Current Legislation (May 2013)
AB 1215 (Hagman and Holden), Clinical Laboratories – This bill is co-sponsored by CAMLT. Please check out the explanation and progress of our bill below for the latest news. Sponsoring a bill requires active support of our members.
SB 264 (Pavley), Accountable Care Organizations
SB 491 (Hernandez), Nurse Practitioners
SB 492 (Hernandez), Optometric Corporations
SB 493 (Hernandez), Pharmacy Practice
AB 213 (Logue), Healing Arts: licensure and certification
AB 399 (Fox), Clinical Laboratories
AB 722 (Lowenthal), Vehicles: driver’s licenses: medical examinations
AB 830 (Holden), Clinical Laboratories
AB 1215 (Hagman and Holden), Clinical Laboratories
Membership Involvement is the Key
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CAMLT Political Update
Public Policy Advocates, LLC, May 2013
Governor Brown Releases Revised State Budget
On May 14 Governor unveiled his revision to the proposed state budget for the 2013-2014 fiscal year. The Governor calls this May Revision to the budget a “prudent” budget that invests in California’s schools, pays down the state’s “wall of debt” and maintains a budget reserve. When Governor Brown took office, the state faced a $26.6 billion budget deficit, estimated annual gaps of roughly $20 billion and a $35 billion “Wall of Debt.” The revised budget plan unveiled today is balanced and on track to lower the state’s debt to $4.7 billion by 2017—a reduction of over 86 percent. This was achieved through billions of dollars in permanent cuts in the 2011-12 and 2012-13 budgets as well as temporary revenues passed by voters last year.
Among the key developments from the proposed budget released in January includes:
- A downward revision in the short-term economic outlook due to recent federal actions due to “sequestration.” Specifically, the federal government did not extend the 2% payroll tax reduction that had been in place in 2011 and 2012. This action was not assumed in the proposed economic outlook from January’s proposed budget. As a result, forecasted personal income growth in 2013 has been cut almost in half-from 4.3% to 2.2%. In addition, the federal government allowed the sequester of tens of billions of dollars in spending.
- The May revision reflects, as required by Proposition 98, $2.9 billion in additional funds in the current year for K-12 schools and community colleges. The May revision proposes that these one-time funds be used to reduce the deferral of payments to schools and community colleges, and to support the implementation of new academic standards known as the Common Core.
- Medi-Cal experiencing higher costs of $467 million, principally as a result of the federal government and the courts either rejecting or delaying approval of previously adopted legislative actions.
- A state-based approach to the optional expansion of subsidized medical care allowed under the Affordable Care Act. This expansion will significantly increase health care coverage and access to new federal dollars.
- The costs of borrowing for both short-term cash and long-term infrastructure investments have been reduced by $484 million. This was made possible by the state’s improved fiscal condition.
Governor Brown indicated that while the budget is projected to remain in balance for the foreseeable future, the May Revision also recognizes the risks posed to the budget-including uncertain economic recovery, court rulings and actions from the federal government-which underscores the need to maintain fiscal discipline.
Health Care Legislative Landscape
The implementation of the Affordable Care Act continues to dominate the legislative landscape with regard to health care with the looming January 1, 2014, deadline for launching a health care exchange, designed to provide consumers a marketplace to purchase affordable insurance coverage. California has been among the most proactive states in adopting rules to implement provisions of the Affordable Health Care Act. Current statistics list the number of uninsured Californians at 4.7 million. There are a variety of Medi-Cal and insurance coverage related issues viewed as critical.
In this context, the Chair of the Senate Health Committee, Senator Ed Hernandez, an optometrist, citing a need for more medical professionals to treat patients under the Affordable Care Act, given the specter of a potential primary care physician shortage, continues to push three bills to expand the services that optometrists, pharmacists and nurse practitioners can offer patients. These “scope of practice” expansion bills potentially pick a major legislative battle with physicians and others. Hernandez argues that because of the physician shortage, other health professionals should be permitted to offer patients more care. With regard to the bill affecting optometrists, amendments have been proposed that will allow optometrists to “do clinical laboratory testing as appropriate.” This flies directly in the face of the agreements reached around last year’s bill in which optometrists were limited to waived tests narrowly within their scope of practice.
CAMLT Legislative Challenges
While Public Policy Advocates (PPA) was successful the first year of the 2011-2012 legislative session in stopping several major pieces of legislation that would have allowed others to perform Clinical Laboratory Science without sufficient training and education, we were actively engaged on bills that returned or had been introduced along those same lines in 2012. 2012 was an extremely active year that not only required hours of high intensity lobbying, but a significant engagement by the CAMLT Governmental Affairs Committee. In 2013, CAMLT is not only co-sponsoring a bill for the first time in almost twenty years, but is also engaged on a number of bills that that would permit the practice of clinical laboratory science without requisite education/training and without a lab director. The Legislature is approaching key deadlines that will determine the fate of hundreds of bills that were introduced at the beginning of the 2013 legislative session. CAMLT members must make it a priority to meet with their legislators to educate them about clinical laboratory science. Be sure to reference the CAMLT Grassroots Guide on the CAMLT website for “how to” meet and interact with elected officials and their staff.
The following is legislation that the CAMLT Governmental Affairs Committee directed PPA to engage in or monitor. Check this website regularly for updates on bill status, legislator lists, and committee assignments.
AB 213 (Logue) Healing Arts: licensure and certification requirements: military experience, as amended 4/18/13 – WATCH
This bill is intended to give military personnel a career pathway to licensure or certification when they have military experience in certain health related disciplines that is applicable and equivalent. This would include radiologic technologists, nuclear medicine technologists, certified nurse assistants, certified home health aides, certified hemodialysis technicians, and nursing home administrators as well as medical laboratory technicians and clinical laboratory scientists. The bill has been amended to remove CAMLT concerns and was held under submission in Assembly Appropriations Committee. The bill cannot be heard again this year.
AB 399 (Fox) Clinical Laboratories, as introduced 2/15/13 – WATCH
Current law authorizes the State Department of Public Health application fees, annual renewal fees, and fees associated with enforcements, and to establish the fees for licensing examinations and for medical laboratory technician licenses. This bill would authorize the department to charge appropriate license fees whenever it determines that a new category of licensure is necessary. CAMLT is awaiting amendments to this California Clinical Laboratory Association sponsored bill. AB 399 failed to move out of its committee of origin and therefore cannot be taken up again this year.
AB 722 (Lowenthal) Vehicles: driver’s licenses: medical examinations, as amended 5/28/13 — WATCH
This bill is sponsored by the California Chiropractic Association. Current law requires applicants for an original or renewal certificate to drive certain vehicles to submit a report, on a form approved by the department, of a medical examination of the applicant given not more than two years prior to the date of the application by a physician licensed to practice medicine, a licensed advanced practice registered nurse qualified to perform a medical examination, or a licensed physician assistant. This bill would add a doctor of chiropractic to the list of persons who may make a report of a medical examination of the specified applicants. While the chiropractors initially intended to introduce legislation allowing for urine dipstick testing without a lab director for commercial driving and employment physicals, after meeting with us they opted for the approach embodied in AB 722. AB 722 was heard in the Senate Transportation and Housing Committee on June 4 and passed from Committee on a 10-0 vote. The bill is currently on the Senate Floor.
AB 830 (Holden) Clinical Laboratories, as amended 3/21/2013—WATCH
Sponsored by the United Nurses Associations of California/Union of Health Care Professionals who also have CLS and MLT membership within the union, this bill was introduced as a spot bill. The UNA/UHCP has decided to have this bill held in favor of supporting the CAMLT co-sponsored AB 1215. AB 830 failed to move out of its committee of origin and therefore cannot be taken up again this year.
AB 1215 (Hagman and Holden) Clinical Laboratories, as amended 4/9/13 – CAMLT CO-SPONSORED BILL
CAMLT is co-sponsoring this bill along with the Engineers and Scientists of California, IFPTE, Local 20, Western States Council of the United Food and Commercial Workers, and the United Nurses Associations of California/Union of Health Care Professionals. In the wake of attempted legislation over the years to allow various allied health professionals to do laboratory testing without a lab director, AB 1215 which will permit Clinical Laboratory Scientists, both generalists and specialists, to be laboratory directors for purposes of clinical laboratory tests classified as waived under the Federal Clinical Laboratory Improvement Amendments of 1988 (CLIA). Under CLIA, CLS’s can be waived lab directors. Under California law, only physicians, surgeons, and naturopaths can be lab directors, along with optometrists and pharmacists who secured statutory authority last year to be lab directors in a more limited way. It is only reasonable that the very professionals trained specifically in clinical laboratory science be utilized to the maximum of their education and training. The implementation of the Affordable Care Act (ACA) will extend health benefits to an estimated 4.7 million uninsured Californians by 2018. This will dramatically increase the demand for care and ancillary services such as clinical laboratory testing. AB 1215 will improve access to clinical laboratory tests and testing oversight without compromising patient safety. Co-authored by Assembly Member Hagman, a Republican and Assembly Member Holden a Democrat, AB 1215 was passed out of the Assembly by a vote of 76 to 4. AB 1215 is also supported by the AFL-CIO Blood Centers of California, American Federation of State, County and Municipal Employees, and the California Society of Pathologists. AB 1215 will be heard in the Senate Business, Professions and Economic Development Committee on June 17.
SB 264 (Pavley), Accountable Care Organizations, as introduced 2/13/13 – SUPPORT
Sponsored by the California Society of Pathologists and the College of American Pathologists, this bill is intended to create a state mandated physician advisory process to be used by Accountable Care Organizations specifically with regard to guidelines or protocols relative to the provision of clinical laboratory testing. The objective is to allow for optimal coordination between treating physicians and laboratory directors to promote care coordination so that California patients receive all medically necessary clinical laboratory testing for diagnosis and treatment as the implementation of the Affordable Care Act strives to control health care costs. SB 264 failed to move out of its committee of origin and therefore cannot be taken up again this year.
SB 491 (Hernandez), Nurse Practitioners, as amended 5/21/13 – WATCH
This bill is designed to broaden the scope of a Nurse Practitioners practice, deleting that they must practice in consultation with a physician surgeon. The bill would permit Nurse Practitioners to diagnose, perform therapeutic procedures and prescribe drugs and devices. This bill is currently located in the Assembly where it awaits a committee assignment and hearing date.
SB 492 (Hernandez) Optometric Corporations, as amended 5/8/13 – OPPOSE
This bill would significantly expand the scope of practice for optometrists. Of particular interest to CAMLT is that the bill would authorize an optometrist to perform or order appropriate laboratory and diagnostic imaging tests. There is no limitation other than the Board of Optometry is to establish by regulation, education and examination requirements for licensure to ensure the competence of optometrists to practice. The bill outright repeals the agreements reached last year restricting optometrists to CLIA waived tests necessary for the diagnosis of conditions and diseases of the eye or adnexa within their scope of practice. This bill is currently located in the Assembly where it awaits a committee assignment and hearing date.
SB 493 (Hernandez), Pharmacy Practice, as amended 5/28/13 – WATCH
This bill significantly expands the scope of practice of pharmacists. It seems to be focused primarily around contraceptives, drug therapies, ordering and interpreting tests for monitoring and managing drug therapies, physical assessments, and the functions of advance practice pharmacists. This bill was taken up on the Senate Appropriations Suspense File on May 23 and passed out of Committee with clarifying amendments relative to duties on a unanimous vote. The bill is currently located in the Assembly where it awaits a committee assignment and hearing date.
Meet with Your Legislators
For the last twenty years, CAMLT has continued to successfully weather advertant or inadvertent legislative assaults on clinical laboratory testing that would jeopardize patient safety. To continue to do so, it is critical that CAMLT build its membership and engage with and educate California’s elected officials. Because of the newly drawn legislative districts which happen every ten years after the census, there will be 40-plus new legislators this year alone.
Have you met with your legislators? Make sure to educate your elected officials about clinical laboratory issues! Meet with your legislators in your district, send letters explaining CAMLT’s philosophy, invite legislators and their staff to tour your laboratories, and introduce yourself as a constituent. We are fighting major legislation this session and are up against well heeled and well organized sponsors of these bills.
- Which Legislator represents your home or laboratory? Visit the CAMLT website for a current roster of Legislators and the cities they represent.
- Visit their offices. Make an appointment with your Legislators’ District offices.
- EDUCATE! Explain to Legislators and their consultants what it takes to be a CLS; what you do; why it is important to maintain the integrity of the Laboratory Director when other personnel are doing laboratory tests, even if they are waived; why other allied health providers shouldn’t be Laboratory Directors; the CLS shortage and what it takes to eliminate it.
Make it a priority to meet with your Legislators now. Remember, these interactions are integral components of your grassroots program. For tips, please refer to the CAMLT Grassroots Guide on the website.
Please note that it is particularly crucial to meet with Legislators who participate on the Assembly and Senate committees through which CAMLT bills most frequently pass so they are better prepared to tackle complex CLS issues that arise in committee.
Assembly Business, Professions and Consumer Protection Committee: Rich Gordon (D- Chair), Brian Jones (R-Vice Chair), Raul Bocanegra (D), Nora Campos (D), Roger Dickinson (D), Susan Eggman (D), Curt Hagman (R), Chris Holden (D), Brian Maienschein (R), Kevin Mullin (D), Nancy Skinner (D), Phil Ting (D), Scott Wilk (R)
Assembly Health Committee: Richard Pan (D-Chair), Dan Logue (R-Vice Chair), Tom Ammiano (D), Toni Atkins (D), Susan Bonilla (D), Rob Bonta (D), Wes Chesbro (D), Jimmy Gomez (D), Roger Hernandez (D), Bonnie Lowenthal (D), Brian Maienschein (R), Allan Mansoor (D), Holly Mitchell (D), Adrin Nazarian (D), Brian Nestande (R), V. Manuel Perez (D), Don Wagner (R), Bob Wieckowski (D), Scott Wilk (D)
Senate Business, Professions and Economic Development Committee: Ted Lieu (D-Chair), Bill Emmerson (R-Vice Chair), Marty Block (D), Ellen Corbett (D), Cathleen Galgiani (D), Ed Hernandez (D), Jerry Hill (D), Alex Padilla (D), Mark Wyland (R), Leland Yee (D)
Senate Health Committee: Ed Hernandez (D-Chair), Joel Anderson (R-Vice Chair), Jim Beall (D), Kevin de Leon (D), Mark DeSaulnier (D), Bill Monning (D), Jim Nielsen (R), Fran Pavley (D), Lois Wolk (D), Vacancy
Strengthen Your Voice: Contribute Today!
Please donate to the CAMLT Lab-PAC fund. Lab-PAC is a critical means of supporting and electing Legislators to the California Legislature who share a like-minded philosophy with CAMLT and who are open-minded to learning the issues and challenges facing your profession. Encourage the colleagues you work with. Get your chapters and chapter members to contribute. Talk to your vendors. Get involved! Your voice in the political process is much louder as CAMLT than as an individual. Contribute to the collective resources of CAMLT to grow your political clout. Visit the Lab-PAC page for a donation form. Your gift in any amount will help your profession. Contribute now!
Please mail donations made payable to: LAB-PAC
1895 Mowry Ave., #112, Fremont, CA 94538-1766.
Please write a check to LAB-PAC now!
Recruit New CAMLT Members!
As we have said, this has been one of the most rigorous and challenging legislative sessions in a long time in terms of bills legislating a frontal attack on the CLS profession. Only you can ensure the growth and vibrancy or a strong, well organized CAMLT. Rise to the challenge. Recruit members to your professional organization – CAMLT. Contribute to your Lab-PAC. Meet with your legislators. CAMLT Membership Information
Ensure the best possible patient safety in laboratory testing, and preserve your important profession.