewal, in addition to any other requirements, the board shall require evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training, pursuant to the attestation of the program director, designated institutional official, or delegated authority for the approved postgraduate training program where the applicant participated. A licensee who fails to meet the requirements of this subdivision shall be automatically placed in delinquent status by the board.
(c)If a physicians and surgeons license is initially renewed pursuant to subdivision (a) and the licensee is disenrolled from the relevant California board-approved postgraduate training program, the board may place the relevant license in delinquent status if the board does not receive evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training. If placed on delinquent status, that license shall be returned to current status upon the board receiving evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program or has received credit for at least 36 months of board-approved postgraduate training before their license changes to canceled status, pursuant to Section 2428. Any license status change made pursuant to this subdivision shall not relieve the licensee of the license renewal requirements of subdivision (b).
(d)(1)Notwithstanding any other law, the board shall issue an initial physicians and surgeons license for a period of 26 months.
(2)A renewed physicians and surgeons license shall be subject to the requirements of Section 2423.
(e)Upon review of supporting documentation, the board, in its discretion, may renew a physicians and surgeons license for an applicant who has demonstrated substantial compliance with this section.
(f)A physician whose license is canceled or who surrenders their license prior to meeting the renewal requirements of either subdivision (b) or (c) is subject to the reinstatement requirements of subdivision (e) of Section 2097.
(g)(1)Except as provided in paragraph (2), this section only applies to individuals who are issued an initial physicians and surgeons license by the board on or after January 1, 2022.
(2)Paragraph (1) of subdivision (d) only applies to individuals who are issued an initial license on or after January 1, 2025.
(h)This section shall not apply to the Osteopathic Medical Board of California.
SEC. 9.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 10.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as indicated on the application, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of one transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation pursuant to this section unless the attestation was produced fraudulently.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 11.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner practicing under this section and not working under standardized procedures shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(i)Subdivision (h) shall not apply to a nurse practitioner if either of the following applies:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 12.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 13.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care-related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 14.Section 4052.04 of the Business and Professions Code is amended to read:4052.04.(a)In addition to the authority provided in Section 4052, a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2, the virus that causes COVID-19.
(b)Prior to furnishing COVID-19 oral therapeutics pursuant to subdivision (a), a pharmacist shall utilize relevant and appropriate evidence-based clinical guidelines published by the federal Food and Drug Administration in providing these patient care services.
(c)A pharmacist who furnishes COVID-19 oral therapeutics shall notify the patients primary care provider, or enter the appropriate information in a patient record system shared with the primary care provider, as permitted by that primary care provider. If the patient does not have a primary care provider, the pharmacist shall provide the patient with a written record of the drugs furnished and advise the patient to consult a physician of the patients choice.
(d)A pharmacist shall document, to the extent possible, the kind and amounts of COVID-19 oral therapeutics furnished pursuant to subdivision (a), as well as information regarding any testing services provided, in the patients record in the record system maintained by the pharmacy. The records shall be maintained for three years and shall be available for inspection by all properly authorized personnel of the board.
(e)For purposes of this section, COVID-19 oral therapeutics means drugs that are approved or authorized by the United States Food and Drug Administration for the treatment of COVID-19 and administered orally.
(f)This section shall remain in effect only until January 1, 2026, and as of that date is repealed.
SEC. 15.Section 4069 is added to the Business and Professions Code, to read:4069.A pharmacist who dispenses or furnishes a dangerous drug, as defined in Section 4022, pursuant to a veterinary prescription shall include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
SEC. 16.Section 4602 of the Business and Professions Code is amended to read:4602.(a)The California Massage Therapy Council, as defined in subdivision (d) of Section 4601, is hereby established and shall carry out the responsibilities and duties set forth in this chapter.
(b)The council may take any reasonable actions necessary to carry out the responsibilities and duties set forth in this chapter, including, but not limited to, hiring staff, entering into contracts, and developing policies, procedures, rules, and bylaws to implement this chapter.
(c)The council may require background checks for all employees, contractors, volunteers, and board members as a condition of their employment, formation of a contractual relationship, or participation in council activities.
(d)The council shall issue a certificate to an individual applicant who satisfies the requirements of this chapter for that certificate.
(e)The council is authorized to determine whether the information provided to the council in relation to the certification of an applicant is true and correct and meets the requirements of this chapter. If the council has any reason to question whether the information provided is true or correct, or meets the requirements of this chapter, the council is authorized to make any investigation it deems necessary to establish that the information received is accurate and satisfies any criteria established by this chapter. The applicant has the burden to prove that they are entitled to certification.
(f)The council shall be governed by a board of directors composed of 13 members who shall be chosen in the following manner:
(1)One member shall be a representative of the League of California Cities, unless that entity chooses not to exercise this right to appoint.
(2)One member shall be a representative of the California Police Chiefs Association, unless that entity chooses not to exercise this right to appoint.
(3)One member shall be a representative of the California State Association of Counties, unless that entity chooses not to exercise this right to appoint.
(4)One member shall be a representative of an anti-human trafficking organization to be determined by the council. This organization shall appoint one member, unless the organization chooses not to exercise this right to appoint.
(5)One member shall be appointed by the Office of the Chancellor of the California Community Colleges, unless that office chooses not to exercise this right to appoint.
(6)One member shall be a member of the public appointed by the Director of the Department of Consumer Affairs, unless the director chooses not to exercise this right to appoint.
(7)One member shall be appointed by the California Association of Private Postsecondary Schools, unless that entity chooses not to exercise this right to appoint.
(8)One member shall be appointed by the American Massage Therapy Association, California Chapter, who shall be a California-certified massage therapist or massage practitioner who is a California resident and who has been practicing massage for at least three years, unless that entity chooses not to exercise this right to appoint.
(9)One member shall be a public health official representing a city, county, city and county, or state health department, to be determined by the council. The city, county, city and county, or state health department chosen, shall appoint one member unless that entity chooses not to exercise this right to appoint.
(10)(A)One member shall be a certified massage therapist or a certified massage practitioner who is a California resident who has practiced massage for at least three years prior to the appointment, selected by a professional society, association, or other entity which membership is composed of massage therapist professionals, and that chooses to participate in the council. To qualify, a professional society, association, or other entity shall have a dues-paying membership in California of at least 1,000 individuals, have been established since 2000, and shall have bylaws that require its members to comply with a code of ethics.
(B)If there is more than one professional society, association, or other entity that meets the requirements of subparagraph (A), the appointment shall rotate based on a four-year term between each of the qualifying entities. The qualifying entity shall maintain its appointment authority during the entirety of the four-year term during which it holds the appointment authority. The order in which a qualifying professional society, association, or other entity has the authority to appoint shall be determined by alphabetical order based on the full legal name of the entity as of January 1, 2014.
(11)The members appointed to the board in accordance with paragraphs (1) to (10), inclusive, shall appoint three additional members, at a duly held board meeting in accordance with the boards bylaws. One of those appointees shall be an attorney licensed by the State Bar of California who has been practicing law for at least three years and who at the time of appointment represents a city, county, or a city and county in the state. One of those appointees shall represent a massage business entity that has been operating in the state for at least three years. The council shall establish in its bylaws a process for appointing an additional member, provided that the member has knowledge of the massage industry or can bring needed expertise to the operation of the council for purposes of complying with Section 4603.
(g)Any decision to change the appointing authority of any member appointed to the board pursuant to paragraphs (1) to (10), inclusive, of subdivision (f) shall not be effective unless the current member has completed their term under subdivision (h) or the appointment is vacant.
(h)(1)Board member terms shall be for four years and until the appointment and qualification of their successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served two terms shall not be eligible for reappointment to the board regardless of the appointing authority. Any board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, shall vacate their appointment no later than July 1, 2025.
(2)A board member may be removed only by their appointing authority under the conditions provided in Section 106.
(i)The board of directors shall establish fees reasonably related to the cost of providing services and carrying out its ongoing responsibilities and duties. Initial and renewal fees for certificates shall be in an amount sufficient to support the functions of the council in the administration of this chapter, but in no event shall exceed three hundred dollars ($300). The renewal fee shall be reassessed biennially by the board.
(j)The meetings of the council shall be subject to the rules of the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). The board may adopt additional policies and procedures that provide greater transparency to certificate holders and the public than required by the Bagley-Keene Open Meeting Act.
(k)Prior to holding a meeting to vote upon a proposal to increase the certification fees, the board shall provide at least 90 days notice of the meeting, including posting a notice on the councils internet website unless at least two-thirds of the board members concur that there is an active threat to public safety and that voting at a meeting without prior notice is necessary. However, the board shall not waive the requirements of subdivision (i).
(l)If the board approves an increase in the certification fees, the council shall update all relevant areas of its internet website and notify all certificate holders and affected applicants by email within 14 days of the boards action.
(m)The council shall assess its contact with non-English speakers. Based on this assessment, the council shall offer and make available all publicly available written and electronic materials provided to certificate holders and applicants in languages other than English that the council determines will be used by a substantial number of non-English speakers who are in contact with the council. This subdivision shall not apply to examinations, denial and disciplinary legal documents, and email communications. The council shall provide a report to the Legislature on the findings of its assessment of contact with non-English speakers on or before January 1, 2019.
SEC. 17.Section 4621 of the Business and Professions Code is amended to read:4621.(a)This chapter shall remain in effect only until January 1, 2026, and as of that date is repealed.
(b)Notwithstanding any other law, the powers and duties of the council shall be subject to review by the appropriate policy committees of the Legislature.
SEC. 18.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 19.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 20.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 21.Section 9880.1 of the Business and Professions Code is amended to read:9880.1.The following definitions apply for the purposes of this chapter:
(a)Automotive repair dealer means a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees.
(b)Automotive technician means an employee of an automotive repair dealer or that dealer, if the employer or dealer repairs motor vehicles and who, for salary or wage, performs repairs of motor vehicles as set forth in subdivision (k).
(c)Bureau means the Bureau of Automotive Repair.
(d)Chief means the Chief of the Bureau of Automotive Repair.
(e)Commercial business agreement means an agreement, whether in writing or oral, entered into between a business or commercial enterprise and an automotive repair dealer, prior to the repair that is requested to be made, that contemplates a continuing business arrangement under which the automotive repair dealer is to repair any motor vehicle covered by the agreement, but does not mean any warranty or extended service agreement normally given by an automotive repair facility to its customers.
(f)Customer means the person presenting a motor vehicle for repair and authorizing the repairs to that motor vehicle. Customer shall not mean the automotive repair dealer providing the repair services or an insurer involved in a claim that includes the motor vehicle being repaired or an employee or agent or a person acting on behalf of the dealer or insurer.
(g)Director means the Director of Consumer Affairs.
(h)Motor vehicle means a passenger vehicle required to be registered with the Department of Motor Vehicles and all motorcycles whether or not required to be registered by the Department of Motor Vehicles.
(i)Person includes a firm, partnership, association, limited liability company, participating tribe, or corporation.
(j)Preventative maintenance services means the following maintenance services: checking tire pressure and adding or relieving pressure, as necessary; rotating tires; changing transmission fluid, transmission filter, engine oil and filter, differential fluid, power steering fluid, and transfer case fluid; changing engine or cabin air filters, and external fuel filters; changing engine coolant; performing a fuel system induction service; replacing belts and windshield wiper blades; replacing light bulbs and restoring headlamps; adding oil or fuel treatments through the designated fill points; and topping off fluids; and all of the listed services include the removal, reinstallation, and replacement of any components necessary to perform each service, and the tapping of damaged threads without removal of any fluid pan.
(k)Repair of motor vehicles means all maintenance of and repairs to motor vehicles performed by an automotive repair dealer, including automotive body repair work, but excluding those repairs made pursuant to a commercial business agreement and roadside services.
(l)Roadside services means the services performed upon a motor vehicle for the purpose of transporting the vehicle or to permit it to be operated under its own power, by, or on behalf of, a motor club holding a certificate of authority pursuant to Chapter 2 (commencing with Section 12160) of Part 5 of Division 2 of the Insurance Code, or by an operator of a tow truck, as defined in Section 615 of the Vehicle Code, that is owned or operated by a person or entity who possesses a valid motor carrier permit, as described in Section 34620 of the Vehicle Code, and is enrolled in the Basic Inspection of Terminals program, as described in Section 34501.12 of the Vehicle Code.
SEC. 22.Section 9880.5 is added to the Business and Professions Code, to read:9880.5.(a)As used in this chapter, the following definitions apply:
(1)Federally recognized tribe means a tribe located in this state and included on the list published in the Federal Register pursuant to the Federally Recognized Indian Tribe List Act of 1994 (25 U.S.C. Sec. 5131) and includes an entity controlled by and established for the benefit of one or more tribes.
(2)Participating tribe means a federally recognized tribe that formally applies for licensure from the bureau pursuant to subdivision (b).
(b)The bureau shall license a federally recognized tribe that applies for licensure and is otherwise compliant with this chapter for the purpose of engaging in a business regulated by this chapter.
(c)Nothing in this chapter is intended to infringe upon or diminish the existing rights, privileges, and immunities of federally recognized tribes as set forth in federal, state, or tribal law, or the jurisdiction of those participating tribes.
(d)Nothing in this chapter, whether express or implied, shall confer upon the bureau or director any rights or authority to regulate any activity within the jurisdiction of a participating tribe.
(e)Any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement shall not apply to a participating tribe.
SEC. 23.Section 19237 of the Business and Professions Code is amended to read:19237.(a)A household mover shall not engage, or attempt to engage, in the business of the transportation of used household goods and personal effects by motor vehicle over any public highway in this state, including by any means or media, advertising, soliciting, offering, arranging as a broker, or entering into an agreement regarding the transportation of used household goods and personal effects, unless both of the following are satisfied:
(1)For transportation of household goods and personal effects within this state, there is in force a permit issued by the bureau authorizing those operations. Permits issued by the Public Utilities Commission pursuant to the former Chapter 7 (commencing with Section 5101) of Division 2 of the Public Utilities Code, that are valid and effective on the operative date of this chapter, shall remain in effect, subject to this chapter, for a period of not more than two years after the operative date of this chapter, or until the time the bureau issues, reissues, renews, suspends, revokes, or otherwise alters or amends the permit, whichever occurs earlier.
(2)(A)For transportation of household goods and personal effects from this state to another state or from another state to this state, there is in force a valid operating authority issued by the Federal Motor Carrier Safety Administration.
(B)An applicant whose principal place of business is not in this state shall not be required to meet the residency requirements pursuant to Section 19239 and shall file with the bureau its designation of persons upon whom court or agency process may be served in this state that the household mover made pursuant to Part 366 of Title 49 of the Code of Federal Regulations.
(C)If the applicant only conducts interstate household moves, the applicant shall not be required to take the examination pursuant to Section 19239 and shall file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state.
(b)A household mover that engages, or attempts to engage, in the business of the transportation of used household goods and personal effects in violation of subdivision (a) shall not enforce any security interest or bring or maintain any action in law or equity to recover any money or property or obtain any other relief from any consignor, consignee, or owner of household goods or personal effects in connection with an agreement to transport, or the transportation of, household goods and personal effects or any related services. A person who utilizes the services of a household mover operating in violation of subdivision (a) may bring an action in any court of competent jurisdiction in this state to recover all compensation paid to that household mover.
(c)The operation of a motor vehicle used in the business of transporting household goods and personal effects by a household mover that does not possess a valid permit or operating authority, as required by subdivision (a), constitutes a public nuisance. Any peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code, may remove any motor vehicle located within the territorial limits in which the officer may act, when the vehicle is found upon a highway and is being used in a manner constituting a public nuisance. At the request of the bureau, the Attorney General, or a district attorney, city attorney, or county counsel, the law enforcement agency may impound the vehicle for a period not to exceed 72 hours to enable the requesting agency to abate the public nuisance, to obtain an order from the superior court of the county in which the vehicle has been impounded to prevent the use of the motor vehicle in violation of law, and to obtain any other remedy available under law as permitted by Section 19282.
(d)Any person having possession or control of used household goods or personal effects, who knows, or through the exercise of reasonable care should know, that a household mover transported those household goods or personal effects in violation of subdivision (a), shall release the household goods and personal effects to the consignor or consignee, as defined in Section 19245, upon the request of the consignor or consignee. If that person fails to release the household goods and personal effects, any peace officer, as defined in subdivision (c), may take custody of the household goods and personal effects and release them to the consignor or consignee.
(e)The bureau shall identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
SEC. 24.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, on and after July 1, 2016, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant has served as an active duty member of the Armed Forces of the United States and was honorably discharged.
(b)Notwithstanding any other law, on and after July 1, 2024, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that the applicant is an active duty member of a regular component of the Armed Forces of the United States enrolled in the United States Department of Defense SkillBridge program as authorized under Section 1143(e) of Title 10 of the United States Code.
(c)A board may adopt regulations necessary to administer this section in accordance with the provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 2.Section 115.5 of the Business and Professions Code is amended to read:115.5.(a)A board within the department shall expedite the licensure process and waive the licensure application fee and the initial or original license fee charged by the board for an applicant who meets both of the following requirements:
(1)Supplies evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)Holds a current license in another state, district, or territory of the United States in the profession or vocation for which the applicant seeks a license from the board.
(b)A board may adopt regulations necessary to administer this section.
(c)This section shall become operative on July 1, 2022.(c)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 3.Section 115.6 of the Business and Professions Code is amended to read:115.6.(a)(1)Except as provided in subdivision (j), a board within the department shall, after appropriate investigation, issue a temporary license to practice a profession or vocation to an applicant who meets the requirements set forth in subdivisions (c) and (d).
(2)Revenues from fees for temporary licenses issued by the California Board of Accountancy shall be credited to the Accountancy Fund in accordance with Section 5132.
(b)The board may conduct an investigation of an applicant for purposes of denying or revoking a temporary license issued pursuant to this section. This investigation may include a criminal background check.
(c)An applicant seeking a temporary license pursuant to this section shall meet the following requirements:
(1)The applicant shall supply evidence satisfactory to the board that the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in this state under official active duty military orders.
(2)The applicant shall hold a current, active, and unrestricted license that confers upon the applicant the authority to practice, in another state, district, or territory of the United States, the profession or vocation within the same scope for which the applicant seeks a temporary license from the board.
(3)The applicant shall submit an application to the board that shall include a signed affidavit attesting to the fact that the applicant meets all of the requirements for the temporary license, and that the information submitted in the application is accurate, to the best of the applicants knowledge. The application shall also include written verification from the applicants original licensing jurisdiction stating that the applicants license is in good standing in that jurisdiction.
(4)The applicant shall not have committed an act in any jurisdiction that would have constituted grounds for denial, suspension, or revocation of the license under this code at the time the act was committed. A violation of this paragraph may be grounds for the denial or revocation of a temporary license issued by the board.
(5)The applicant shall not have been disciplined by a licensing entity in another jurisdiction and shall not be the subject of an unresolved complaint, review procedure, or disciplinary proceeding conducted by a licensing entity in another jurisdiction.
(6)(A)The applicant shall, upon request by a board, furnish a full set of fingerprints for purposes of conducting a criminal background check.
(B)The board shall request a fingerprint-based criminal history information check from the Department of Justice in accordance with subdivision (u) of Section 11105 of the Penal Code and the Department of Justice shall furnish state or federal criminal history information in accordance with subdivision (p) of Section 11105 of the Penal Code.
(d)The applicant shall pass a California law and ethics examination if otherwise required by the board for the profession or vocation for which the applicant seeks licensure.
(e)Except as specified in subdivision (g), a board shall issue a temporary license pursuant to this section within 30 days of receiving documentation that the applicant has met the requirements specified in subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(f)(1)A temporary license issued pursuant to this section may be immediately terminated upon a finding that the temporary licenseholder failed to meet any of the requirements described in subdivision (c) or (d) or provided substantively inaccurate information that would affect the persons eligibility for temporary licensure. Upon termination of the temporary license, the board shall issue a notice of termination that shall require the temporary licenseholder to immediately cease the practice of the licensed profession upon receipt.
(2)Notwithstanding any other law, if, after notice and an opportunity to be heard, a board finds that a temporary licenseholder engaged in unprofessional conduct or any other act that is a cause for discipline by the board, the board shall revoke the temporary license.
(g)An applicant seeking a temporary license as a civil engineer, geotechnical engineer, structural engineer, land surveyor, professional geologist, professional geophysicist, certified engineering geologist, or certified hydrogeologist pursuant to this section shall successfully pass the appropriate California-specific examination or examinations required for licensure in those respective professions by the Board for Professional Engineers, Land Surveyors, and Geologists. The board shall issue a temporary license pursuant to this subdivision within 30 days of receiving documentation that the applicant has met the requirements specified in this subdivision and subdivisions (c) and (d) if the results of the criminal background check do not show grounds for denial.
(h)A temporary license issued pursuant to this section is nonrenewable and shall expire 12 months after issuance, upon issuance or denial of a standard license, upon issuance or denial of a license by endorsement, or upon issuance or denial of an expedited license pursuant to Section 115.5, whichever occurs first.
(i)A board shall submit to the department for approval, if necessary to implement this section, draft regulations necessary to administer this section. These regulations shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(j)(1)This section shall not apply to a board that has a process in place by which an out-of-state licensed applicant in good standing who is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States is able to receive expedited, temporary authorization to practice while meeting state-specific requirements for a period of at least one year or is able to receive an expedited license by endorsement with no additional requirements superseding those described in subdivisions (c) and (d).
(2)This section shall apply only to the extent that it does not amend an initiative or violate constitutional requirements.
(k)This section shall become operative on July 1, 2023.(k)An applicant for a temporary license pursuant to this section shall not be required to provide, and no board shall collect, a fee for the application or issuance of a temporary license.
(l)For purposes of this section, the term applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 4.Section 135.4 of the Business and Professions Code is amended to read:135.4.(a)Notwithstanding any other law, a board within the department shall expedite, and may assist, the initial licensure process for an applicant who supplies satisfactory evidence to the board that they have been admitted to the United States as a refugee under Section 1157 of Title 8 of the United States Code, have been granted asylum by the Secretary of Homeland Security or the Attorney General of the United States pursuant to Section 1158 of Title 8 of the United States Code, or they have a special immigrant visa (SIV) that has been granted a status under Section 1244 of Public Law 110-181, under Public Law 109-163, or under Section 602(b) of Title VI of Division F of Public Law 111-8.
(b)Nothing in this section shall be construed as changing existing licensure requirements. A person applying for expedited licensure under subdivision (a) shall meet all applicable statutory and regulatory licensure requirements.
(c)A board may adopt regulations necessary to administer this section.
(d)For purposes of this section, applicant refers to an applicant for an individual license and does not refer to applicants for business or entity licenses.
SEC. 5.Section 1905.2 of the Business and Professions Code is repealed.1905.2.Recommendations by the dental hygiene board regarding scope of practice issues, as specified in paragraph (8) of subdivision (a) of Section 1905, shall be approved, modified, or rejected by the board within 90 days of submission of the recommendation to the board. If the board rejects or significantly modifies the intent or scope of the recommendation, the dental hygiene board may request that the board provide its reasons in writing for rejecting or significantly modifying the recommendation, which shall be provided by the board within 30 days of the request.SECTION 1.SEC. 6.Section 1926 of the Business and Professions Code is amended to read:1926.In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services, and shall annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
(e)Dental offices.
SEC. 2.SEC. 7.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that the person is entitled to practice hereunder, or who represents or holds themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(4)A person holding a current and active license under another chapter of this division or any initiative act referred to in this division, to the extent the use of the title is consistent with the act governing the practice of that license.
(5)A person whose use of the word doctor or the prefix Dr. is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500.
SEC. 8.Section 2097.5 is added to the Business and Professions Code, to read:2097.5.(a)(1)Notwithstanding Section 2097, a physicians and surgeons license may be renewed for the first time if the board receives evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program at the time the license expires.
(2)The relevant postgraduate training program director shall report to the board within 30 days, on a form approved by the board, if a licensee who renews their license pursuant to this subdivision is disenrolled from their training program for any reason, including, but not limited to, resignation, termination, or graduation.
(b)If a physicians and surgeons license is initially renewed pursuant to subdivision (a), then, at the time of their second renewal, in addition to any other requirements, the board shall require evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training, pursuant to the attestation of the program director, designated institutional official, or delegated authority for the approved postgraduate training program where the applicant participated. A licensee who fails to meet the requirements of this subdivision shall be automatically placed in delinquent status by the board.
(c)If a physicians and surgeons license is initially renewed pursuant to subdivision (a) and the licensee is disenrolled from the relevant California board-approved postgraduate training program, the board may place the relevant license in delinquent status if the board does not receive evidence satisfactory to the board that the licensee has received credit for at least 36 months of board-approved postgraduate training. If placed on delinquent status, that license shall be returned to current status upon the board receiving evidence satisfactory to the board that the licensee is enrolled in a California board-approved postgraduate training program or has received credit for at least 36 months of board-approved postgraduate training before their license changes to canceled status, pursuant to Section 2428. Any license status change made pursuant to this subdivision shall not relieve the licensee of the license renewal requirements of subdivision (b).
(d)(1)Notwithstanding any other law, the board shall issue an initial physicians and surgeons license for a period of 26 months.
(2)A renewed physicians and surgeons license shall be subject to the requirements of Section 2423.
(e)Upon review of supporting documentation, the board, in its discretion, may renew a physicians and surgeons license for an applicant who has demonstrated substantial compliance with this section.
(f)A physician whose license is canceled or who surrenders their license prior to meeting the renewal requirements of either subdivision (b) or (c) is subject to the reinstatement requirements of subdivision (e) of Section 2097.
(g)(1)Except as provided in paragraph (2), this section only applies to individuals who are issued an initial physicians and surgeons license by the board on or after January 1, 2022.
(2)Paragraph (1) of subdivision (d) only applies to individuals who are issued an initial license on or after January 1, 2025.
(h)This section shall not apply to the Osteopathic Medical Board of California.
SEC. 3.SEC. 9.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 4.SEC. 10.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California or another state of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as of January 1, 2023, indicated on the application, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of one transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation pursuant to this section. section unless the attestation was produced fraudulently.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 5.SEC. 11.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (g) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner practicing under this section and not working under standardized procedures shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(i)Subdivision (h) shall not apply to a nurse practitioner if either of the following applies:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 6.SEC. 12.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 7.SEC. 13.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care-related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 14.Section 4052.04 of the Business and Professions Code is amended to read:4052.04.(a)In addition to the authority provided in Section 4052, a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2, the virus that causes COVID-19.
(b)Prior to furnishing COVID-19 oral therapeutics pursuant to subdivision (a), a pharmacist shall utilize relevant and appropriate evidence-based clinical guidelines published by the federal Food and Drug Administration in providing these patient care services.
(c)A pharmacist who furnishes COVID-19 oral therapeutics shall notify the patients primary care provider, or enter the appropriate information in a patient record system shared with the primary care provider, as permitted by that primary care provider. If the patient does not have a primary care provider, the pharmacist shall provide the patient with a written record of the drugs furnished and advise the patient to consult a physician of the patients choice.
(d)A pharmacist shall document, to the extent possible, the kind and amounts of COVID-19 oral therapeutics furnished pursuant to subdivision (a), as well as information regarding any testing services provided, in the patients record in the record system maintained by the pharmacy. The records shall be maintained for three years and shall be available for inspection by all properly authorized personnel of the board.
(e)For purposes of this section, COVID-19 oral therapeutics means drugs that are approved or authorized by the United States Food and Drug Administration for the treatment of COVID-19 and administered orally.
(f)This section shall remain in effect only until January 1, 2025, 2026, and as of that date is repealed.
SEC. 8.SEC. 15.Section 4069 is added to the Business and Professions Code, to read:4069.A pharmacist who dispenses or furnishes a dangerous drug, as defined in Section 4022, pursuant to a veterinary prescription shall include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
SEC. 16.Section 4602 of the Business and Professions Code is amended to read:4602.(a)The California Massage Therapy Council, as defined in subdivision (d) of Section 4601, is hereby established and shall carry out the responsibilities and duties set forth in this chapter.
(b)The council may take any reasonable actions necessary to carry out the responsibilities and duties set forth in this chapter, including, but not limited to, hiring staff, entering into contracts, and developing policies, procedures, rules, and bylaws to implement this chapter.
(c)The council may require background checks for all employees, contractors, volunteers, and board members as a condition of their employment, formation of a contractual relationship, or participation in council activities.
(d)The council shall issue a certificate to an individual applicant who satisfies the requirements of this chapter for that certificate.
(e)The council is authorized to determine whether the information provided to the council in relation to the certification of an applicant is true and correct and meets the requirements of this chapter. If the council has any reason to question whether the information provided is true or correct, or meets the requirements of this chapter, the council is authorized to make any investigation it deems necessary to establish that the information received is accurate and satisfies any criteria established by this chapter. The applicant has the burden to prove that they are entitled to certification.
(f)The council shall be governed by a board of directors composed of 13 members who shall be chosen in the following manner:
(1)One member shall be a representative of the League of California Cities, unless that entity chooses not to exercise this right to appoint.
(2)One member shall be a representative of the California Police Chiefs Association, unless that entity chooses not to exercise this right to appoint.
(3)One member shall be a representative of the California State Association of Counties, unless that entity chooses not to exercise this right to appoint.
(4)One member shall be a representative of an anti-human trafficking organization to be determined by the council. This organization shall appoint one member, unless the organization chooses not to exercise this right to appoint.
(5)One member shall be appointed by the Office of the Chancellor of the California Community Colleges, unless that office chooses not to exercise this right to appoint.
(6)One member shall be a member of the public appointed by the Director of the Department of Consumer Affairs, unless the director chooses not to exercise this right to appoint.
(7)One member shall be appointed by the California Association of Private Postsecondary Schools, unless that entity chooses not to exercise this right to appoint.
(8)One member shall be appointed by the American Massage Therapy Association, California Chapter, who shall be a California-certified massage therapist or massage practitioner who is a California resident and who has been practicing massage for at least three years, unless that entity chooses not to exercise this right to appoint.
(9)One member shall be a public health official representing a city, county, city and county, or state health department, to be determined by the council. The city, county, city and county, or state health department chosen, shall appoint one member unless that entity chooses not to exercise this right to appoint.
(10)(A)One member shall be a certified massage therapist or a certified massage practitioner who is a California resident who has practiced massage for at least three years prior to the appointment, selected by a professional society, association, or other entity which membership is composed of massage therapist professionals, and that chooses to participate in the council. To qualify, a professional society, association, or other entity shall have a dues-paying membership in California of at least 1,000 individuals, have been established since 2000, and shall have bylaws that require its members to comply with a code of ethics.
(B)If there is more than one professional society, association, or other entity that meets the requirements of subparagraph (A), the appointment shall rotate based on a four-year term between each of the qualifying entities. The qualifying entity shall maintain its appointment authority during the entirety of the four-year term during which it holds the appointment authority. The order in which a qualifying professional society, association, or other entity has the authority to appoint shall be determined by alphabetical order based on the full legal name of the entity as of January 1, 2014.
(11)The members appointed to the board in accordance with paragraphs (1) to (10), inclusive, shall appoint three additional members, at a duly held board meeting in accordance with the boards bylaws. One of those appointees shall be an attorney licensed by the State Bar of California who has been practicing law for at least three years and who at the time of appointment represents a city, county, or a city and county in the state. One of those appointees shall represent a massage business entity that has been operating in the state for at least three years. The council shall establish in its bylaws a process for appointing an additional member, provided that the member has knowledge of the massage industry or can bring needed expertise to the operation of the council for purposes of complying with Section 4603.
(g)Any decision to change the appointing authority of any member appointed to the board pursuant to paragraphs (1) to (10), inclusive, of subdivision (f) shall not be effective unless the current member has completed their term under subdivision (h) or the appointment is vacant.
(g)(h)(1)Board member terms shall be for four years. years and until the appointment and qualification of their successor or until one year from the expiration of the term for which the member was appointed, whichever occurs first. A board member who has served two terms shall not be eligible for reappointment to the board regardless of the appointing authority. Any board member who, as of January 1, 2025, has served on the board for 8 out of the preceding 10 years, regardless of the appointing authority, shall vacate their appointment no later than July 1, 2025.
(2)A board member may be removed only by their appointing authority under the conditions provided in Section 106.
(h)(i)The board of directors shall establish fees reasonably related to the cost of providing services and carrying out its ongoing responsibilities and duties. Initial and renewal fees for certificates shall be in an amount sufficient to support the functions of the council in the administration of this chapter, but in no event shall exceed three hundred dollars ($300). The renewal fee shall be reassessed biennially by the board.
(i)(j)The meetings of the council shall be subject to the rules of the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). The board may adopt additional policies and procedures that provide greater transparency to certificate holders and the public than required by the Bagley-Keene Open Meeting Act.
(j)(k)Prior to holding a meeting to vote upon a proposal to increase the certification fees, the board shall provide at least 90 days notice of the meeting, including posting a notice on the councils internet website unless at least two-thirds of the board members concur that there is an active threat to public safety and that voting at a meeting without prior notice is necessary. However, the board shall not waive the requirements of subdivision (i).
(k)(l)If the board approves an increase in the certification fees, the council shall update all relevant areas of its internet website and notify all certificate holders and affected applicants by email within 14 days of the boards action.
(l)(m)The council shall assess its contact with non-English speakers. Based on this assessment, the council shall offer and make available all publicly available written and electronic materials provided to certificate holders and applicants in languages other than English that the council determines will be used by a substantial number of non-English speakers who are in contact with the council. This subdivision shall not apply to examinations, denial and disciplinary legal documents, and email communications. The council shall provide a report to the Legislature on the findings of its assessment of contact with non-English speakers on or before January 1, 2019.
SEC. 17.Section 4621 of the Business and Professions Code is amended to read:4621.(a)This chapter shall remain in effect only until January 1, 2027, 2026, and as of that date is repealed.
(b)Notwithstanding any other law, the powers and duties of the council shall be subject to review by the appropriate policy committees of the Legislature.
SEC. 9.SEC. 18.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 10.SEC. 19.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 11.SEC. 20.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 21.Section 9880.1 of the Business and Professions Code is amended to read:9880.1.The following definitions apply for the purposes of this chapter:
(a)Automotive repair dealer means a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees.
(b)Automotive technician means an employee of an automotive repair dealer or that dealer, if the employer or dealer repairs motor vehicles and who, for salary or wage, performs repairs of motor vehicles as set forth in subdivision (k).
(c)Bureau means the Bureau of Automotive Repair.
(d)Chief means the Chief of the Bureau of Automotive Repair.
(e)Commercial business agreement means an agreement, whether in writing or oral, entered into between a business or commercial enterprise and an automotive repair dealer, prior to the repair that is requested to be made, that contemplates a continuing business arrangement under which the automotive repair dealer is to repair any motor vehicle covered by the agreement, but does not mean any warranty or extended service agreement normally given by an automotive repair facility to its customers.
(f)Customer means the person presenting a motor vehicle for repair and authorizing the repairs to that motor vehicle. Customer shall not mean the automotive repair dealer providing the repair services or an insurer involved in a claim that includes the motor vehicle being repaired or an employee or agent or a person acting on behalf of the dealer or insurer.
(g)Director means the Director of Consumer Affairs.
(h)Motor vehicle means a passenger vehicle required to be registered with the Department of Motor Vehicles and all motorcycles whether or not required to be registered by the Department of Motor Vehicles.
(i)Person includes a firm, partnership, association, limited liability company, participating tribe, or corporation.
(j)Preventative maintenance services means the following maintenance services: checking tire pressure and adding or relieving pressure, as necessary; rotating tires; changing transmission fluid, transmission filter, engine oil and filter, differential fluid, power steering fluid, and transfer case fluid; changing engine or cabin air filters, and external fuel filters; changing engine coolant; performing a fuel system induction service; replacing belts and windshield wiper blades; replacing light bulbs and restoring headlamps; adding oil or fuel treatments through the designated fill points; and topping off fluids; and all of the listed services include the removal, reinstallation, and replacement of any components necessary to perform each service, and the tapping of damaged threads without removal of any fluid pan.
(k)Repair of motor vehicles means all maintenance of and repairs to motor vehicles performed by an automotive repair dealer, including automotive body repair work, but excluding those repairs made pursuant to a commercial business agreement and roadside services.
(l)Roadside services means the services performed upon a motor vehicle for the purpose of transporting the vehicle or to permit it to be operated under its own power, by, or on behalf of, a motor club holding a certificate of authority pursuant to Chapter 2 (commencing with Section 12160) of Part 5 of Division 2 of the Insurance Code, or by an operator of a tow truck, as defined in Section 615 of the Vehicle Code, that is owned or operated by a person or entity who possesses a valid motor carrier permit, as described in Section 34620 of the Vehicle Code, and is enrolled in the Basic Inspection of Terminals program, as described in Section 34501.12 of the Vehicle Code.
SEC. 22.Section 9880.5 is added to the Business and Professions Code, to read:9880.5.(a)As used in this chapter, the following definitions apply:
(1)Federally recognized tribe means a tribe located in this state and included on the list published in the Federal Register pursuant to the Federally Recognized Indian Tribe List Act of 1994 (25 U.S.C. Sec. 5131) and includes an entity controlled by and established for the benefit of one or more tribes.
(2)Participating tribe means a federally recognized tribe that formally applies for licensure from the bureau pursuant to subdivision (b).
(b)The bureau shall license a federally recognized tribe that applies for licensure and is otherwise compliant with this chapter for the purpose of engaging in a business regulated by this chapter.
(c)Nothing in this chapter is intended to infringe upon or diminish the existing rights, privileges, and immunities of federally recognized tribes as set forth in federal, state, or tribal law, or the jurisdiction of those participating tribes.
(d)Nothing in this chapter, whether express or implied, shall confer upon the bureau or director any rights or authority to regulate any activity within the jurisdiction of a participating tribe.
(e)Any requirement to register with the Secretary of State, maintain good standing with the Secretary of State, provide a corporate number issued by the Secretary of State, or any other associated requirement shall not apply to a participating tribe.
SEC. 23.Section 19237 of the Business and Professions Code is amended to read:19237.(a)A household mover shall not engage, or attempt to engage, in the business of the transportation of used household goods and personal effects by motor vehicle over any public highway in this state, including by any means or media, advertising, soliciting, offering, arranging as a broker, or entering into an agreement regarding the transportation of used household goods and personal effects, unless both of the following are satisfied:
(1)For transportation of household goods and personal effects entirely within this state, there is in force a permit issued by the bureau authorizing those operations. Permits issued by the Public Utilities Commission pursuant to the former Chapter 7 (commencing with Section 5101) of Division 2 of the Public Utilities Code, that are valid and effective on the operative date of this chapter, shall remain in effect, subject to the provisions of this chapter, for a period of not more than two years after the operative date of this chapter, or until the time the bureau issues, reissues, renews, suspends, revokes, or otherwise alters or amends the permit, whichever occurs earlier.
(2)(A)For transportation of household goods and personal effects from this state to another state or from another state to this state, there is in force a valid operating authority issued by the Federal Motor Carrier Safety Administration.
(B)An applicant whose principal place of business is not in this state shall not be required to meet the residency requirements pursuant to Section 19239 and shall file with the bureau its designation of persons upon whom court or agency process may be served in this state that the household mover made pursuant to Part 366 of Title 49 of the Code of Federal Regulations.
(C)If the applicant only conducts interstate household moves, the applicant shall not be required to take the examination pursuant to Section 19239 and shall file an affidavit with the bureau stating it shall not conduct any intrastate household moves in this state.
(b)A household mover that engages, or attempts to engage, in the business of the transportation of used household goods and personal effects in violation of subdivision (a) shall not enforce any security interest or bring or maintain any action in law or equity to recover any money or property or obtain any other relief from any consignor, consignee, or owner of household goods or personal effects in connection with an agreement to transport, or the transportation of, household goods and personal effects or any related services. A person who utilizes the services of a household mover operating in violation of subdivision (a) may bring an action in any court of competent jurisdiction in this state to recover all compensation paid to that household mover.
(c)The operation of a motor vehicle used in the business of transporting household goods and personal effects by a household mover that does not possess a valid permit or operating authority, as required by subdivision (a), constitutes a public nuisance. Any peace officer, as defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code, may remove any motor vehicle located within the territorial limits in which the officer may act, when the vehicle is found upon a highway and is being used in a manner constituting a public nuisance. At the request of the bureau, the Attorney General, or a district attorney, city attorney, or county counsel, the law enforcement agency may impound the vehicle for a period not to exceed 72 hours to enable the requesting agency to abate the public nuisance, to obtain an order from the superior court of the county in which the vehicle has been impounded to prevent the use of the motor vehicle in violation of law, and to obtain any other remedy available under law as permitted by Section 19282.
(d)Any person having possession or control of used household goods or personal effects, who knows, or through the exercise of reasonable care should know, that a household mover transported those household goods or personal effects in violation of subdivision (a), shall release the household goods and personal effects to the consignor or consignee, as defined in Section 19245, upon the request of the consignor or consignee. If that person fails to release the household goods and personal effects, any peace officer, as defined in subdivision (c), may take custody of the household goods and personal effects and release them to the consignor or consignee.
(e)The bureau shall identify household movers that are authorized to conduct intrastate and interstate moves in the state on its internet website.
SEC. 12.SEC. 24.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services. services, and shall annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
(e)Dental offices.
SEC. 2.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that the person is entitled to practice hereunder, or who represents or holds themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.. D.O.
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(4)A person holding a current and active license under another chapter of this division or any initiative act referred to in this division, to the extent the use of the title is consistent with the act governing the practice of that license.
(5)A person whose use of the word doctor or the prefix Dr. is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500.
SEC. 3.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 4.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California or another state of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last 5 five years, as of January 1, 2023, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of a one transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be liable for any civil damages and shall not be subject to an administrative action, sanction, or penalty for attesting only to the completion of a transition to practice. be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation pursuant to this section.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 5.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (f) (g) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (f) (g) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner practicing under this section and not working under standardized procedures shall inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon.
(e)A nurse practitioner practicing under this section and not working under standardized procedures shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(f)A nurse practitioner practicing under this section and not working under standardized procedures shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(i)Subdivision (h) shall not apply to a nurse practitioner if either of the following apply: applies:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 6.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 7.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care related care-related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 8.Section 4069 is added to the Business and Professions Code, to read:4069.A pharmacist who dispenses or furnishes a dangerous drug, as defined in Section 4022, pursuant to a veterinary prescription shall include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
SEC. 8.SEC. 9.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 9.SEC. 10.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 10.SEC. 11.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 11.SEC. 12.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services.
(e)Dental offices.
SEC. 2.Section 2054 of the Business and Professions Code is amended to read:2054.(a)Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words doctor or physician, the letters or prefix Dr., the initials M.D., M.D. or D.O., or any other terms or letters indicating or implying that he or she the person is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that he or she the person is entitled to practice hereunder, or who represents or holds himself or herself themselves out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor. No person shall use the words doctor or physician, the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O..
(b)Notwithstanding subdivision (a), any of the following persons may use the words doctor or physician, the letters or prefix Dr., or the initials M.D.: M.D. or D.O.:
(1)A graduate of a medical or an osteopathic medical school approved or recognized by the medical or osteopathic medical board while enrolled in a postgraduate training program approved by the board.
(2)A graduate of a medical or an osteopathic medical school who does not have a certificate as a physician and surgeon under this chapter if he or she the individual meets all of the following requirements:
(A)If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B)Does not otherwise hold himself or herself themselves out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C)Does not engage in any of the acts prohibited by Section 2060.
(3)A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
SEC. 3.Section 2837.101 of the Business and Professions Code is amended to read:2837.101.For purposes of this article, the following terms have the following meanings:
(a)Committee means the Nurse Practitioner Advisory Committee.
(b)Standardized procedures has the same meaning as that term is defined in Section 2725.
(c)Transition to practice means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. Transition to practice includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. The board shall, by regulation, define minimum standards for transition to practice. Clinical experience may include experience obtained before January 1, 2021, if the experience meets the requirements established by the board. For purposes of the transition to practice:
(1)Clinical experience shall not be limited to experience in a single category that a nurse practitioner may practice in pursuant to Section 2836.
(2)Clinical experience may include experience obtained before January 1, 2021, but clinical experience obtained before a person is certified by the board as a nurse practitioner shall not be included.
SEC. 4.Section 2837.103 of the Business and Professions Code is amended to read:2837.103.(a)(1)Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A)Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B)Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C)Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D)Has completed a transition to practice in California or another state of a minimum of three full-time equivalent years of practice or 4600 hours. A nurse practitioner who has been practicing as a nurse practitioner for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, may be deemed to have satisfied this requirement. For purposes of this subparagraph:
(i)Proof of completion of a transition to practice shall be provided to the board, on a form prescribed by the board, as an attestation from either a licensed physician and surgeon, a certified nurse practitioner practicing pursuant to this section, or a certified nurse practitioner practicing pursuant to Section 2837.104.
(ii)A licensed physician and surgeon or a certified nurse practitioner who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant pursuant to Section 2836.
(iii)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and shall only attest to the completion of the transition to practice, as defined in Section 2837.101.
(iv)A licensed physician and surgeon or a certified nurse practitioner practicing pursuant to this section or Section 2837.104 who attests to the completion of a transition to practice shall not be liable for any civil damages and shall not be subject to an administrative action, sanction, or penalty for attesting only to the completion of a transition to practice.
(2)A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A)A clinic, as defined in Section 1200 of the Health and Safety Code.
(B)A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i)A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii)A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C)A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D)A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E)A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F)A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3)In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A)A nurse practitioner shall adhere to all applicable bylaws.
(B)A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C)A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensees employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b)An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c)In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1)Conduct an advanced assessment.
(2)(A)Order, perform, and interpret diagnostic procedures.
(B)For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3)Establish primary and differential diagnoses.
(4)Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A)Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B)Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C)Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5)After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6)Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d)A nurse practitioner shall verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon. For purposes of Spanish language speakers, the nurse practitioner shall use the standardized phrase enfermera especializada.
(e)A nurse practitioner shall not be required to tell a patient the patient has a right to see a physician and surgeon.
(e)(f)A nurse practitioner shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and the internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(f)(g)A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(g)(h)A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(h)(i)Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 5.Section 2837.104 of the Business and Professions Code is amended to read:2837.104.(a)Beginning January 1, 2023, notwithstanding any other law, the following apply to a nurse practitioner who holds an active certification issued by the board pursuant to subdivision (b):
(1)The nurse practitioner may perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings or organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103.
(2)Subject to subdivision (f) and any applicable conflict of interest policies of the bylaws, the nurse practitioner shall be eligible for membership of an organized medical staff.
(3)Subject to subdivision (f) and any applicable conflict of interest policies of the bylaws, a nurse practitioner member may vote at meetings of the department to which nurse practitioners are assigned.
(b)The board shall issue a certificate to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision outside of the settings and organizations specified under subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) of Section 2837.103, if the nurse practitioner satisfies all of the following requirements:
(1)Meets all of the requirements specified in paragraph (1) of subdivision (a) of Section 2837.103.
(2)Holds a valid and active license as a registered nurse in California and a masters degree in nursing or in a clinical field related to nursing or a doctoral degree in nursing.
(3)Has practiced as a nurse practitioner in good standing for at least three years, not inclusive of the transition to practice required pursuant to subparagraph (D) of paragraph (1) of subdivision (a) of Section 2837.103. The board may, at its discretion, lower this requirement for a nurse practitioner holding a Doctorate of Nursing Practice degree (DNP) based on practice experience gained in the course of doctoral education experience.
(c)A nurse practitioner authorized to practice pursuant to this section shall comply with all of the following:
(1)The nurse practitioner, consistent with applicable standards of care, shall not practice beyond the scope of their clinical and professional education and training, including specific areas of concentration and shall only practice within the limits of their knowledge and experience and national certification.
(2)The nurse practitioner shall consult and collaborate with other healing arts providers based on the clinical condition of the patient to whom health care is provided. Physician consultation shall be obtained as specified in the individual protocols and under the following circumstances:
(A)Emergent conditions requiring prompt medical intervention after initial stabilizing care has been started.
(B)Problem which is not resolving as anticipated after an ongoing evaluation and management of the situation.
(C)History, physical, or lab findings inconsistent with the clinical perspective.
(D)Upon request of patient.
(3)Nurse practitioner consultation with a physician and surgeon alone shall not create a physician-patient relationship. The nurse practitioner shall be solely responsible for the services they provide.
(4)The nurse practitioner shall establish a plan for referral of complex medical cases and emergencies to a physician and surgeon or other appropriate healing arts providers. The nurse practitioner shall have an identified referral plan specific to the practice area, that includes specific referral criteria. The referral plan shall address the following:
(A)Whenever situations arise which go beyond the competence, scope of practice, or experience of the nurse practitioner.
(B)Whenever patient conditions fail to respond or the patient is acutely decompensating in a manner that is not consistent with the progression of the disease and corresponding treatment plan.
(C)Any patient with a rare condition.
(D)Any patient conditions that do not fit the commonly accepted diagnostic pattern for a disease or disorder.
(E)All emergency situations after initial stabilizing care has been started.
(d)A nurse practitioner shall verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon. For purposes of Spanish language speakers, the nurse practitioner shall use the standardized phrase enfermera especializada.
(e)A nurse practitioner shall not be required by the board to tell a patient that the patient has a right to see a physician and surgeon.
(e)(f)A nurse practitioner shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the boards telephone number and internet website where the nurse practitioners license may be checked and complaints against the nurse practitioner may be made.
(f)(g)A nurse practitioner practicing pursuant to this section shall maintain professional liability insurance appropriate for the practice setting.
(g)(h)For purposes of this section, corporations and other artificial legal entities shall have no professional rights, privileges, or powers.
(h)(i)Subdivision (g) (h) shall not apply to a nurse practitioner if either of the following apply:
(1)The certificate issued pursuant to this section is inactive, surrendered, revoked, or otherwise restricted by the board.
(2)The nurse practitioner is employed pursuant to the exemptions under Section 2401.
SEC. 2.SEC. 6.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 3.SEC. 7.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 4.SEC. 8.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 5.SEC. 9.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
SEC. 6.SEC. 10.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board.
SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a)Residences of the homebound.
(b)Schools.
(c)Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
(d)Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines. If the dental health professional shortage area certification is removed, a registered dental hygienist in alternative practice with an existing practice in the area may continue to provide dental hygiene services.
(e)Dental offices.
SEC. 2.Section 2837.105 of the Business and Professions Code is amended to read:2837.105.(a)(1)The board shall request the departments Office of Professional Examination Services, or an equivalent organization, to perform an occupational analysis of nurse practitioners performing the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision.
(2)The board, together with the Office of Professional Examination Services, shall assess the alignment of the competencies tested in the national nurse practitioner certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103 with the occupational analysis performed according to paragraph (1). This paragraph shall not apply to a national nurse practitioner certification examination discontinued before January 1, 2017.
(3)The occupational analysis shall be completed by January 1, 2023.
(4)If the assessment performed according to paragraph (2) identifies additional competencies necessary to perform the functions specified in subdivision (c) of Section 2837.103 pursuant to that subdivision that are not sufficiently validated by the national nurse practitioner board certification examination required by subparagraph (A) of paragraph (1) of subdivision (a) of Section 2837.103, the board shall identify and develop a supplemental exam that properly validates identified competencies.
(b)The examination process shall be regularly reviewed pursuant to Section 139.
SEC. 3.Section 3765 of the Business and Professions Code is amended to read:3765.This act does not prohibit any of the following activities:
(a)The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
(b)Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of this chapter.
(c)The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
(d)The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
(e)Temporary performance, by other health care personnel, students, or groups, of respiratory care services, as identified and authorized by the board, in the event of an epidemic, pandemic, public disaster, or emergency.
(f)Persons from engaging in cardiopulmonary research.
(g)Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication as defined in Section 1596.798 of the Health and Safety Code.
(h)The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific, limited, and basic respiratory care or respiratory care related services that have been authorized by the board.
(i)The performance, by a vocational nurse licensed by the Board of Vocational Nursing and Psychiatric Technicians of the State of California who is employed by a home health agency licensed by the State Department of Public Health, of respiratory tasks and services identified by the board, if the licensed vocational nurse complies with the following:
(1)Before January 1, 2025, 2028, the licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(2)On or after January 1, 2025, 2028, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, 2028, in collaboration with the Board of Vocational Nursing and Psychiatric Technicians of the State of California.
(j)The performance of respiratory care services identified by the board by a licensed vocational nurse who satisfies the requirements in paragraph (1) in the settings listed in paragraph (2).
(1)(A)The licensed vocational nurse is licensed pursuant to Chapter 6.5 (commencing with Section 2840).
(B)The licensed vocational nurse has completed patient-specific training satisfactory to their employer.
(C)The licensed vocational nurse holds a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
(2)A licensed vocational nurse may perform the respiratory care services identified by the board pursuant to this subdivision in the following settings:
(A)At a congregate living health facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(B)At an intermediate care facility licensed by the State Department of Public Health that is designated as six beds or fewer.
(C)At an adult day health care center licensed by the State Department of Public Health.
(D)As an employee of a home health agency licensed by the State Department of Public Health or an individual nurse provider working in a residential home.
(E)At a pediatric day health and respite care facility licensed by the State Department of Public Health.
(F)At a small family home licensed by the Department of Social Services that is designated as six beds or fewer.
(G)As a private duty nurse as part of daily transportation and activities outside a patients residence or family respite for home- and community-based patients.
(3)This subdivision is operative on January 1, 2028.
(j)(k)The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years.
SEC. 4.Section 7423 of the Business and Professions Code is amended to read:7423.The amounts of the fees required by this chapter relating to licenses for individual practitioners are as follows:
(a)(1)Cosmetologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A cosmetologist initial license fee shall not be more than fifty dollars ($50).
(b)(1)An esthetician application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An esthetician initial license fee shall not be more than forty dollars ($40).
(c)(1)A manicurist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A manicurist initial license fee shall not be more than thirty-five dollars ($35).
(d)(1)A barber application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)A barber initial license fee shall be not more than fifty dollars ($50).
(e)(1)An electrologist application and examination fee shall be the actual cost to the board for developing, purchasing, grading, and administering the examination.
(2)An electrologist initial license fee shall be not more than fifty dollars ($50).
(f)An apprentice application and license fee shall be not more than twenty-five dollars ($25).
(g)The license renewal fee for individual practitioner licenses that are subject to renewal shall be not more than fifty dollars ($50).
(h)A hairstylist application and examination fee shall be fifty dollars ($50) or a fee in an amount as determined by the board, not to exceed the reasonable cost of the actual cost to the board for developing, purchasing, grading, and administering the examination, not to exceed fifty dollars ($50). examination.
(i)A hairstylists initial license fee shall be no more than fifty dollars ($50).
(i)(j)Notwithstanding Section 163.5 the license renewal delinquency fee shall be 50 percent of the renewal fee in effect on the date of renewal.
SEC. 5.Section 8593 of the Business and Professions Code is amended to read:8593.(a)The board shall require as a condition to the renewal of each operators and field representatives license that the holder submit proof satisfactory to the board that he or she has informed himself or herself they have informed themselves of developments in the field of pest control either by completion of courses of continuing education in pest control approved by the board or equivalent activity approved by the board. In lieu of submitting that proof, the licenseholder, if he or she so desires, may take and successfully complete an examination given by the board, designed to test his or her knowledge of developments in the field of pest control since the issuance of his or her license.
(b)The board shall develop a correspondence course or courses with any educational institution or institutions as it deems appropriate. This course may be used to fulfill the requirements of this section. The institution may charge a reasonable fee for each course.
(c)The board may charge a fee for the taking of an examination in each branch of pest control pursuant to this section in an amount sufficient to cover the reasonable regulatory cost of administering each examination.SEC. 6.Section 8593.1 of the Business and Professions Code is amended to read:8593.1.The board shall require as a condition to the renewal of each applicators license that the holder thereof submit proof satisfactory to the board that he or she has they have completed courses of continuing education in pesticide application and use approved by the board or equivalent activity approved by the board. In lieu of submitting that proof, the licenseholder, if he or she so desires, may successfully apply for and pass an appropriate applicators examination for renewal of a license given by the board.
|
Date
|
Status
|
|---|---|
| Sep 22, 2024 | Chaptered by Secretary of State. Chapter 481, Statutes of 2024. |
| Sep 22, 2024 | Approved by the Governor. |
| Sep 12, 2024 | Enrolled and presented to the Governor at 3 p.m. |
| Aug 31, 2024 | Assembly amendments concurred in. (Ayes 38. Noes 0. Page 5775.) Ordered to engrossing and enrolling. |
| Aug 30, 2024 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 30, 2024 | Read third time. Passed. (Ayes 65. Noes 1. Page 6975.) Ordered to the Senate. |
| Aug 28, 2024 | Read second time. Ordered to third reading. |
| Aug 27, 2024 | From committee: Do pass. (Ayes 14. Noes 1.) (August 27). |
| Aug 26, 2024 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B. & P. |
| Aug 22, 2024 | Read third time and amended. |
| Aug 22, 2024 | Re-referred to Com. on B. & P. pursuant to Assembly Rule 77.2. |
| Aug 22, 2024 | Ordered to third reading. |
| Aug 8, 2024 | Read second time. Ordered to third reading. |
| Aug 7, 2024 | From committee: Do pass. (Ayes 10. Noes 0.) (August 7). |
| Jun 25, 2024 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 1.) (June 25). Re-referred to Com. on APPR. |
| Jun 19, 2024 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B. & P. |
| May 20, 2024 | Referred to Com. on B. & P. |
| May 13, 2024 | In Assembly. Read first time. Held at Desk. |
| May 13, 2024 | Read third time. Passed. (Ayes 36. Noes 0. Page 3895.) Ordered to the Assembly. |
| May 7, 2024 | Read second time. Ordered to third reading. |
| May 6, 2024 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Apr 26, 2024 | Set for hearing May 6. |
| Apr 22, 2024 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 12. Noes 0. Page 3699.) (April 22). Re-referred to Com. on APPR. |
| Apr 17, 2024 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B., P. & E. D. |
| Apr 5, 2024 | Set for hearing April 22. |
| Feb 29, 2024 | Referred to Com. on B., P. & E. D. |
| Feb 20, 2024 | From printer. May be acted upon on or after March 18. |
| Feb 16, 2024 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 31, 2024 | Unfinished Business SB1451 Ashby Concurrence | Senate Floor |
Passed |
|
| Aug 30, 2024 | SB 1451 Ashby Senate Third Reading By Berman | Assembly Floor |
Passed |
|
| Aug 27, 2024 | Do pass. | Assembly Standing Committee on Business and Professions |
Passed |
|
| Aug 7, 2024 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 25, 2024 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
|
| May 13, 2024 | Senate 3rd Reading SB1451 Ashby | Senate Floor |
Passed |
|
| Apr 22, 2024 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Aaron Read and Associates | * Support | Apr 22, 2024 |
| American Association of Nurse Practitioners | * Against Unless Amend | Jun 25, 2024 |
| American Association of Nurse Practitioners | ** Against | |
| American Nurses Association of California | ** Against | |
| Associated Bodywork And Massage Professionals | ** Support | |
| Association of California Healthcare Districts | ** Support | |
| Bay Area Cancer Connections | ** Support | |
| Bay Area Council | ** Support | |
| Board of Barbering and Cosmetology | ** Support | |
| California Access Coalition | ** Support | |
| California Alliance Of Child And Family Services | ** Support | |
| California Association for Nurse Practitioners | ** Support | |
| California Association Of Alcohol And Drug Program Executives, Inc. | ** Support | |
| California Association Of Medical Product Suppliers | ** Support | |
| California Association of Nurse Anesthesiology | * Support | Apr 22, 2024 |
| California Association Of Orthodontists | * Support | Apr 22, 2024 |
| California Black Health Network | ** Support | |
| California Community Pharmacy Coalition | ** Support | |
| California Consortium of Addiction Programs and Professionals | ** Support | |
| California Council Of Community Behavioral Health Agencies | ** Support | |
| California Dental Association | ** Against | |
| California Dental Hygienists Association | ** Support | |
| california dental hygienists' association | ** Support | |
| California Health Collaborative | ** Support | |
| California Hepatitis C Task Force | ** Support | |
| California Hospital Association | ** Support | |
| California Medical Association | ** Against | |
| California Moving And Storage Association | ** Support | |
| California Nurse-Midwives Association | ** Against | |
| California Nurses Association | ** Support | |
| California Psychological Association | * Indeterminate | Jun 26, 2024 |
| California Society Of Dermatology & Dermatologic Surgery | ** Against | |
| California Society of Dermatology and Dermatologic Surgery | * Against Unless Amend | Jun 26, 2024 |
| California State Oriental Medical Association | ** Against | |
| Center for Inherited Blood Disorders | ** Support | |
| Chronic Disease Coalition | ** Support | |
| City Of Hayward | * Support | Jun 25, 2024 |
| Close the Provider Gap | ** Support | |
| Dental Hygiene Board of California | ** Support | |
| ElderHelp | ** Support | |
| Leading Age California | ** Support | |
| Little Lobbyists | ** Support | |
| Liver Coalition | ** Support | |
| Liver Coalition of San Diego | ** Support | |
| Lizzie Initiative for Pet Protection | * Support | Jun 25, 2024 |
| Looms for Lupus | ** Support | |
| Los Angeles County Department of Health Services | * Support | Apr 22, 2024 |
| Madera Community Hospital | ** Support | |
| Mental Health America of California | ** Support | |
| Michelle’s Place Cancer Resource Center | ** Support | |
| Osteopathic Medical Board of California | ** Against | |
| Osteopathic Physicians And Surgeons Of California | ** Against | |
| Patient Advocates United in San Diego County | ** Support | |
| Pediatric Day Health Care Coalition | ** Support | |
| Respiratory Care Board of California | ** Support | |
| Russian River Health Center | * Support | Jun 25, 2024 |
| SEIU California State Council | ** Support | |
| Senior Care Clinic Medical House Calls | ** Support | |
| Shingle Springs Band Of Miwok Indians | ** Support | |
| Sickle Cell Disease Foundation | ** Support | |
| SMYLE Essentials | * Support | Apr 22, 2024 |
| SMYLE Essentials | * Support | Apr 22, 2024 |
| The California Naturopathic Doctors Association | ** Against | |
| UC Davis Health System | * Support | Apr 22, 2024 |
| UC Davis Medical Center | * Support | Apr 22, 2024 |
| University of Pacific | * Support | Apr 22, 2024 |
| University of the Pacific, Arthur A. Dugoni School of Dentistry | * Support | Jun 25, 2024 |
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 1451 |
UNFINISHED BUSINESS
Bill No: SB 1451
Author: Ashby (D)
Amended: 8/26/24
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 12-0, 4/22/24
AYES: Ashby, Nguyen, Alvarado-Gil, Archuleta, Becker, Dodd, Eggman, Glazer, Niello, Roth, Smallwood-Cuevas, Wilk
NO VOTE RECORDED: Menjivar
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 36-0, 5/13/24
AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
NO VOTE RECORDED: Atkins, Gonzalez, Menjivar, Padilla
ASSEMBLY FLOOR: 65-1, 8/30/24 - See last page for vote
SUBJECT: Professions and vocations
SOURCE: Author
DIGEST:
This bill makes various changes to the operations of programs governed by practice acts in the Business and Professions Code (BPC) and various professions regulated by these programs, stemming from prior sunset review oversight efforts.
Assembly Amendments
make various technical and conforming changes; waive fees for military and military spouse expedited licensure; strike obsolete reference in the Dental Hygiene Practice Act; clarify physician licensure renewal for postgraduates; revert to existing law limiting the completion of a transition to practice in only California; extend the authority for pharmacists to furnish COVID-19 oral therapeutics until January 1, 2026; update the California Massage Therapy Council (CAMTC) sunset date and update CAMTC board member terms; authorize tribal licensure by the Bureau of Automotive Repair and ; exempt out-of-state household movers regulated by the Bureau of Household Goods and Services (BHGS) from certain requirements, as specified.
ANALYSIS:
Existing law:
- Requires the Dental Board of California (DBC) to approve, modify, or reject recommendations by the Dental Hygiene Board of California (DHBC) regarding scope of practice issues within 90 days of submission of the recommendation. (BPC § 1905.2)
- Authorizes registered dental hygienists in alternative practice (RDHAP) in only limited settings including residences of the homebound; schools; residential facilities and other institutions; and, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information to perform specified, narrow services. (BPC § 1926)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the Medical Board of California (MBC) from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Authorizes an independently practicing nurse practitioner (NP) to perform specified functions in a defined healthcare setting if the NP has met specified requirements and authorizes a NP who meets these requirements to practice in an outpatient health facility, except for a correctional treatment center or a state hospital; a health facility including a general acute care hospital; a county hospital; a medical group practice, including a professional medical corporation, as specified, another form of corporation controlled by physicians, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians that provide healthcare services; and a licensed hospice facility. (BPC §§ 2837.103, 2837.104)
- Defines a transition to practice (TTP) for purposes of NP independent practice to mean “additional clinical experience and mentorship provided to prepare a NP to practice independently, and includes, but is not limited to, managing a panel of patients, working in a complex healthcare setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism and business management of a practice.” (BPC § 2837.101(c))
- Specifies various activities that are not prohibited by the Respiratory Care Practice Act, including a licensed vocational nurse (LVN) employed by a home health agency who has met certain training requirements performing Respiratory Care Board of California (RBC)-specified respiratory services. (BPC § 3765 (i))
- Establishes the Massage Therapy Act until January 1, 2027 to provide for the voluntary certification of massage therapists by CAMTC, a private nonprofit organization. (BPC §§ 4600 et seq.)
- Authorizes pharmacists to furnish COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2025. (BPC § 4052.04)
- Requires that, each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation including specified information. (BPC § 4829.5(a)
- Specifies that in order to become a licensed hairstylist, an applicant must be at least 17, complete 10th grade (or the equivalent of public school 10th grade), is not subject to denial based on having been convicted of a crime within a certain time frame that is substantially related to the qualifications, functions, or duties of being a hairstylist, and has either completed a course in hairstyling from a BBC-approved school or practiced hairstyling, as defined, in another state for a specified period of time. (BPC § 7322)
- Establishes the Bureau of Automotive Repair (BAR) within the DCA to administer and enforce the Automotive Repair Act. (BPC § 9882)
- Requires that, in order to engage in business of transportation of used household goods and personal effects, a household mover shall obtain a permit issued by the BHGS. (BPC § 19237(a))
This bill:
- Specifies that if the DHPSA certification is removed, a RDHAP with an existing practice in the area may continue to provide dental hygiene services. Eliminates language requiring DHBC to submit recommendations regarding dental hygienist scope of practice to the DBC for approval.
- Clarifies that no person shall use the words “doctor” or “physician,” the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O. Clarifies these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license.
- Make changes to the MBC’s process for approving licenses for individuals still enrolled in postgraduate training.
- Makes various changes to provisions in the Nursing Practice Act related to licensure of nurse practitioners practicing independently.
- Clarifies that LVNs who have met specified requirements may perform specified respiratory care services as identified by the RCB in specified settings and according to certain patient-specific training satisfactory to their employer.
- Updates CAMTC’s sunset date from January 1, 2027 to January 1, 2026 and updates CAMTC board member terms and removal by their appointing authority.
- Authorizes pharmacists to continue furnishing COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2026.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to receive drug documentation specifically designed for veterinary drugs.
- Clarifies that BBC can only charge a hairstylist application and examination fee in an amount equal to BBC’s actual costs for developing, purchasing, grading, and administering the examination. Limits a hairstylist’s initial license to not more than $50.
- Replaces gendered language in the Structural Pest Control Act and eliminates the option for SPCB licensees to take challenge examinations in lieu of completing continuing education requirements.
- Authorizes BAR to issue a license to a federally recognized tribe, as defined, and makes additional conforming changes.
- Exempts out-of-state household movers regulated by the BHGS from residency requirements if they provide an agent of service for process.
- Exempts applicants for household mover permits that only conduct inter-state moves from BHGS exam requirements upon the applicant signing an affidavit declaring they will not conduct any intrastate moves.
- Requires the BHGS to identify on its internet website those movers that can conduct intrastate moves and those that can conduct interstate moves.
- Makes technical amendments to the licensing requirements section of the Household Movers Act.
- Make conforming changes and waive fees for military and military spouse expedited licensure by various boards and bureaus under the DCA.
Background
Registered Dental Hygienists in Alternative Practice. The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. Currently, a RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice.
Doctor Title Protection and Postgraduate Training. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice.
MBC recently encountered some licensees who opted to conduct research for a period of time after obtaining their physician and surgeon license rather than continuing in clinical training. As a result, they could not show 36 months of training as required for license renewal and without an updated, they could not continue to be licensed.
Nurse Practitioners. AB 890 (Wood, Chapter 256, Statutes of 2020) set education and experience requirements for an NP to be eligible to practice independent of physician supervision. The BRN regulations further expanding on the TTP included requirements more stringent than AB 890 and which in some cases, do not include references that sync with current NP certification and the training and clinical experience of a NP. While some categories have a corresponding physician specialty, such as pediatrics, a “women’s health” NP may have clinical experiences with a wide range of physician specialists and BRN regulations could leave those individuals without a physician to attest to their completion of the TTP.
The BRN regulations also narrowly define the TTP so that it must be completed in “direct patient care in the role of a [NP] in the category…in which the applicant seeks certification as a NP…”.
Respiratory Care Services. SB 1436 (Roth, Chapter 624, Statutes of 2022) resolved a serious and long-standing consumer safety issue regarding the safe practice of respiratory care in health care facilities by allowing RCB to identify the basic respiratory tasks and services that could be safely delivered by LVNs. There is currently no legal path for LVNs to provide respiratory care services beyond basic care. Patients receiving home and community-based services often require advanced respiratory care. Respiratory care services are not “skilled nursing services.” Respiratory patients are often the most vulnerable of the home and community-based patient population with an overwhelming majority of those patients reliant upon Medi-Cal reimbursement.
COVID-19 Therapeutics. On September 14, 2021, the Secretary of the federal Department of Health and Human Services, Xavier Becerra, issued a declaration authorizing pharmacists to independently order and administer any COVID-19 therapeutic in compliance with FDA authorization. While the EUAs for both Paxlovid and Lagevrio were expected to remain in effect until the FDA completed its full approval of these therapeutics, it was determined that pharmacists would likely only remain authorized to furnish the drugs directly to patients until the federal stockpile established during the EUA has expired. AB 1341 (Berman, Chapter 276, Statutes of 2023) preserved the ability of pharmacists in California to continue furnishing these drugs directly to patients after the federal authorization has ended, until January 1, 2025. This bill further extends that sunset date by one additional year, authorizing pharmacists to furnish oral therapeutics for COVID-19 until January 1, 2026.
Barbering and Cosmetology Hairstylist License. In 2021, SB 803 (Roth, Chapter 648, Statutes of 2021) continued the operations of the BBC until January 1, 2027 and made various technical changes, statutory improvements, and policy reforms to the Act based on the joint sunset review oversight of BBC by the Senate Committee on Business, Professions, and Economic Development and Assembly Committee on Business and Professions. SB 803 established a separate hairstylist license and outlined a specified practice of hairstyling that includes arranging, dressing, curling, cleansing, and shampooing, among other hair-specific beautification practices that utilize instruments or require chemical products to be applied.
Structural Pest Control. The Structural Pest Control Act requires that licensees fulfill CE requirements by completing industry-relevant courses to stay fluent with technology and accepted professional practices. Instead of completing CE courses, current law also provides an alternative option of taking and successfully completing an examination. Currently, BPC sections 8593 and 8593.1 require the SPCB offer examinations to its licensees to take in lieu of completing their CE requirements. On March 6, 2017, the United States Environmental Protection Agency (U.S. EPA) revised the federal rule for certification and recertification of applicators of restricted use pesticides under the Code of Federal Regulations Part 171 (40 CFR 171). This affects SPCB’s Field Representative and Operator license types because the federal rule specifies that if recertification is based upon written examination, the State must ensure the examination evaluates whether the licensee demonstrates the level of competencies.
Automotive Repair Licensure of Tribes. Current law does not authorize BAR, which licenses and regulates automotive repair dealers as well as Smog Check stations, repair technicians, and inspectors, to issue a license to a federally recognized tribe. BPC Section 9880.1(i) defines “person” as “a firm, partnership, association, limited liability company, or corporation.” The omission of federally recognized tribes creates a barrier to licensure for federally recognized tribes.
Household Movers. Among other prerequisites, applicants for a household movers permit must meet specified residency requirements, and pass an examination as directed by the BHGS. Prior to 2018, the household moving industry in California was regulated by the Public Utilities Commission (PUC). PUC code provided certain exemptions for those movers who were solely performing interstate moves, including waiving the examination requirement, and exempting them from residency requirements so long as the applicant provided an agent of service. On July 1, 2018, regulatory authority transferred to the BHGS, but these statutory exemptions for interstate movers did not carry over. As a result, it has been challenging in recent years for state regulators to reasonably administer interstate moves, and the technical clean-up in this bill has been a long-standing request from BHGS staff to better regulate interstate household movers.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Assembly Committee on Appropriations, RCB anticipates minor and absorbable costs to draft and implement the regulatory provisions for an LVN to perform respiratory care services; BBC anticipates minor workload to update the application and examination fees to reflect actual cost, resulting in minor and absorbable costs; SPCB anticipates cost savings of approximately $316,000 in future years; Board of Pharmacy anticipates minor and absorbable costs and; the Department of Consumer Affairs (DCA), Office of Information Services states it will need to add a new application question for the BRN, update a fee code for the BBC, and add enforcement codes for the Board of Pharmacy, resulting in an absorbable fiscal impact of $3,000.
SUPPORT: (Verified 8/30/24)
Associated Bodywork and Massage Professionals
Association of California Healthcare Districts
Bay Area Cancer Connections
Board of Barbering and Cosmetology
California Access Coalition
California Alliance of Child and Family Services
California Association for Nurse Practitioners
California Association of Alcohol and Drug Program Executives, INC.
California Association of Medical Product Suppliers
California Community Pharmacy Coalition
California Dental Hygienists' Association
California Health Collaborative
California Hospital Association
California Moving and Storage Association
California Nurses Association
California Dental Hygienists Association
Center for Inherited Blood Disorders
Chronic Disease Coalition
Close the Provider Gap
Dental Hygiene Board of California
Elderhelp
Leading Age California
Little Lobbyists
Liver Coalition of San Diego
Madera Community Hospital
Mental Health America of California
Michelle's Place Cancer Resource Center
Patient Advocates United in San Diego County
Pediatric Day Health Care Coalition
Respiratory Care Board of California
SEIU California State Council
Senior Care Clinic Medical House Calls
Shingle Springs Band of Miwok Indians
OPPOSITION: (Verified 8/30/24)
California Medical Association
Osteopathic Medical Board of California
Osteopathic Physicians and Surgeons of California
ARGUMENTS IN SUPPORT: Supporters write that AB 890 is mired with implementation barriers that delay the application process for NPs who are qualified to work without physician supervision. As a result, the state is underutilizing a valuable group of health professionals that could help address the significant shortage of primary care providers, particularly in rural areas of the state. Supporters note that NPs are critical to addressing access to care shortages – not only do they accept greater numbers of uninsured, Medi-Cal, and Medicare patients compared to physicians, they are more likely to work in rural and underserved communities. Supporters believe that provisions in the bill to expand the settings in which LVN can perform respiratory care services and provide flexibility that ensures patients can receive respiratory care services in their own homes and other community settings will allow California to meet the expanding demand for specialization in emergency departments, intensive care units, and other acute care settings. Supporters appreciate additional information being provided about animal patient medication and supporters believe changes to allow federally recognized tribes to become licensed are important.
ARGUMENTS IN OPPOSITION: The Osteopathic Medical Board of California and Osteopathic Physicians and Surgeons of California are concerned that foreign-trained osteopaths will use the title and offer services without being regulated and are concerned about these individuals who do not have a path to licensure in California or the United States using any terms associated with a licensed D.O.
The California Medical Association states that this bill eliminates a requirement that a NP complete a variation of a three-year training requirement in one of six different specialty categories.
ASSEMBLY FLOOR: 65-1, 8/30/24
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Connolly, Megan Dahle, Flora, Mike Fong, Friedman, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Santiago, Schiavo, Soria, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Wicks, Wilson, Wood, Zbur, Robert Rivas
NOES: Bains
NO VOTE RECORDED: Arambula, Cervantes, Chen, Davies, Dixon, Essayli, Gallagher, Lackey, Ortega, Jim Patterson, Sanchez, Ta, Weber
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Prepared by: Sarah Mason / B., P. & E.D. / 916-651-4104
8/31/24 12:46:51
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SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 1451 |
UNFINISHED BUSINESS
Bill No: SB 1451
Author: Ashby (D)
Amended: 8/26/24
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 12-0, 4/22/24
AYES: Ashby, Nguyen, Alvarado-Gil, Archuleta, Becker, Dodd, Eggman, Glazer, Niello, Roth, Smallwood-Cuevas, Wilk
NO VOTE RECORDED: Menjivar
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 36-0, 5/13/24
AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
NO VOTE RECORDED: Atkins, Gonzalez, Menjivar, Padilla
ASSEMBLY FLOOR: 49-0, 8/30/24
(ROLL CALL NOT AVAILABLE)
SUBJECT: Professions and vocations
SOURCE: Author
DIGEST:
This bill makes various changes to the operations of programs governed by practice acts in the Business and Professions Code (BPC) and various professions regulated by these programs, stemming from prior sunset review oversight efforts.
Assembly Amendments
make various technical and conforming changes; waive fees for military and military spouse expedited licensure; strike obsolete reference in the Dental Hygiene Practice Act; clarify physician licensure renewal for postgraduates; revert to existing law limiting the completion of a transition to practice in only California; extend the authority for pharmacists to furnish COVID-19 oral therapeutics until January 1, 2026; update the California Massage Therapy Council (CAMTC) sunset date and update CAMTC board member terms; authorize tribal licensure by the Bureau of Automotive Repair and ; exempt out-of-state household movers regulated by the Bureau of Household Goods and Services (BHGS) from certain requirements, as specified.
ANALYSIS:
Existing law:
- Requires the Dental Board of California (DBC) to approve, modify, or reject recommendations by the Dental Hygiene Board of California (DHBC) regarding scope of practice issues within 90 days of submission of the recommendation. (BPC § 1905.2)
- Authorizes registered dental hygienists in alternative practice (RDHAP) in only limited settings including residences of the homebound; schools; residential facilities and other institutions; and, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information to perform specified, narrow services. (BPC § 1926)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the Medical Board of California (MBC) from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Authorizes an independently practicing nurse practitioner (NP) to perform specified functions in a defined healthcare setting if the NP has met specified requirements and authorizes a NP who meets these requirements to practice in an outpatient health facility, except for a correctional treatment center or a state hospital; a health facility including a general acute care hospital; a county hospital; a medical group practice, including a professional medical corporation, as specified, another form of corporation controlled by physicians, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians that provide healthcare services; and a licensed hospice facility. (BPC §§ 2837.103, 2837.104)
- Defines a transition to practice (TTP) for purposes of NP independent practice to mean “additional clinical experience and mentorship provided to prepare a NP to practice independently, and includes, but is not limited to, managing a panel of patients, working in a complex healthcare setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism and business management of a practice.” (BPC § 2837.101(c))
- Specifies various activities that are not prohibited by the Respiratory Care Practice Act, including a licensed vocational nurse (LVN) employed by a home health agency who has met certain training requirements performing Respiratory Care Board of California (RBC)-specified respiratory services. (BPC § 3765 (i))
- Establishes the Massage Therapy Act until January 1, 2027 to provide for the voluntary certification of massage therapists by CAMTC, a private nonprofit organization. (BPC §§ 4600 et seq.)
- Authorizes pharmacists to furnish COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2025. (BPC § 4052.04)
- Requires that, each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation including specified information. (BPC § 4829.5(a)
- Specifies that in order to become a licensed hairstylist, an applicant must be at least 17, complete 10th grade (or the equivalent of public school 10th grade), is not subject to denial based on having been convicted of a crime within a certain time frame that is substantially related to the qualifications, functions, or duties of being a hairstylist, and has either completed a course in hairstyling from a BBC-approved school or practiced hairstyling, as defined, in another state for a specified period of time. (BPC § 7322)
- Establishes the Bureau of Automotive Repair (BAR) within the DCA to administer and enforce the Automotive Repair Act. (BPC § 9882)
- Requires that, in order to engage in business of transportation of used household goods and personal effects, a household mover shall obtain a permit issued by the BHGS. (BPC § 19237(a))
This bill:
- Specifies that if the DHPSA certification is removed, a RDHAP with an existing practice in the area may continue to provide dental hygiene services. Eliminates language requiring DHBC to submit recommendations regarding dental hygienist scope of practice to the DBC for approval.
- Clarifies that no person shall use the words “doctor” or “physician,” the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O. Clarifies these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license.
- Make changes to the MBC’s process for approving licenses for individuals still enrolled in postgraduate training.
- Makes various changes to provisions in the Nursing Practice Act related to licensure of nurse practitioners practicing independently.
- Clarifies that LVNs who have met specified requirements may perform specified respiratory care services as identified by the RCB in specified settings and according to certain patient-specific training satisfactory to their employer.
- Updates CAMTC’s sunset date from January 1, 2027 to January 1, 2026 and updates CAMTC board member terms and removal by their appointing authority.
- Authorizes pharmacists to continue furnishing COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2026.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to receive drug documentation specifically designed for veterinary drugs.
- Clarifies that BBC can only charge a hairstylist application and examination fee in an amount equal to BBC’s actual costs for developing, purchasing, grading, and administering the examination. Limits a hairstylist’s initial license to not more than $50.
- Replaces gendered language in the Structural Pest Control Act and eliminates the option for SPCB licensees to take challenge examinations in lieu of completing continuing education requirements.
- Authorizes BAR to issue a license to a federally recognized tribe, as defined, and makes additional conforming changes.
- Exempts out-of-state household movers regulated by the BHGS from residency requirements if they provide an agent of service for process.
- Exempts applicants for household mover permits that only conduct inter-state moves from BHGS exam requirements upon the applicant signing an affidavit declaring they will not conduct any intrastate moves.
- Requires the BHGS to identify on its internet website those movers that can conduct intrastate moves and those that can conduct interstate moves.
- Makes technical amendments to the licensing requirements section of the Household Movers Act.
- Make conforming changes and waive fees for military and military spouse expedited licensure by various boards and bureaus under the DCA.
Background
Registered Dental Hygienists in Alternative Practice. The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. Currently, a RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice.
Doctor Title Protection and Postgraduate Training. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice.
MBC recently encountered some licensees who opted to conduct research for a period of time after obtaining their physician and surgeon license rather than continuing in clinical training. As a result, they could not show 36 months of training as required for license renewal and without an updated, they could not continue to be licensed.
Nurse Practitioners. AB 890 (Wood, Chapter 256, Statutes of 2020) set education and experience requirements for an NP to be eligible to practice independent of physician supervision. The BRN regulations further expanding on the TTP included requirements more stringent than AB 890 and which in some cases, do not include references that sync with current NP certification and the training and clinical experience of a NP. While some categories have a corresponding physician specialty, such as pediatrics, a “women’s health” NP may have clinical experiences with a wide range of physician specialists and BRN regulations could leave those individuals without a physician to attest to their completion of the TTP.
The BRN regulations also narrowly define the TTP so that it must be completed in “direct patient care in the role of a [NP] in the category…in which the applicant seeks certification as a NP…”.
Respiratory Care Services. SB 1436 (Roth, Chapter 624, Statutes of 2022) resolved a serious and long-standing consumer safety issue regarding the safe practice of respiratory care in health care facilities by allowing RCB to identify the basic respiratory tasks and services that could be safely delivered by LVNs. There is currently no legal path for LVNs to provide respiratory care services beyond basic care. Patients receiving home and community-based services often require advanced respiratory care. Respiratory care services are not “skilled nursing services.” Respiratory patients are often the most vulnerable of the home and community-based patient population with an overwhelming majority of those patients reliant upon Medi-Cal reimbursement.
COVID-19 Therapeutics. On September 14, 2021, the Secretary of the federal Department of Health and Human Services, Xavier Becerra, issued a declaration authorizing pharmacists to independently order and administer any COVID-19 therapeutic in compliance with FDA authorization. While the EUAs for both Paxlovid and Lagevrio were expected to remain in effect until the FDA completed its full approval of these therapeutics, it was determined that pharmacists would likely only remain authorized to furnish the drugs directly to patients until the federal stockpile established during the EUA has expired. AB 1341 (Berman, Chapter 276, Statutes of 2023) preserved the ability of pharmacists in California to continue furnishing these drugs directly to patients after the federal authorization has ended, until January 1, 2025. This bill further extends that sunset date by one additional year, authorizing pharmacists to furnish oral therapeutics for COVID-19 until January 1, 2026.
Barbering and Cosmetology Hairstylist License. In 2021, SB 803 (Roth, Chapter 648, Statutes of 2021) continued the operations of the BBC until January 1, 2027 and made various technical changes, statutory improvements, and policy reforms to the Act based on the joint sunset review oversight of BBC by the Senate Committee on Business, Professions, and Economic Development and Assembly Committee on Business and Professions. SB 803 established a separate hairstylist license and outlined a specified practice of hairstyling that includes arranging, dressing, curling, cleansing, and shampooing, among other hair-specific beautification practices that utilize instruments or require chemical products to be applied.
Structural Pest Control. The Structural Pest Control Act requires that licensees fulfill CE requirements by completing industry-relevant courses to stay fluent with technology and accepted professional practices. Instead of completing CE courses, current law also provides an alternative option of taking and successfully completing an examination. Currently, BPC sections 8593 and 8593.1 require the SPCB offer examinations to its licensees to take in lieu of completing their CE requirements. On March 6, 2017, the United States Environmental Protection Agency (U.S. EPA) revised the federal rule for certification and recertification of applicators of restricted use pesticides under the Code of Federal Regulations Part 171 (40 CFR 171). This affects SPCB’s Field Representative and Operator license types because the federal rule specifies that if recertification is based upon written examination, the State must ensure the examination evaluates whether the licensee demonstrates the level of competencies.
Automotive Repair Licensure of Tribes. Current law does not authorize BAR, which licenses and regulates automotive repair dealers as well as Smog Check stations, repair technicians, and inspectors, to issue a license to a federally recognized tribe. BPC Section 9880.1(i) defines “person” as “a firm, partnership, association, limited liability company, or corporation.” The omission of federally recognized tribes creates a barrier to licensure for federally recognized tribes.
Household Movers. Among other prerequisites, applicants for a household movers permit must meet specified residency requirements, and pass an examination as directed by the BHGS. Prior to 2018, the household moving industry in California was regulated by the Public Utilities Commission (PUC). PUC code provided certain exemptions for those movers who were solely performing interstate moves, including waiving the examination requirement, and exempting them from residency requirements so long as the applicant provided an agent of service. On July 1, 2018, regulatory authority transferred to the BHGS, but these statutory exemptions for interstate movers did not carry over. As a result, it has been challenging in recent years for state regulators to reasonably administer interstate moves, and the technical clean-up in this bill has been a long-standing request from BHGS staff to better regulate interstate household movers.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Assembly Committee on Appropriations, RCB anticipates minor and absorbable costs to draft and implement the regulatory provisions for an LVN to perform respiratory care services; BBC anticipates minor workload to update the application and examination fees to reflect actual cost, resulting in minor and absorbable costs; SPCB anticipates cost savings of approximately $316,000 in future years; Board of Pharmacy anticipates minor and absorbable costs and; the Department of Consumer Affairs (DCA), Office of Information Services states it will need to add a new application question for the BRN, update a fee code for the BBC, and add enforcement codes for the Board of Pharmacy, resulting in an absorbable fiscal impact of $3,000.
SUPPORT: (Verified 8/30/24)
Associated Bodywork and Massage Professionals
Association of California Healthcare Districts
Bay Area Cancer Connections
Board of Barbering and Cosmetology
California Access Coalition
California Alliance of Child and Family Services
California Association for Nurse Practitioners
California Association of Alcohol and Drug Program Executives, INC.
California Association of Medical Product Suppliers
California Community Pharmacy Coalition
California Dental Hygienists' Association
California Health Collaborative
California Hospital Association
California Moving and Storage Association
California Nurses Association
California Dental Hygienists Association
Center for Inherited Blood Disorders
Chronic Disease Coalition
Close the Provider Gap
Dental Hygiene Board of California
Elderhelp
Leading Age California
Little Lobbyists
Liver Coalition of San Diego
Madera Community Hospital
Mental Health America of California
Michelle's Place Cancer Resource Center
Patient Advocates United in San Diego County
Pediatric Day Health Care Coalition
Respiratory Care Board of California
SEIU California State Council
Senior Care Clinic Medical House Calls
Shingle Springs Band of Miwok Indians
OPPOSITION: (Verified 8/30/24)
California Medical Association
Osteopathic Medical Board of California
Osteopathic Physicians and Surgeons of California
ARGUMENTS IN SUPPORT: Supporters write that AB 890 is mired with implementation barriers that delay the application process for NPs who are qualified to work without physician supervision. As a result, the state is underutilizing a valuable group of health professionals that could help address the significant shortage of primary care providers, particularly in rural areas of the state. Supporters note that NPs are critical to addressing access to care shortages – not only do they accept greater numbers of uninsured, Medi-Cal, and Medicare patients compared to physicians, they are more likely to work in rural and underserved communities. Supporters believe that provisions in the bill to expand the settings in which LVN can perform respiratory care services and provide flexibility that ensures patients can receive respiratory care services in their own homes and other community settings will allow California to meet the expanding demand for specialization in emergency departments, intensive care units, and other acute care settings. Supporters appreciate additional information being provided about animal patient medication and supporters believe changes to allow federally recognized tribes to become licensed are important.
ARGUMENTS IN OPPOSITION: The Osteopathic Medical Board of California and Osteopathic Physicians and Surgeons of California are concerned that foreign-trained osteopaths will use the title and offer services without being regulated and are concerned about these individuals who do not have a path to licensure in California or the United States using any terms associated with a licensed D.O.
The California Medical Association states that this bill eliminates a requirement that a NP complete a variation of a three-year training requirement in one of six different specialty categories.
Click here to enter text.
Prepared by: Sarah Mason / B., P. & E.D. / 916-651-4104
8/30/24 17:27:13
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SENATE THIRD READING
STR Bill Id:SB 1451
Author:(Ashby)
As Amended Ver:August 26, 2024
Majority vote
SUMMARY
Authorizes registered dental hygienists in alternative practice (RHDAPs) to continue to provide services in an area that has been decertified as a dental health professional shortage area; updates existing restrictions on the use of the words "doctor" or "physician" or similar terms by individuals not licensed as physicians and surgeons; makes changes to the requirements for nurse practitioners (NPs) practicing independent of standardized procedures; expressly authorizes licensed vocational nurses (LVNs) who have completed additional training to perform certain respiratory care services in specified settings; reschedules the Legislature's sunset review of the California Massage Therapy Council (CAMTC) and clarifies the term lengths and removal process for its board of directors; extends the sunset date on the authority for pharmacists to directly furnish COVID-19 oral therapeutics; requires pharmacists who dispense or furnish a dangerous drug pursuant to a veterinary prescription to offer specified drug documentation as part of their consultation; and makes various other changes to practice acts administered by boards and bureaus under the Department of Consumer Affairs (DCA).
Major Provisions
- Allow RDHAPs working in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed and requires those RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Strike an obsolete requirement that the Dental Board of California (DBC) take into account recommendations from the Dental Hygiene Board (DHB) related to scope of practice.
- Update existing generally prohibiting use of the terms "doctor," "physician," "Dr.," and "M.D." by persons who are not licensed physicians and surgeons and clarifies that these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license, or when the use is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading.
- Make changes to the Medical Board of California's process for approving licenses for individuals still enrolled in postgraduate training.
- Make various changes to the requirements for NP practicing independent of standardized procedures, including:
- Amends the definition of "transition to practice" to delete the requirement that clinical experience must meet the requirements established by the BRN, clarify that clinical experience may not be limited to experience in a single category of NP practice, and exclude experience obtained before a person is certified as an NP.
- Specifies that an NP who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years as of the time of application has satisfied the transition to practice requirement.
- Specifies the process of completing the transition to practice.
- Deletes from the requirement that an NP practicing independent of standardized procedures inform all new patients in a language understandable to the patient that an NP is not a physician and surgeon that the NP do so verbally.
- Deletes requirement that an NP nurse practitioner use the standardized phrase "enfermera especializada" with Spanish language speakers.
- Specifies that an NP is not be required to tell a patient the patient has a right to see a physician and surgeon.
- Clarifies that the disclosure requirements only apply to NPs practicing independently of standardized procedures.
- Specifies that the occupational analysis performed by the BRN related to NP competencies and independent practice did not need to include NP certification examinations discontinued before January 1, 2017.
- Extends dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT, to January 1, 2028, and authorizes, operative January 1, 2028, an LVN to perform respiratory care services.
- Reschedules the sunset review of CAMTC by providing for a January 1, 2026 repeal date and clarifies that only a member of CAMTC's board of directors may only be removed by their appointing authority and that any change to the appointing authority of a member shall not take effect until the completion of that member's term or until it is vacant.
- Provides that CAMTC board members may not serve more than two terms, with a grace period of up to one additional year pending the appointment and qualification of their successor, and that current board members who have already exceeded these term limits will be required to vacate their appointments.
- Extends the authority for pharmacists to directly furnish COVID-19 oral therapeutics.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the Board of Barbering and Cosmetology (BBC) to charge a hairstylist application and examination fee.
- Authorizes the Bureau of Automotive Repair to issue a license to a federally recognized tribe, as defined, and makes additional conforming changes.
- Exempt out-of-state household movers regulated by the Bureau of Household Goods and Services (BHGS) from residency requirements that provide an agent for service of process.
- Exempt household movers that only conduct inter-state moves from BHGS exam requirements upon the applicant signing an affidavit to state they will not conduct any intrastate moves.
- Require BHGS to identify which movers can conduct intrastate moves and those that can conduct interstate moves by posting on its website.
- Make technical amendments to the licensing requirements in the Household Movers Act.
- Removes the authority for Structural Pest Control Board (SCPB) licensees to take an examination issued by the board in lieu of continuing education.
- Make technical changes and waive fees for military and military spouse expedited licensure.
COMMENTS
Registered Dental Hygienists in Alternative Practice. An RDHP is trained and authorized to provide unsupervised dental hygiene services in certain limited practice settings, including residences of the homebound, schools, residential facilities, and dental offices. RDHAPs are also authorized to provide services without supervision in certified dental health professional shortage areas. The original intent of this authority was to allow RDHAPs to perform unsupervised services on vulnerable and challenging populations, such as children, individuals with limited access to dental care, and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings.
This bill would address concerns that were raised in the DHBC's prior sunset reviews by amending the law to allow an RDHAP that previously provided services without supervision in a dental health professional shortage area to continue to provide dental hygiene services in the event that the dental health professional shortage area certification is removed for that area. The bill would require RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services. While it is uncertain whether there is any imminent risk of the federal government removing a substantial number of dental health professional shortage area designations in the future, this authority will arguably help encourage RDHAPs to invest in opening practices in these communities, which would correspondingly result in underserved patients receiving access to dental hygiene services. This bill would also delete outdated language in the DHBC's practice act requiring any recommendations regarding scope of practice to be submitted to the DBC.
Restriction of Medical Terms. This bill would make several updates and clarifications to existing law restricting use of "doctor" and similar terms. Because osteopathic physicians and surgeons have the same scope of practice as physicians and surgeons licensed by the MBC and are regulated under the same chapter of code, this bill would provide them with the same title protection for the initials "D.O." that licensees of the MBC receive for "M.D." Additionally, the bill clarifies that exemptions in current law for graduates of medical schools apply equally to graduates of osteopathic medical schools. The bill would then expressly provide that no person may use words, initials, or other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed "M.D." or "D.O."
Additionally, this bill would further clarify existing law by adding two new exceptions to the restriction of these terms that are reflective of the status quo but not expressly referenced in the Medical Practice Act. First, the bill would confirm that licensees of other healing arts boards, such as optometrists, naturopathic doctors, and dentists, may continue to use words such as "doctor" to the extent the use of the title is consistent with the act governing the practice of that license. Second, the bill would exempt any person whose use of the word "doctor" or the prefix "Dr." is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500. This clarification would capture both those who have earned the right to the title "doctor" by obtaining a doctoral degree and those who merely use the term as playful branding, as long as the use is outside any medical context that could be confusing to consumers.
Nurse Practitioners. An NP is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master's or Doctorate, and obtained a certificate from a certifying body. For state recognition to practice as an NP, the NP must also meet the educational standards established by the BRN. As the result of the more advanced NP training, standardized procedures may authorize a greater number or difficulty of functions and settings while reducing the amount of supervision needed. The Nursing Practice Act also specifically authorizes NPs under standardized procedures to order durable medical equipment; certify disability; approve, modify, and add to a home health services treatment plan; furnish and order prescription drugs; and perform abortions by aspirations techniques with additional training.
Independent NPs and the "transition to practice" requirement. NPs who meet additional requirements, including the completion of a 3-year or 4600-hour "transition to practice," may practice independently without standardized procedures. There are two categories of independent NPs, those who practice in licensed healthcare settings where physicians practice and those who practice in any setting. Due to the variety of NP educational pathways, in order to practice independently in any setting, an NP would be required to meet the above training requirements above as well as meet additional educational experience prerequisites. Once an NP meets the transition to practice, the NP may perform various functions independent of standardized procedures. While there are still requirements in the law that specify when an independent NP would need to consult with a physician or refer a patient, the NP is not required to establish a relationship with a physician before practicing without standardized procedures.
BRN Transition to Practice Regulations. Existing law requires the BRN to establish requirements related to the transition to practice. The BRN's regulations require that a physician or another NP authorized to practice independently who is practicing in the same practice area as the applicant NP to attest to the completion of the transition to practice. This bill codifies portions of those requirements and preempts others.
NP Disclosure Requirements. NPs under the independent practice provisions are statutorily required to make several disclosures to patients, including verbally informing all new patients in a language understandable to the patient that the NP is not a physician and surgeon and referring to themselves as "enfermera especializada" with Spanish language speakers. BRN regulations also require NPs to tell all patients they have the right to see a physician. This bill deletes "verbally" from the requirement that new patients are informed that an NP is not a physician and deletes the "enfermera especializada" requirement. This bill also prohibits requiring NPs to tell all patients they have the right to see a physician.
Respiratory Care and LVNs. In the 2022 sunset review of the RCB, a long-standing issue was raised related to the appropriate scope of practice between LVNs and respiratory care professionals in administering respiratory services for managing patients. While the RCB has historically contended that LVNs should not be administering any ventilator services, the BVNPT issued guidance to licensees permitting LVNs to adjust ventilator settings. The RCB has maintained this policy was not a formal regulation, and made numerous requests to rescind the policy, but the BVNPT has maintained the position that LVNs should be able to adjust ventilators.
As a result of this continuing issue, the 2022 sunset bill for the RCB (SB 1436, Roth, Ch. 624, Statutes of 2022) included provisions that respiratory care and services may be provided if an LVN completes, before January 1, 2025, patient-specific training satisfactory to their employer, and if that LVN is employed by a home health agency licensed by the CDPH. Additionally, the bill required that on or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the BVNPT. Stemming from this collaboration, this bill extends the respective deadlines for the RCB and BVNPT to promulgate regulations and for LVNs to complete training to January 1, 2028, and expands the circumstances under which an LVN can perform certain respiratory care practices to include, among other things: those working at licensed congregate living facilities designated as six beds or fewer, licensed adult day health care center, licensed pediatric day health and respite care facilities, and more.
Massage Therapy. CAMTC was first established in 2009. Unlike most regulatory bodies responsible for overseeing healing arts professionals in California, CAMTC is not a state agency and does not function as part of the state's government. Instead, it is incorporated as a private nonprofit, governed by a board of appointed directors. As discussed during CAMTC's most recent sunset review, there are numerous downsides to empowering a private entity to exercise regulatory control over a profession. Proposals have been made to convert CAMTC into a state licensing board, or to revise the Massage Therapy Act to require the council to further emulate the state licensing board model in areas that would increase public confidence and allow the industry to more closely resemble other health care professionals. However, CAMTC's most recent sunset review ultimately did not substantially change how CAMTC is structured.
In the years following CAMTC's most recent sunset review, further scrutiny to its operations has been elicited by actions taken by the council that appear to reflect a deliberate circumvention of transparency and accountability. In November 2022, CAMTC increased its certificate fees by fifty percent, despite having indicated to the Legislature during its sunset review that it was sufficiently funded. Additionally, as described in a subsequent letter sent from members of the California State Assembly to CAMTC's leadership, the logistics of the vote to increase fees appeared "intentionally intended to obstruct public discussion."
Further concerns were subsequently raised by members of CAMTC's board of directors about the council's operations, including its staff compensation, spending, and political activities. During a June 2024 board meeting, there appeared to be a concerted effort by CAMTC's leadership to remove several directors from the board who had questioned the council's actions. Following this meeting, it became apparent that CAMTC's board of directors was expected to loyally affirm the decisions of the council's staff, rather than provide independent oversight of its functions on behalf of the public.
This bill would ensure that CAMTC is subjected to an appropriate level of transparency and accountability by moving its sunset review by the Legislature up one year so that it would be scheduled for repeal on January 1, 2026. In the meantime, this bill would additionally clarify that CAMTC cannot remove board members appointed by other entities pursuant to statute, either directly or by changing a member's appointing authority midterm. This bill would further prohibit CAMTC board members from serving more than two terms, applied retroactively so that a more independent board of directors will be in place during the council's next sunset review.
COVID-19 Therapeutics. The federal Food and Drug Administration (FDA) has authorized two oral antiviral pills for the treatment of mild-to-moderate COVID-19. Paxlovid, developed by Pfizer, is a combination formulation of two protease inhibitor medications: nirmatrelvir and ritonavirhas. On September 14, 2021, the Secretary of the federal Department of Health and Human Services issued a declaration authorizing pharmacists to independently order and administer any COVID-19 therapeutic in compliance with FDA authorization. On July 6, 2022, the FDA announced that it had revised the Emergency Use Authorization (EUA) for Paxlovid to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients. This authority was effectuated in California through a waiver issued by the Director of DCA, which waived any provisions of law prohibiting a pharmacist from independently initiating and furnishing Paxlovid consistent with the EUA.
While the EUAs for both Paxlovid and Lagevrio were expected to remain in effect until the FDA completed its full approval of these therapeutics, it was determined that pharmacists would likely only remain authorized to furnish the drugs directly to patients until the federal stockpile established during the EUA has expired. AB 1341 (Berman) was subsequently passed by the Legislature to preserve the ability of pharmacists in California to continue furnishing these drugs directly to patients after the federal authorization has ended, until January 1, 2025. This bill would further extend that sunset date by one additional year, authorizing pharmacists to furnish oral therapeutics for COVID-19 until January 1, 2026.
Veterinary Prescriptions. During the VMB's 2016 sunset review, it was made clear that, though a common practice amongst the veterinary community, veterinarians were not explicitly required to provide a consultation to clients regarding information about drugs and medicines they prescribe to patients. As a result, omnibus legislation authored by then-Senator Jerry Hill (SB 1480, Ch. 571, Stats. of 2018) added a requirement that veterinarians offer a consultation to any client whom they prescribe, administer or otherwise furnish a drug to, and provide any available drug documentation upon request. In line with this greater transparency for pet owners, this bill requires licensed pharmacists who dispense a drug pursuant to a veterinary prescription to, as part of consultation, offer documentation with information on the veterinary drug to the client.
Hairstylist License. A number of reforms were passed through the BBC's sunset bill in 2021, including the creation of a new hairstylist license, which allows licensees to provide certain basic hair services after meeting lower education and training requirements than needed for barbering or cosmetology license. SB 803 authorized the BBC to charge an application and examination fee to individuals seeking licensure as hairstylists. Statute currently provides the BBC with two options: they can either charge $50, or they can charge a different amount that does not exceed either $50 or the reasonable cost of developing, purchasing, grading, and administering the examination. This bill would remove the BBC's authority to charge $50 if that is not the amount that it determines to be its actual costs of developing, purchasing, grading, and administering the examination. This bill would additionally cap the initial fee for a hairstylist's license at $50.
Structural Pest Control. This bill makes minor, yet substantive, changes to the Structural Pest Control Act, which is administered by the Structural Pest Control Board (SPCB). All licensees under the SPCB must, as a condition of their license renewal, submit proof of completion of continuing education (CE) that as deemed satisfactory by the board. Under current law, SPCB allows licensees to pass a board-administered examination in lieu of completing CE in order to obtain license renewal. However, the U.S. Environmental Protection Agency amended federal law in 2017 to tighten requirements related to restricted use pesticides and those certified to utilize them. Specifically, the EPA clarified that if individuals are certified - or in California's case, licensed – based on written examination, the respective state must ensure the examination is adequately developed to demonstrate competencies required by federal law.
Automotive Repair Licensure of Tribes. Current law does not authorize BAR, which licenses and regulates automotive repair dealers as well as Smog Check stations, repair technicians, and inspectors, to issue a license to a federally recognized tribe. Statute defines "automotive repair dealer" as "a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees." However, statute further defines "person" as "a firm, partnership, association, limited liability company, or corporation." The omission of federally recognized tribes creates a barrier to licensure for federally recognized tribes. Other boards share similar challenges associated with issuing licenses to tribal businesses including the Bureau of Security and Investigative Services (BSIS) and the Contractors State License Board (CSLB). SB 1454 (Ashby) and SB 1455 (Ashby) of this year would both authorize the BSIS and CSLB to issue a license to a federally recognized tribe. This bill would similarly provide a pathway for licensure for tribes that wish to be licensed by BAR.
Household Movers. Under California law, all individuals or businesses offering household moving services must obtain a permit from the BHGS authorizing them to do so. Among other prerequisites, applicants for a household movers permit must meet specified residency requirements, and pass an examination as directed by the BHGS. Prior to 2018, the household moving industry in California was regulated by the state's Public Utilities Commission (PUC). PUC code provided certain exemptions for those movers who were solely performing interstate moves, including waiving the examination requirement, and exempting them from residency requirements so long as the applicant provided an agent of service. On July 1, 2018, regulatory authority was transferred to the BHGS, but these statutory exemptions for interstate movers were not carried over. As a result, it has been harder in recent years for state regulators to reasonably administer interstate moves, and the technical clean-up in this bill has been a long-standing request from BHGS staff to better regulate interstate household movers.
According to the Author
"This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients."
Arguments in Support
Close the Provider Gap and a coalition of organizations representing nurse practitioners, hospitals, labor groups, and nonprofits write in support of this bill's provisions related to NPs: "To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance, SB 1451 will help streamline the application process and enable California's most experienced NPs to expand access to quality, affordable care. We must close the provider gap – the Californians we serve don't have the time to wait any longer. Through SB 1451, we can ensure our state's communities and families – especially those in health care deserts – can access the high-quality, timely care they need and deserve."
The California Dental Hygienists' Association (CDHA) supports this bill's provisions related to RDHAPs, writing: "It is a goal of the DHPSA designation to attract enough oral health providers to the shortage area. Prohibiting a provider from providing services in the area is counter to the legislature's goals of increasing access to oral healthcare for the underserved areas of the state. There is no harm to patients to have more than enough providers in an area. In fact, patients and consumers only benefit by having more than enough oral health providers available."
Arguments in Opposition
The California Medical Association (CMA) has taken an "oppose unless amended" position on the provisions in this bill related to NPs. The CMA writes: "This bill eliminates the requirement that a nurse practitioner must complete a variation of a three-year training requirement in one of six different specialty categories. Amendments have been suggested to have this section removed or restored with a requirement to demonstrate that a nurse practitioner has completed some portion of their three years of clinical experience in a specific category before being approved for independent practice." The CMA additionally writes that the organization "is supportive of the section regarding the usage of the term doctor; updating the statute to ensure only M.D.'s and D.O.'s are using the term doctor in a health care setting."
The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as "doctor," writing: "A strength of today's healthcare workforce is the growing number of healthcare providers holding doctoral and advanced graduate preparation. More than a dozen health professional disciplines –including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. The American Association of Nurse Practitioners supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients."
FISCAL COMMENTS
According to the Assembly Committee on Appropriations, the SPCB anticipates cost savings of approximately $316,000 and the DCA's Office of Information Services anticipates $3,000 in absorbable costs; additional minor and absorbable costs to other boards.
VOTES
SENATE FLOOR: 36-0-4
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Atkins, Gonzalez, Menjivar, Padilla
ASM BUSINESS AND PROFESSIONS: 13-1-4
YES: Berman, Flora, Juan Carrillo, Grayson, Irwin, Jackson, Low, Lowenthal, McKinnor, Stephanie Nguyen, Pellerin, Soria, Zbur
NO: Bains
ABS, ABST OR NV: Alanis, Chen, Dixon, Sanchez
ASM APPROPRIATIONS: 10-0-5
YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin
ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta, Villapudua
ASM BUSINESS AND PROFESSIONS: 14-1-3
YES: Berman, Flora, Alanis, Juan Carrillo, Grayson, Irwin, Jackson, Low, Lowenthal, McKinnor, Stephanie Nguyen, Pellerin, Soria, Zbur
NO: Dixon
ABS, ABST OR NV: Bains, Chen, Sanchez
UPDATED
VERSION: August 26, 2024
CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0004792
Date of Hearing: August 27, 2024
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
SBPCA Bill Id:SB 1451
Author:(Ashby) – As Amended Ver:August 26, 2024
NOTE: This bill is being heard pursuant to Assembly Rule 77.2.
SENATE VOTE: 36-0
SUBJECT: Professions and vocations
SUMMARY: Authorizes registered dental hygienists in alternative practice (RHDAPs) to continue to provide services in an area that has been decertified as a dental health professional shortage area; updates existing restrictions on the use of the words “doctor” or “physician” or similar terms by individuals not licensed as physicians and surgeons; makes changes to the requirements for nurse practitioners (NPs) practicing independent of standardized procedures; expressly authorizes licensed vocational nurses (LVNs) who have completed additional training to perform certain respiratory care services in specified settings; reschedules the Legislature’s sunset review of the California Massage Therapy Council (CAMTC) and clarifies the term lengths and removal process for its board of directors; extends the sunset date on the authority for pharmacists to directly furnish COVID-19 oral therapeutics; requires pharmacists who dispense or furnish a dangerous drug pursuant to a veterinary prescription to offer specified drug documentation as part of their consultation; and makes various other changes to practice acts administered by boards and bureaus under the Department of Consumer Affairs (DCA).
EXISTING LAW:
- Establishes the DCA within the Business, Consumer Services, and Housing Agency. (Business and Professions Code (BPC) § 100)
- Enumerates various regulatory boards, bureaus, committees, and commissions under the DCA’s jurisdiction. (BPC § 101)
- Establishes the Dental Hygiene Board of California (DHBC) within the DCA to regulate dental hygienists under the Dental Hygiene Practice Act. (BPC §§ 1902 et seq.)
- Establishes the Department of Health Care Access and Information (HCAI), vested with responsibilities related to health planning and research development relating to the health professional workforce. (Health and Safety Code (HSC) §§ 127000 et seq.)
- Provides that the DHBC shall issue a license as an RDHAP to a registered dental hygienist who meets additional specified education and training requirements or to a person who has received a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project No. 155 established by HCAI. (BPC § 1922)
- Authorizes RDHAPs to practice as an employee of a dentist or of another RDHAP, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, or in specified clinic settings. (BPC § 1925)
- Additionally authorizes an RDHAP to perform specified duties in the following settings:
- Residences of the homebound.
- Schools.
- Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
- Dental health professional shortage areas, as certified by HCAI in accordance with existing office guidelines.
- Dental offices.
- (BPC § 1926)
- Requires the Dental Board of California (DBC) to approve, modify, or reject recommendations by the DHBC regarding scope of practice issues within 90 days of submission of the recommendation. (BPC § 1905.2)
- Establishes the Medical Board of California (MBC) within the DCA to regulate physicians and surgeons under the Medical Practice Act. (BPC §§ 2000 et seq.)
- Establishes the Osteopathic Medical Board of California (OMBC) within the DCA to regulate osteopathic physicians and surgeons under the Osteopathic Act who possess the same privileges as licensees regulated by the MBC. (BPC §§ 2450 et seq.)
- Declares that protection of the public shall be the highest priority for both the MBC and the OMBC in exercising their respective licensing, regulatory, and disciplinary functions, and that whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 2001.1; § 2450.1)
- Provides that any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon or without being otherwise authorized to perform the act is guilty of a crime. (BPC § 2052)
- Requires a person who provides certain alternative or complementary to healing arts services and who is not a licensed physician and surgeon to make a written disclosure to the client that they are not a licensed physician and that the services to be provided are not licensed by the state, among other disclosures. (BPC § 2053.6)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the MBC from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Allows a person who has been issued a physician’s and surgeon’s certificate by the MBC to use the initials “M.D.” (BPC § 2055)
- Provides that nothing in the Medical Practice Act shall be construed as limiting the practice of other persons licensed, certified, or registered under any other provision of healing arts law when that person is engaged in their authorized and licensed practice. (BPC § 2061)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Establishes the Board of Registered Nursing (BRN) within the DCA to regulate licensed registered nurses under the Nursing Practice Act. (BPC §§ 2700 et seq.)
- Defines “the practice of nursing” as functions, including basic healthcare, that help people cope with or treat difficulties in daily living that are associated with their actual or potential health or illness problems, and that require a substantial amount of scientific knowledge or technical skill. (BPC § 2725)
- Includes within the scope of nursing practice the following:
- Direct and indirect patient care services that ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures. (BPC § 2725(b)(1))
- Direct and indirect patient care services, including the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist. (BPC § 2725(b)(2))
- The performance of skin tests, immunization techniques, and the withdrawal of human blood from veins and arteries. (BPC § 2725(b)(3))
- Observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and determination of whether the signs, symptoms, reactions, behavior, or general appearance exhibit abnormal characteristics, and implementation, based on observed abnormalities, of appropriate reporting, or referral, or standardized procedures, or changes in treatment regimen in accordance with “standardized procedures,” or the initiation of emergency procedures. (BPC § 2725(b)(4))
- Defines “standardized procedures” as either of the following:
- Policies and protocols developed by a licensed health facility through collaboration among administrators and health professionals including physicians and nurses. (BPC § 2725(c)(1))
- Policies and protocols developed through collaboration among administrators and health professionals, including physicians and nurses, by an organized healthcare system that is not a licensed health facility. (BPC § 2725(c)(2))
- Establishes standardized procedure guidelines jointly promulgated by the Medical Board of California and the BRN. (California Code of Regulations (CCR), Title 16, § 1474)
- Requires standardized procedures to include a written description of the method used during development and approval. (CCR, tit. 16, § 1474(a))
- Specifies the required form and content of standardized procedures, including that they are in writing and signed, specify the authorized functions, establish procedure protocols, detail education and training requirements, provide for evaluation and of authorized nurses, provide for the maintenance of records of authorized nurses, establish the scope of physician supervision, set forth circumstances requiring physician consultation, state limitations on settings, specify patient record keeping requirements, and provide for periodic review of the standardized procedures. (CCR, tit. 16, § 1474(b))
- Establishes a category of advanced practice registered nurses known as NPs, and specifies the requirements for certification. (BPC §§ 2834-2837.105)
- Establishes the following categories of NP:
- Family/individual across the lifespan. (CCR, tit. 16, § 1481(a)(1))
- Adult-gerontology, primary care or acute care. (CCR, tit. 16, § 1481(a)(2))
- Neonatal. (CCR, tit. 16, § 1481(a)(3))
- Pediatrics, primary care or acute care. (CCR, tit. 16, § 1481(a)(4))
- Women's health/gender-related. (CCR, tit. 16, § 1481(a)(5))
- Psychiatric-Mental Health across the lifespan. (CCR, tit. 16, § 1481(a)(6))
- Authorizes an NP who meets specified requirements, commencing January 1, 2023, to perform the following procedures independent of standardized procedures and physician oversight:
- Conduct an advanced assessment. (BPC § 2837.103(c)(1))
- Order, perform, and interpret diagnostic procedures. (BPC § 2837.103(c)(2)(A))
- For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA). (BPC § 2837.103(c)(2)(B))
- Establish primary and differential diagnoses. (BPC § 2837.103(c)(3))
- Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
- Diagnose, prescribe, and institute therapy or referral of patients to health care agencies, health care providers, and community resources. (BPC § 2837.103(c)(4)(A))
- Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances. (BPC § 2837.103(c)(4)(B))
- Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy. (BPC § 2837.103(c)(4)(C))
- After performing a physical examination, certify disability. (BPC § 2837.103(c)(5))
- Delegate specified tasks to a medical assistant. (BPC § 2837.103(c)(6))
- Requires an NP who seeks to practice independent of standardized procedures to obtain certification from the BRN and complete a “transition to practice” in California of a minimum of three full-time equivalent years of practice or 4,600 hours. (BPC § 2837.103(a)(1)(D); CCR, tit. 16, §§ 1482.3, 1482.4).
- Defines “transition to practice” as additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently, including managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. (BPC § 2837.101(c))
- Requires the BRN to, by regulation, define minimum standards for transition to practice and specifies that clinical experience may include experience obtained before January 1, 2021, if the experience meets the requirements established by the BRN. (BPC § 2837.101(c))
- Requires an NP who seeks to practice independent of standardized procedures to prove completion of a transition to practice by submitting to the BRN one or more attestations of a physician or surgeon or another NP already authorized to practice independent of standardized procedures; requires an attesting physician or surgeon or NP practicing to specialize in the same specialty area or category in which the applicant seeks certification as an NP; and prohibits the attester from having a familial or financial relationship with the applicant. (CCR, tit. 16, §§ 1482.3(a)(13), 1482.4(a)(13))
- Requires the transition to practice to be completed within five years prior to the date the applicant applies for certification as an NP practicing independent of standardized procedures. (CCR, tit. 16, §§ 1482.3(a)(13)(A)(ii), 1482.4(a)(13)(A)(ii))
- Requires the transition to practice to be completed in direct patient care and in the same category of NP practice in which the applicant seeks certification. (CCR, tit. 16, § 1482.3(a)(13)(A)(iv), 1482.4(a)(13)(A)(iv))
- Authorizes an NP who meets all of the requirements for practice independent of standardized procedures to practice in one of the following settings or organizations in which one or more physician and surgeons practice with the NP:
- A clinic. (BPC § 2837.103(a)(2)(A))
- A health facility, except for correctional treatment centers and state hospitals. (BPC § 2837.103(a)(2)(B))
- A county medical facility. (BPC § 2837.103(a)(2)(C))
- Any lawfully organized group of physicians and surgeons that provides health care services. (BPC § 2837.103(a)(2)(D))
- A home health agency. (BPC § 2837.103(a)(2)(E))
- A licensed hospice facility. (BPC § 2837.103(a)(2)(F))
- Authorizes an NP who has practiced in good standing for three years independent of standardized procedures to seek a certificate from the BRN to practice outside of the settings in which one or physician and surgeons practice. (BPC § 2837.104(b); (CCR, tit. 16, § 1482.4(a)(14))
- Requires an NP to verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon, for purposes of Spanish language speakers, use standardized phrase “enfermera especializada.” (BPC §§ 2837.103(d), 2837.104(d); CCR, tit. 16, § 1487(b))
- Requires an NP, except when working in facilities under the Department of Corrections and Rehabilitation, to advise patients that they have the right to see a physician and surgeon on request and the circumstances under which they must be referred to see a physician and surgeon. (CCR, tit. 16, § 1487(c))
- Establishes the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) within the DCA to regulate licensed vocational nurses (LVNs) and psychiatric technicians under the Vocational Nursing Practice Act and the Psychiatric Technicians Law. (BPC §§ 2840–2895.5; 4500–4548)
- Establishes the Respiratory Care Board of California (RCB) within the DCA to regulate respiratory care practitioners under the Respiratory Care Practice Act. (BPC §§ 3700 et seq.)
- Defines respiratory care practice as a health care profession employed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of cardiopulmonary and other systems functions, as specified. (BPC §§ 3702; 3702.7)
- Provides that the practice of respiratory care shall be performed under the supervision of a medical director in accordance with a prescription of a physician and surgeon or pursuant to respiratory care protocols. (BPC § 3703)
- Specifies activities that are not prohibited by the Respiratory Care Act, including:
- The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
- Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of the Act.
- The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
- The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
- Respiratory care services in case of an emergency, which includes an epidemic or public disaster.
- Persons from engaging in cardiopulmonary research.
- Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication.
- The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the Department of Public Health (CDPH) of specific, limited, and basic respiratory care or respiratory care related services that have been authorized by the board.
- The performance of certain respiratory care practices by an LVN licensed by the BVNPT who is employed by a home health agency licensed by the CDPH, subject to certain conditions.
- (BPC § 3765)
- Requires that, before January 1, 2025, LVNs performing respiratory care practices complete patient-specific training satisfactory to their employer. (BPC § 3765(i)(1))
- Requires that, on or after January 1, 2025, patient-specific training offered by employers are in accordance with guidelines that shall be promulgated by the RCB no later than that same date, in collaboration with the BVNPT. (BPC § 3765(i)(2))
- Establishes the Massage Therapy Act to provide for the voluntary certification of massage therapists by CAMTC, a private nonprofit organization. (BPC §§ 4600 et seq.)
- Provides CAMTC with authority to take any reasonable actions necessary to carry out the responsibilities and duties set forth in the Massage Therapy Act, including, but not limited to, hiring staff, entering into contracts, and developing policies, procedures, rules, and bylaws to implement this chapter. (BPC § 4602(b))
- Provides that CAMTC shall be governed by a board of directors comprised of 13 members, each appointed by an agency or organization representing local government, anti-trafficking advocates, higher education, and the massage industry. (BPC § 4602(f))
- States that protection of the public shall be the highest priority for CAMTC in exercising its certification and disciplinary authority, and any other functions; whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 4603)
- Provides that it is an unfair business practice for any person to use the title of “certified massage therapist” or “certified massage practitioner,” or any other term, such as “licensed,” “certified,” “CMT,” or “CMP,” in any manner whatsoever that implies or suggests that the person is certified as a massage therapist or massage practitioner, unless that person currently holds an active and valid certificate issued by CAMTC. (BPC § 4611)
- Provides CAMTC with responsibility for approving massage schools. (BPC § 4615)
- Provides that the Massage Therapy Act shall remain in effect only until January 1, 2027, and as of that date is repealed. (BPC § 4621)
- Establishes the California State Board of Pharmacy (BOP) within the DCA to regulate the pharmacy profession under the Pharmacy Law. (BPC §§ 4000 et seq.)
- Authorizes pharmacists to furnish COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2025. (BPC § 4052.04)
- Establishes the Veterinary Medical Board (VMB) within the DCA to regulate veterinarians and registered veterinary technicians (RVTs) under the Veterinary Medicine Practice Act. (BPC §§ 4800 et seq.)
- Provides that a person practices veterinary medicine when they, among other things, administer a drug or medicine for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals. (BPC § 4826)
- Prohibits a veterinarian from prescribing, dispensing, or administering a drug, medicine, or treatment unless a veterinarian-client-patient relationship exists, subject to certain exceptions. (BPC § 4826.6)
- Requires that, each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation including the following:
- The name and description of the dangerous drug,
- The route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug,
- Any special directions for proper use and storage,
- Actions to be taken in the event of a missed dose, and
- If available, precautions and relevant warnings provided by the drug’s manufacturer, including common severe adverse effects of the drug.
- (BPC § 4829.5(a))
- Requires a veterinarian to provide drug documentation to a client, if available. (BPC § 4829.5(b))
- Authorizes a veterinarian to delegate the task of providing consultation and drug documentation to an RVT or veterinary assistant. (BPC § 4829.5(c))
- Establishes the State Board of Barbering and Cosmetology (BBC) within the DCA to regulate barbers, cosmetologists, hairstylists, electrologists, estheticians, and manicurists under the Barbering and Cosmetology Act. (BPC §§ 7301 et seq.)
- Defines the practice of hairstyling as all or any combination of the following:
- Styling of all textures of hair by standard methods that are current at the time of the hairstyling.
- Arranging, blow drying, cleansing, curling, cutting, dressing, extending, shampooing, waving, or nonchemically straightening the hair of any person using both electrical and nonelectrical devices.
- (BPC § 7316)
- Establishes fee amounts that may be charged to applicants and licensees by the BBC and specifically provides that the fee for a hairstylist application and examination shall be either $50 or a lower fee in an amount as determined by the BBC, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination. (BPC § 7323)
- Establishes the Structural Pest Control Board (SPCB) within the DCA to regulate structural pest control operators under the Structural Pest Control Act. (BPC §§ 8500 et seq.)
- Requires that, as a condition of license renewal, a licensee of the SPCB must submit proof of continuing education, or equivalent activity, informing themselves of developments in the field of pest control, and authorizes licensees to take an examination issued by the SPCB in lieu of continuing education. (BPC § 8593)
- Provides that the SPCB shall require applicants for license renewal to submit proof that they have completed approved courses of continuing education in pesticide application and use, and provides that in lieu of submitting that proof, the licensee may successfully pass an applicator’s examination for renewal of a license given by the SPCB. (BPC § 8593.1)
- Establishes the Bureau of Automotive Repair (BAR) within the DCA to administer and enforce the Automotive Repair Act. (BPC § 9882)
- Establishes the Bureau of Household Goods and Services (BHGS) within the DCA to regulate movers, home inspectors, and other household services under the Home Furnishings and Thermal Insulation Act and the Household Movers Act. (BPC § 9810; §§ 19000 et seq; §§ 19225 et seq.)
- Requires that, in order to engage in business of transportation of used household goods and personal effects, a household mover shall obtain a permit issued by the BHGS. (BPC § 19237(a))
- Requires that, in order to transport household goods and personal effects from this state to another state or from another state to this state, a household mover shall obtain valid operating authority issued by the Federal Motor Carrier Safety Administration. (BPC § 19237(a)(2))
- Requires that, among other requirements, an applicant for a household movers permit may qualify by personal examination, by examination of their responsible managing employee or managing officer, or partner of the applicant firm. (BPC § 19239(b))
- Prohibits BHGS from issuing a household movers permit to any applicant that does not meet residency requirements, as specified. (BPC § 19239(g))
- THIS BILL:
- Allows RDHAPs working in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed and requires those RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Eliminates language requiring the DHBC to submit recommendations regarding scope of practice to the DBC for approval.
- Adds references to osteopathic physicians and surgeons licensed by the OMBC to provisions of existing law generally prohibiting use of the terms “doctor,” “physician,” “Dr.,” and “M.D.” by persons who are not licensed physicians and surgeons.
- Expressly prohibits a person from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.” or “D.O.,” or any other terms or letters indicating or implying that the person is a physician and surgeon or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed “M.D.” or “D.O.”
- Clarifies that the above prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license.
- Additionally allows a person who is not a physician and surgeon to use the word “doctor” or the prefix “Dr.” if the use is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading.
- Make changes to the MBC’s process for approving licenses for individuals still enrolled in postgraduate training.
- Makes the following changes to the requirements for NP practicing independent of standardized procedures:
- Amends the definition of “transition to practice” to delete the requirement that clinical experience must meet the requirements established by the BRN, clarify that clinical experience may not be limited to experience in a single category of NP practice, and exclude experience obtained before a person is certified as an NP.
- Authorizes the transition to practice to be completed in another state.
- Specifies that an NP who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years, as of the time of application, may be deemed to have satisfied the transition to practice requirement.
- Specifies the following for purposes of completion of the transition to practice:
- The BRN must receive proof of completion of a transition to practice on a form prescribed by the BRN as an attestation from either a licensed physician and surgeon or an NP authorized to practice independent of standardized procedures.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and only attests to the completion of the transition to practice.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation.
- Deletes from the requirement that an NP practicing independent of standardized procedures inform all new patients in a language understandable to the patient that an NP is not a physician and surgeon that the NP do so verbally.
- Deletes requirement that an NP nurse practitioner use the standardized phrase “enfermera especializada” with Spanish language speakers.
- Specifies that an NP is not be required to tell a patient the patient has a right to see a physician and surgeon.
- Clarifies that the disclosure requirements only apply to NPs practicing independently of standardized procedures.
- Specifies that the occupational analysis performed by the BRN related to NP competencies and independent practice did not need to include NP certification examinations discontinued before January 1, 2017.
- Extends respective dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT, to January 1, 2028.
- Authorizes, operative January 1, 2028, an LVN to perform respiratory care services identified by the RCB so long as they:
- Complete patient-specific training satisfactory to their employer, and
- Hold a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
- Authorizes, operative January 1, 2028, LVNs to perform respiratory care services identified by the RCB in the following settings:
- At a congregate living health facility licensed by the CDPH that is designated as six beds or fewer.
- At an intermediate care facility licensed by the CDPH that is designated as six beds or fewer.
- At an adult day health care center licensed by the CDPH.
- As an employee of a home health agency licensed by the CDPH or an individual nurse provider working in a residential home.
- At a pediatric day health and respite care facility licensed by the CDPH.
- At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
- As a private duty nurse as part of daily transportation and activities outside a patient’s residence or family respite for home- and community-based patients.
- Reschedules the Legislature’s sunset review of CAMTC by providing for a January 1, 2026 repeal date.
- Clarifies that only a member of CAMTC’s board of directors may only be removed by their appointing authority and that any change to the appointing authority of a member shall not take effect until the completion of that member’s term or until it is vacant.
- Provides that CAMTC board members may not serve more than two terms, with a grace period of up to one additional year pending the appointment and qualification of their successor, and that current board members who have already exceeded these term limits will be required to vacate their appointments.
- Authorizes pharmacists to continue furnishing COVID-19 oral therapeutics to patients who test positive for SARS-CoV-2, without a prior prescription, until January 1, 2026.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the BBC to charge a hairstylist application and examination fee to require the fee amount to be the actual cost to the board for developing, purchasing, grading, and administering the examination and establishes the fee for a hairstylist’s initial license fee as $50.
- Removes the authority for SCPB licensees to take an examination issued by the board in lieu of continuing education.
- Authorizes BAR to issue a license to a federally recognized tribe, as defined, and makes additional conforming changes.
- Exempts out-of-state household movers regulated by the BHGS from residency requirements if they provide an agent of service for process.
- Exempts applicants for household mover permits that only conduct inter-state moves from BHGS exam requirements upon the applicant signing an affidavit declaring they will not conduct any intrastate moves.
- Requires the BHGS to identify on its internet website those movers that can conduct intrastate moves and those that can conduct interstate moves.
- Makes technical amendments to the licensing requirements section of the Household Movers Act.
- Make conforming changes and waive fees for military and military spouse expedited licensure by various boards and bureaus under the DCA.
FISCAL EFFECT: Pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
Purpose. This bill is sponsored by the author, who is Chair of the Senate Committee on Business, Professions, and Economic Development. According to the author:
“This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients.”
Background.
Registered Dental Hygienists in Alternative Practice. The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists. The DHBC regulates three categories of mid-level dental professionals. These categories include registered dental hygienists, registered dental hygienists in extended functions, and RDHAPs.
An RDHP is trained and authorized to provide unsupervised dental hygiene services in certain limited practice settings, including residences of the homebound, schools, residential facilities, and dental offices. RDHAPs are also authorized to provide services without supervision in certified dental health professional shortage areas. The original intent of this authority was to allow RDHAPs to perform unsupervised services on vulnerable and challenging populations, such as children, individuals with limited access to dental care, and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings.
During the DHBC’s sunset review in 2018, the board’s sunset hearing background paper discussed the fact that while an RDHAP may set up practice in a dental health professional shortage area, the RDHAP must relocate their practice once that shortage is deemed to no longer exist. Health professional shortage areas are federal designations, certified in California by HCAI, and therefore decertification could in theory occur with little notice or public input. Assembly Bill 502 (Chau) of 2015 included language that would have allowed an RDHAP to continue practicing in an area that has lost its dental health professional shortage area designation; however, this language was subsequently removed from the bill.
This issue was again discussed during the DHBC’s most recent sunset review in 2023. Issue #5 in the board’s sunset hearing background paper discussed the question of whether current law should be amended to allow an RDHAP with a stand-alone dental hygiene practice site in a dental health professional shortage area to remain in practice even if the area’s shortage area certification is removed. The background paper noted that “licensees are wary of opening a dental hygiene practice with the risk that they could lose the business if the designation is lifted by the federal government due to the dental hygiene services they are providing to the population.” The DHBC opined that if this concern were addressed, more RDHAPs would potentially be willing to open new practices in these communities where their dental services are vitally needed the most.
This bill would address the concerns that were raised in the DHBC’s prior sunset reviews by amending the law to allow an RDHAP that previously provided services without supervision in a dental health professional shortage area to continue to provide dental hygiene services in the event that the dental health professional shortage area certification is removed for that area. The bill would require RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services. While it is uncertain whether there is any imminent risk of the federal government removing a substantial number of dental health professional shortage area designations in the future, this authority will arguably help encourage RDHAPs to invest in opening practices in these communities, which would correspondingly result in underserved patients receiving access to dental hygiene services.
This bill would also delete outdated language in the DHBC’s practice act requiring any recommendations regarding scope of practice to be submitted to the DBC. While the DHBC was previously identified as a committee with implied subservience to the DBC, this has not been the practical effect of the law since the DHBC was created as a fully independent regulatory entity, and any language implying the DHBC must obtain approval from the DBC is arguably vestigial and unnecessary. Further, the DHBC is not authorized to make any decisions regarding scope of practice for its licensees without statutory change.
Restriction of Medical Terms. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. To use these words, prefixes, or initials, a person’s license must be valid, unrevoked, and unsuspended. The statute features three limited exceptions for individuals who are trained as physicians but not currently licensed in California.
General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice. Statute specifically prohibits a licensee from using “any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading, or deceptive.” Practitioners may advertise that they are certified or that they limit their practice to specific fields; however, the term “board certified” reserve for physicians certified by an American Board of Medical Specialties member board.
Additionally, Section 17500 of the Business and Professions Code broadly prohibits false advertising of a product or service. Specifically, this law makes it unlawful for any person to make any statement or advertisement with intent to perform services, professional or otherwise, that is untrue or misleading. While this code section covers a wide range of false advertisements by sellers of goods or services, its provisions would be applicable to health care licensees.
While the Medical Practice Act expressly reserves use of the words “doctor” or “physician” for actively licensed physicians, this provision does not comprehensively reflect the current state of the law. For example, while podiatrists are independently licensed by the Podiatric Medical Board of California, their formal title is “doctors of podiatric medicine.” Similarly, the California Board of Naturopathic Medicine licenses and regulates a profession statutorily referred to as “naturopathic doctors.” Optometrists, dentists, chiropractors, psychologists, and other practitioners possessing professional doctorates are also expressly authorized by law to use the term “doctor.” “Dr.” is also commonly used as a social honorific for anyone who has received a doctoral degree, including research doctorates not associated with licensure.
Current law also does not expressly exempt individuals who do not imply any authority to practice a healing art but who use the honorific “Dr.” to recognize a nonprofessional doctorate or as part of an established nickname. For example, Dr. Dre is an American rapper and entrepreneur whose debut record as a solo performer, The Chronic, is widely recognized as a seminal hip hop album of the 1990s and credited with popularizing the G-funk rap subgenre. Born Andre Romell Young, the artist’s moniker was inspired Julius Erving, a professional basketball player for the Philadelphia 76ers who is considered to be one of the greatest dunkers of all time and who is known by his nickname “Dr. J.” Neither Dr. Dre nor Dr. J is a graduate of any medical school and neither holds a current license as a physician and surgeon from a state medical board. However, the MBC has not prosecuted Dr. Dre or Dr. J for violating the Medical Practice Act, likely because they are clearly not implying that they are physicians, which is the obvious intent of the law.
Under the status quo, it is apparent that someone who is not a physician and surgeon may nevertheless safely use the term “doctor” and its associated prefix without fear of incurring a misdemeanor conviction if they are authorized by another law to use that title (e.g. a person licensed under the Naturopathic Doctors Act); in possession of a doctoral degree (e.g. Dr. Jill Biden, Ed.D.); or clearly not implying any qualification to practice medicine (e.g. Dr. Demento). However, current law does not expressly reference any of these exemptions. Current law also does not reflect the fact that physicians and surgeons are not exclusively licensed as M.D.s by the MBC; osteopathic physicians and surgeons possess the same authority and scope as D.O.s licensed by the OMBC.
This bill would make several updates and clarifications to existing law restricting use of “doctor” and similar terms. Because osteopathic physicians and surgeons have the same scope of practice as physicians and surgeons licensed by the MBC and are regulated under the same chapter of code, this bill would provide them with the same title protection for the initials “D.O.” that licensees of the MBC receive for “M.D.” Additionally, the bill clarifies that exemptions in current law for graduates of medical schools apply equally to graduates of osteopathic medical schools. The bill would then expressly provide that no person may use words, initials, or other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed “M.D.” or “D.O.”
Additionally, this bill would further clarify existing law by adding two new exceptions to the restriction of these terms that are reflective of the status quo but not expressly referenced in the Medical Practice Act. First, the bill would confirm that licensees of other healing arts boards, such as optometrists, naturopathic doctors, and dentists, may continue to use words such as “doctor” to the extent the use of the title is consistent with the act governing the practice of that license. Second, the bill would exempt any person whose use of the word “doctor” or the prefix “Dr.” is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500. This clarification would capture both those who have earned the right to the title “doctor” by obtaining a doctoral degree and those who merely use the term as playful branding, as long as the use is outside any medical context that could be confusing to consumers.
Nurse Practitioners. An NP is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master’s or Doctorate, and obtained a certificate from a certifying body. For state recognition to practice as an NP, the NP must also meet the educational standards established by the BRN. According to BRN regulations, an NP is an advanced practice registered nurse who meets BRN education and certification requirements and possesses additional advanced practice educational preparation and skills in physical diagnosis, psycho-social assessment, and management of health-illness needs in primary care or acute care.
As RNs, NPs generally have the same base scope of practice as non-NP RNs, although their additional education and training allows them to perform more advanced functions under standardized procedures. Currently, all RNs practicing outside of the basic scope of nursing operate under a supervision mechanism known as a “standardized procedure.” The standardized procedure authorizes functions that would otherwise be considered the practice of medicine and must be based on the guidelines jointly promulgated by the Medical Board of California and the BRN.
Standardized procedures must meet specified requirements, including that they:
- Are developed with the organized healthcare system or physician.
- Outline the scope of the functions allowed.
- Specify the circumstances under which they may be performed.
- Specify any training prerequisites.
- Establish a method for initial and ongoing evaluation of the competence of the RN.
- Specify the level of physician supervision required (e.g. indirect, on-site, present during the procedure).
- Establish physician consultation protocols.
- Specify any limitations on settings where the functions may be performed.
- Specify record-keeping requirements and methods for periodic review.
As the result of the more advanced NP training, standardized procedures may authorize a greater number or difficulty of functions and settings while reducing the amount of supervision needed. The Nursing Practice Act also specifically authorizes NPs under standardized procedures to order durable medical equipment; certify disability; approve, modify, and add to a home health services treatment plan; furnish and order prescription drugs; and perform abortions by aspirations techniques with additional training.
DCA’s Annual Report for Fiscal Year 2022-23 reported 36,092 actively licensed NPs and 32,780 NPs with a furnishing certificate authorizing them to furnish drugs.
Independent NPs and the “transition to practice” requirement. NPs who meet additional requirements, including the completion of a 3-year or 4600-hour “transition to practice,” may practice independently without standardized procedures. There are two categories of independent NPs, those who practice in licensed healthcare settings where physicians practice and those who practice in any setting. Due to the variety of NP educational pathways, in order to practice independently in any setting, an NP would be required to meet the above training requirements above as well as meet additional educational experience prerequisites.
Once an NP meets the transition to practice, the NP may perform the following functions independent of standardized procedures:
- Conduct an advanced assessment.
- Order, perform, and interpret diagnostic procedures, including radiologic procedures and specified laboratory procedures.
- Establish primary and differential diagnoses.
- Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
- Diagnose, prescribe, and institute therapy or referral of patients to healthcare agencies, healthcare providers, and community resources.
- Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
- Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
- After performing a physical examination, certify disability pursuant to the Unemployment Insurance Code.
- Delegate tasks to a medical assistant.
While there are still requirements in the law that specify when an independent NP would need to consult with a physician or refer a patient, the NP is not required to establish a relationship with a physician for those purposes before practicing without standardized procedures.
Transition to Practice in Other States. There are 24 states that authorize NPs to practice without standardized procedures. Of those, 10 require a transition to practice, ranging from six months of full-time practice or 1,000 hours to 3 years or 2,000 hours. The remaining 14 do not require a transition to practice.
BRN Transition to Practice Regulations. Existing law requires the BRN to establish requirements related to the transition to practice. Pursuant to that requirement, BRN regulations require that the transition to practice meet the following:
- Be completed in the five years preceding application.
- Be completed after initial certification as an NP by the BRN.
- Be completed in direct patient care.
- Be completed in a specified NP practice area (family/individual across the lifespan; adult-gerontology, primary care or acute care; neonatal; pediatrics, primary care, or acute care; women's health/gender-related; psychiatric-mental health).
The BRN’s regulations also require that a physician or another NP authorized to practice independently who is practicing in the same practice area as the applicant NP to attest to the completion of the transition to practice. This bill codifies portions of those requirements and preempts others.
NP Disclosure Requirements. NPs under the independent practice provisions are statutorily required to make several disclosures to patients, including verbally informing all new patients in a language understandable to the patient that the NP is not a physician and surgeon and referring to themselves as “enfermera especializada” with Spanish language speakers. BRN regulations also require NPs to tell all patients they have the right to see a physician. This bill deletes “verbally” from the requirement that new patients are informed that an NP is not a physician and deletes the “enfermera especializada” requirement. This bill also prohibits requiring NPs to tell all patients they have the right to see a physician.
Respiratory Care and LVNs. In the 2022 sunset review of the RCB, a long-standing issue was raised related to the appropriate scope of practice between LVNs and respiratory care professionals in administering respiratory services for managing patients. While the RCB has historically contended that LVNs should not be administering any ventilator services, the BVNPT issued guidance to licensees permitting LVNs to adjust ventilator settings. The RCB has maintained this policy was not a formal regulation, and made numerous requests to rescind the policy, but the BVNPT has maintained the position that LVNs should be able to adjust ventilators.
In 2019, the two boards attempted to resolve this issue and worked collaboratively. From that work, the two boards issued a joint statement clarifying respiratory care professional and LVN roles relating to patient care on mechanical ventilators. After reactions and comments from a variety of facilities and organizations, there was momentum to further clarify its respective regulations regarding patient care. The boards hosted a stakeholder meeting to further discuss the joint statement and concerns grew about expanding places LVNs can conduct ventilator services to home based settings as well. According to the RCB, BVNPT backed out of the agreement and began exploring continuing to train LVNs to perform ventilator services in more settings.
As a result of this continuing issue, the 2022 sunset bill for the RCB (SB 1436, Roth, Ch. 624, Statutes of 2022) included provisions that respiratory care and services may be provided if an LVN completes, before January 1, 2025, patient-specific training satisfactory to their employer, and if that LVN is employed by a home health agency licensed by the CDPH. Additionally, the bill required that on or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the BVNPT. Stemming from this collaboration, this bill extends the respective deadlines for the RCB and BVNPT to promulgate regulations and for LVNs to complete training to January 1, 2028, and expands the circumstances under which an LVN can perform certain respiratory care practices to include, among other things: those working at licensed congregate living facilities designated as six beds or fewer, licensed adult day health care center, licensed pediatric day health and respite care facilities, and more.
Massage Therapy. CAMTC was first established in 2009. Unlike most regulatory bodies responsible for overseeing healing arts professionals in California, CAMTC is not a state agency and does not function as part of the state’s government. Instead, it is incorporated as a private nonprofit, governed by a board of appointed directors. CAMTC’s sunset review background paper in 2021 outlined a number of issues arguably related to CAMTC’s status as a nonprofit. These issues included the composition of CAMTC’s board of directors, the compensation of its CEO, and the lack of applicability of various laws aimed at improving transparency and accountability for state regulators. Issue #27 in CAMTC’s sunset review background paper asked whether the certification of massage professionals be continued by CAMTC in its current form.
The background paper concluded that from an administrative perspective, CAMTC has certainly delivered upon the promises inherent with the nongovernmental regulator model. The council is able to act swiftly, flexibly, and inexpensively in its operations, particularly when compared to analogous boards and bureaus under the DCA. However, as discussed throughout the sunset background paper, there are potential downsides to empowering an entity outside state government to exercise regulatory control over a profession, with the efficiencies boasted by CAMTC arguably coming at the cost of transparency, accountability, and due process secured through various “good government laws” applicable to state boards but not private nonprofits.
Proposals have been made to convert CAMTC into a state licensing board, or to revise the Massage Therapy Act to require the council to further emulate the state licensing board model in areas that would increase public confidence and allow the industry to more closely resemble other health care professionals. However, CAMTC’s most recent sunset review ultimately did not substantially change how CAMTC is structured. Instead, CAMTC’s sunset date was given a typical four-year extension with only minor changes made to the Massage Therapy Act.
In the years following CAMTC’s most recent sunset review, further scrutiny to its operations has been elicited by actions taken by the council that appear to reflect a deliberate circumvention of transparency and accountability. In November 2022, CAMTC increased its certificate fees by fifty percent, despite having indicated to the Legislature during its sunset review that it was sufficiently funded. Additionally, as described in a subsequent letter sent from members of the California State Assembly to CAMTC’s leadership, the logistics of the vote to increase fees appeared “intentionally intended to obstruct public discussion.”
Further concerns were subsequently raised by members of CAMTC’s board of directors about the council’s operations, including its staff compensation, spending, and political activities. During a June 2024 board meeting, there appeared to be a concerted effort by CAMTC’s leadership to remove several directors from the board who had questioned the council’s actions. Following this meeting, it became apparent that CAMTC’s board of directors was expected to loyally affirm the decisions of the council’s staff, rather than provide independent oversight of its functions on behalf of the public.
This bill would ensure that CAMTC is subjected to an appropriate level of transparency and accountability by moving its sunset review by the Legislature up one year so that it would be scheduled for repeal on January 1, 2026. In the meantime, this bill would additionally clarify that CAMTC cannot remove board members appointed by other entities pursuant to statute, either directly or by changing a member’s appointing authority midterm. This bill would further prohibit CAMTC board members from serving more than two terms, applied retroactively so that a more independent board of directors will be in place during the council’s next sunset review.
COVID-19 Therapeutics. The federal Food and Drug Administration (FDA) has authorized two oral antiviral pills for the treatment of mild-to-moderate COVID-19. Paxlovid, developed by Pfizer, is a combination formulation of two protease inhibitor medications: nirmatrelvir and ritonavirhas. Molnupiravir, developed by Merck & Co., is sold under the brand name Lagevrio. Both therapeutics have been shown to prevent hospitalization or death in high-risk patients with mild to moderate COVID-19.
As antiviral therapeutics for COVID-19 became available at the beginning of 2022, the CDPH and other public health entities pushed to make those treatments accessible, particularly to high-risk patients. Therapeutics were made free to all Californians, including the uninsured. COVID-19 therapeutics are most effective when taken within days of a patient developing symptoms, so beginning treatment immediately upon receipt of a positive test is the most efficacious way of prevent a patient’s condition from becoming more severe.
On September 14, 2021, the Secretary of the federal Department of Health and Human Services, Xavier Becerra, issued a declaration authorizing pharmacists to independently order and administer any COVID-19 therapeutic in compliance with FDA authorization. On July 6, 2022, the FDA announced that it had revised the Emergency Use Authorization (EUA) for Paxlovid (nirmatrelvir and ritonavir) to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients. This authority was effectuated in California through a waiver issued by the Director of DCA, which waived any provisions of law prohibiting a pharmacist from independently initiating and furnishing Paxlovid consistent with the EUA.
While the EUAs for both Paxlovid and Lagevrio were expected to remain in effect until the FDA completed its full approval of these therapeutics, it was determined that pharmacists would likely only remain authorized to furnish the drugs directly to patients until the federal stockpile established during the EUA has expired. AB 1341 (Berman) was subsequently passed by the Legislature to preserve the ability of pharmacists in California to continue furnishing these drugs directly to patients after the federal authorization has ended, until January 1, 2025. This bill would further extend that sunset date by one additional year, authorizing pharmacists to furnish oral therapeutics for COVID-19 until January 1, 2026.
Veterinary Prescriptions. Licensed veterinarians are permitted to order, prescribe, and administer certain controlled substances so long as they perform an in-person examination of the patient and confirm such a substance is medically necessary. In addition, RVTs and veterinary assistants that possess a valid controlled substances permit issued by the VMB, may obtain and administer a controlled substance to a patient. Importantly, law expressly prohibits veterinarians from ordering, prescribing or furnishing a controlled substance to themselves or any human.
During the VMB’s 2016 sunset review, it was made clear that, though a common practice amongst the veterinary community, veterinarians were not explicitly required to provide a consultation to clients regarding information about drugs and medicines they prescribe to patients. As a result, omnibus legislation authored by then-Senator Jerry Hill (SB 1480, Ch. 571, Stats. of 2018) added a requirement to law that veterinarians must offer a consultation to any client whom they prescribe, administer or otherwise furnish a drug to, and provide any available drug documentation upon request. This bill requires licensed pharmacists who dispense a drug pursuant to a veterinary prescription to, as part of consultation, offer documentation with information specific to the veterinary drug to the client.
Hairstylist License. The BBC is responsible for licensing and regulating barbers, cosmetologists, hairstylists, estheticians, electrologists, manicurists, apprentices, and establishments. The BBC is one of the largest boards in the country, with over 615,000 licensees. As of the board’s most recent sunset review, the BBC annually issues approximately 261,000 licenses and administers approximately 28,000 written examinations (initial and retake examinees). Each profession has its own scope of practice, entry-level requirements, and professional settings, with some overlap in areas. In addition to licensing individuals, the BBC approves schools.
During the BBC’s most recent sunset review in 2021, a number of reforms were passed through the BBC’s sunset extension vehicle (SB 803, Roth). These included adding further specificity to the composition of the BBC, recasting the scope of practice for skincare, and authorizing cosmetology students to obtain more clock hours through paid externships. The BBC’s sunset bill also created a new hairstylist license, which allows licensees to provide certain basic hair services after meeting lower education and training requirements than are needed for barbering or cosmetology license.
The Barbering and Cosmetology Act generally prohibits the BBC from charging fees beyond what is necessary to cover the expenses of the board in performing its duties. SB 803 authorized the BBC to charge an application and examination fee to individuals seeking licensure as hairstylists. Statute currently provides the BBC with two options: they can either charge $50, or they can charge a different amount that does not exceed either $50 or the reasonable cost of developing, purchasing, grading, and administering the examination. This bill would remove the BBC’s authority to charge $50 if that is not the amount that it determines to be its actual costs of developing, purchasing, grading, and administering the examination. This bill would then additionally cap the initial fee for a hairstylist’s license at $50.
Structural Pest Control. This bill makes minor, yet substantive, changes to the Structural Pest Control Act, which is administered by the SPCB. All licensees under the SPCB must, as a condition of their license renewal, submit proof of completion of continuing education (CE) that as deemed satisfactory by the board. Under current law, SPCB allows licensees to pass a board-administered examination in lieu of completing CE in order to obtain license renewal. However, the U.S. Environmental Protection Agency amended federal law in 2017 to tighten requirements related to restricted use pesticides and those certified to utilize them. Specifically, the EPA clarified that if individuals are certified - or in California’s case, licensed – based on written examination, the respective state must ensure the examination is adequately developed to demonstrate competencies required by federal law.
The SPCB surmises that aligning competency examinations with this new standard will be onerous, as they do not have staff within the agency itself qualified to develop the exam to a defensible standard, and deem that engagement with the DCA’s Office of Professional Examination Services (OPES) would be too costly. As a result, this bill deletes the competency examination as an alternative for completing CE, thus eliminating the SPCB’s need to continue developing or administering such an examination.
Automotive Repair Licensure of Tribes. Current law does not authorize BAR, which licenses and regulates automotive repair dealers as well as Smog Check stations, repair technicians, and inspectors, to issue a license to a federally recognized tribe. BPC § 9880.1 defines “automotive repair dealer” as “a person who, for compensation, engages in the business of repairing or diagnosing malfunctions of motor vehicles, or engages in the business of collecting compensation for automotive repair services that are referred or sublet to someone other than the dealer or their employees.” However, BPC 9880.1(i) defines “person” as “a firm, partnership, association, limited liability company, or corporation.” The omission of federally recognized tribes creates a barrier to licensure for federally recognized tribes. Other boards share similar challenges associated with issuing licenses to tribal businesses including the Bureau of Security and Investigative Services (BSIS) and the Contractors State License Board (CSLB). SB 1454 (Ashby) and SB 1455 (Ashby) of this year would both authorize the BSIS and CSLB to issue a license to a federally recognized tribe. This bill would similarly provide a pathway for licensure for tribes that wish to be licensed by BAR.
Household Movers. Under California law, all individuals or businesses offering household moving services must obtain a permit from the Bureau of Household Goods and Services (BHGS) authorizing them to do so. Among other prerequisites, applicants for a household movers permit must meet specified residency requirements, and pass an examination as directed by the BHGS.
Prior to 2018, the household moving industry in California was regulated by the state’s Public Utilities Commission (PUC). PUC code provided certain exemptions for those movers who were solely performing interstate moves, including waiving the examination requirement, and exempting them from residency requirements so long as the applicant provided an agent of service. On July 1, 2018, regulatory authority was transferred to the BHGS, but these statutory exemptions for interstate movers were not carried over. As a result, it has been harder in recent years for state regulators to reasonably administer interstate moves, and the technical clean-up in this bill has been a long-standing request from BHGS staff to better regulate interstate household movers.
Current Related Legislation.
SB 1526 (Business, Professions, and Economic Development Committee) makes numerous technical and clarifying changes to acts within the DCA. This bill is in the Assembly.
Prior Related Legislation.
AB 765 (Wood) of 2023 would have prohibited any person who is not a licensed physician and surgeon from using various medical specialty titles or otherwise implying that they are a physician and surgeon. This bill died on suspense in the Assembly Committee on Appropriations.
SB 817 (Roth) of 2023 would have recast provisions of law authorizing the BBC to charge a hairstylist license application and examination fee to require that the fee be the actual cost, not to exceed $50. This bill was not set for a hearing in the Assembly Committee on Appropriations.
SB 1436 (Roth, Chapter 624, Statutes of 2022) extended until January 1, 2027, the provisions establishing the RCB and makes additional technical changes and reforms in response to issues raised during the RCB’s sunset review oversight process.
AB 2684 (Berman, Chapter 2684, Statutes of 2022) was the BRN’s 2022 sunset review bill and, among other things, added technical, clarifying and conforming changes to the Nursing Practice Act to assist with implementation of AB 890.
AB 890 (Wood, Chapter 265, Statutes of 2020) authorized an NP to provide specified services in specified settings, without standardized procedures, if the NP meets additional education, examination, and training requirements; required the BRN to adopt regulations defining a transition to practice; required the BRN to establish a Nurse Practitioner Advisory Committee to advise and make recommendations to the BRN on NP all issues; and required the BRN and the DCA to identify or develop an examination that tests for independent practice competency.
ARGUMENTS IN SUPPORT:
Close the Provider Gap and a coalition of organizations representing nurse practitioners, hospitals, labor groups, and nonprofits write in support of this bill’s provisions related to NPs: “To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance, SB 1451 will help streamline the application process and enable California’s most experienced NPs to expand access to quality, affordable care. We must close the provider gap – the Californians we serve don’t have the time to wait any longer. Through SB 1451, we can ensure our state’s communities and families – especially those in health care deserts – can access the high-quality, timely care they need and deserve.”
The California Dental Hygienists’ Association (CDHA) supports this bill’s provisions related to RDHAPs, writing: “It is a goal of the DHPSA designation to attract enough oral health providers to the shortage area. Prohibiting a provider from providing services in the area is counter to the legislature’s goals of increasing access to oral healthcare for the underserved areas of the state. There is no harm to patients to have more than enough providers in an area. In fact, patients and consumers only benefit by having more than enough oral health providers available.”
ARGUMENTS IN OPPOSITION:
The California Medical Association (CMA) has taken an “oppose unless amended” position on the provisions in this bill related to NPs. The CMA writes: “This bill eliminates the requirement that a nurse practitioner must complete a variation of a three-year training requirement in one of six different specialty categories. Amendments have been suggested to have this section removed or restored with a requirement to demonstrate that a nurse practitioner has completed some portion of their three years of clinical experience in a specific category before being approved for independent practice.” The CMA additionally writes that the organization “is supportive of the section regarding the usage of the term doctor; updating the statute to ensure only M.D.’s and D.O.’s are using the term doctor in a health care setting.”
The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as “doctor,” writing: “A strength of today's healthcare workforce is the growing number of healthcare providers holding doctoral and advanced graduate preparation. More than a dozen health professional disciplines –including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. The American Association of Nurse Practitioners supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients.”
REGISTERED SUPPORT:
Association of California Healthcare Districts
Bay Area Cancer Connections
Board of Barbering and Cosmetology
California Access Coalition
California Alliance of Child and Family Services
California Association for Nurse Practitioners
California Association of Alcohol and Drug Program Executives
California Association of Medical Product Suppliers
California Community Pharmacy Coalition
California Dental Hygienists’ Association
California Health Collaborative
California Hospital Association
California Moving and Storage Association
California Nurses Association
Center for Inherited Blood Disorders
Chronic Disease Coalition
Close the Provider Gap
Dental Hygiene Board of California
ElderHelp
Leading Age California
Little Lobbyists
Liver Coalition of San Diego
Madera Community Hospital
Mental Health America of California
Michelle’s Place Cancer Resource Center
Patient Advocates United in San Diego County
Pediatric Day Health Care Coalition
Respiratory Care Board of California
SEIU California State Council
Senior Care Clinic Medical House Calls
26 individuals
REGISTERED OPPOSITION:
American Association of Nurse Practitioners
American Nurses Association of California
California Dental Association
California Medical Association
California Nurse-Midwives Association
California Society of Dermatology & Dermatologic Surgery
California State Oriental Medical Association
Osteopathic Medical Board of California
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301, Vincent Chee / B. & P. / (916) 319-3301, Kaitlin Curry / B. & P. / (916) 319-3301, Edward Franco / B. & P. / (916) 319-3301
SENATE THIRD READING
STR Bill Id:SB 1451
Author:(Ashby)
As Amended Ver:August 22, 2024
Majority vote
SUMMARY
Authorizes registered dental hygienists in alternative practice (RHDAPs) to continue to provide services in an area that has been decertified as a dental health professional shortage area; updates existing restrictions on the use of the words "doctor" or "physician" or similar terms by individuals not licensed as physicians and surgeons; makes changes to the requirements for nurse practitioners (NPs) practicing independent of standardized procedures; expressly authorizes licensed vocational nurses (LVNs) who have completed additional training to perform certain respiratory care services in specified settings; reschedules the Legislature's sunset review of the California Massage Therapy Council (CAMTC) and clarifies the term lengths and removal process for its board of directors; requires pharmacists who dispense or furnish a dangerous drug pursuant to a veterinary prescription to offer specified drug documentation as part of their consultation; and makes various other changes to practice acts administered by boards and bureaus under the Department of Consumer Affairs (DCA).
Major Provisions
- Make conforming changes and waive fees for military and military spouse expedited licensure.
- Strike an obsolete requirement that the Dental Board of California (DBC) take into account recommendations from the Dental Hygiene Board (DHB) related to dental hygienist scope of practice.
- Make changes to the Medical Board of California's process for approving licenses for individuals still enrolled in postgraduate training.
- Allows RDHAPs working in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed and requires those RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Updates existing generally prohibiting use of the terms "doctor," "physician," "Dr.," and "M.D." by persons who are not licensed physicians and surgeons and clarifies that these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license, or when the use is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading.
- Makes various changes to the requirements for NP practicing independent of standardized procedures, including:
- Amends the definition of "transition to practice" to delete the requirement that clinical experience must meet the requirements established by the BRN, clarify that clinical experience may not be limited to experience in a single category of NP practice, and exclude experience obtained before a person is certified as an NP.
- Specifies that an NP who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years as of the time of application may be deemed to have satisfied the transition to practice requirement.
- Specifies the process of completing the transition to practice.
- Deletes from the requirement that an NP practicing independent of standardized procedures inform all new patients in a language understandable to the patient that an NP is not a physician and surgeon that the NP do so verbally.
- Deletes requirement that an NP nurse practitioner use the standardized phrase "enfermera especializada" with Spanish language speakers.
- Specifies that an NP is not be required to tell a patient the patient has a right to see a physician and surgeon.
- Clarifies that the disclosure requirements only apply to NPs practicing independently of standardized procedures.
- Specifies that the occupational analysis performed by the BRN related to NP competencies and independent practice did not need to include NP certification examinations discontinued before January 1, 2017.
- Extends respective dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT, to January 1, 2028, and authorizes, operative January 1, 2028, an LVN to perform certain respiratory care services.
- Reschedules the Legislature's sunset review of CAMTC by providing for a January 1, 2026 repeal date.
- Clarifies that only a member of CAMTC's board of directors may only be removed by their appointing authority and that any change to the appointing authority of a member shall not take effect until the completion of that member's term or until it is vacant.
- Provides that CAMTC board members may not serve more than two terms, with a grace period of up to one additional year pending the appointment and qualification of their successor, and that current board members who have already exceeded these term limits will be required to vacate their appointments.
- Extends the sunset date on existing law authorizing pharmacists to furnish COVID-19 oral therapeutics.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the Board of Barbering and Cosmetology (BBC) to charge a hairstylist application and examination fee.
- Authorizes the Bureau of Automotive Repair to issue a license to a federally recognized tribe, as defined, and makes additional conforming changes.
- Exempt out-of-state household movers regulated by the Bureau of Household Goods and Services (BHGS) from residency requirements if they provide an agent for service of process.
- Exempt household movers that only conduct inter-state moves from BHGS exam requirements upon the applicant signing an affidavit to state they will not conduct any intrastate moves.
- Require BHGS to identify which movers can conduct intrastate moves and those that can conduct interstate moves by posting on its website.
- Make technical amendments to the licensing requirements section of the Household Movers Act.
- Removes the authority for Structural Pest Control Board (SCPB) licensees to take an examination issued by the board in lieu of continuing education.
COMMENTS
Registered Dental Hygienists in Alternative Practice. An RDHP is trained and authorized to provide unsupervised dental hygiene services in certain limited practice settings, including residences of the homebound, schools, residential facilities, and dental offices. RDHAPs are also authorized to provide services without supervision in certified dental health professional shortage areas. The original intent of this authority was to allow RDHAPs to perform unsupervised services on vulnerable and challenging populations, such as children, individuals with limited access to dental care, and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings.
This bill would address concerns that were raised in the DHBC's prior sunset reviews by amending the law to allow an RDHAP that previously provided services without supervision in a dental health professional shortage area to continue to provide dental hygiene services in the event that the dental health professional shortage area certification is removed for that area. The bill would require RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services. While it is uncertain whether there is any imminent risk of the federal government removing a substantial number of dental health professional shortage area designations in the future, this authority will arguably help encourage RDHAPs to invest in opening practices in these communities, which would correspondingly result in underserved patients receiving access to dental hygiene services.
Restriction of Medical Terms. This bill would make several updates and clarifications to existing law restricting use of "doctor" and similar terms. Because osteopathic physicians and surgeons have the same scope of practice as physicians and surgeons licensed by the MBC and are regulated under the same chapter of code, this bill would provide them with the same title protection for the initials "D.O." that licensees of the MBC receive for "M.D." Additionally, the bill clarifies that exemptions in current law for graduates of medical schools apply equally to graduates of osteopathic medical schools. The bill would then expressly provide that no person may use words, initials, or other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed "M.D." or "D.O."
Additionally, this bill would further clarify existing law by adding two new exceptions to the restriction of these terms that are reflective of the status quo but not expressly referenced in the Medical Practice Act. First, the bill would confirm that licensees of other healing arts boards, such as optometrists, naturopathic doctors, and dentists, may continue to use words such as "doctor" to the extent the use of the title is consistent with the act governing the practice of that license. Second, the bill would exempt any person whose use of the word "doctor" or the prefix "Dr." is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500. This clarification would capture both those who have earned the right to the title "doctor" by obtaining a doctoral degree and those who merely use the term as playful branding, as long as the use is outside any medical context that could be confusing to consumers.
Nurse Practitioners. An NP is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master's or Doctorate, and obtained a certificate from a certifying body. For state recognition to practice as an NP, the NP must also meet the educational standards established by the BRN. As the result of the more advanced NP training, standardized procedures may authorize a greater number or difficulty of functions and settings while reducing the amount of supervision needed. The Nursing Practice Act also specifically authorizes NPs under standardized procedures to order durable medical equipment; certify disability; approve, modify, and add to a home health services treatment plan; furnish and order prescription drugs; and perform abortions by aspirations techniques with additional training.
Independent NPs and the "transition to practice" requirement. NPs who meet additional requirements, including the completion of a 3-year or 4600-hour "transition to practice," may practice independently without standardized procedures. There are two categories of independent NPs, those who practice in licensed healthcare settings where physicians practice and those who practice in any setting. Due to the variety of NP educational pathways, in order to practice independently in any setting, an NP would be required to meet the above training requirements above as well as meet additional educational experience prerequisites.
Once an NP meets the transition to practice, the NP may perform various functions independent of standardized procedures.
While there are still requirements in the law that specify when an independent NP would need to consult with a physician or refer a patient, the NP is not required to establish a relationship with a physician for those purposes before practicing without standardized procedures.
Transition to Practice in Other States. There are 24 states that authorize NPs to practice without standardized procedures. Of those, 10 require a transition to practice, ranging from six months of full-time practice or 1,000 hours to 3 years or 2,000 hours. The remaining 14 do not require a transition to practice.
BRN Transition to Practice Regulations. Existing law requires the BRN to establish requirements related to the transition to practice. The BRN's regulations require that a physician or another NP authorized to practice independently who is practicing in the same practice area as the applicant NP to attest to the completion of the transition to practice. This bill codifies portions of those requirements and preempts others.
NP Disclosure Requirements. NPs under the independent practice provisions are statutorily required to make several disclosures to patients, including verbally informing all new patients in a language understandable to the patient that the NP is not a physician and surgeon and referring to themselves as "enfermera especializada" with Spanish language speakers. BRN regulations also require NPs to tell all patients they have the right to see a physician. This bill deletes "verbally" from the requirement that new patients are informed that an NP is not a physician and deletes the "enfermera especializada" requirement. This bill also prohibits requiring NPs to tell all patients they have the right to see a physician.
Respiratory Care and LVNs. In the 2022 sunset review of the RCB, a long-standing issue was raised related to the appropriate scope of practice between LVNs and respiratory care professionals in administering respiratory services for managing patients. While the RCB has historically contended that LVNs should not be administering any ventilator services, the BVNPT issued guidance to licensees permitting LVNs to adjust ventilator settings. The RCB has maintained this policy was not a formal regulation, and made numerous requests to rescind the policy, but the BVNPT has maintained the position that LVNs should be able to adjust ventilators.
As a result of this continuing issue, the 2022 sunset bill for the RCB (SB 1436, Roth, Ch. 624, Statutes of 2022) included provisions that respiratory care and services may be provided if an LVN completes, before January 1, 2025, patient-specific training satisfactory to their employer, and if that LVN is employed by a home health agency licensed by the CDPH. Additionally, the bill required that on or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the BVNPT. Stemming from this collaboration, this bill extends the respective deadlines for the RCB and BVNPT to promulgate regulations and for LVNs to complete training to January 1, 2028, and expands the circumstances under which an LVN can perform certain respiratory care practices to include, among other things: those working at licensed congregate living facilities designated as six beds or fewer, licensed adult day health care center, licensed pediatric day health and respite care facilities, and more.
Massage Therapy. CAMTC was first established in 2009. Unlike most regulatory bodies responsible for overseeing healing arts professionals in California, CAMTC is not a state agency and does not function as part of the state's government. Instead, it is incorporated as a private nonprofit, governed by a board of appointed directors. As discussed throughout CAMTC's most recent sunset review background paper, there are numerous potential downsides to empowering an entity outside of state government to exercise regulatory control over a profession. Proposals have been made to convert CAMTC into a state licensing board, or to revise the Massage Therapy Act to require the council to further emulate the state licensing board model in areas that would increase public confidence and allow the industry to more closely resemble other health care professionals. However, CAMTC's most recent sunset review ultimately did not substantially change how CAMTC is structured.
In the years following CAMTC's most recent sunset review, further scrutiny to its operations has been elicited by actions taken by the council that appear to reflect a deliberate circumvention of transparency and accountability. In November 2022, CAMTC increased its certificate fees by fifty percent, despite having indicated to the Legislature during its sunset review that it was sufficiently funded. Additionally, as described in a subsequent letter sent from members of the California State Assembly to CAMTC's leadership, the logistics of the vote to increase fees appeared "intentionally intended to obstruct public discussion."
Further concerns were subsequently raised by members of CAMTC's board of directors about the council's operations, including its staff compensation, spending, and political activities. During a June 2024 board meeting, there appeared to be a concerted effort by CAMTC's leadership to remove several directors from the board who had questioned the council's actions. Following this meeting, it became apparent that CAMTC's board of directors was expected to loyally affirm the decisions of the council's staff, rather than provide independent oversight of its functions on behalf of the public.
This bill would ensure that CAMTC is subjected to an appropriate level of transparency and accountability by moving its sunset review by the Legislature up one year so that it would be scheduled for repeal on January 1, 2026. In the meantime, this bill would additionally clarify that CAMTC cannot remove board members appointed by other entities pursuant to statute, either directly or by changing a member's appointing authority midterm. This bill would further prohibit CAMTC board members from serving more than two terms, applied retroactively so that a more independent board of directors will be in place during the council's next sunset review.
Veterinary Prescriptions. Licensed veterinarians are permitted to order, prescribe, and administer certain controlled substances so long as they perform an in-person examination of the patient and confirm such a substance is medically necessary. In addition, RVTs and veterinary assistants that possess a valid controlled substances permit issued by the VMB, may obtain and administer a controlled substance to a patient. Importantly, law expressly prohibits veterinarians from ordering, prescribing or furnishing a controlled substance to themselves or any human.
During the VMB's 2016 sunset review, it was made clear that, though a common practice amongst the veterinary community, veterinarians were not explicitly required to provide a consultation to clients regarding information about drugs and medicines they prescribe to patients. As a result, omnibus legislation authored by then-Senator Jerry Hill (SB 1480, Ch. 571, Stats. of 2018) added a requirement to law that veterinarians must offer a consultation to any client whom they prescribe, administer or otherwise furnish a drug to, and provide any available drug documentation upon request. In line with this greater transparency for pet owners, this bill requires licensed pharmacists who dispense a drug pursuant to a veterinary prescription to, as part of consultation, offer documentation with information specific to the veterinary drug to the client.
Hairstylist License. During the BBC's most recent sunset review in 2021, a number of reforms were passed through the BBC's sunset extension vehicle (SB 803, Roth). These included adding further specificity to the composition of the BBC, recasting the scope of practice for skincare, and authorizing cosmetology students to obtain more clock hours through paid externships. The BBC's sunset bill also created a new hairstylist license, which allows licensees to provide certain basic hair services after meeting lower education and training requirements than are needed for barbering or cosmetology license.
The Barbering and Cosmetology Act generally prohibits the BBC from charging fees beyond what is necessary to cover the expenses of the board in performing its duties. SB 803 authorized the BBC to charge an application and examination fee to individuals seeking licensure as hairstylists. Statute currently provides the BBC with two options: they can either charge $50, or they can charge a different amount that does not exceed either $50 or the reasonable cost of developing, purchasing, grading, and administering the examination. This bill would remove the BBC's authority to charge $50 if that is not the amount that it determines to be its actual costs of developing, purchasing, grading, and administering the examination. This bill would then additionally cap the initial fee for a hairstylist's license at $50.
Structural Pest Control. This bill makes minor, yet substantive, changes to the Structural Pest Control Act, which is administered by the Structural Pest Control Board (SPCB). All licensees under the SPCB must, as a condition of their license renewal, submit proof of completion of continuing education (CE) that as deemed satisfactory by the board. Under current law, SPCB allows licensees to pass a board-administered examination in lieu of completing CE in order to obtain license renewal. However, the U.S. Environmental Protection Agency amended federal law in 2017 to tighten requirements related to restricted use pesticides and those certified to utilize them. Specifically, the EPA clarified that if individuals are certified - or in California's case, licensed – based on written examination, the respective state must ensure the examination is adequately developed to demonstrate competencies required by federal law.
According to the Author
"This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients."
Arguments in Support
Close the Provider Gap and a coalition of organizations representing nurse practitioners, hospitals, labor groups, and nonprofits write in support of this bill's provisions related to NPs: "To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance, SB 1451 will help streamline the application process and enable California's most experienced NPs to expand access to quality, affordable care. We must close the provider gap – the Californians we serve don't have the time to wait any longer. Through SB 1451, we can ensure our state's communities and families – especially those in health care deserts – can access the high-quality, timely care they need and deserve."
The California Dental Hygienists' Association (CDHA) supports this bill's provisions related to RDHAPs, writing: "It is a goal of the DHPSA designation to attract enough oral health providers to the shortage area. Prohibiting a provider from providing services in the area is counter to the legislature's goals of increasing access to oral healthcare for the underserved areas of the state. There is no harm to patients to have more than enough providers in an area. In fact, patients and consumers only benefit by having more than enough oral health providers available."
Arguments in Opposition
The California Medical Association (CMA) has taken an "oppose unless amended" position on the provisions in this bill related to NPs, writing: "This bill eliminates the requirement that a nurse practitioner must complete a variation of a three-year training requirement in one of six different specialty categories. Amendments have been suggested to have this section removed or restored with some sort of requirement or proof to demonstrate a nurse practitioner has completed at least three years of clinical experience in a specific category before being approved for independent practice. CMA also requests that the physician attestation section of this bill linked to a nurse practitioner transitioning to independent practice is amended to guarantee patient safety and physician liability protection. Additionally, this bill strikes a section related to nurse practitioner's notifying patients that they have the right to see a physician. Amendments are recommended to ensure patients know they have the option to see a physician when they are being treated by an independently practicing nurse practitioner."
The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as "doctor," writing: "A strength of today's healthcare workforce is the growing number of healthcare providers holding doctoral and advanced graduate preparation. More than a dozen health professional disciplines –including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. The American Association of Nurse Practitioners supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients."
FISCAL COMMENTS
According to the Assembly Committee on Appropriations:
- No costs to the DHBC, BRN, MBC, and OMBC.
- The RCB anticipates minor and absorbable costs to draft and implement the regulatory provisions for an LVN to perform respiratory care services.
- The BBC anticipates minor workload to update the application and examination fees to reflect actual cost, resulting in minor and absorbable costs.
- The SPCB states that, because this bill removes the exam option for SPCB licensees, SPCB will no longer need to update and validate an exam or conduct occupational analyses, resulting in a reduced workload. The SPCB anticipates cost savings of approximately $316,000 in future years (Structural Pest Control Fund).
- The Board of Pharmacy states it will provide education about the provision requiring pharmacists to provide documentation for veterinary patients through the Board of Pharmacy's newsletter and law webinar. The Board of Pharmacy anticipates minor and absorbable costs.
- The Department of Consumer Affairs (DCA), Office of Information Services states it will need to add a new application question for the BRN, update a fee code for the BBC, and add enforcement codes for the Board of Pharmacy, resulting in an absorbable fiscal impact of $3,000.
VOTES
SENATE FLOOR: 36-0-4
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood- Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Atkins, Gonzalez, Menjivar, Padilla
ASM BUSINESS AND PROFESSIONS: 13-1-4
YES: Berman, Flora, Juan Carrillo, Grayson, Irwin, Jackson, Low, Lowenthal, McKinnor, Stephanie Nguyen, Pellerin, Soria, Zbur
NO: Bains
ABS, ABST OR NV: Alanis, Chen, Dixon, Sanchez
ASM APPROPRIATIONS: 10-0-5
YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin
ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta, Villapudua
UPDATED
VERSION: August 22, 2024
CONSULTANT: Kaitlin Curry / Vincent Chee/Robert Sumner / Edward Franco / B. & P. / (916) 319-3301 FN: 0004435
SENATE THIRD READING
STR Bill Id:SB 1451
Author:(Ashby)
As Amended Ver:June 19, 2024
Majority vote
SUMMARY
Authorizes registered dental hygienists in alternative practice (RHDAPs) to continue to provide services in an area that has been decertified as a dental health professional shortage area; updates existing restrictions on the use of the words "doctor" or "physician" or similar terms by individuals not licensed as physicians and surgeons; makes changes to the requirements for nurse practitioners (NPs) practicing independent of standardized procedures; expressly authorizes licensed vocational nurses (LVNs) who have completed additional training to perform certain respiratory care services in specified settings; requires pharmacists who dispense or furnish a dangerous drug pursuant to a veterinary prescription to offer specified drug documentation as part of their consultation; and makes various other changes to practice acts administered by boards and bureaus under the Department of Consumer Affairs (DCA).
Major Provisions
- Allows RDHAPs working in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed and requires those RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Updates existing generally prohibiting use of the terms "doctor," "physician," "Dr.," and "M.D." by persons who are not licensed physicians and surgeons and clarifies that these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license, or when the use is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading.
- Makes various changes to the requirements for NP practicing independent of standardized procedures, including:
- Amends the definition of "transition to practice" to delete the requirement that clinical experience must meet the requirements established by the BRN, clarify that clinical experience may not be limited to experience in a single category of NP practice, and exclude experience obtained before a person is certified as an NP.
- Authorizes the transition to practice to be completed in another state.
- Specifies that an NP who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as of January 1, 2023, may be deemed to have satisfied the transition to practice requirement.
- Specifies the process of completing the transition to practice.
- Deletes from the requirement that an NP practicing independent of standardized procedures inform all new patients in a language understandable to the patient that an NP is not a physician and surgeon that the NP do so verbally.
- Deletes requirement that an NP nurse practitioner use the standardized phrase "enfermera especializada" with Spanish language speakers.
- Specifies that an NP is not be required to tell a patient the patient has a right to see a physician and surgeon.
- Clarifies that the disclosure requirements only apply to NPs practicing independently of standardized procedures.
- Specifies that the occupational analysis performed by the Board of Registered Nursing (BRN) related to NP competencies and independent practice did not need to include NP certification examinations discontinued before January 1, 2017.
- Extends respective dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT, to January 1, 2028, and authorizes, operative January 1, 2028, an LVN to perform certain respiratory care services.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the Board of Barbering and Cosmetology (BBC) to charge a hairstylist application and examination fee.
- Removes the authority for Structural Pest Control Board (SCPB) licensees to take an examination issued by the board in lieu of continuing education.
COMMENTS
Registered Dental Hygienists in Alternative Practice. An RDHP is trained and authorized to provide unsupervised dental hygiene services in certain limited practice settings, including residences of the homebound, schools, residential facilities, and dental offices. RDHAPs are also authorized to provide services without supervision in certified dental health professional shortage areas. The original intent of this authority was to allow RDHAPs to perform unsupervised services on vulnerable and challenging populations, such as children, individuals with limited access to dental care, and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings.
This bill would address concerns that were raised in the Dental Hygiene Board of California (DHBC)'s prior sunset reviews by amending the law to allow an RDHAP that previously provided services without supervision in a dental health professional shortage area to continue to provide dental hygiene services in the event that the dental health professional shortage area certification is removed for that area. The bill would require RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services. While it is uncertain whether there is any imminent risk of the federal government removing a substantial number of dental health professional shortage area designations in the future, this authority will arguably help encourage RDHAPs to invest in opening practices in these communities, which would correspondingly result in underserved patients receiving access to dental hygiene services.
Restriction of Medical Terms. This bill would make several updates and clarifications to existing law restricting use of "doctor" and similar terms. Because osteopathic physicians and surgeons have the same scope of practice as physicians and surgeons licensed by the Medical Board of California (MBC) and are regulated under the same chapter of code, this bill would provide them with the same title protection for the initials "D.O." that licensees of the MBC receive for "M.D." Additionally, the bill clarifies that exemptions in current law for graduates of medical schools apply equally to graduates of osteopathic medical schools. The bill would then expressly provide that no person may use words, initials, or other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed "M.D." or "D.O."
Additionally, this bill would further clarify existing law by adding two new exceptions to the restriction of these terms that are reflective of the status quo but not expressly referenced in the Medical Practice Act. First, the bill would confirm that licensees of other healing arts boards, such as optometrists, naturopathic doctors, and dentists, may continue to use words such as "doctor" to the extent the use of the title is consistent with the act governing the practice of that license. Second, the bill would exempt any person whose use of the word "doctor" or the prefix "Dr." is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500. This clarification would capture both those who have earned the right to the title "doctor" by obtaining a doctoral degree and those who merely use the term as playful branding, as long as the use is outside any medical context that could be confusing to consumers.
Nurse Practitioners. An NP is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master's or Doctorate, and obtained a certificate from a certifying body. For state recognition to practice as an NP, the NP must also meet the educational standards established by the BRN. As the result of the more advanced NP training, standardized procedures may authorize a greater number or difficulty of functions and settings while reducing the amount of supervision needed. The Nursing Practice Act also specifically authorizes NPs under standardized procedures to order durable medical equipment; certify disability; approve, modify, and add to a home health services treatment plan; furnish and order prescription drugs; and perform abortions by aspirations techniques with additional training.
Independent NPs and the "transition to practice" requirement. NPs who meet additional requirements, including the completion of a 3-year or 4600-hour "transition to practice," may practice independently without standardized procedures. There are two categories of independent NPs, those who practice in licensed healthcare settings where physicians practice and those who practice in any setting. Due to the variety of NP educational pathways, in order to practice independently in any setting, an NP would be required to meet the above training requirements above as well as meet additional educational experience prerequisites.
Once an NP meets the transition to practice, the NP may perform various functions independent of standardized procedures.
While there are still requirements in the law that specify when an independent NP would need to consult with a physician or refer a patient, the NP is not required to establish a relationship with a physician for those purposes before practicing without standardized procedures.
Transition to Practice in Other States. There are 24 states that authorize NPs to practice without standardized procedures. Of those, 10 require a transition to practice, ranging from six months of full-time practice or 1,000 hours to 3 years or 2,000 hours. The remaining 14 do not require a transition to practice.
BRN Transition to Practice Regulations. Existing law requires the BRN to establish requirements related to the transition to practice. The BRN's regulations require that a physician or another NP authorized to practice independently who is practicing in the same practice area as the applicant NP to attest to the completion of the transition to practice. This bill codifies portions of those requirements and preempts others.
NP Disclosure Requirements. NPs under the independent practice provisions are statutorily required to make several disclosures to patients, including verbally informing all new patients in a language understandable to the patient that the NP is not a physician and surgeon and referring to themselves as "enfermera especializada" with Spanish language speakers. BRN regulations also require NPs to tell all patients they have the right to see a physician. This bill deletes "verbally" from the requirement that new patients are informed that an NP is not a physician and deletes the "enfermera especializada" requirement. This bill also prohibits requiring NPs to tell all patients they have the right to see a physician.
Respiratory Care and LVNs. In the 2022 sunset review of the Respiratory Care Board of California (RCB), a long-standing issue was raised related to the appropriate scope of practice between LVNs and respiratory care professionals in administering respiratory services for managing patients. While the RCB has historically contended that LVNs should not be administering any ventilator services, the BVNPT issued guidance to licensees permitting LVNs to adjust ventilator settings. The RCB has maintained this policy was not a formal regulation, and made numerous requests to rescind the policy, but the BVNPT has maintained the position that LVNs should be able to adjust ventilators.
As a result of this continuing issue, the 2022 sunset bill for the RCB SB 1436 (Roth), Chapter 624, Statutes of 2022 included provisions that respiratory care and services may be provided if an LVN completes, before January 1, 2025, patient-specific training satisfactory to their employer, and if that LVN is employed by a home health agency licensed by the CDPH. Additionally, the bill required that on or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the BVNPT. Stemming from this collaboration, this bill extends the respective deadlines for the RCB and BVNPT to promulgate regulations and for LVNs to complete training to January 1, 2028, and expands the circumstances under which an LVN can perform certain respiratory care practices to include, among other things: those working at licensed congregate living facilities designated as six beds or fewer, licensed adult day health care center, licensed pediatric day health and respite care facilities, and more.
Veterinary Prescriptions. Licensed veterinarians are permitted to order, prescribe, and administer certain controlled substances so long as they perform an in-person examination of the patient and confirm such a substance is medically necessary. In addition, RVTs and veterinary assistants that possess a valid controlled substances permit issued by the VMB, may obtain and administer a controlled substance to a patient. Importantly, law expressly prohibits veterinarians from ordering, prescribing or furnishing a controlled substance to themselves or any human.
During the VMB's 2016 sunset review, it was made clear that, though a common practice amongst the veterinary community, veterinarians were not explicitly required to provide a consultation to clients regarding information about drugs and medicines they prescribe to patients. As a result, omnibus legislation authored by then-Senator Jerry Hill (SB 1480, Chapter 571, Statutes of 2018) added a requirement to law that veterinarians must offer a consultation to any client whom they prescribe, administer or otherwise furnish a drug to, and provide any available drug documentation upon request. In line with this greater transparency for pet owners, this bill requires licensed pharmacists who dispense a drug pursuant to a veterinary prescription to, as part of consultation, offer documentation with information specific to the veterinary drug to the client.
Hairstylist License. During the BBC's most recent sunset review in 2021, a number of reforms were passed through the BBC's sunset extension vehicle (SB 803 (Roth) Chapter 648, Statutes of 2021). These included adding further specificity to the composition of the BBC, recasting the scope of practice for skincare, and authorizing cosmetology students to obtain more clock hours through paid externships. The BBC's sunset bill also created a new hairstylist license, which allows licensees to provide certain basic hair services after meeting lower education and training requirements than are needed for barbering or cosmetology license.
The Barbering and Cosmetology Act generally prohibits the BBC from charging fees beyond what is necessary to cover the expenses of the board in performing its duties. SB 803 authorized the BBC to charge an application and examination fee to individuals seeking licensure as hairstylists. Statute currently provides the BBC with two options: they can either charge $50, or they can charge a different amount that does not exceed either $50 or the reasonable cost of developing, purchasing, grading, and administering the examination. This bill would remove the BBC's authority to charge $50 if that is not the amount that it determines to be its actual costs of developing, purchasing, grading, and administering the examination. This bill would then additionally cap the initial fee for a hairstylist's license at $50.
Structural Pest Control. This bill makes minor, yet substantive, changes to the Structural Pest Control Act, which is administered by the Structural Pest Control Board (SPCB). All licensees under the SPCB must, as a condition of their license renewal, submit proof of completion of continuing education (CE) that as deemed satisfactory by the board. Under current law, SPCB allows licensees to pass a board-administered examination in lieu of completing CE in order to obtain license renewal. However, the U.S. Environmental Protection Agency amended federal law in 2017 to tighten requirements related to restricted use pesticides and those certified to utilize them. Specifically, the EPA clarified that if individuals are certified - or in California's case, licensed – based on written examination, the respective state must ensure the examination is adequately developed to demonstrate competencies required by federal law.
According to the Author
"This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients."
Arguments in Support
Close the Provider Gap and a coalition of organizations representing nurse practitioners, hospitals, labor groups, and nonprofits write in support of this bill's provisions related to NPs: "To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance, SB 1451 will help streamline the application process and enable California's most experienced NPs to expand access to quality, affordable care. We must close the provider gap – the Californians we serve don't have the time to wait any longer. Through SB 1451, we can ensure our state's communities and families – especially those in health care deserts – can access the high-quality, timely care they need and deserve."
The California Dental Hygienists' Association (CDHA) supports this bill's provisions related to RDHAPs, writing: "It is a goal of the DHPSA designation to attract enough oral health providers to the shortage area. Prohibiting a provider from providing services in the area is counter to the legislature's goals of increasing access to oral healthcare for the underserved areas of the state. There is no harm to patients to have more than enough providers in an area. In fact, patients and consumers only benefit by having more than enough oral health providers available."
Arguments in Opposition
The California Medical Association (CMA) has taken an "oppose unless amended" position on the provisions in this bill related to NPs, writing: "This bill eliminates the requirement that a nurse practitioner must complete a variation of a three-year training requirement in one of six different specialty categories. Amendments have been suggested to have this section removed or restored with some sort of requirement or proof to demonstrate a nurse practitioner has completed at least three years of clinical experience in a specific category before being approved for independent practice. CMA also requests that the physician attestation section of this bill linked to a nurse practitioner transitioning to independent practice is amended to guarantee patient safety and physician liability protection. Additionally, this bill strikes a section related to nurse practitioner's notifying patients that they have the right to see a physician. Amendments are recommended to ensure patients know they have the option to see a physician when they are being treated by an independently practicing nurse practitioner."
The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as "doctor," writing: "A strength of today's healthcare workforce is the growing number of healthcare providers holding doctoral and advanced graduate preparation. More than a dozen health professional disciplines –including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. The American Association of Nurse Practitioners supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients."
FISCAL COMMENTS
According to the Assembly Committee on Appropriations:
- No costs to the DHBC, BRN, MBC, and OMBC.
- The RCB anticipates minor and absorbable costs to draft and implement the regulatory provisions for an LVN to perform respiratory care services.
- The BBC anticipates minor workload to update the application and examination fees to reflect actual cost, resulting in minor and absorbable costs.
- The SPCB states that, because this bill removes the exam option for SPCB licensees, SPCB will no longer need to update and validate an exam or conduct occupational analyses, resulting in a reduced workload. The SPCB anticipates cost savings of approximately $316,000 in future years (Structural Pest Control Fund).
- The Board of Pharmacy states it will provide education about the provision requiring pharmacists to provide documentation for veterinary patients through the Board of Pharmacy's newsletter and law webinar. The Board of Pharmacy anticipates minor and absorbable costs.
- The Department of Consumer Affairs (DCA), Office of Information Services states it will need to add a new application question for the BRN, update a fee code for the BBC, and add enforcement codes for the Board of Pharmacy, resulting in an absorbable fiscal impact of $3,000.
VOTES
SENATE FLOOR: 36-0-4
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Atkins, Gonzalez, Menjivar, Padilla
ASM BUSINESS AND PROFESSIONS: 13-1-4
YES: Berman, Flora, Juan Carrillo, Grayson, Irwin, Jackson, Low, Lowenthal, McKinnor, Stephanie Nguyen, Pellerin, Soria, Zbur
NO: Bains
ABS, ABST OR NV: Alanis, Chen, Dixon, Sanchez
ASM APPROPRIATIONS: 10-0-5
YES: Wicks, Arambula, Bryan, Calderon, Wendy Carrillo, Mike Fong, Grayson, Haney, Hart, Pellerin
ABS, ABST OR NV: Sanchez, Dixon, Jim Patterson, Ta, Villapudua
UPDATED
VERSION: June 19, 2024
CONSULTANT: Edward Franco / B. & P. / (916) 319-3301 FN: 0003772
Date of Hearing: August 7, 2024
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Buffy Wicks, Chair
SBPCA Bill Id:SB 1451
Author:(Ashby) – As Amended Ver:June 19, 2024
Policy Committee: | Business and Professions | Vote: | 13 - 1 |
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Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill makes various changes to the operations of the following boards governed by practice acts in the Business and Professions Code, and the professions regulated by these boards: Dental Hygiene Board of California (DHBC) for registered dental hygienists in alternative practice (RDHAPs), Medical Board of California for physicians and the Osteopathic Medical Board of California (OMBC) for osteopathic physicians, Board of Registered Nursing (BRN) for nurse practitioners, Board of Vocational Nursing and Psychiatric Technicians (BVNPT) for licensed vocational nurses (LVNs), Respiratory Care Board of California (RCB) for respiratory care practitioners, Board of Pharmacy for pharmacists, Board of Barbering and Cosmetology (BBC) for hairstylists, and Structural Pest Control Board (SPCB) for structural pest control operators.
Specifically, this bill:
- Allows an RDHAP with an existing practice in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed. Requires the RDHAP to annually provide patients with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Adds references to osteopathic physicians licensed by OMBC to provisions of law generally prohibiting use of the terms “doctor,” “physician,” “Dr.,” and “M.D.” by a person who is not a licensed physician.
- Expressly prohibits a person from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.” or “D.O.,” or any other terms or letters that would lead a reasonable patient to determine that person is a licensed “M.D.” or “D.O.” and clarifies that these prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license.
- Makes various changes to the Nursing Practice Act related to nurse practitioners, including:
- Changes requirements for clinical experience for transition to practice (TTP).
- Authorizes the BRN to deem a nurse practitioner who has been practicing for a minimum of three full-time equivalent years or 4,600 hours within the last five years, as of January 1, 2023, as having satisfied the TTP, as specified.
- Clarifies that a nurse practitioner is not required to tell a patient the patient has a right to see a physician.
- Clarifies that specified disclosure requirements apply only to nurse practitioners practicing independently of standardized procedures.
- Extends, to January 1, 2028, dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT. Authorizes, beginning January 1, 2028, an LVN to perform respiratory care services identified by the RCB under specified conditions.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to provide, as part of the consultation, the option for a representative of an animal patient to receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the BBC to charge a hairstylist application and examination fee to require the fee amount to be the actual cost to the board for developing, purchasing, grading, and administering the examination and establishes the fee for a hairstylist’s initial license fee at $50.
- Removes the ability of a structural pest control operator to take an examination issued by the SCPB in lieu of continuing education.
FISCAL EFFECT:
- No costs to the DHBC, BRN, MBC, and OMBC.
- The RCB anticipates minor and absorbable costs to draft and implement the regulatory provisions for an LVN to perform respiratory care services.
- The BBC anticipates minor workload to update the application and examination fees to reflect actual cost, resulting in minor and absorbable costs.
- The SPCB states that, because this bill removes the exam option for SPCB licensees, SPCB will no longer need to update and validate an exam or conduct occupational analyses, resulting in a reduced workload. The SPCB anticipates cost savings of approximately $316,000 in future years (Structural Pest Control Fund).
- The Board of Pharmacy states it will provide education about the provision requiring pharmacists to provide documentation for veterinary patients through the Board of Pharmacy’s newsletter and law webinar. The Board of Pharmacy anticipates minor and absorbable costs.
- The Department of Consumer Affairs (DCA), Office of Information Services states it will need to add a new application question for the BRN, update a fee code for the BBC, and add enforcement codes for the Board of Pharmacy, resulting in an absorbable fiscal impact of $3,000.
COMMENTS:
- Purpose. This bill is sponsored by the author, who is Chair of the Senate Committee on Business, Professions, and Economic Development. According to the author:
This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients.
- Opposition. The OMBC and Osteopathic Physicians and Surgeons of California oppose the absence of the term “osteopath” among the terms an unlicensed person is prohibited from using. The California Medical Association opposes several provisions relating to nurse practitioners’ TTP and notifying a patient of the right to see a physician. The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as “doctor,” writing:
More than a dozen health professional disciplines—including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. [AANP] supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients.
The American Psychological Association and the California Naturopathic Doctors Association, along with organizations representing physical therapists, nurse midwives, nurses, and oriental medicine practitioners, also wrote in opposition to the same provisions AANP opposes.
- Related Legislation.
SB 887 (Committee on Business, Professions and Economic Development), Chapter 510, Statutes of 2023, last year’s omnibus bill, made numerous technical, clarifying, and minor changes to programs within the DCA.
SB 1526 (Committee on Business, Professions and Economic Development) makes numerous technical and clarifying changes related to programs within the DCA. SB 1526 is pending on the Assembly Floor.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: June 25, 2024
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
SBPCA Bill Id:SB 1451
Author:(Ashby) – As Amended Ver:June 19, 2024
SENATE VOTE: 36-0
SUBJECT: Professions and vocations
SUMMARY: Authorizes registered dental hygienists in alternative practice (RHDAPs) to continue to provide services in an area that has been decertified as a dental health professional shortage area; updates existing restrictions on the use of the words “doctor” or “physician” or similar terms by individuals not licensed as physicians and surgeons; makes changes to the requirements for nurse practitioners (NPs) practicing independent of standardized procedures; expressly authorizes licensed vocational nurses (LVNs) who have completed additional training to perform certain respiratory care services in specified settings; requires pharmacists who dispense or furnish a dangerous drug pursuant to a veterinary prescription to offer specified drug documentation as part of their consultation; and makes various other changes to practice acts administered by boards and bureaus under the Department of Consumer Affairs (DCA).
EXISTING LAW:
- Establishes the DCA within the Business, Consumer Services, and Housing Agency. (Business and Professions Code (BPC) § 100)
- Enumerates various regulatory boards, bureaus, committees, and commissions under the DCA’s jurisdiction. (BPC § 101)
- Establishes the Dental Hygiene Board of California (DHBC) within the DCA to regulate dental hygienists under the Dental Hygiene Practice Act. (BPC §§ 1902 et seq.)
- Establishes the Department of Health Care Access and Information (HCAI), vested with responsibilities related to health planning and research development relating to the health professional workforce. (Health and Safety Code (HSC) §§ 127000 et seq.)
- Provides that the DHBC shall issue a license as an RDHAP to a registered dental hygienist who meets additional specified education and training requirements or to a person who has received a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project No. 155 established by HCAI. (BPC § 1922)
- Authorizes RDHAPs to practice as an employee of a dentist or of another RDHAP, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, or in specified clinic settings. (BPC § 1925)
- Additionally authorizes an RDHAP to perform specified duties in the following settings:
- Residences of the homebound.
- Schools.
- Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
- Dental health professional shortage areas, as certified by HCAI in accordance with existing office guidelines.
- Dental offices.
(BPC § 1926)
- Establishes the Medical Board of California (MBC) within the DCA to regulate physicians and surgeons under the Medical Practice Act. (BPC §§ 2000 et seq.)
- Establishes the Osteopathic Medical Board of California (OMBC) within the DCA to regulate osteopathic physicians and surgeons under the Osteopathic Act who possess the same privileges as licensees regulated by the MBC. (BPC §§ 2450 et seq.)
- Declares that protection of the public shall be the highest priority for both the MBC and the OMBC in exercising their respective licensing, regulatory, and disciplinary functions, and that whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 2001.1; § 2450.1)
- Provides that any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon or without being otherwise authorized to perform the act is guilty of a crime. (BPC § 2052)
- Requires a person who provides certain alternative or complementary to healing arts services and who is not a licensed physician and surgeon to make a written disclosure to the client that they are not a licensed physician and that the services to be provided are not licensed by the state, among other disclosures. (BPC § 2053.6)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the MBC from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Allows a person who has been issued a physician’s and surgeon’s certificate by the MBC to use the initials “M.D.” (BPC § 2055)
- Provides that nothing in the Medical Practice Act shall be construed as limiting the practice of other persons licensed, certified, or registered under any other provision of healing arts law when that person is engaged in their authorized and licensed practice. (BPC § 2061)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Establishes the Board of Registered Nursing (BRN) within the DCA to regulate licensed registered nurses under the Nursing Practice Act. (BPC §§ 2700 et seq.)
- Defines “the practice of nursing” as functions, including basic healthcare, that help people cope with or treat difficulties in daily living that are associated with their actual or potential health or illness problems, and that require a substantial amount of scientific knowledge or technical skill. (BPC § 2725)
- Includes within the scope of nursing practice the following:
- Direct and indirect patient care services that ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures. (BPC § 2725(b)(1))
- Direct and indirect patient care services, including the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist. (BPC § 2725(b)(2))
- The performance of skin tests, immunization techniques, and the withdrawal of human blood from veins and arteries. (BPC § 2725(b)(3))
- Observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and determination of whether the signs, symptoms, reactions, behavior, or general appearance exhibit abnormal characteristics, and implementation, based on observed abnormalities, of appropriate reporting, or referral, or standardized procedures, or changes in treatment regimen in accordance with “standardized procedures,” or the initiation of emergency procedures. (BPC § 2725(b)(4))
- Defines “standardized procedures” as either of the following:
- Policies and protocols developed by a licensed health facility through collaboration among administrators and health professionals including physicians and nurses. (BPC § 2725(c)(1))
- Policies and protocols developed through collaboration among administrators and health professionals, including physicians and nurses, by an organized healthcare system that is not a licensed health facility. (BPC § 2725(c)(2))
- Establishes standardized procedure guidelines jointly promulgated by the Medical Board of California and the BRN. (California Code of Regulations (CCR), Title 16, § 1474)
- Requires standardized procedures to include a written description of the method used during development and approval. (CCR, tit. 16, § 1474(a))
- Specifies the required form and content of standardized procedures, including that they are in writing and signed, specify the authorized functions, establish procedure protocols, detail education and training requirements, provide for evaluation and of authorized nurses, provide for the maintenance of records of authorized nurses, establish the scope of physician supervision, set forth circumstances requiring physician consultation, state limitations on settings, specify patient record keeping requirements, and provide for periodic review of the standardized procedures. (CCR, tit. 16, § 1474(b))
- Establishes a category of advanced practice registered nurses known as NPs, and specifies the requirements for certification. (BPC §§ 2834-2837.105)
- Establishes the following categories of NP:
- Family/individual across the lifespan. (CCR, tit. 16, § 1481(a)(1))
- Adult-gerontology, primary care or acute care. (CCR, tit. 16, § 1481(a)(2))
- Neonatal. (CCR, tit. 16, § 1481(a)(3))
- Pediatrics, primary care or acute care. (CCR, tit. 16, § 1481(a)(4))
- Women's health/gender-related. (CCR, tit. 16, § 1481(a)(5))
- Psychiatric-Mental Health across the lifespan. (CCR, tit. 16, § 1481(a)(6))
- Authorizes an NP who meets specified requirements, commencing January 1, 2023, to perform the following procedures independent of standardized procedures and physician oversight:
- Conduct an advanced assessment. (BPC § 2837.103(c)(1))
- Order, perform, and interpret diagnostic procedures. (BPC § 2837.103(c)(2)(A))
- For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA). (BPC § 2837.103(c)(2)(B))
- Establish primary and differential diagnoses. (BPC § 2837.103(c)(3))
- Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
- Diagnose, prescribe, and institute therapy or referral of patients to health care agencies, health care providers, and community resources. (BPC § 2837.103(c)(4)(A))
- Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances. (BPC § 2837.103(c)(4)(B))
- Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy. (BPC § 2837.103(c)(4)(C))
- After performing a physical examination, certify disability. (BPC § 2837.103(c)(5))
- Delegate specified tasks to a medical assistant. (BPC § 2837.103(c)(6))
- Requires an NP who seeks to practice independent of standardized procedures to obtain certification from the BRN and complete a “transition to practice” in California of a minimum of three full-time equivalent years of practice or 4,600 hours. (BPC § 2837.103(a)(1)(D); CCR, tit. 16, §§ 1482.3, 1482.4).
- Defines “transition to practice” as additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently, including managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice. (BPC § 2837.101(c))
- Requires the BRN to, by regulation, define minimum standards for transition to practice and specifies that clinical experience may include experience obtained before January 1, 2021, if the experience meets the requirements established by the BRN. (BPC § 2837.101(c))
- Requires an NP who seeks to practice independent of standardized procedures to prove completion of a transition to practice by submitting to the BRN one or more attestations of a physician or surgeon or another NP already authorized to practice independent of standardized procedures; requires an attesting physician or surgeon or NP practicing to specialize in the same specialty area or category in which the applicant seeks certification as an NP; and prohibits the attester from having a familial or financial relationship with the applicant. (CCR, tit. 16, §§ 1482.3(a)(13), 1482.4(a)(13))
- Requires the transition to practice to be completed within five years prior to the date the applicant applies for certification as an NP practicing independent of standardized procedures. (CCR, tit. 16, §§ 1482.3(a)(13)(A)(ii), 1482.4(a)(13)(A)(ii))
- Requires the transition to practice to be completed in direct patient care and in the same category of NP practice in which the applicant seeks certification. (CCR, tit. 16, § 1482.3(a)(13)(A)(iv), 1482.4(a)(13)(A)(iv))
- Authorizes an NP who meets all of the requirements for practice independent of standardized procedures to practice in one of the following settings or organizations in which one or more physician and surgeons practice with the NP:
- A clinic. (BPC § 2837.103(a)(2)(A))
- A health facility, except for correctional treatment centers and state hospitals. (BPC § 2837.103(a)(2)(B))
- A county medical facility. (BPC § 2837.103(a)(2)(C))
- Any lawfully organized group of physicians and surgeons that provides health care services. (BPC § 2837.103(a)(2)(D))
- A home health agency. (BPC § 2837.103(a)(2)(E))
- A licensed hospice facility. (BPC § 2837.103(a)(2)(F))
- Authorizes an NP who has practiced in good standing for three years independent of standardized procedures to seek a certificate from the BRN to practice outside of the settings in which one or physician and surgeons practice. (BPC § 2837.104(b); (CCR, tit. 16, § 1482.4(a)(14))
- Requires an NP to verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon, for purposes of Spanish language speakers, use standardized phrase “enfermera especializada.” (BPC §§ 2837.103(d), 2837.104(d); CCR, tit. 16, § 1487(b))
- Requires an NP, except when working in facilities under the Department of Corrections and Rehabilitation, to advise patients that they have the right to see a physician and surgeon on request and the circumstances under which they must be referred to see a physician and surgeon. (CCR, tit. 16, § 1487(c))
- Establishes the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) within the DCA to regulate licensed vocational nurses (LVNs) and psychiatric technicians under the Vocational Nursing Practice Act and the Psychiatric Technicians Law. (BPC §§ 2840–2895.5; 4500–4548)
- Establishes the Respiratory Care Board of California (RCB) within the DCA to regulate respiratory care practitioners under the Respiratory Care Practice Act. (BPC §§ 3700 et seq.)
- Defines respiratory care practice as a health care profession employed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of cardiopulmonary and other systems functions, as specified. (BPC §§ 3702; 3702.7)
- Provides that the practice of respiratory care shall be performed under the supervision of a medical director in accordance with a prescription of a physician and surgeon or pursuant to respiratory care protocols. (BPC § 3703)
- Specifies activities that are not prohibited by the Respiratory Care Act, including:
- The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs.
- Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold themselves out to be a respiratory care practitioner licensed under the provisions of the Act.
- The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training.
- The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty.
- Respiratory care services in case of an emergency, which includes an epidemic or public disaster.
- Persons from engaging in cardiopulmonary research.
- Formally trained licensees and staff of child day care facilities from administering to a child inhaled medication.
- The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the Department of Public Health (CDPH) of specific, limited, and basic respiratory care or respiratory care related services that have been authorized by the board.
- The performance of certain respiratory care practices by an LVN licensed by the BVNPT who is employed by a home health agency licensed by the CDPH, subject to certain conditions.
(BPC § 3765)
- Requires that, before January 1, 2025, LVNs performing respiratory care practices complete patient-specific training satisfactory to their employer. (BPC § 3765(i)(1))
- Requires that, on or after January 1, 2025, patient-specific training offered by employers are in accordance with guidelines that shall be promulgated by the RCB no later than that same date, in collaboration with the BVNPT. (BPC § 3765(i)(2))
- Establishes the California State Board of Pharmacy (BOP) within the DCA to regulate the pharmacy profession under the Pharmacy Law. (BPC §§ 4000 et seq.)
- Establishes the Veterinary Medical Board (VMB) within the DCA to regulate veterinarians and registered veterinary technicians (RVTs) under the Veterinary Medicine Practice Act. (BPC §§ 4800 et seq.)
- Provides that a person practices veterinary medicine when they, among other things, administer a drug or medicine for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals. (BPC § 4826)
- Prohibits a veterinarian from prescribing, dispensing, or administering a drug, medicine, or treatment unless a veterinarian-client-patient relationship exists, subject to certain exceptions. (BPC § 4826.6)
- Requires that, each time a veterinarian initially prescribes, dispenses, or furnishes a dangerous drug to an animal patient in an outpatient setting, the veterinarian shall offer to provide, verbally, in writing, or by email to the client, a consultation that includes the following:
- The name and description of the dangerous drug,
- The route of administration, dosage form, dosage, duration of drug therapy, the duration of the effects of the drug, and the common severe adverse effects associated with the use of a short-acting or long-acting drug,
- Any special directions for proper use and storage,
- Actions to be taken in the event of a missed dose, and
- If available, precautions and relevant warnings provided by the drug’s manufacturer, including common severe adverse effects of the drug.
(BPC § 4829.5(a))
- Requires a veterinarian to provide drug documentation to a client, if available. (BPC § 4829.5(b))
- Authorizes a veterinarian to delegate the task of providing consultation and drug documentation to an RVT or veterinary assistant. (BPC § 4829.5(c))
- Establishes the State Board of Barbering and Cosmetology (BBC) within the DCA to regulate barbers, cosmetologists, hairstylists, electrologists, estheticians, and manicurists under the Barbering and Cosmetology Act. (BPC §§ 7301 et seq.)
- Defines the practice of hairstyling as all or any combination of the following:
- Styling of all textures of hair by standard methods that are current at the time of the hairstyling.
- Arranging, blow drying, cleansing, curling, cutting, dressing, extending, shampooing, waving, or nonchemically straightening the hair of any person using both electrical and nonelectrical devices.
(BPC § 7316)
- Establishes fee amounts that may be charged to applicants and licensees by the BBC and specifically provides that the fee for a hairstylist application and examination shall be either $50 or a lower fee in an amount as determined by the BBC, not to exceed the reasonable cost of developing, purchasing, grading, and administering the examination. (BPC § 7323)
- Establishes the Structural Pest Control Board (SPCB) within the DCA to regulate structural pest control operators under the Structural Pest Control Act. (BPC §§ 8500 et seq.)
- Requires that, as a condition of license renewal, a licensee of the SPCB must submit proof of continuing education, or equivalent activity, informing themselves of developments in the field of pest control, and authorizes licensees to take an examination issued by the SPCB in lieu of continuing education. (BPC § 8593)
- Provides that the SPCB shall require applicants for license renewal to submit proof that they have completed approved courses of continuing education in pesticide application and use, and provides that in lieu of submitting that proof, the licensee may successfully pass an applicator’s examination for renewal of a license given by the SPCB. (BPC § 8593.1)
THIS BILL:
- Allows RDHAPs working in a dental health professional shortage area to continue to provide dental hygiene services if the dental health professional shortage area certification is removed and requires those RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services.
- Adds references to osteopathic physicians and surgeons licensed by the OMBC to provisions of existing law generally prohibiting use of the terms “doctor,” “physician,” “Dr.,” and “M.D.” by persons who are not licensed physicians and surgeons.
- Expressly prohibits a person from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.” or “D.O.,” or any other terms or letters indicating or implying that the person is a physician and surgeon or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed “M.D.” or “D.O.”
- Clarifies that the above prohibitions do not apply to a person holding a current and active license under another healing arts board, to the extent the use of the title is consistent with the act governing the practice of that license.
- Additionally allows a person who is not a physician and surgeon to use the word “doctor” or the prefix “Dr.” if the use is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading.
- Makes the following changes to the requirements for NP practicing independent of standardized procedures:
- Amends the definition of “transition to practice” to delete the requirement that clinical experience must meet the requirements established by the BRN, clarify that clinical experience may not be limited to experience in a single category of NP practice, and exclude experience obtained before a person is certified as an NP.
- Authorizes the transition to practice to be completed in another state.
- Specifies that an NP who has been practicing as a nurse practitioner in direct patient care for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, may be deemed to have satisfied the transition to practice requirement.
- Specifies the following for purposes of completion of the transition to practice:
- The BRN must receive proof of completion of a transition to practice on a form prescribed by the BRN as an attestation from either a licensed physician and surgeon or an NP authorized to practice independent of standardized procedures.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not required to specialize in the same category as the applicant.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and only attests to the completion of the transition to practice.
- A licensed physician and surgeon or an NP who attests to the completion of a transition to practice is not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for providing an attestation or refusing to provide an attestation.
- Deletes from the requirement that an NP practicing independent of standardized procedures inform all new patients in a language understandable to the patient that an NP is not a physician and surgeon that the NP do so verbally.
- Deletes requirement that an NP nurse practitioner use the standardized phrase “enfermera especializada” with Spanish language speakers.
- Specifies that an NP is not be required to tell a patient the patient has a right to see a physician and surgeon.
- Clarifies that the disclosure requirements only apply to NPs practicing independently of standardized procedures.
- Specifies that the occupational analysis performed by the BRN related to NP competencies and independent practice did not need to include NP certification examinations discontinued before January 1, 2017.
- Extends respective dates for LVNs to complete patient-specific training, and for the RCB to promulgate regulations in consultation with the BVNPT, to January 1, 2028.
- Authorizes, operative January 1, 2028, an LVN to perform respiratory care services identified by the RCB so long as they:
- Complete patient-specific training satisfactory to their employer, and
- Hold a current and valid certification of competency for each respiratory task to be performed from the California Association of Medical Product Suppliers, the California Society for Respiratory Care, or another organization identified by the board.
- Authorizes, operative January 1, 2028, LVNs to perform respiratory care services identified by the RCB in the following settings:
- At a congregate living health facility licensed by the CDPH that is designated as six beds or fewer.
- At an intermediate care facility licensed by the CDPH that is designated as six beds or fewer.
- At an adult day health care center licensed by the CDPH.
- As an employee of a home health agency licensed by the CDPH or an individual nurse provider working in a residential home.
- At a pediatric day health and respite care facility licensed by the CDPH.
- At a small family home licensed by the State Department of Social Services that is designated as six beds or fewer.
- As a private duty nurse as part of daily transportation and activities outside a patient’s residence or family respite for home- and community-based patients.
- Requires a pharmacist who dispenses or furnishes a dangerous drug pursuant to a veterinary prescription to include, as part of the consultation, the option for a representative of an animal patient to also receive drug documentation specifically designed for veterinary drugs.
- Recasts the authority of the BBC to charge a hairstylist application and examination fee to require the fee amount to be the actual cost to the board for developing, purchasing, grading, and administering the examination and establishes the fee for a hairstylist’s initial license fee as $50.
- Removes the authority for SCPB licensees to take an examination issued by the board in lieu of continuing education.
FISCAL EFFECT: Pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
Purpose. This bill is sponsored by the author, who is Chair of the Senate Committee on Business, Professions, and Economic Development. According to the author:
“This bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients.”
Background.
Registered Dental Hygienists in Alternative Practice. The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists. The DHBC regulates three categories of mid-level dental professionals. These categories include registered dental hygienists, registered dental hygienists in extended functions, and RDHAPs.
An RDHP is trained and authorized to provide unsupervised dental hygiene services in certain limited practice settings, including residences of the homebound, schools, residential facilities, and dental offices. RDHAPs are also authorized to provide services without supervision in certified dental health professional shortage areas. The original intent of this authority was to allow RDHAPs to perform unsupervised services on vulnerable and challenging populations, such as children, individuals with limited access to dental care, and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings.
During the DHBC’s sunset review in 2018, the board’s sunset hearing background paper discussed the fact that while an RDHAP may set up practice in a dental health professional shortage area, the RDHAP must relocate their practice once that shortage is deemed to no longer exist. Health professional shortage areas are federal designations, certified in California by HCAI, and therefore decertification could in theory occur with little notice or public input. Assembly Bill 502 (Chau) of 2015 included language that would have allowed an RDHAP to continue practicing in an area that has lost its dental health professional shortage area designation; however, this language was subsequently removed from the bill.
This issue was again discussed during the DHBC’s most recent sunset review in 2023. Issue #5 in the board’s sunset hearing background paper discussed the question of whether current law should be amended to allow an RDHAP with a stand-alone dental hygiene practice site in a dental health professional shortage area to remain in practice even if the area’s shortage area certification is removed. The background paper noted that “licensees are wary of opening a dental hygiene practice with the risk that they could lose the business if the designation is lifted by the federal government due to the dental hygiene services they are providing to the population.” The DHBC opined that if this concern were addressed, more RDHAPs would potentially be willing to open new practices in these communities where their dental services are vitally needed the most.
This bill would address the concerns that were raised in the DHBC’s prior sunset reviews by amending the law to allow an RDHAP that previously provided services without supervision in a dental health professional shortage area to continue to provide dental hygiene services in the event that the dental health professional shortage area certification is removed for that area. The bill would require RDHAPs to annually provide patients treated at an existing practice with a list of dentists in the previous dental health professional shortage area who may be able to see the patient for comprehensive services. While it is uncertain whether there is any imminent risk of the federal government removing a substantial number of dental health professional shortage area designations in the future, this authority will arguably help encourage RDHAPs to invest in opening practices in these communities, which would correspondingly result in underserved patients receiving access to dental hygiene services.
Restriction of Medical Terms. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. To use these words, prefixes, or initials, a person’s license must be valid, unrevoked, and unsuspended. The statute features three limited exceptions for individuals who are trained as physicians but not currently licensed in California.
General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice. Statute specifically prohibits a licensee from using “any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading, or deceptive.” Practitioners may advertise that they are certified or that they limit their practice to specific fields; however, the term “board certified” reserve for physicians certified by an American Board of Medical Specialties member board.
Additionally, Section 17500 of the Business and Professions Code broadly prohibits false advertising of a product or service. Specifically, this law makes it unlawful for any person to make any statement or advertisement with intent to perform services, professional or otherwise, that is untrue or misleading. While this code section covers a wide range of false advertisements by sellers of goods or services, its provisions would be applicable to health care licensees.
While the Medical Practice Act expressly reserves use of the words “doctor” or “physician” for actively licensed physicians, this provision does not comprehensively reflect the current state of the law. For example, while podiatrists are independently licensed by the Podiatric Medical Board of California, their formal title is “doctors of podiatric medicine.” Similarly, the California Board of Naturopathic Medicine licenses and regulates a profession statutorily referred to as “naturopathic doctors.” Optometrists, dentists, chiropractors, psychologists, and other practitioners possessing professional doctorates are also expressly authorized by law to use the term “doctor.” “Dr.” is also commonly used as a social honorific for anyone who has received a doctoral degree, including research doctorates not associated with licensure.
Current law also does not expressly exempt individuals who do not imply any authority to practice a healing art but who use the honorific “Dr.” to recognize a nonprofessional doctorate or as part of an established nickname. For example, Dr. Dre is an American rapper and entrepreneur whose debut record as a solo performer, The Chronic, is widely recognized as a seminal hip hop album of the 1990s and credited with popularizing the G-funk rap subgenre. Born Andre Romell Young, the artist’s moniker was inspired Julius Erving, a professional basketball player for the Philadelphia 76ers who is considered to be one of the greatest dunkers of all time and who is known by his nickname “Dr. J.” Neither Dr. Dre nor Dr. J is a graduate of any medical school and neither holds a current license as a physician and surgeon from a state medical board. However, the MBC has not prosecuted Dr. Dre or Dr. J for violating the Medical Practice Act, likely because they are clearly not implying that they are physicians, which is the obvious intent of the law.
Under the status quo, it is apparent that someone who is not a physician and surgeon may nevertheless safely use the term “doctor” and its associated prefix without fear of incurring a misdemeanor conviction if they are authorized by another law to use that title (e.g. a person licensed under the Naturopathic Doctors Act); in possession of a doctoral degree (e.g. Dr. Jill Biden, Ed.D.); or clearly not implying any qualification to practice medicine (e.g. Dr. Demento). However, current law does not expressly reference any of these exemptions. Current law also does not reflect the fact that physicians and surgeons are not exclusively licensed as M.D.s by the MBC; osteopathic physicians and surgeons possess the same authority and scope as D.O.s licensed by the OMBC.
This bill would make several updates and clarifications to existing law restricting use of “doctor” and similar terms. Because osteopathic physicians and surgeons have the same scope of practice as physicians and surgeons licensed by the MBC and are regulated under the same chapter of code, this bill would provide them with the same title protection for the initials “D.O.” that licensees of the MBC receive for “M.D.” Additionally, the bill clarifies that exemptions in current law for graduates of medical schools apply equally to graduates of osteopathic medical schools. The bill would then expressly provide that no person may use words, initials, or other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed “M.D.” or “D.O.”
Additionally, this bill would further clarify existing law by adding two new exceptions to the restriction of these terms that are reflective of the status quo but not expressly referenced in the Medical Practice Act. First, the bill would confirm that licensees of other healing arts boards, such as optometrists, naturopathic doctors, and dentists, may continue to use words such as “doctor” to the extent the use of the title is consistent with the act governing the practice of that license. Second, the bill would exempt any person whose use of the word “doctor” or the prefix “Dr.” is not associated with any claim of entitlement to practice medicine or any other professional service for which the use of the title would be untrue or misleading pursuant to Section 17500. This clarification would capture both those who have earned the right to the title “doctor” by obtaining a doctoral degree and those who merely use the term as playful branding, as long as the use is outside any medical context that could be confusing to consumers.
Nurse Practitioners. An NP is a registered nurse (RN) who has additionally earned a postgraduate nursing degree, such as a Master’s or Doctorate, and obtained a certificate from a certifying body. For state recognition to practice as an NP, the NP must also meet the educational standards established by the BRN. According to BRN regulations, an NP is an advanced practice registered nurse who meets BRN education and certification requirements and possesses additional advanced practice educational preparation and skills in physical diagnosis, psycho-social assessment, and management of health-illness needs in primary care or acute care.
As RNs, NPs generally have the same base scope of practice as non-NP RNs, although their additional education and training allows them to perform more advanced functions under standardized procedures. Currently, all RNs practicing outside of the basic scope of nursing operate under a supervision mechanism known as a “standardized procedure.” The standardized procedure authorizes functions that would otherwise be considered the practice of medicine and must be based on the guidelines jointly promulgated by the Medical Board of California and the BRN.
Standardized procedures must meet specified requirements, including that they:
- Are developed with the organized healthcare system or physician.
- Outline the scope of the functions allowed.
- Specify the circumstances under which they may be performed.
- Specify any training prerequisites.
- Establish a method for initial and ongoing evaluation of the competence of the RN.
- Specify the level of physician supervision required (e.g. indirect, on-site, present during the procedure).
- Establish physician consultation protocols.
- Specify any limitations on settings where the functions may be performed.
- Specify record-keeping requirements and methods for periodic review.
As the result of the more advanced NP training, standardized procedures may authorize a greater number or difficulty of functions and settings while reducing the amount of supervision needed. The Nursing Practice Act also specifically authorizes NPs under standardized procedures to order durable medical equipment; certify disability; approve, modify, and add to a home health services treatment plan; furnish and order prescription drugs; and perform abortions by aspirations techniques with additional training.
DCA’s Annual Report for Fiscal Year 2022-23 reported 36,092 actively licensed NPs and 32,780 NPs with a furnishing certificate authorizing them to furnish drugs.
Independent NPs and the “transition to practice” requirement. NPs who meet additional requirements, including the completion of a 3-year or 4600-hour “transition to practice,” may practice independently without standardized procedures. There are two categories of independent NPs, those who practice in licensed healthcare settings where physicians practice and those who practice in any setting. Due to the variety of NP educational pathways, in order to practice independently in any setting, an NP would be required to meet the above training requirements above as well as meet additional educational experience prerequisites.
Once an NP meets the transition to practice, the NP may perform the following functions independent of standardized procedures:
- Conduct an advanced assessment.
- Order, perform, and interpret diagnostic procedures, including radiologic procedures and specified laboratory procedures.
- Establish primary and differential diagnoses.
- Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
- Diagnose, prescribe, and institute therapy or referral of patients to healthcare agencies, healthcare providers, and community resources.
- Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
- Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
- After performing a physical examination, certify disability pursuant to the Unemployment Insurance Code.
- Delegate tasks to a medical assistant.
While there are still requirements in the law that specify when an independent NP would need to consult with a physician or refer a patient, the NP is not required to establish a relationship with a physician for those purposes before practicing without standardized procedures.
Transition to Practice in Other States. There are 24 states that authorize NPs to practice without standardized procedures. Of those, 10 require a transition to practice, ranging from six months of full-time practice or 1,000 hours to 3 years or 2,000 hours. The remaining 14 do not require a transition to practice.
BRN Transition to Practice Regulations. Existing law requires the BRN to establish requirements related to the transition to practice. Pursuant to that requirement, BRN regulations require that the transition to practice meet the following:
- Be completed in the five years preceding application.
- Be completed after initial certification as an NP by the BRN.
- Be completed in direct patient care.
- Be completed in a specified NP practice area (family/individual across the lifespan; adult-gerontology, primary care or acute care; neonatal; pediatrics, primary care, or acute care; women's health/gender-related; psychiatric-mental health).
The BRN’s regulations also require that a physician or another NP authorized to practice independently who is practicing in the same practice area as the applicant NP to attest to the completion of the transition to practice. This bill codifies portions of those requirements and preempts others.
NP Disclosure Requirements. NPs under the independent practice provisions are statutorily required to make several disclosures to patients, including verbally informing all new patients in a language understandable to the patient that the NP is not a physician and surgeon and referring to themselves as “enfermera especializada” with Spanish language speakers. BRN regulations also require NPs to tell all patients they have the right to see a physician. This bill deletes “verbally” from the requirement that new patients are informed that an NP is not a physician and deletes the “enfermera especializada” requirement. This bill also prohibits requiring NPs to tell all patients they have the right to see a physician.
Respiratory Care and LVNs. In the 2022 sunset review of the RCB, a long-standing issue was raised related to the appropriate scope of practice between LVNs and respiratory care professionals in administering respiratory services for managing patients. While the RCB has historically contended that LVNs should not be administering any ventilator services, the BVNPT issued guidance to licensees permitting LVNs to adjust ventilator settings. The RCB has maintained this policy was not a formal regulation, and made numerous requests to rescind the policy, but the BVNPT has maintained the position that LVNs should be able to adjust ventilators.
In 2019, the two boards attempted to resolve this issue and worked collaboratively. From that work, the two boards issued a joint statement clarifying respiratory care professional and LVN roles relating to patient care on mechanical ventilators. After reactions and comments from a variety of facilities and organizations, there was momentum to further clarify its respective regulations regarding patient care. The boards hosted a stakeholder meeting to further discuss the joint statement and concerns grew about expanding places LVNs can conduct ventilator services to home based settings as well. According to the RCB, BVNPT backed out of the agreement and began exploring continuing to train LVNs to perform ventilator services in more settings.
As a result of this continuing issue, the 2022 sunset bill for the RCB (SB 1436, Roth, Ch. 624, Statutes of 2022) included provisions that respiratory care and services may be provided if an LVN completes, before January 1, 2025, patient-specific training satisfactory to their employer, and if that LVN is employed by a home health agency licensed by the CDPH. Additionally, the bill required that on or after January 1, 2025, the licensed vocational nurse has completed patient-specific training by the employer in accordance with guidelines that shall be promulgated by the board no later than January 1, 2025, in collaboration with the BVNPT. Stemming from this collaboration, this bill extends the respective deadlines for the RCB and BVNPT to promulgate regulations and for LVNs to complete training to January 1, 2028, and expands the circumstances under which an LVN can perform certain respiratory care practices to include, among other things: those working at licensed congregate living facilities designated as six beds or fewer, licensed adult day health care center, licensed pediatric day health and respite care facilities, and more.
Veterinary Prescriptions. Licensed veterinarians are permitted to order, prescribe, and administer certain controlled substances so long as they perform an in-person examination of the patient and confirm such a substance is medically necessary. In addition, RVTs and veterinary assistants that possess a valid controlled substances permit issued by the VMB, may obtain and administer a controlled substance to a patient. Importantly, law expressly prohibits veterinarians from ordering, prescribing or furnishing a controlled substance to themselves or any human.
During the VMB’s 2016 sunset review, it was made clear that, though a common practice amongst the veterinary community, veterinarians were not explicitly required to provide a consultation to clients regarding information about drugs and medicines they prescribe to patients. As a result, omnibus legislation authored by then-Senator Jerry Hill (SB 1480, Ch. 571, Stats. of 2018) added a requirement to law that veterinarians must offer a consultation to any client whom they prescribe, administer or otherwise furnish a drug to, and provide any available drug documentation upon request. In line with this greater transparency for pet owners, this bill requires licensed pharmacists who dispense a drug pursuant to a veterinary prescription to, as part of consultation, offer documentation with information specific to the veterinary drug to the client.
Hairstylist License. The BBC is responsible for licensing and regulating barbers, cosmetologists, hairstylists, estheticians, electrologists, manicurists, apprentices, and establishments. The BBC is one of the largest boards in the country, with over 615,000 licensees. As of the board’s most recent sunset review, the BBC annually issues approximately 261,000 licenses and administers approximately 28,000 written examinations (initial and retake examinees). Each profession has its own scope of practice, entry-level requirements, and professional settings, with some overlap in areas. In addition to licensing individuals, the BBC approves schools.
During the BBC’s most recent sunset review in 2021, a number of reforms were passed through the BBC’s sunset extension vehicle (SB 803, Roth). These included adding further specificity to the composition of the BBC, recasting the scope of practice for skincare, and authorizing cosmetology students to obtain more clock hours through paid externships. The BBC’s sunset bill also created a new hairstylist license, which allows licensees to provide certain basic hair services after meeting lower education and training requirements than are needed for barbering or cosmetology license.
The Barbering and Cosmetology Act generally prohibits the BBC from charging fees beyond what is necessary to cover the expenses of the board in performing its duties. SB 803 authorized the BBC to charge an application and examination fee to individuals seeking licensure as hairstylists. Statute currently provides the BBC with two options: they can either charge $50, or they can charge a different amount that does not exceed either $50 or the reasonable cost of developing, purchasing, grading, and administering the examination. This bill would remove the BBC’s authority to charge $50 if that is not the amount that it determines to be its actual costs of developing, purchasing, grading, and administering the examination. This bill would then additionally cap the initial fee for a hairstylist’s license at $50.
Structural Pest Control. This bill makes minor, yet substantive, changes to the Structural Pest Control Act, which is administered by the Structural Pest Control Board (SPCB). All licensees under the SPCB must, as a condition of their license renewal, submit proof of completion of continuing education (CE) that as deemed satisfactory by the board. Under current law, SPCB allows licensees to pass a board-administered examination in lieu of completing CE in order to obtain license renewal. However, the U.S. Environmental Protection Agency amended federal law in 2017 to tighten requirements related to restricted use pesticides and those certified to utilize them. Specifically, the EPA clarified that if individuals are certified - or in California’s case, licensed – based on written examination, the respective state must ensure the examination is adequately developed to demonstrate competencies required by federal law.
The SPCB surmises that aligning competency examinations with this new standard will be onerous, as they do not have staff within the agency itself qualified to develop the exam to a defensible standard, and deem that engagement with the DCA’s Office of Professional Examination Services (OPES) would be too costly. As a result, this bill deletes the competency examination as an alternative for completing CE, thus eliminating the SPCB’s need to continue developing or administering such an examination.
Current Related Legislation.
SB 1526 (Business, Professions, and Economic Development Committee) makes numerous technical and clarifying provisions related to programs within the DCA.
Prior Related Legislation.
AB 765 (Wood) of 2023 would have prohibited any person who is not a licensed physician and surgeon from using various medical specialty titles or otherwise implying that they are a physician and surgeon. This bill died on suspense in the Assembly Committee on Appropriations.
SB 817 (Roth) of 2023 would have recast provisions of law authorizing the BBC to charge a hairstylist license application and examination fee to require that the fee be the actual cost, not to exceed $50. This bill was not set for a hearing in the Assembly Committee on Appropriations.
SB 1436 (Roth, Chapter 624, Statutes of 2022) extended until January 1, 2027, the provisions establishing the RCB and makes additional technical changes and reforms in response to issues raised during the RCB’s sunset review oversight process.
AB 2684 (Berman, Chapter 2684, Statutes of 2022) was the BRN’s 2022 sunset review bill and, among other things, added technical, clarifying and conforming changes to the Nursing Practice Act to assist with implementation of AB 890.
AB 890 (Wood, Chapter 265, Statutes of 2020) authorized an NP to provide specified services in specified settings, without standardized procedures, if the NP meets additional education, examination, and training requirements; required the BRN to adopt regulations defining a transition to practice; required the BRN to establish a Nurse Practitioner Advisory Committee to advise and make recommendations to the BRN on NP all issues; and required the BRN and the DCA to identify or develop an examination that tests for independent practice competency.
ARGUMENTS IN SUPPORT:
Close the Provider Gap and a coalition of organizations representing nurse practitioners, hospitals, labor groups, and nonprofits write in support of this bill’s provisions related to NPs: “To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance, SB 1451 will help streamline the application process and enable California’s most experienced NPs to expand access to quality, affordable care. We must close the provider gap – the Californians we serve don’t have the time to wait any longer. Through SB 1451, we can ensure our state’s communities and families – especially those in health care deserts – can access the high-quality, timely care they need and deserve.”
The California Dental Hygienists’ Association (CDHA) supports this bill’s provisions related to RDHAPs, writing: “It is a goal of the DHPSA designation to attract enough oral health providers to the shortage area. Prohibiting a provider from providing services in the area is counter to the legislature’s goals of increasing access to oral healthcare for the underserved areas of the state. There is no harm to patients to have more than enough providers in an area. In fact, patients and consumers only benefit by having more than enough oral health providers available.”
ARGUMENTS IN OPPOSITION:
The California Medical Association (CMA) has taken an “oppose unless amended” position on the provisions in this bill related to NPs, writing: “This bill eliminates the requirement that a nurse practitioner must complete a variation of a three-year training requirement in one of six different specialty categories. Amendments have been suggested to have this section removed or restored with some sort of requirement or proof to demonstrate a nurse practitioner has completed at least three years of clinical experience in a specific category before being approved for independent practice. CMA also requests that the physician attestation section of this bill linked to a nurse practitioner transitioning to independent practice is amended to guarantee patient safety and physician liability protection. Additionally, this bill strikes a section related to nurse practitioner’s notifying patients that they have the right to see a physician. Amendments are recommended to ensure patients know they have the option to see a physician when they are being treated by an independently practicing nurse practitioner.”
The American Association of Nurse Practitioners (AANP) opposes the provisions in this bill relating to the restriction of medical terms such as “doctor,” writing: “A strength of today's healthcare workforce is the growing number of healthcare providers holding doctoral and advanced graduate preparation. More than a dozen health professional disciplines –including nurse practitioners, osteopathic physicians, pharmacists, physical therapists, and psychologists—are educated at the doctoral level. The American Association of Nurse Practitioners supports the use of the title doctor in conjunction with licensure title for doctorly prepared nurses and other health care providers in the clinical setting and advertising. California clinicians are already prohibited from falsely identifying themselves and from providing fraudulent or purposeful misinformation to patients.”
REGISTERED SUPPORT:
Association of California Healthcare Districts
Bay Area Cancer Connections
Board of Barbering and Cosmetology
California Access Coalition
California Alliance of Child and Family Services
California Association for Nurse Practitioners
California Association of Alcohol and Drug Program Executives
California Association of Medical Product Suppliers
California Dental Hygienists’ Association
California Health Collaborative
California Hospital Association
California Nurses Association
Center for Inherited Blood Disorders
Chronic Disease Coalition
Close the Provider Gap
Dental Hygiene Board of California
ElderHelp
LeadingAge California
Little Lobbyists
Liver Coalition of San Diego
Madera Community Hospital
Mental Health America of California
Michelle’s Place Cancer Resource Center
Patient Advocates United in San Diego County
Pediatric Day Health Care Coalition
Respiratory Care Board of California
SEIU California State Council
Senior Care Clinic Medical House Calls
26 individuals
REGISTERED OPPOSITION:
American Association of Nurse Practitioners
American Nurses Association of California
California Dental Association
California Medical Association
California Nurse-Midwives Association
California Society of Dermatology & Dermatologic Surgery
California State Oriental Medical Association
Osteopathic Medical Board of California
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301, Vincent Chee / B. & P. / (916) 319-3301, Edward Franco / B. & P. / (916) 319-3301
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 1451 |
THIRD READING
Bill No: SB 1451
Author: Ashby (D)
Amended: 4/17/24
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 12-0, 4/22/24
AYES: Ashby, Nguyen, Alvarado-Gil, Archuleta, Becker, Dodd, Eggman, Glazer, Niello, Roth, Smallwood-Cuevas, Wilk
NO VOTE RECORDED: Menjivar
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Professions and vocations
SOURCE: Author
DIGEST:
This bill makes various changes to the operations of programs governed by practice acts in the Business and Professions Code and various professions regulated by these programs, stemming from prior sunset review oversight efforts.
ANALYSIS:
Existing law:
- Provides for the licensure of registered dental hygienists in alternative practice (RDHAP), who must meet the same requirements as registered dental hygienists (RDHs) in addition to either meeting minimum experience and higher education requirements, or possessing a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project. Requires a RDHAP to provide the Dental Hygiene Board documentation of an existing relationship with at least one dentist for referral, consultation, and emergency services. (Business and Professions Code (BPC) §§ 1922 and 1930)
- Authorizes an RDHAP, in only limited settings including residences of the homebound; schools; residential facilities and other institutions; and, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information (HCAI) to perform specified, narrow services. (BPC § 1926)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the Medical Board of California (MBC) from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Allows a person who has been issued a physician’s and surgeon’s certificate by the MBC to use the initials “M.D.” (BPC § 2055)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Authorizes an independently practicing nurse practitioner (NP) to perform specified functions in a defined healthcare setting if the NP has met specified requirements and authorizes a NP who meets these requirements to practice in an outpatient health facility, except for a correctional treatment center or a state hospital; a health facility including a general acute care hospital; a county hospital; a medical group practice, including a professional medical corporation, as specified, another form of corporation controlled by physicians, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians that provide healthcare services; and a licensed hospice facility. (BPC §§ 2837.103, 2837.104)
- Defines a transition to practice (TTP) for purposes of NP independent practice to mean “additional clinical experience and mentorship provided to prepare a NP to practice independently, and includes, but is not limited to, managing a panel of patients, working in a complex healthcare setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism and business management of a practice.” (BPC § 2837.101(c))
- Defines “respiratory care” as a health care profession performed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of cardiopulmonary and other systems functions. (BPC § 3702)
- Specifies various activities that are not prohibited by the Respiratory Care Practice Act, including a licensed vocational nurse (LVN) employed by a home health agency who has met certain training requirements performing Respiratory Care Board (RCB)-specified respiratory services. (BPC § 3765 (i))
- Specifies that in order to become a licensed hairstylist, an applicant must be at least 17, complete 10th grade (or the equivalent of public school 10th grade), is not subject to denial based on having been convicted of a crime within a certain time frame that is substantially related to the qualifications, functions, or duties of being a hairstylist, and has either completed a course in hairstyling from a Board of Barbering and Cosmetology (BBC)-approved school or practiced hairstyling, as defined, in another state for a specified period of time. (BPC § 7322)
This bill:
- Specifies that if the DHPSA certification is removed, a RDHAP with an existing practice in the area may continue to provide dental hygiene services.
- Clarifies that no person shall use the words “doctor” or “physician,” the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
- Makes various changes to provisions in the Nursing Practice Act related to licensure of an NP practicing independently.
- Clarifies that LVNs who have met specified requirements may perform specified respiratory care services as identified by the RCB in specified settings and according to certain patient-specific training satisfactory to their employer.
- Clarifies that BBC can only charge a hairstylist application and examination fee in an amount equal to BBC’s actual costs for developing, purchasing, grading, and administering the examination. Limits a hairstylist’s initial license to not more than $50.
- Replaces gendered language in the Structural Pest Control Act and eliminates the option for Structural Pest Control Board (SPCB) licensees to take challenge examinations in lieu of completing continuing education requirements.
Background
- Registered Dental Hygienists in Alternative Practice. As policymakers have explored opportunities to expand access to oral health care, it has continued to be argued that dental hygienists are underutilized and could play a larger role in delivering dental services to vulnerable communities. The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. Currently, a RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice. Concerns remain that prohibiting a RDHAP from continuing to offer their narrow safe and effective services without supervision, as they can when a DHPSA designation is in place, once the designation is removed does not appear to benefit patients and the public. There is no change in the training, education, and skills the RDHAP receives and no adjustment to the fact that they still have to comply with scope of practice and standard of care laws – the only result of continued prohibition that these trained professionals serve patients once a designation is removed is further exacerbation of access to care challenges.
- Doctor Title Protection. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. To use these words, prefixes, or initials, a person’s license must be valid, unrevoked, and unsuspended. The statute features three limited exceptions for individuals who are trained as physicians but not currently licensed in California.
General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice. Practitioners may advertise that they are certified or that they limit their practice to specific fields; however, the term “board certified” is reserved for physicians certified by an American Board of Medical Specialties member board. Additionally, Section 17500 of the Business and Professions Code makes it unlawful for any person to make any statement or advertisement with intent to perform services, professional or otherwise, that is untrue or misleading. While this code section covers a wide range of false advertisements by sellers of goods or services, its provisions would be applicable to health care licensees.
- Nurse Practitioners. A NP is a registered nurse who has earned a postgraduate nursing degree, such as a Master’s or Doctorate degree, and has obtained a certificate from a national certifying body or Board of Registered Nursing (BRN)-approved educational program. In 2020, the Legislature passed, and the Governor signed, AB 890 (Wood, Chapter 256, Statutes of 2020) into law which set education and experience requirements for an NP to be eligible to practice independent of physician supervision. While AB 890 provided the definition of a TTP, it also required that the BRN define the minimum standards of the TTP through regulations by January 1, 2023. The BRN regulations further expanding on the TTP included requirements more stringent than AB 890 and which in some cases, do not include references that sync with current NP certification and the training and clinical experience of a NP.
While some categories have a corresponding physician specialty, such as pediatrics, a “women’s health” NP may have clinical experiences with a wide range of physician specialists and BRN regulations could leave those individuals without a physician to attest to their completion of the TTP.
The BRN regulations also narrowly define the TTP so that it must be completed in “direct patient care in the role of a [NP] in the category…in which the applicant seeks certification as a NP…”. The BRN regulations were adopted in 2022 and effective at the beginning of 2023.
- Respiratory Care Services. SB 1436 (Roth, Chapter 624, Statutes of 2022) resolved a serious and long-standing consumer safety issue regarding the safe practice of respiratory care in health care facilities by allowing the RCB to identify the basic respiratory tasks and services that could be safely delivered by LVNs. There is currently no legal path for LVNs to provide respiratory care services beyond basic care. Patients receiving home and community-based services often require advanced respiratory care. Respiratory care services are not “skilled nursing services.” Respiratory patients are often the most vulnerable of the home and community-based patient population with an overwhelming majority of those patients reliant upon Medi-Cal reimbursement.
- Barbering and Cosmetology Hairstylist License. In 2021, SB 803 (Roth, Chapter 648, Statutes of 2021) continued the operations of the BBC until January 1, 2027 and made various technical changes, statutory improvements, and policy reforms to the Act based on the joint sunset review oversight of BBC by the Senate Business, Professions, and Economic Development Committee and Assembly Business and Professions Committee. SB 803 established a separate hairstylist license and outlined a specified practice of hairstyling that includes arranging, dressing, curling, cleansing, and shampooing, among other hair-specific beautification practices that utilize instruments or require chemical products to be applied.
- Structural Pest Control. The Structural Pest Control Act requires that licensees fulfill continuing education (CE) requirements by completing industry-relevant courses to stay fluent with technology and accepted professional practices. Instead of completing CE courses, current law also provides an alternative option of taking and successfully completing an examination. Currently, BPC sections 8593 and 8593.1 require the SPCB offer examinations to its licensees to take in lieu of completing their CE requirements. On March 6, 2017, the United States Environmental Protection Agency (U.S. EPA) revised the federal rule for certification and recertification of applicators of restricted use pesticides under the Code of Federal Regulations Part 171 (40 CFR 171). This affects SPCB’s Field Representative and Operator license types because the federal rule specifies that if recertification is based upon written examination, the State must ensure the examination evaluates whether the licensee demonstrates the level of competencies.
Comments
- Use of the term “Dr.” and potential unintended consequences. Various health professional licensee practice acts authorize use of the term “Doctor” or “Dr.” under specified circumstances and limitations. For example, an acupuncturist can use the term in connection with the practice of acupuncture if they possess an earned doctorate degree in specific disciplines and the title is related to the authorized practice of an acupuncturist. An optometrist can use the title as a prefix but must us the word “optometrist” as a suffix and only if they hold an Opt. D or O.D. diploma. A physical therapist and an occupational therapist who has received a doctoral degree can use the term if they also specify they are a physical therapist or occupational therapist. A naturopathic doctor is authorized to use the designation “Dr.” if they also further identify themselves as a naturopathic doctor so long as they do not use any term that would indicate the practice of medicine other than naturopathic medicine. In order to ensure that licensed healthcare professionals authorized to utilize the title “Doctor” or “Dr.”, according to the specified requirements and limitations for the use of that term in various Business and Professions Code practice acts, are not in violation of the Medical Practice Act due to the changes in this bill, the Author is proposing to amend this bill moving forward to clarify that licensees whose practice act authorizes limited use of the title are not prevented from continuing to do so.
- RDHAP practice. In order to ensure access to quality dental care for vulnerable patients, the Author is proposing to amend this bill moving forward to facilitate better connection and collaboration between RDHAPs who continue to operate a practice in a dental shortage area and dentists who can increase comprehensive care opportunities to those patients.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
SUPPORT: (Verified 5/6/24)
California Association for Nurse Practitioners
California Association of Alcohol and Drug Program Executives, Inc.
California Dental Hygienists’ Association
California Dental Hygienists Association
California Nurses Association
Leading Age California
Little Lobbyists
Pediatric Day Health Care Coalition
Respiratory Care Board of California
OPPOSITION: (Verified 5/6/24)
California Dental Association
The California Naturopathic Doctors Association
ARGUMENTS IN SUPPORT: The California Association for Nurse Practitioners says that the BRN refusal to approve applications from NPs certified by legacy boards hinders the goals of AB 890 by blocking access to care, rather than increasing access to care.
Organizations in support of this bill state that California is the largest and most diverse state in the nation, yet we have a severe health care provider gap, particularly among primary care and behavioral health providers...NPs are critical to addressing these shortages – not only do they accept greater numbers of uninsured, Medi-Cal, and Medicare patients compared to physicians, but NPs are also more likely to work in rural and underserved communities. Additionally, to address the urgent health needs of our state in a sustainable and equitable manner, organizations in support of this bill say that we must ensure NPs are able to close the provider gap. By providing clarifying guidance surrounding legacy certifications, this bill will help streamline the application process and enable California’s most experienced NPs to expand access to quality, affordable care.
According to the California Dental Hygienists’ Association, “The legislature’s goal is to increase access to oral healthcare in dental deserts. Therefore, it is essential amend the statute and allow APs to keep their practices open if the DHPSA designation is removed… This uncertainty in statute is impeding AP hygienists from investing in and opening dental hygiene practices in shortage areas. APs would be incentivized to invest in these shortage areas if the risk of losing their practice was removed.
The Respiratory Care Board of California notes that this bill “addresses the immediate need to ensure patients are not in jeopardy of having their lives severely disrupted by providing additional exemptions allowing LVNs with appropriate training to practice respiratory care in home and community-based settings where it is not feasible to employ a licensed RCP.”
ARGUMENTS IN OPPOSITION: The California Dental Association opposes allowing RDHAPs to continue their independent brick-and-mortar practices outside of a DHPSA designation and has suggested changes such as ensuring that 30% of an RDHAP’s brick and mortar practice’s patient base be in service of Medi-Cal Dental patients in the unlikely scenario a DHPSA designation was removed. “This requirement is consistent with dentists and physicians receiving
student loan repayment and would ensure access to dental care for the state’s most vulnerable populations.”
Prepared by: Sarah Mason / B., P. & E.D. /
5/8/24 13:47:37
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Angelique Ashby, Chair
2023 - 2024 Regular
Bill No: SB 1451 Hearing Date: April 22, 2024
Author: | Ashby | ||
Version: | February 16, 2024 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Mason | ||
Subject: Professions and vocations
SUMMARY:
Makes various changes to the operations of programs governed by practice acts in the Business and Professions Code and various professions regulated by these programs, stemming from prior sunset review oversight efforts.
Existing law:
- Establishes the Dental Hygiene Board of California, until January 1, 2028, tasked with oversight of registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). States that in establishing the DHB, the intent of the Legislature was to permit the full utilization of RDHs, RDHAPs, and registered dental hygienists in extended functions (RDHEFs) in order to meet the dental care needs of all of the state’s citizens. (Business and Professions Code (BPC) § 1900 et. seq.)
- Authorizes a RDH to perform the following procedures under direct supervision of a licensed dentist, after submitting the Dental Hygiene Board evidence of satisfactory completion of a course of instruction, approved by the board, in the procedures:
- Soft-tissue curettage.
- Administration of local anesthesia.
- Administration of nitrous oxide and oxygen, whether administered alone or in combination with each other. (BPC § 1909)
- Provides for the licensure of RDHAPs, who must meet the same requirements as RDHs in addition to either meeting minimum experience and higher education requirements, or possessing a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project. Requires a RDHAP to provide the Dental Hygiene Board documentation of an existing relationship with at least one dentist for referral, consultation, and emergency services. (BPC §§ 1922 and 1930)
- Authorizes an RDHAP, in only limited settings including residences of the homebound; schools; residential facilities and other institutions; and, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information (HCAI) to:
- Perform functions that may be performed by a registered dental assistant
- Provide assessment and development, planning, and implementation of a dental hygiene care plan, including oral health education, counseling, and health screenings
- Perform preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planing.
- Apply topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease. (BPC § 1926)
- Enacts the Medical Practice Act, which provides for the licensure and regulation of physicians and surgeons. (BPC) §§ 2000 et seq.)
- Enacts the Osteopathic Act, which provides for the licensure and regulation of osteopathic physicians and surgeons who possess effectively the same practice privileges and prescription authority as those regulated by the MBC. (BPC §§ 2450 et seq.)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the MBC from using the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that they are a physician and surgeon, with certain exceptions. (BPC § 2054)
- Allows a person who has been issued a physician’s and surgeon’s certificate by the MBC to use the initials “M.D.” (BPC § 2055)
- Makes it unlawful for any healing arts licensee to publically communicate a false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional services in connection with the professional practice or business for which they are licensed. (BPC § 651)
- Makes it unlawful for any person to make or disseminate any statement in the advertising of services, professional or otherwise, which is untrue or misleading. (BPC § 17500)
- Establishes the Board of Registered Nursing (BRN) to provide for the licensure and regulation of the practice of nursing and authorizes the BRN to issue a certificate to practice as a NP. (Business and Professions Code (BPC) §§ 2700 et seq.)
- Defines an advanced practice registered nurse, as those licensed RNs who have met specified requirements for registration as Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, and Clinical Nurse Specialists, as specified. (BPC § 2725.5)
- Authorizes an independently practicing NP to perform specified functions in a defined healthcare setting if the NP 1) has successfully passed a national NP-board certification examination; 2) holds a certificate from a national certifying body recognized by the BRN; 3) provides documentation that educational training was consistent with standards established by the BRN and; 4) completed a transition to practice (TTP) program in California consisting of a minimum of three full-time equivalent years of practice or 4,600 hours. Authorizes an NP who meets these requirements to practice in an outpatient health facility, except for a correctional treatment center or a state hospital; a health facility including a general acute care hospital; a county hospital; a medical group practice, including a professional medical corporation, as specified, another form of corporation controlled by physicians, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians that provide healthcare services; and a licensed hospice facility. (BPC §§ 2837.103, 2837.104)
- Defines a TTP for purposes of NP independent practice to mean “additional clinical experience and mentorship provided to prepare a NP to practice independently, and includes, but is not limited to, managing a panel of patients, working in a complex healthcare setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism and business management of a practice.” (BPC § 2837.101(c))
- Requires the BRN to define the minimum standards for TTP, and allows clinical experience to include experience obtained before January 1, 2021, if the experience meets the requirements established by the BRN. (BPC § 2837.101(c))
- Establishes the Respiratory Care Board of California (RCP) to administer and enforce the Respiratory Care Practice Act until January 1, 2027. (Business and Professions Code (BPC) §§ 3700 and 3710)
- Defines “respiratory care” as a health care profession performed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of cardiopulmonary and other systems functions. (BPC § 3702)
- Specifies various activities that are not prohibited by the Respiratory Care Practice Act, including a licensed LVN employed by a home health agency who has met certain training requirements performing RCB-specified respiratory services. (BPC § 3765 (i))
- Establishes the Board of Vocational Nursing to license and regulate licensed vocational nurses (LVNs) and psychiatric technicians and administer the Vocational Nursing Practice Act and the Psychiatric Technicians Law. (BPC) §§ 2840-2895.5 and §§ 4500-4548)
- Establishes the Board of Barbering and Cosmetology (BBC), until January 1, 2027, responsible for administering the Barbering and Cosmetology Act and regulating specified practices through the licensure of barbers, cosmetologists, hairstylists, electrologists, manicurists, and estheticians and oversight of establishments. (Business and Professions Code § 7301 et. seq.)
- Specifies that in order to become a licensed hairstylist, an applicant must be at least 17, complete 10th grade (or the equivalent of public school 10th grade), is not subject to denial based on having been convicted of a crime within a certain time frame that is substantially related to the qualifications, functions, or duties of being a hairstylist, and has either completed a course in hairstyling from a BBC-approved school or practiced hairstyling, as defined, in another state for a specified period of time. (BPC § 7322)
This bill:
- Specifies that if the DHPSA certification is removed, a RDHAP with an existing practice in the area may continue to provide dental hygiene services.
- Clarifies that no person shall use the words “doctor” or “physician,” the letters or prefix Dr., the initials M.D. or D.O., or any other terms or letters indicating or implying that the person is a physician and surgeon, physician, surgeon, or practitioner in a health care setting that would lead a reasonable patient to determine that person is a licensed M.D. or D.O.
- Makes various changes to provisions in the Nursing Practice Act related to nurse practitioners, including:
- Specifying that clinical experience, for purposes of the TTP, shall not be limited to experience in a single category that a NP may practice in and include experience obtained before January 1, 2021, but does not include clinical experience obtained before a person is certified as a NP by BRN.
- Authorizes a NP who has been practicing for a minimum of three full-time equivalent years or 4,600 hours within the last 5 years, as of January 1, 2023, to be deemed to have satisfied the TTP.
- Requires proof of completion of a TTP to be provided to BRN on a form prescribed by BRN as an attestation from either a licensed physician and surgeon or a certified NP practicing independently as authorized by the Nursing Practice Act.
- Clarifies that a licensed physician and surgeon or a certified NP who attests to the completion of a TTP is not required to specialize in the same category as the applicant.
- Clarifies that a licensed physician and surgeon or a certified NP practicing who attests to the completion of a TTP is not required to verify competence, clinical expertise, or any other standards related to the practice of the applicant and is only required to attest to the completion of the TTP.
- Provides that a licensed physician and surgeon or a certified NP who attests to the completion of a TTP is not liable for any civil damages and is not subject to an administrative action, sanction, or penalty for attesting only to the completion of a TTP.
- Clarifies that BRN shall not require a NP practicing independency as authorized by the Nursing Practice Act to tell a patient the individual has a right to see a physician and surgeon.
- Clarifies that OPES does not need to assess the alignment of competencies tested in national NP examinations for national NP certification examinations discontinued before January 1, 2017.
- Clarifies that LVNs who have met specified requirements may perform specified respiratory care services as identified by the Respiratory Care Board in specified settings and according to certain patient-specific training satisfactory to their employer.
- Clarifies that BBC can only charge a hairstylist application and examination fee in an amount equal to BBC’s actual costs for developing, purchasing, grading, and administering the examination. Limits a hairstylist’s initial license to not more than $50.
- Replaces gendered language in the Structural Pest Control Act and eliminates the option for SPCB licensees to take challenge examinations in lieu of completing continuing education requirements.
FISCAL EFFECT:
Unknown. This bill is keyed fiscal by Legislative Counsel.
COMMENTS:
- Purpose. This bill is sponsored by the Author. According to the Author, “this bill is intended to be an omnibus bill which includes several changes to programs reviewed through the sunset review oversight process. Among other important clarifying provisions, SB 1451 addresses a number of practice areas impacting the ability for female-dominant healthcare professions to effectively provide safe and expanded access to care to California patients.”
- Registered Dental Hygienists in Alternative Practice. The Dental Hygiene Board regulates three categories of dental professionals: Registered Dental Hygienists, Registered Dental Hygienists in Alternative Practice, and Registered Dental Hygienists with Extended Functions:
- A RDH is a dental professional authorized to perform all duties assigned to dental assistants (DA) and registered dental assistants (RDA), and those additionally enumerated in statute and regulation, under the supervision of a licensed dentist.
- A RDHAP may perform all the functions of a DA, RDA, and RDH under general supervision, and certain RDH duties independently, if prescribed by a dentist or physician and under other qualifying conditions.
- A RDHEF may perform all the functions of a DA, RDA, and RDH under general supervision, and other procedures specified in regulation under the direct supervision of a dentist.
Broadly, the practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings.
Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation.
As policymakers have explored opportunities to expand access to oral health care, it has continued to be argued that dental hygienists are underutilized and could play a larger role in delivering dental services to vulnerable communities. A report published by the Legislative Analyst’s Office (LAO) in September 2018 recommended expanding RDHAP scope of practice as a solution for improving access to dental care, particularly for the developmentally disabled. Specifically, the LAO argued that “given the valuable role that RDHAPs can play in increasing access to dental care for consumers (particularly among those who are homebound or have anxiety about going to the dentist),” the Department of Health Care Services should work with stakeholders and the Legislature to propose statutory scope of practice changes for consideration.
Similar issues were discussed during the 2018 joint sunset review oversight of DHBC in 2018. At the time, the committees discussed “whether it would be in the best interest of public health and safety to expand the unsupervised hygiene practices of an RDH.” The committees also considered whether limiting the areas in which RDHAPs are authorized to provide unsupervised dental hygiene services creates unnecessary barriers to practice in other dental health care settings.
Because RDHs and RDHAPs possess meaningful education and training and are already entrusted to perform a range of procedures with varying degrees of dentist supervision, access to dental care could be responsibly expanded by continuing to empowering these professionals to provide additional services in more settings and with less supervision.
The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. If an RDHAP chooses to practice in more traditional settings, like a dentist office, clinic, or hospital, they must perform those same services under general supervision licensed as an RDH. This does not align with the statutory authority of an RDHAP to be employed by a dentist, community clinic, free clinic, surgical clinic, chronic dialysis clinic, rehabilitation clinic, alternative birth center, specialty care clinic, clinic owned and operated by a federally recognized Indian tribe or tribal organization, or various iterations of a public hospital. Essentially, an RDHAP may not practice in many of the same settings as his or her employer.
Currently, a RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice. AB 502 (Chau, Chapter 516, Statutes of 2015) originally contained provisions that would have allowed a RDHAP to continue practicing. This language was later removed, but not before the California Health Benefits Review Program (CHBRP) performed an independent, evidence-based analysis of the legislation. It determined that the services RDHAPs provide are largely effective in improving oral health and that “The reductions in administrative barriers associated with RDHAP practice may result in increasing numbers of RDHAP licensees. Thus, the long-term effects would likely increase access to dental health services and improve dental health for patient populations in RDHAP practice settings. Essentially, CHBRP stated that RDHAPs improve oral health where they practice, and if there were fewer barriers to expanded practice, more people would benefit from their care.
The Federal Trade Commission (FTC) commented on a similar situation in Georgia, in which the FTC was asked to weigh in on a bill proposing to relax supervision requirements on dental hygienists providing care in certain settings. In stating its support for the legislation, the FTC wrote, “Various authorities have concluded that direct supervision of dental hygienists is not necessary for them to provide preventive services safely. According to the National Governors Association, there is no clear evidence to support state dental boards’ concerns about quality and safety, which boards sometimes raise to justify restrictions on hygienists’ practicing without supervision in settings where dentists are not available. The Institute of Medicine has likewise concluded that restrictive scope of practice and supervision laws and regulations governing dental hygienists ‘are often unrelated to competence, education and training, or the safety’ of the services they provide. The IOM recommends that state legislatures increase access to basic oral health care by amending dental practice acts to allow allied dental professionals such as hygienists to work to the full extent of their education and training ‘in a variety of settings under evidence-supported supervision levels[.]’” FTC also noted that relaxing supervision standards could improve access and improve cost-effective care, since hygienists generally cost less than dentists.
Further, any concern about dentist involvement should be obviated by the existing requirements that a RDHAP is required to have a dentist of record with whom he or she consults, and the requirement that a RDHAP patient receive a prescription from a dentist or physician to continue receiving services after a certain period of time.
One reason the RDHAP license category was created was to serve areas of the state where dental hygiene services are scarce. Licensees are wary of opening a dental hygiene practice with the risk that they could lose the business if the shortage area designation is lifted, however just by virtue of removing formal population based data, that does not imply that the needs of those same communities and areas will also go away. The designation can be removed if more providers are successful in treating patients in the DHPSA and in theory, additional oral health providers have opted to serve in the shortage area.
Concerns remain that prohibiting a RDHAP from continuing to offer their narrow safe and effective services without supervision, as they can when a DHPSA designation is in place, once the designation is removed does not appear to benefit patients and the public. There is no change in the training, education, and skills the RDHAP receives and no adjustment to the fact that they still have to comply with scope of practice and standard of care laws – the only result of continued prohibition that these trained professionals serve patients once a designation is removed is further exacerbation of access to care challenges.
- Doctor Title Protection. The Medical Practice Act currently prohibits any person from practicing or advertising as practicing medicine without a license. Statute specifically makes it a misdemeanor for any unlicensed person to use the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that the person is a licensed physician and surgeon on any sign, business card, or letterhead, or, in an advertisement. To use these words, prefixes, or initials, a person’s license must be valid, unrevoked, and unsuspended. The statute features three limited exceptions for individuals who are trained as physicians but not currently licensed in California.
General provisions governing health professional licensing boards make it unlawful for any healing arts licensee to publically communicate any false, fraudulent, misleading, or deceptive statement, claim, or image for the purpose of rendering professional services in connection with their licensed practice. Statute specifically prohibits a licensee from using “any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading, or deceptive.” Practitioners may advertise that they are certified or that they limit their practice to specific fields; however, the term “board certified” is reserved for physicians certified by an American Board of Medical Specialties member board.
Additionally, Section 17500 of the Business and Professions Code broadly prohibits false advertising of a product or service. Specifically, this law makes it unlawful for any person to make any statement or advertisement with intent to perform services, professional or otherwise, that is untrue or misleading. While this code section covers a wide range of false advertisements by sellers of goods or services, its provisions would be applicable to health care licensees.
While the Medical Practice Act expressly reserves use of the words “doctor” or “physician” for actively licensed physicians, this provision does not comprehensively reflect the current state of the law. For example, while podiatrists are independently licensed by the Podiatric Medical Board of California, their formal title is “doctors of podiatric medicine.” Similarly, the California Board of Naturopathic Medicine licenses and regulates a profession statutorily referred to as “naturopathic doctors.” Optometrists, dentists, chiropractors, psychologists, and other practitioners possessing professional doctorates are also expressly authorized by law to use the term “doctor.” “Dr.” is also commonly used as a social honorific for anyone who has received a doctoral degree, including research doctorates not associated with licensure.
In 2009, the American Medical Association (AMA) launched an initiative branded by the organization as the “Truth in Advertising campaign.” According to the AMA, the goal of the campaign is to address confusion among patients regarding the qualifications of health providers from whom they receive care. A survey published by the AMA in 2018 found that “only half of patients surveyed believe that it is easy to identify who is a physician—and who is not—by reading what services they offer, their title, and other licensing credentials in advertising and marketing materials.”
Following the publication of its survey results, the AMA embarked on a campaign to seek both national and state legislation to reserve various professional titles for licensed physicians and surgeons. A model bill, the “Health Care Professional Transparency Act,” has been introduced and passed in a number of states. Generally, the legislation requires all health care professionals to clearly and accurately describe their license type in advertisements, during patient encounters, and on name tags, and reserves the use of certain titles.
- Nurse Practitioners. A NP is a registered nurse (RN) who possesses additional preparation and skills in physical diagnosis, psychosocial assessment, and management of health-illness needs in primary health care. NPs are licensed/certified by the BRN.
A NP has earned a postgraduate nursing degree, such as a Master’s or Doctorate degree, and has obtained a certificate from a national certifying body or BRN-approved educational program. At the state level, the BRN sets the educational standards for NP certification and education program approval. NPs must also pass a national certifying examination. There are six categories of practice for NPs, as identified in Title 14, California Code of Regulations (CCR) § 1481, including: family/individual across the lifespan, adult-gerontology, primary care or acute care, neonatal, pediatrics, primary care or acute care, women’s health/gender related, and psychiatric-mental health across the lifespan.
In 2020, the Legislature passed, and the Governor signed, AB 890 (Wood, Chapter 256, Statutes of 2020) into law. The bill established a new regulatory framework for NPs to practice independent of physician supervision. AB 890 created a three-tiered framework for NPs who choose to practice independently in California depending on the healthcare setting where the NP will practice. Under the provisions of AB 890, NPs have the option to practice independently of physician supervision either in a defined health care setting, or outside of those settings (a private practice). NPs may also continue to operate under the current structure, which allows NPs to practice in any healthcare facility under established protocols and procedures with physician supervision.
AB 890 set education and experience requirements for an NP to be eligible to practice independent of physician supervision. NPs who want to practice independently in a defined healthcare setting (hospitals clinics, correctional treatment centers, etc.), often referred to as “103 NPs” based on reference to the enabling statute, are required to pass a national NP board certification examination, obtain certification as a NP from an accredited national certifying body, and complete the TTP in California, of a minimum of three full-time equivalent years of practice or 4,600 hours. NPs who want to practice independently outside of a defined healthcare setting, often referred to as “104 NPs”, are required to meet all of the above requirements and provide proof of practice for three-years, in addition to satisfying the TTP requirement.
Twenty-five states permit NPs to practice independent of physician supervision, and only ten of those states require a TTP, including California. Of those states that require the TTP, California requires NPs to complete the longest of 3-years or 4,600 hours. The next longest is in Delaware, which specifies two-years or 4,000 hours. The other eight states require anywhere between 1,040-2,000 hours, but no more than two years of a TTP.
While AB 890 provided the definition of a TTP, it also required that the BRN define the minimum standards of the TTP through regulations by January 1, 2023. The BRN NP Advisory Committee met a number of times throughout 2021 and 2022 and, in its work to make recommendations to BRN on all matters relating to NPs, including, but not limited to, education, appropriate standard of care, and disciplinary action against NPs by the BRN, also discussed the TTP and drafted regulations to further define how to implement AB 890 and ensure NPs can practice independently.
The BRN regulations further expanding on the TTP included requirements more stringent than AB 890 and which in some cases, do not include references that sync with current NP certification and the training and clinical experience of a NP. BRN regulations require the individual attesting to the completion of the TTP to “specialize in the same specialty area or category” as the NP. NP categories are determined by the population of patients served and are not directly comparable to physician specialty training in a specific system of the body. Further, there are not matches between physician specialty types and NP categories. Categories of NPs include:
- Family/individual across the lifespan;
- Adult-gerontology, primary care or acute care;
- Neonatal;
- Pediatrics, primary care or acute care;
- Women's health/gender-related;
- Psychiatric-Mental Health across the lifespan.
While some categories have a corresponding physician specialty, such as pediatrics, a “women’s health” NP may have clinical experiences with a wide range of physician specialists and BRN regulations could leave those individuals without a physician to attest to their completion of the TTP.
The BRN regulations also narrowly define the TTP so that it must be completed in “direct patient care in the role of a [NP] in the category…in which the applicant seeks certification as a NP…”. The Nursing Practice Act defines the TTP as:
“additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. ‘Transition to practice’ includes, but is not limited to, managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice.”
It is unclear how professionalism and business management of a practice are considered direct patient care, and it is unclear why a NP should be limited to complying with TTP requirements by learning business management of a practice in their specific practice category.
The BRN regulations were adopted in 2022 and effective at the beginning of 2023. BRN began accepting applications for 103 and 104 NPs in January 2023.
March data from BRN for 103 NP applications is below
Nurse Practitioner 103 Application Statistics 1/18/2023 – 3/15/2024 | |
Applications Approved | 1603 |
Applications Pending | 578 |
Applications Expired | 0 |
Applications Withdrawn | 2035 |
Total Applications Received | 4216 |
208 of the 578 pending applications were awaiting confirmation of the NP’s national certification while 379 of those were awaiting provider attestation of the applicant’s completed TTP. 41 of these pending applications had other issues.
Withdrawn applications have occurred for a number of reasons as well. 455 applications have been withdrawn because the applicant is certified by a retired or legacy national certifying organization. 855 applications have been withdrawn due to issues with provider attestation. 531 applications have been withdrawn because the applicant submitted multiple applications. 194 applications have been withdrawn for other reasons such as the TTP hours not being completed in California, TTP hours were completed prior to the individual being certified as an NP in California, TTP hours were completed outside of the 5 year framework, and TTP hours were not completed only in the direct patient care role of the NP’s national certification.
- Respiratory Care Services. SB 1436 (Roth, Chapter 624, Statutes of 2022) resolved a serious and long-standing consumer safety issue regarding the safe practice of respiratory care in health care facilities by allowing the Board to identify the basic respiratory tasks and services that could be safely delivered by LVNs. SB 1436 also recognized that health care reimbursement and the health care delivery model that has evolved since the 1990s, made it unfeasible to employ an RCP, in addition to a nurse, in the home care setting and as such, an exemption for home health agencies was included in SB 1436.
Since the passage of SB 1436, RCB has been made aware that there are other licensed “home and community based” facilities and patients in the same predicament: With only one or a few patients requiring respiratory services making it unfeasible to hire an RCP, there are fears of patients being re-institutionalized or losing access to daily living services. In response to this issue, RCP conducted extensive research to identify all the types of small facilities outside of acute care facilities, and services that provide respiratory care. RCB also reviewed several additional facilities and independent providers who provide for transporting and/or overseeing care of patients during daily activities, such as an outing, attending school, or providing a few hours of relief for parents in homecare.
There is currently no legal path for LVNs to provide respiratory care services beyond basic care. Patients receiving home and community-based services often require advanced respiratory care. Respiratory care services are not “skilled nursing services.” Respiratory patients are often the most vulnerable of the home and community-based patient population with an overwhelming majority of those patients reliant upon Medi-Cal reimbursement. The language in this bill authorizes LVNs, with specified training, to perform tasks beyond basic respiratory tasks in the home and community-based settings where it is unfeasible to employ a RCP, which in turn will establish a legal pathway for trained LVNs to provide more advanced respiratory care allowing patients to have the choice to remain at home or in a home and community-based setting..
- Barbering and Cosmetology Hairstylist License. BBC is responsible for licensing and regulating barbers, cosmetologists, hairstylists, estheticians, electrologists, manicurists, apprentices and establishments. BBC is an autonomous regulatory entity supported by licensing fees, with full policy and enforcement authority over the practices of hair, skin and nail care, and electrolysis in the state. The Act provides exemptions for: those involved in the health care field who, within their own scope of practice, may perform particular procedures which would constitute the practice of barbering or cosmetology; commissioned officers in the military service, or their attendants, when engaged in the actual performance of their official duties; persons employed in the movie, television, theatrical, or radio business; persons selling or demonstrating certain products. BBC is one of the largest boards in the country, with over 615,000 licensees. Annually, BBC issues approximately 261,000 licenses (initial and renewal licenses). Each profession has its own scope of practice, entry-level requirements, and professional settings, with some overlap in areas.
In 2021, SB 803 (Roth, Chapter 648, Statutes of 2021) continued the operations of the BBC until January 1, 2027 and made various technical changes, statutory improvements, and policy reforms to the Act based on the joint sunset review oversight of BBC by the Senate Committee on Business, Professions, and Economic Development and Assembly Committee on Business and Professions. At the time, BBC suggested creating a hairstylist and waxing license to allow practitioners to obtain fewer training hours and gain faster entry to the profession. Stemming from workshops held throughout 2018 during its statutorily mandated review of the current requirements to obtain licensure, BBC decided that a hairstylist-only license, like the cosmetology license but not including skin and nail care, should be pursued. SB 803 established a separate hairstylist license and outlined a specified practice of hairstyling that includes arranging, dressing, curling, cleansing, and shampooing, among other hair-specific beautification practices that utilize instruments or require chemical products to be applied.
- Structural Pest Control. The sphere of the SPCB's mission and vision is under the leadership of a 7-member appointed Board and the executive officer who serves at the Board's leisure. The SPCB's mission is to protect the general welfare of Californians and the environment by promoting outreach, education, and regulation of the structural pest management profession. The SPCB's vision is to strive to be the national regulatory and environmental leader of pest management for consumer protection. In achieving these priorities, the SPCB actively follows its core values: 1) accountability, 2) consumer protection, 3) service, 4) transparency, and 5) professionalism.
The Structural Pest Control Act requires that licensees fulfill CE requirements by completing industry-relevant courses to stay fluent with technology and accepted professional practices. Instead of completing CE courses, current law also provides an alternative option of taking and successfully completing an examination.
Currently, BPC sections 8593 and 8593.1 require the SPCB offer examinations to its licensees to take in lieu of completing their CE requirements. The SPCB and DCA’s OPES determined the challenge examination format is not an adequate substitute for the learning and experience acquired through the continuing education process.
On March 6, 2017, the United States Environmental Protection Agency (U.S. EPA) revised the federal rule for certification and recertification of applicators of restricted use pesticides under the Code of Federal Regulations Part 171 (40 CFR 171). This affects SPCB’s Field Representative and Operator license types. Specifically, part 171.303(b)(4)(iii) of 40 CFR requires that if recertification is based upon written examination, the State must ensure the examination evaluates whether the licensee demonstrates the level of competencies required by 40 CFR section 171.103.
Aligning the SPCB challenge examinations with these competency standards would require SPCB to engage OPES for examination development services, for seven additional examinations. In the past, SPCB staff and specialists developed and administered these examinations, in-house, for its seven license categories. However, for an examination to be defensible and operate as a valid alternative to completing continuing education courses, it would need to be frequently updated by expert consultants such as educators and pesticide manufacturers. Without such experts on staff, it has been determined that SPCB does not have the necessary resources to ensure these examinations are adequately developed and administered. Additionally, the cost for SPCB to contract with OPES to develop and continuously update the examinations is substantial, and not feasible or practical.
- Arguments in Support. The California Association of Nurse Practitioners notes that examinations discontinued before January 1,2017, have been deemed “legacy” certifications by the BRN. Legacy certifications are certification exams that were developed for certain populations of patients under stringent criteria and then offered to NPs to sit for the exams. Over time, as providing care to wider populations was emphasized, the legacy certifications were sunset so that no future applicants could apply for the certification. For example, one national NP certification exam, the Adult Nurse Practitioner, was created in 1976 and the prevailing thinking at the time was that the term “adult” included the continuum of young adult to the older adult. However, as geriatric care became more emphasized as an important subset of the adult population, the Adult Nurse Practitioner certification was sunset and the Adult Gerontology Nurse Practitioner certification replaced it. Those who held the “legacy” certification, such as the Adult Nurse Practitioner certification, and were still in good standing could continue to hold that legacy certification as a valid national nurse practitioner certification. The organization says that the BRN refusal to approve applications from these individuals hinders the goals of AB 890 by blocking access to care, rather than increasing access to care.
Supporters write that “California is the largest and most diverse state in the nation, yet we have a severe health care provider gap, particularly among primary care and behavioral health providers. More than 11 million Californians – one-quarter of the state’s population – live in a federally designated Primary Care Health Professional Shortage Area, and two-thirds of them are people of color. NPs are critical to addressing these shortages – not only do they accept greater numbers of uninsured, Medi-Cal, and Medicare patients compared to physicians, but NPs are also more likely to work in rural and underserved communities.” According to supporters, “implementation barriers have delayed the application process for NPs who are qualified and seeking to be recognized to work without physician supervision. To address the urgent health needs of our state in a sustainable and equitable manner, we must ensure NPs are able to close the provider gap. By providing clarifying guidance surrounding legacy certifications, SB 1451 will help streamline the application process and enable California’s most experienced NPs to expand access to quality, affordable care.”
According to the California Dental Hygienists’ Association, “The legislature’s goal is to increase access to oral healthcare in dental deserts. Therefore, it is essential amend the statute and allow APs to keep their practices open if the DHPSA designation is removed… This uncertainty in statute is impeding AP hygienists from investing in and opening dental hygiene practices in shortage areas. APs would be incentivized to invest in these shortage areas if the risk of losing their practice was removed.
The Respiratory Care Board of California notes that this bill “addresses the immediate need to ensure patients are not in jeopardy of having their lives severely disrupted by providing additional exemptions allowing LVNs with appropriate training to practice respiratory care in home and community-based settings where it is not feasible to employ a licensed RCP. The Board strongly supports SB 1451 which addresses an overarching goal to ensure consumers continue to have access to respiratory care in all settings, while minimizing the risks in the quality of respiratory care to meet consumer demands for their own and their loved one’s quality of life.”
- Arguments in Opposition. The California Dental Association opposes “allowing RDHAPs to continue their independent brick-and-mortar practices outside of a DHPSA designation for several reasons. The purpose behind the RDHAP license category is to provide care to individuals who are physically unable to get themselves to a dental office, like school children and those who are homebound, or because there are no dental offices nearby… In many of the past legislative attempts, CDA has offered rebuffed bill amendments that would align with the impetus for the RDHAP licensure category, such as ensuring that 30% of an RDHAP’s brick and mortar practice’s patient base be in service of Medi-Cal Dental patients in the unlikely scenario a DHPSA designation was removed. This requirement is consistent with dentists and physicians receiving student loan repayment and would ensure access to dental care for the state’s most vulnerable populations.”
- Policy Comments and Proposed Author’s Amendments.
Use of the term “Dr.” and potential unintended consequences. Various health professional licensee practice acts authorize use of the term “Doctor” or “Dr.” under specified circumstances and limitations. For example, an acupuncturist can use the term in connection with the practice of acupuncture if they possess an earned doctorate degree in specific disciplines and the title is related to the authorized practice of an acupuncturist. An optometrist can use the title as a prefix but must us the word “optometrist” as a suffix and only if they hold an Opt. D or O.D. diploma. A physical therapist and an occupational therapist who has received a doctoral degree can use the term if they also specify they are a physical therapist or occupational therapist. A naturopathic doctor is authorized to use the designation “Dr.” if they also further identify themselves as a naturopathic doctor so long as they do not use any term that would indicate the practice of medicine other than naturopathic medicine. In order to ensure that licensed healthcare professionals authorized to utilize the title “Doctor” or “Dr.”, according to the specified requirements and limitations for the use of that term in various Business and Professions Code practice acts, are not in violation of the Medical Practice Act due to the changes in this bill, the Author is proposing to amend the bill moving forward to clarify that licensees whose practice act authorizes limited use of the title are not prevented from continuing to do so.
RDHAP practice. In order to ensure access to quality dental care for vulnerable patients, the Author is proposing to amend the bill moving forward to facilitate better connection and collaboration between RDHAPs who continue to operate a practice in a dental shortage area and dentists who can increase comprehensive care opportunities to those patients.
SUPPORT AND OPPOSITION:
Support:
Bay Area Cancer Connections
Bay Area Council
California Access Coalition
California Association of Alcohol and Drug Program Executives, Inc
California Association of Nurse Anesthesiology
California Black Health Network
California Consortium of Addiction Programs and Professionals
California Council of Community Behavioral Health Agencies
California Dental Hygienists’ Association
California Hepatitis C Task Force
California Hospital Association
LeadingAge California
Liver Coalition
Looms for Lupus
Madera Community Hospital
Michelle’s Place Cancer Resource Center
Patient Advocates United in San Diego County
Respiratory Care Board of California
SEIU California State Council
Sickle Cell Disease Foundation
Opposition:
California Dental Association
-- END --
Discussed in Hearing
2MIN
Senate Floor
1MIN
Assembly Floor
13MIN
Assembly Standing Committee on Business and Professions
1MIN
Assembly Floor
3MIN
Assembly Standing Committee on Appropriations
16MIN
Assembly Standing Committee on Business and Professions
1MIN
Senate Floor
12MIN
Senate Standing Committee on Business, Professions and Economic Development
Bill Author
Bill Co-Author(s):