The California State Legislature has now adjourned, which completes the first year of the 2021-2022 legislative session. Mirroring last year, legislative business continued with limited access to the Capitol Building due to spikes in COVID cases and the rise of variants. As anticipated, a flurry of legislative measures was introduced using the pandemic to justify changes to professional standards. Public Policy Advocates, at the direction of the CAMLT Legislative Committee opposed six measures. California requires stringent laboratory personnel standards/licensing, but year after year, we see that it has not deterred attempts to dilute those standards through legislation or regulations. This year, in addition to the usual measures backed by dentists and optometrists, we dealt with pharmacist backed legislation as well. We cannot stress enough, that without the vigilance of CAMLT and strong representation by their legislative advocates, these continued attempts to weaken or repeal critical laboratory and laboratory personnel licensing law would have without a doubt succeeded.
Bills monitored from 2021-2022 legislative session
CAMLT Expand To Excel Update
CAMLT’s Expand to Excel effort to expand training program seats is still alive and well. Originally introduced in late 2020, this effort is a budget item and will add 200 seats to existing training programs.
It is making slow progress, but it will be under consideration in January as part of the new budget. One setback was that it was said that our sector (healthcare) already receives adequate funding. Another angle is to present it as a women’s rights issue. Key people in high places within the legislature are dedicated to this coming to be.
At an upcoming CLTAC meeting (Clinical Laboratory Technology Advisory Committee), the Workforce Subcommittee will present a white paper (explanation and recommendation) on the workforce shortage, to CLTAC. If adopted, it will be presented.
PPA is jockeying to bring the budget item to the forefront of what Governor Newsom will consider. Several key people in Sacramento have been working tirelessly to help further the effort. Let’s hope this important budget item can be realized soon.
CAMLT Political Update
By Public Policy Advocates, LLC
The California State Legislature has now adjourned, which completes the second year of the 2021-2022 legislative session. The recently concluded legislation session was extremely active on the CAMLT legislative front. Public Policy Advocates, at the direction of the CAMLT Legislative Committee opposed nine measures. The COVID-19 pandemic was seen by dentists, optometrists, and pharmacists as an avenue to expand scope of practice, and in turn, we saw a flurry of bills introduced aimed to do just that. Despite California requiring stringent laboratory personnel standards and licensing we continue to see, year after year, attempts to dilute those standards through legislation or regulations.
As in the two prior sessions, the CAMLT legislative team continued to pursue the long-term objective of providing funding incentives for credentialed hospitals to offer increased training positions for qualified students seeking internships to address the diminution of available training slots and overall reduction of CLS and MLTs in the profession. As you all know, this effort began with a CAMLT survey that identified the training bottleneck and this year led to a formal budget augmentation request for $12.6 million to fund a pilot program to create 200 new training posts over a three-year period to be administered by the Office of Statewide Health Planning and Development (OSHPD). Along with the support of the California Hospital Association and labor organizations representing CLS and MLTs, we met with the Health Budget staff of both houses of the legislature as well as the Governor’s Budget staff to place the item on the list of budget augmentations to be considered in the health omnibus budget trailer bill that ultimately became Assembly Bill 204. We testified in support of the measure in committee and had a productive meeting with Senator Nancy Skinner, a Democrat who represents Berkeley and Oakland and Chairs the Senate Budget Committee. The Senator presented our request to the Governor’s staff along with many other items as the trailer bill was being compiled. Unfortunately, the Administration opted to reduce most of the augmentation items and to not include it in the final version of Assembly Bill 204 that passed on the last night of the Session. However, real progress occurred late this session. Senator Skinner and her staff are very interested in engaging with us to formulate a plan to fund the training positions next session, including working directly with the Newsom Administration health budget staff to convince them to include it in their initial budget proposal that gets crafted over the winter and released in January.
THE FUTURE OF CAMLT
Public Policy Advocates continues to stress the importance of having a strong legislative program in place. The likelihood of legislative measures adversely affecting the laboratory profession continuing to be introduced in future legislative sessions remains high. For decades, CAMLT has continued to defend laboratory standards to protect patients as others continue to try and convince legislators to dilute licensing and personnel standards. As your legislative advocacy team in Sacramento, we continue to emphasize that growth of CAMLT membership is of paramount importance. A financially strong association coupled with sustainable membership growth is vital to effectively execute a comprehensive legislative program in California. Education of key legislators and government officials is of critical 35
importance. To date, CAMLT continues to be at the forefront exclusively protecting the legislative interests of CLS’s, MLT’s and other laboratory personnel. CAMLT continues to be the only professional association solely representing clinical laboratory science personnel that retains a lobbying firm in Sacramento.
CAMLT is typically the last Association holding the line against onerous legislative and regulatory changes. No other laboratory personnel professional associations have a Sacramento presence or help financially underwrite CAMLT’s governmental program on behalf of the entire profession.
As in each past legislative session, PPA has been honored to work to protect CAMLTs interests. As the pandemic continues to evolve and other viral outbreaks surface - encroachments on the laboratory profession show no sign of abating. The California Legislature continues to count medical doctors, dentists, and optometrists among its elected membership. For as long as medical professionals hold office, we must anticipate that they will continue to introduce legislation that conflicts with what is in the best interests of the laboratory professional. Build CAMLT membership. Embark on a strong grass-roots program. Contribute to LAB-PAC. Educate your own legislators. This is the only way to secure your future and the future of the patients that you serve.
As mentioned above, our legislative engagement/effort has been substantial over the course of the 2-year legislative session. The following is comprehensive report on legislation that PPA lobbied or monitored on behalf of CAMLT for the 2021-2022 session. Please check the CAMLT website for updates on bill status, Legislator lists, and Committee assignments. Please note – the Governor has until September 30, 2022, to sign or veto legislation.
LEGISLATION PPA ACTIVELY LOBBIED OVER THE 2021-2022 LEGISLATIVE SESSION
AB 392 (Nazarian) Clinical laboratories: total protein test. As amended 8/4/22 – OPPOSE-UNLESS AMENDED: AB 392 is the latest iteration of AB 613, signed into law in 2018 and AB 2199 , signed into law in 2020. In its introduced form, AB 392 removed the sunset date and other requirements that results be verified in a specified manner as a condition of a person being authorized to conduct a total protein test. As in the past CAMLT opposed. PPA, in conjunction with the CAMLT Legislative Committee, worked with the Author to amend his bill to restore previous language which included safeguards. With that action, CAMLT moved to a watch position. Unfortunately, after being rendered inactive since September 2021, the bill was amended on August 4,2022 and started moving again. The striking/repealing of the sunset clause regarding the Pilot Study resulted in CAMLT changing from neutral to oppose unless amended. Location: The measure has been forwarded to the Governor for consideration.
AB 526 (Wood) Dentist: clinical laboratories: vaccines. As amended 9/1/21 – NEUTRAL In its introduced form, AB 526 would expand the scope of practice for dentists allowing them to become unrestricted waived lab directors regarding rapid SARS-CoV-2 Ag tests. PPA at the direction of the CAMLT Legislative Committee initially took an oppose-unless-amended position on AB 526. After extensive meetings with the Authors office as well as Health Committee staff, CAMLT moved to a neutral position. Location: Signed into law by the Governor on 10/8/21.
AB 691 (Chau) Optometry: SARS-CoV-2 vaccinations: clinical laboratory tests or examinations. As amended 9/3/21 – NEUTRAL AB 691 aimed to expand the scope of practice for Optometrists by allowing them to order/perform waived tests. As with AB 526 (Wood), PPA on behalf of CAMLT initially took an oppose-unless-amended position on AB 691, and after extensive meetings with the Authors office, CAMLT moved to a neutral position. Location: Signed into law by the Governor 10/8/21.
AB 1120 (Irwin) Clinical laboratories: blood withdrawal. As amended 8/3/21 – OPPOSE AB 1120 is a reintroduction of AB 822 (Irwin) from last session which failed to advance out of committee. The Sponsor – Velano Vascular again brought forth the measure, and if passed, would allow a phlebotomist or another health care worker to withdraw blood using needleless technology in inpatient settings. PPA at the direction of CAMLT, opposed this measure citing an inappropriate expansion of scope of practice of certified phlebotomy technicians which in turn dilutes patient safety. PPA also engaged stakeholders who opposed this legislation last year. Sustained pressure on the proponents of the measure kept the bill from advancing in 2021. After sitting idle in committee since March 2021 the bill was amended on 1/3/22 and began moving again. As directed by CAMLT, PPA renewed opposition. Location: The measure has been forwarded to the Governor for consideration.
AB 1328 (Irwin) Clinical laboratory technology and pharmacists. As amended 7/14/21 – OPPOSE AB 1328 would expand the pharmacist scope of practice into clinical laboratory sciences and the practice of medicine without the requisite education, training, or clinical experience. PPA opposed at the direction of CAMLT on the basis that if pharmacists want to perform laboratory tests, they should adhere to the same state standards as everyone else. AB 1328 failed to advance and was made a 2-year bill. On 8/11/22 the bill began to move again and PPA on behalf of CAMLT actively opposed once again. Location: The measure did not advance of the Assembly Floor and therefore died.
AB 2107 (Flora) Clinical Laboratory Testing. As amended 8/23/22 – NEUTRAL AB 2107 if passed, would permit those who are licensed to conduct molecular testing for human genetics to also do so for infectious disease. Existing law specifies what duties the clinical laboratory personnel can engage in, or supervise others engaged in, including, for a person licensed as a Clinical Genetic Molecular Biologist (CGMB), the subspecialty of molecular biology related to the diagnosis of human genetic abnormalities within the specialty of genetics or other specified subspecialty. This bill, for a rapid antigen or point-of-care molecular infectious disease test classified as waived under CLIA, would authorize an adult who has received appropriate training and is acting under the direction of the laboratory director and ordering physician for testing in a non-healthcare congregate setting, to collect anterior nasal swabs, if the person to be tested is unable to self-swab, and to perform the test on the collected sample. PPA as directed by CAMLT opposed unless amended, on the basis that current amendments to BPC 1207 expands CGMB scope of practice to direct a microbiology laboratory. On 8/23/22 the Author took CAMLT’s requested amendments and as a result went to a neutral position. Location: The measure has been forwarded to the Governor for consideration.
SB 409 (Caballero) Pharmacy practice: SARS-CoV-2 and influenza testing. As amended 9/3/21 – OPPOSE UNLESS AMENDED SB 409 aims to allow pharmacists to expand scope of practice without the requisite education or training. On CAMLTs behalf, PPA submitted an amendment that would expand the law to achieve the objective of pharmacists, while crucially maintaining the best standard of practice for California clinical laboratory science and the highest level of patient care. Senator Caballero declined to accept CAMLT’s 37 amendments. Location: PPA submitted a request for veto letter to the Governor. Signed into law by the Governor on 10/6/21.
SB 962 (Jones) Healing arts: clinical laboratory technology: moderate-complexity laboratories. As amended 4/5/22 – OPPOSE SB 962, if passed, would expand the definition of a “laboratory director” to include an individual who meets the College of American Pathologists (CAP) guidelines. SB 962 is an attempt to dilute CA. Laboratory Law down to the CAP standards, which are less stringent. SB 962 was sponsored by the California Society of Respiratory Care. PPA opposed at the direction of CAMLT citing dilution of clinical personnel standards potentially undermining the health and welfare of critically ill patients. Location: SB 962 failed to pass from committee and the measure died.
SB 1267 (Pan) Clinical Laboratories. As introduced 8/25/22 – OPPOSE SB 1267 would add geneticists and reproductive biologists to the types of clinical laboratory personnel that are licensed and regulated by the department and would define their subspecialities and duties. PPA was directed to monitor this measure for amendments. The 8/25/22 late amendments simply deal with a potential bill chaptering conflict. As such, no position change. Location: The measure has been forwarded to the Governor for consideration.
LEGISLATION PPA MONITORED FOR AMENDMENTS
AB 1064 (Fong) Pharmacy Practice: vaccines: independent initiation and administration. As amended 9/7/21 – NEUTRAL AB 1064 if passed, would authorize a pharmacist to independently initiate and administer any vaccine approved or authorized by the United States Food and Drug Administration for persons 3 years of age or and older. This measure, in its current form makes no mention of testing, therefore, CAMLT took a neutral position. PPA continued to monitor throughout the process to ensure no onerous amendments were inserted into the legislation. Location: Signed into law by the Governor on 10/8/21.
AB 1306 (Arambula) Health Professions Career Opportunity Program: As introduced 6/16/21 – WATCH AB 1306 states that California has an insufficient number of minority health professionals to meet the health care needs of the state.. The bill adds recommended actions to address identified barriers to entry in the health professions for students from underrepresented and low-income backgrounds. Location: AB 1361 had a fiscal component and did not clear the Assembly Appropriations Committee and therefore, the measure died.
AB 2574 (Salas) Optometry. As amended 8/22/22 – WATCH The Optometry Practice Act authorizes an optometrist certified to use therapeutic pharmaceutical agents to utilize certain techniques and instrumentation necessary for the diagnosis of conditions and diseases of the eye and adnexa, including laboratory tests or examinations performed in an office classified as waived under the federal Clinical Laboratory Improvement Amendments of 1988. AB 2574 would specify that the above-described tests or examinations are direct laboratory tests or examinations. AB 2574 would also require an optometrist to stabilize, if possible, and immediately refer any patient who has an acute attack of angle closure to an ophthalmologist. By imposing a new requirement on licensees, the bill would expand the scope of a crime, thereby imposing a state-mandated local program. PPA as directed by CAMLT monitored the measure for any amendments to 38 expand OD’s waived lab directorship. The late session amendments do not change CAMLT’s initial position. Location: The measure has been forwarded to the Governor for consideration.
REACH OUT TO YOUR DISTRICT LEGISLATORS
It is critical that CAMLT build its membership and engage with and educate California's elected officials. The November election will result in at least a ¼ turnover of the California Legislature. This is the perfect opportunity to reach out to new members of the legislature that represent your districts to educate them on all aspects of your laboratory profession. Legislators are allowed to serve up to twelve years under term limit law – the opportunity for a long-lasting working relationship is present - make the connection.
Make it a priority to meet with your Legislators. After legislative session, each Legislator returns to their districts until January. This is the time to educate elected officials about clinical laboratory issues and the labs that serve their districts. Meet with your legislators in your district, send letters/educational materials explaining CAMLT's philosophy, invite legislators and their staff to tour your laboratories, and introduce yourself as a constituent. These steps help CAMLT to be in a position of offense rather than defense when it comes time to support or oppose legislative measures. Remember, these interactions are crucial components of your grassroots program. For tips, please refer to the CAMLT Grassroots Guide on the website.
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.
CONTRIBUTE NOW TO LAB-PAC – STRENGTHEN YOUR ORGANIZATION
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. Your voice in the political process is much louder as CAMLT than as an individual. Visit the Lab-PAC Page for a donation form. Your gift in any amount will help your profession. Contribute now!