meeting minutes - physician assistant2017/10/30 · meeting minutes october 30, 2017 physician...

MEETING MINUTES

October 30, 2017 PHYSICIAN ASSISTANT BOARD 2005 Evergreen Street, Suite 1100

Sacramento, CA 95815 8:30 A.M. – 5:00 P.M.

1. Call to Order by President

President Sachs called the meeting to order at 8:36 a.m.

2. Roll Call

Staff called the roll. A quorum was present.

Board Members Present: Charles Alexander, PhD. Jennifer Carlquist, PA-C Sonya Earley, PA-C Javier Esquivel-Acosta, PA-C Jed Grant, PA-C Catherine Hazelton Xavier Martinez Robert Sachs, PA Mary Valencia

Staff Present: Maureen L. Forsyth, Executive Officer Kristy Schieldge, Attorney III Julie Caldwell, Administrative Analyst Anita Winslow, Diversion Program Analyst Rozana Firdaus, Enforcement Analyst Sarah Fletcher, Licensing Technician

3. Approval of August 11, 2017, Meeting Minutes

M/ Sonya Earley S/ Jed Grant to:

Approve the August 11, 2017, Meeting Minutes.

Member Yes No Abstain Absent Recusal Charles Alexander X Jennifer Carlquist X Sonya Earley X Javier Esquivel-Acosta X Jed Grant X Catherine Hazelton X Xavier Martinez X Robert Sachs X Mary Valencia X

1

Motion approved with the condition to correct the last paragraph in Agenda Item 15: Report by the Legislative Committee to read SB 544.

4. Public Comment on items not on the Agenda

Public comment included a request to ask the board to consider licensing a foreign medical graduate who has passed all USMLE steps, meets all the requirements asked of a PA program and passed exams but cannot obtain residency.

5. Nomination and Election of Physician Assistant Board Officers

Business and Professions Code (BPC) Section 3509.5 states that, “the board shall elect annually a president and vice president from among its members.” Typically, the nomination and election of board officers is held at the last meeting of the year.

Ms. Forsyth asked for nominations for president for 2018.

M/ Jed Grant S/ Sonya Earley to:

Nominate Robert Sachs as President of the Physician Assistant Board for 2018. No other nominations were made.


Motion approved.

Ms. Forsyth asked for nominations for Vice-President for 2018.

M/ Robert Sachs S/ Jennifer Carlquist to:

Nominate Mr. Grant as Vice-President of the Physician Assistant Board for 2018. No other nominations were made.

Member Yes No Abstain Absent Recusal Charles Alexander X Jennifer Carlquist X Sonya Earley X Javier Esquivel-Acosta X Jed Grant X Catherine Hazelton X Xavier Martinez X Robert Sachs X

2

Mary Valencia X

Motion approved.

6. Reports

a. President’s Report

1) Report on California Academy of PAs (CAPA) Conference Activities and August 11th Board Meeting:

Mr. Sachs reported that holding the August board meeting concurrently with the CAPA conference was very beneficial and well attended by both licensees and the public.

2) Board Member Recognition:

Mr. Sachs presented board member Catherine Hazelton with a plaque recognizing her dedicated service to the consumers of California. Ms. Hazelton thanked Mr. Sachs and the board and stated she felt honored to serve the people of California.

Mr. Sachs presented Ms. Firdaus, Physician Assistant Board Enforcement Analyst, with an American flag in celebration of her becoming an American citizen.

b. Executive Officer’s Report

1) Update on Negotiations for Board Office Lease:

Ms. Forsyth reported that the Physician Assistant Board (PAB) is currently in a soft lease with the owners of the building that the board currently occupies. Negotiations for new leases are currently underway with the building owners, executive officers who currently hold office space at 2005 Evergreen Street, Department of Consumer Affairs Facilities and Department of General Services. Ms. Forsyth reported that multiple issues are being addressed one of which includes safety and the pending homeless shelters scheduled to open in close proximity to the building. Depending on the outcome of the negotiations the board may need to entertain the possibility of moving.

2) Staff Update:

Mr. Forsyth reported that the PAB office is fully staffed but recruitment will begin at the conclusion of the board meeting to hire two additional probation monitors.

d. Licensing Program Activity Report

Anita Winslow reported licensing activity from July 28, 2017 to October 10, 2017 to be:

• Initial applications received – 345 3

• Renewal applications processed – 1,116 • Total licenses renewed and current – 11,782 • Average time to process an initial application – 35 days

In response to Ms. Hazelton’s request as to why the processing time of initial applications has changed, Ms. Winslow stated that numbers reported previously were higher due to applicants submitting applications too early; the average time frame to receive a new physician assistant (PA) license is 30 days.

In response to Mr. Grant’s question of whether the board has provided PA programs with a timeframe to follow when submitting a new application and also asked for clarification on the “desk age” and “application age” information depicted in the report, Mr. Winslow stated she has not reached out to the programs. She specified that the “desk age” is the number of days an application has been assigned to a current staff member and the “application age” is the number of days the application has been in the system. Ms. Forsyth stated that the board has provided initial licensing education to the PA programs in the past but due to staffing limitations the presentations were put on hold.

e. Diversion Program Activity Report

Ms. Winslow reported as of October 1, 2017, total licensees participating in the drug and alcohol diversion program are:

• Voluntary referrals - 2 • Board referrals - 14 • Total participants – 16 • Cases closed year-to-date - 127

Ms. Winslow indicated a correction to the handout provided to the board should read “as of October 1, 2017” not January 1, 2017.

In response to Mr. Sachs request for clarification on report information showing “applicants of public risk – 5”, Ms. Winslow stated the individuals were removed from diversion because they failed to complete the program.

Mr. Sachs requested that Maximus, who provides diversion program services to the PAB, be invited to the next board meeting. This would provide an opportunity for Maximus to make a presentation to the board regarding their services.

f. Enforcement Program Activity Report

Ms. Firdaus reported the following statistics from July 1, 2017 to September 30, 2017:

• Three licensees placed on probation; • One public letter of reprimand issued; • Zero revocations • Two licenses were surrendered; • Two probationary licenses issued; • Zero cease practice order issued;

4

• Zero petitions for reinstatement denied; • Zero petitions for reinstatement granted; • Zero petitions for termination of probation denied; • Zero petitions for termination of probation granted; • Four accusations filed; • Zero accusations withdrawn or dismissed; • One statement of issues; • Zero statement of issues withdrawn or dismissed; • Zero accusations or petition to revoke filed; • Zero petitions to compel a physical or psychiatric examination; • Zero interim suspension orders issued; • Zero license applications denied; • Six new cases initiated with the Attorney General’s office; • Forty-one cases pending with the Attorney General’s office; • Two citations pending and $500 in fines pending from the last fiscal year, payments received this quarter: $250;

• Fifty-three active probationers; • Seven probationers who are tolling; • Eighty-nine complaints received; • Zero complaints closed without investigation; • Ninety complaints referred for investigation; ten pending; • Two pending citations/fines from previous quarter totaling $500.00; • Five citations issued

In addition to the Enforcement Program Activity Report, Ms. Firdaus reviewed a new report pertaining the types of complaints the PAB receives and the source of the complaints. The board appreciated the additional information and requested that this report be included in future board meetings.

In response to Mr. Martinez’s question of the aging of the fines due, Ms. Firdaus stated some of the balances due are from the last fiscal year and Ms. Forsyth responded that if fines aren’t paid the information is turned over to Franchise Tax Board (FTB), she also confirmed that interest starts accruing once the fine reaches FTB.

Ms. Schieldge stated the Franchise Tax Board’s program is titled the Tax Intercept Program and if an individual is entitled to a refund the refund will be intercepted.

Ms. Firdaus provided clarity to the reports discrepancy with the amount of complaints received. Ms. Winslow clarified that the board has only been placing licensees in an inactive status based on failing the CME audit not failure to respond to the CME audit letter.

7. Department of Consumer Affairs – Director’s Update

Christopher Castrillo introduced himself to the board and stated he was appointed the Deputy Director to the Office of Board and Bureau Services on October 9, 2017. His background consists of public policy and campaign management having most recently worked as a legislative advocate where he covered a variety of policy areas including labor, higher education, youth mental health, foster care, health care, local

5

government and public transit. He has worked on both candidate and initiative campaigns in both California and Oregon. He looks forward to applying his experience and skill set towards establishing an Office of Board and Bureau Services that implements goals laid out in the strategic plan, exemplifying organizational effectiveness, and providing relevant, timely and accurate information to all stakeholders.

Mr. Castrillo shared information regarding additional individuals recently appointed by Governor Brown to the Department of Consumer Affairs. Karen Nelson, has been chief operations officer at the American Leadership Forum Mountain Valley Chapter since 2014, appointed Assistant Deputy Director at the Office of Board and Bureau Services. Patrick Le, has been Assistant Chief of External Affairs at Covered California since 2015, appointed Assistant Deputy Director at the Office of Board and Bureau Services. Christopher Shultz, has been Deputy Commissioner of Community Programs and Policy Initiatives at the California Department of Insurance since 2011, appointed Chief Deputy Director at the California Department of Consumer Affairs. Natalie Daniel, has been Fiscal Supervisor at the Judicial Council of California since 2015, appointed Deputy Director of administration and will be overseeing the department’s Office of Human Resources, Business Services Office and Fiscal Operations.

He stated with the new staff structure we’ll be able to further the mission vision and values we have set forth as a department and most importantly serve the needs of California’s consumers.

Mr. Castrillo stated that in September the second director’s quarterly meeting with board executive officers was held. Mr. Castrillo stated as a department we are focused on ensuring open dialogue with the boards and bureaus and will be holding an annual meeting with all board presidents to ensure that the director’s available to hear feedback from board leadership. One of the items announced at that meeting is that DCA has released a new online license verification search for all boards and bureaus using the Breeze platform.

DCA officially launched its new Future Leadership Development Program in May 2017 and recently held a kickoff meeting with program participants and mentors on August 28, 2017. The program includes executive mentoring, customized leadership training and project management.

The department has also established a pro-rata work group for board executives to discuss potential improvements on how DCA communicates with boards on the pro-rata process the department uses to distribute departmental service costs among the boards and bureaus. These services include IT, legal and publication. The next meeting is scheduled for August 31, 2017 at DCA headquarters. A pro-rata open house is scheduled for November 14, 2017.

In July the department released its new strategic plan that outlines DCA’s goals and objectives for the next four years. The plan is available on the publication’s page of the DCA website.

The final Board Member Orientation Training for 2017 is scheduled for November 15th.

6

Reminder that 2017 is a mandatory sexual harassment prevention training year, this means all employees and board members are required to complete this training in 2017.

PETITION FOR EARLY TERMINATION HEARING

Petition for Early Termination of Probation – MariJo Hanson, PA 16359, Case No.950-2016-001018

The Board was notified by petitioner MariJo Hanson that she was declining the opportunity to appear so the scheduled hearing was cancelled.

8. Approval of Passing Score for 2018 PA Initial Licensing Examination and2018 Dates and Locations for PA Initial Examination


To approve the passing score for the physician assistant initial licensing examination for year 2018 as established by the National Commission on Certification of Physician Assistants.


Motion approved.


To approve the dates and locations for the physician assistant initial licensing examination for year 2018; the examine dates will be given on a year-round basis. There will be no testing December 17-31, 2018. The locations will be at Pearson VUE Professional Centers.


7

Motion approved.

9. Schedule of 2018 Board meeting Dates and Locations

Mr. Sachs presented the dates available and suggested holding the August 2018 meeting in San Diego to coincide with the CAPA conference.


Approve the following dates and locations of the PAB’s board meetings:

January 22, 2018 - Sacramento April 23, 2018 - Sacramento August 10, 2018 - San Diego November 5, 2018 - Sacramento


Motion approved.

10.Discussion Regarding Nationwide Trends Related to Optimal Team Practiceof Physician Assistants

Mr. Grant stated he attended the Physician Assistant Education Association (PAEA) national conference, where discussions by the professional organization, credentialing body for PA programs, certifying body for PAs and Education Association focused on the strong demand for PAs. Last year there were 34,000 job posting for both PA and nurse practitioners (NP) and about 7,000 PA graduates.

Mr. Grant stated that because of the administrative requirements that some state laws, including California, put on PAs, the American Academy of Physician Assistants’ (AAPA) House of Delegates voted to recommend removal of some of the barriers placed on PA practice. The AAPA has developed some good recommendations for optimal team practice (OTP). OTP doesn’t change the relationship between the physician and the PA it changes who determines the role of the PA in that practice. Other recommendations include having an independent PA board at the state level and being able to see the work that the PA is providing in terms of billing and reimbursement.

Mr. Grant stated that there is a misconception that OTP is independent practice but PAs are not, now nor have they ever been, independent and they will always have a

8

relationship with a physician. One of the things that can be problematic is the supervising physician’s or collaborating physician’s responsibility for what the PA does, even when the physician may not be on-site. PAs are trained to think independently and should be responsible for what they are doing unless they consult with or collaborate with a physician on a specific case.

Mr. Grant indicated that OTP is about modernizing the practice act, state by state, to reflect the optimal practice for PAs and to appropriately relieve physicians of unneeded responsibility and restrictive documentation requirements regarding supervision. There are a lot of conversations on the impact these changes may have regarding PA education and training, accreditation of PA programs and certification of PAs. The PA Education Association is conducting a study on the changes to the laws and will report the outcome of the study in October 2018.

In response to Mr. Martinez’s question of whether or not California NPs are required to have a supervising agreement, Mr. Grant stated that NP’s are required to collaborate with a physician but the way their collaboration is documented is less burdensome.

Mr. Sachs stated that the topic needs to be looked into very seriously while remembering the primary charter which is public protection. He stated that part of OTP is having an independent board which the PAB has partly achieved. The PAB uses shared services, provided by the Medical Board, and if PAB were to become independent from the Medical Board would the current license renewal fee of $350 be sufficient to cover additional costs.

Ms. Forsyth stated that the PAB has outgrown their facility and if they were to become independent then the shared services provided by the Medial Board would be the sole responsibility of the PAB. This would make it necessary for the board to hire additional staff, increase office space and provide their own information technology services.

Public Comment: Teresa Anderson, Public Policy Director for California Academy of PAs (CAPA), concurred with Mr. Grant, changes need to be made to the PA Practice Act. PA services are hidden, there isn’t a good way to collect information on the contributions that PAs make to the healthcare industry. CAPA has voted to look at exploring what OTP looks like in California. Parity in the profession needs to be addressed in terms of nurse practitioners and the administrative processes. There are a lot of differences in terms of what the administrative burdens are for nurse practitioners versus PAs and the differences need to be evaluated to determine what needs to be done and who we need to work with to make changes.

11.CLOSED SESSION:

Pursuant to Section 11126(c)(3) of the Government Code, the Board moved into closed session to deliberate and take action on disciplinary matters.

RETURN TO OPEN SESSION

9

12.California Highway Patrol Presentation “Safety in the Workplace”

Officer Gabriel Parker with the North Sacramento California Highway Patrol (CHP) office provided the board with a presentation on safety. In 1995 the CHP absorbed the state police and any duties carried out by the state police. The CHP has jurisdiction over county roadways, freeways and all state facilities. The presentation covered topics such as workplace safety, personal safety, destroying complacency, awareness of criminal indicators and safe driving tips. These topics were designed to increase awareness of criminal activity and promote personal safety on state property. Officer Parker also shared a video titled Run, Hide, Fight – Surviving an Active Shooter Event and stressed the requirement that every state agency needs to have an Emergency Action Plan in place.

13.Regulations

Ms. Winslow introduced and reviewed flowcharts depicting the regulatory process and provided the following updates:

Proposed Amendments to Title 16, California Code of Regulations, Section 1399.514 – Renewal of License

This amendment is currently under review with the Department of Consumers Affairs Budget Office.

Ms. Earley requested clarification for reason why the reporting threshold needed to be increased when licensees renew, Ms. Winslow responded that licensees currently have to report convictions involving fine amounts ranging from $300 to $500 dollars. By raising the reporting threshold to $500 or more the workload will be greatly reduced without compromising the public because fines for drug related convictions are above the $500 threshold.

Proposed Amendments to Title 16, California Code of Regulations, Section 1399.515 – Retirement Status for Physician Assistant Licenses

This amendment is currently under review with the Department of Consumers Affairs Budget Office.

Proposed Repeal of Title 16, California Code of Regulations, Sections 1399.531 – Curriculum Requirements for an Approved Program for Primary Care Physician Assistants and 1399.32 – Board Requirements for Approving Specialty Training for Physician Assistants

This amendment is currently under review with the Department of Consumers Affairs Legal Office.

Proposed Amendments to title 16, California Code of Regulations, Section 1399.573 – Citations for Unlicensed Practice

This amended is currently with Business, Consumer Services and Housing Authority (Agency).

10

Discussion and possible Action to Initiate a Rulemaking to Amend Title 16, California Code of Regulations, section 1399.545 – Supervision Required

Business and Professions Code (BPC) sections 3502 and 3502.1 were amended in 2016 with the implementation of SB 337. This bill recast requirements for documenting supervision by the supervising physician using one or more mechanisms, and recast prescribing provision, including setting forth a new mechanism for how a supervising physician ensure adequate supervision of the administration, provision or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances.

In comparing the amendments enacted by SB 337 to the regulatory requirements, staff has determined that Section 1399.545 needs to be amended to eliminate duplicative and inconsistent provisions and to reflect all mechanisms available under current law for supervising a physician assistant.

Ms. Winslow provided the board with the proposed changes, stated that the proposed changes hold no fiscal impact and asked that the board approve the proposed changes so the rulemaking process could begin.

Ms. Schieldge stated the proposal is to conform regulation 1399.545 to the changes in SB 337 and that includes striking language in subdivision (e) of what’s duplicative in 3502 and making sure that the regulation refers back to the other mechanisms that are now available for supervision. In addition language is being added to describe the mechanism in 3502.1 for administration of Schedule II controlled substances.

Mr. Grant stated that this is a good example of why OTP is important.

Ms. Schieldge stated that she views this as a step towards how supervision restrictions can be eased. The goal of the regulation proposal is to get the regulation current with the statute and make it easier for people to understand what their supervision requirements are.

Ms. Hazelton asked if there was any concern that if the state legislature amended the statute, and such an amendment was open-ended, would it cause a problem for the board. Ms. Schieldge stated that regulations are not supposed to duplicate what is already in statute, the purpose of a regulation is to make a law more specific and clear and right now the statute is self-executing in terms of the three mechanisms. There isn’t really anything the regulation can add to the statute; it puts all of the mechanisms in one place. If the statute were to become more ambiguous then the regulation could be amended to make it more specific.

Ms. Hazelton stated that is might be beneficial to work with the board’s legislative committee on regulations.

Public comment: Gaye Breyman, Executive Director, California Academy of PAs (CAPA) commented that she receives calls daily from practices who are trying to understand both the regulation and statute. The regulation may be very specific but it is not clear, there are layers of regulations that are impossible for people to understand or follow. She commented that OTP will make life better by being more specific and clear. Ms. Breyman’s asked how long the process takes for regulation to

11

be reviewed by DCA. Ms. Schieldge responded that last year there was an internal policy shift which changed the process and seems to have added an additional five months to the review process. Once it is through DCA it is takes about a year for a regulation to be approved by the external control agencies and that is why sometimes legislative proposals can be a faster track than regulations.

Ms. Winslow offered additional reasons for why the regulation process may be taking longer.

Ms. Schieldge advised to update the regulation summary provided by staff to read “sixty day review” for DCA so the board members have a benchmark for how long the review is supposed to take. She suggested to discuss older pending regulation proposals with the board president and her chief counsel to see whether DCA can provide a firm date on when their review will be complete.


Mr. Grant moved to accept option number one provided in the board packet which reads: Approve the proposed regulatory test for section 1399.545, direct staff to submit the text to the Director of the Department of Consumer Affairs and the Business, Consumer Services, and Housing Agency for review and if no adverse comments are received, authorize the Executive Officer to take all steps necessary to initiate the rulemaking process, make any non-substantive changes to the package, and set the matter for hearing.


Motion approved.

Discussion and Possible Action to Initiate a Rulemaking to Amend Title 16 California Code of Regulations, Section 1399.617 – Audit and Sanctions for Noncompliance

Ms. Winslow stated that the proposed language has been updated to include the following:

1) A statement that includes that licensee must respond to the inquiry of CME compliance; include the amount of time (65 days) in which they have to comply with the request.

2) A statement for failure to provide adequate complete compliance.

Ms. Winslow requested that the board approve the proposed language and move forward with the rulemaking process.

12

Ms. Schieldge stated the proposed language also addresses the following:

1) The current regulation doesn’t state the licensee has to respond to the CME audit so the proposed language added to the regulation addresses that they have to respond to any Board inquiry.

2) Staff is suggesting to add language that specifies a sixty-five (65) day compliance window to respond to an inquiry.

3) Staff is also suggesting to add a sentence that if staff is unable to obtain records from the NCCPA regarding the licensee’s CME compliance the licensee still has to provide the board with certification records.

4) Staff is encountering not only that the licensee misrepresents the information but that they fail to provide information or complete information and the proposed language would give authority to potentially cite and fine someone for not providing information.

5) Staff also proposed to add the sentence “that the hours earned to make up the deficiency shall not be counted towards compliance with the next biennial renewal period” to clarify any confusion by the licensee who makes up a CME deficiency.

Ms. Schieldge stated the proposals are to help staff because they have been encountering, in the audit process, non-compliance and non-responsiveness on the part of the auditee. These additions would help bolster the authority to take matters to the next level, cite and fine, and further if there is still non-compliance.

Ms. Schieldge confirmed Ms. Hazelton’s statement regarding section 1399.617 (b) that states “misrepresentation of CME compliance shall constitute unprofessional conduct” and authorizes citations or possible discipline for non-compliance.

In response to Ms. Hazelton’s question on what percentage of licensees who are audited are unresponsive, Ms. Winslow stated 1% per month.

In response to Mr. Martinez’s question on whether a method could be established where a PA automatically logs in their CMEs to the PAB so there would be no need to generate a CME audit letter, Ms. Winslow stated she would need to contact the Breeze team to see if this would be possible. Mr. Grant provided additional comment on the process currently in place by the NCCPA for recording CMEs.

Mr. Martinez asked for clarification regarding the fines, the proposed language states that the executive officer has discretion regarding the amount of the fine, Ms. Winslow stated that on advice of legal counsel the amount was not specified since the regulation states that the board can fine anywhere from $100 to $5000. In response to Mr. Martinez’s question on how the fine amount is determined, Ms. Forsyth stated it is based on severity. Ms. Schieldge additionally commented that existing regulation section 1399.571 allows the executive officer to issue a citation for any violation of statute or regulation and lists several factors used to analyze the fine amount which include:

1) The good or bad faith exhibited by the cited person. 2) The nature and severity of the violation. 3) Evidence that the violation was willful. 4) History of violations of the same or similar nature.

13

5) The extent to which the cited person has cooperated with the board. 6) The extent to which the cited person has mitigated or attempted to mitigate any damage or injury.

7) Other matters as justice may require.

Ms. Schieldge stated that most of the citations in the department are derived from that fact-based analysis because then it allows for a case-by-case examination and you’re not rigidly tied to a specific amount. The order of abatement, which is an order to stop violating the law and is included with the citation, will be tailored to the particular violation alleged.

Public comment: Gaye Breyman, Executive Director, California Academy of PAs (CAPA) commented that the NCCPA website provides immediate information regarding a PA’s certification including when the certification ends.


To accept option number one provided in the board packet which reads: Approve the proposed regulatory text for section 1399.617, direct staff to submit the text to the Director of the Department of Consumer Affairs and the Business, Consumer Services, and Housing Agency for review and if no adverse comments are received, authorize the Executive Officer to take all steps necessary to initiate the rulemaking process, make any non-substantive changes to the package, and set the matter for hearing.


Motion approved.

14.Discussion and Possible Action Regarding Seeking LegislativeAmendment to Increase License Application Fee or Initial License Fee

Ms. Winslow described the process she undertook to provide justification for seeking an increase in the license application fee and initial license fee. She stated she randomly selected 6% of the initial applications received by the board, performed a desk study which included tallying time allocated by each staff member during the processing of the initial application, cost breakdown of each staff member’s hourly wage and based on this information concluded that it cost the board $57.20 to process an initial license application and the board is currently charging $25.00. Ms. Winslow stated the board experienced a 6% growth in applications received from fiscal year 2014/2015 to 2015/2016 and a 16% growth in applications received from fiscal year 2015/2016 to 2016/2017. She stated if the application fee was increased

14

to the actual cost of processing the application it would increase the board’s annual income of over $37,000. Ms. Winslow is recommending to prepare a proposal to increase the initial application fee from $25.00 to $57.00 and include language specifying a fee range to allow for any additional increases to be addressed through regulation and not through statute.

Mr. Grant stated that currently there are 229 PA programs, forty-six (46) developing PA programs nationwide which include five (5) in California so within the next few years there would be nineteen (19) PA programs in California. These factors also support the need to increase the fees. He also suggested to track the velocity of a typical or complicated application to document trends moving forward.

In response to Mr. Martinez’s question on whether the application fee of fifty-seven dollars ($57) could be rounded up to sixty dollars ($60), Ms. Schieldge suggested to authorize staff to seek a legislative amendment to increase the fee to at least fifty-seven dollars ($57) and then let the legislature decide. The factual basis of the desk study is used to determine the fee amount but the legislature can decide to make the minimum application fee sixty dollars ($60).

Ms. Hazelton questioned the process used to determine the application fee range and how future application fee increases would be determined. Ms. Schieldge stated typically the statute provides the floor and the ceiling for fee ranges and then you have to demonstrate to the Office of Administrative Law (OAL) when there is a need to go above the floor. The Administrative Procedure Act prohibits changing the fee above the floor except through regulation. Any additional increases would be determined by performing another desk audit and then reviewed for approval by OAL.

Based on Ms. Hazelton’s suggestion, Ms. Schieldge agreed to include context in the regulation that rulemaking would be required when increases above the floor become necessary.

The board discussed concerns of whether the floor would not be sufficient to capture the increase in PA programs, the growth of the PA profession and professional issues educators which may produce more questionable license applications. Ms. Schieldge stated when a board is looking at recovering fees of processing an initial application it can’t allow for any additional amount, the increase is based on the actual cost. For license renewal fees, there is more flexibility in setting the fee because that is based on the enforcement line item and if you are seeing potential failures in the licensing population then increasing the renewal fee is justified to cover that additional investigative expense you may have moving forward.

In response to Ms. Earley’s question on the accuracy of the desk audit, Ms. Winslow provided, in detail, the desk audit process and stands behind the accuracy.

Ms. Schieldge expressed concerns with redoing the desk study as it may prevent the board from securing a sponsor for the proposal next year; Ms. Hazelton commented that the last day to submit bill requests to the legislative council is January 19, 2018. Ms. Schieldge advised the board to give staff the authority begin the process of seeking an author for the increase in the application fee or the initial license fee and then address the fixed dollar amount at a later date. Boards ask for fee ranges so

15

the OAL sees a purely fact-based driven analysis, which is demonstrated by a desk audit, that the board is spending more than it is taking in.


Direct staff to work with the legislative committee to seek legislative assistance with submitting a bill to increase the initial application fee to a floor of fifty-seven dollars ($57) and a cap of $300.


Motion approved.

15.Developments Since the February 2015 United States Supreme Courtdecision in North Carolina State Board of Dental Examiners v. Federal Trade Commission (FTC)

Ms. Schieldge stated that at the last board meeting the creation of the Federal Trade Commission’s Economic Liberty Task Force was discussed. The task force has been meeting regularly to discuss various issues involving competition and how state licensure affects competition. The next round table, scheduled for November 7, 2017, in Washington D.C., will examine empirical evidence on the effects of occupational licensure. The round table will be a discussion among economic and policy experts on the costs and benefits of licensing, the effects on workers compensation and the overall economy. Topics examined will include what the alternatives are to occupational licensing including registration, certification and market-based solutions that might serve some of the same consumer protection goals of licensing.

Ms. Schieldge stated the reason they are tracking the FTC is because they have become very active, particularly in the rulemaking process for various state boards and it’s good to be aware FTC’s position on these issues because of the North Carolina case and the potential liability of the board for arguments involving anti-competitive conduct.

16.Report on Medical Board of California Activities

No report.

16

17.Budget Update

Mr. Rumbaoa, DCA Budget Analyst, reported that the beginning budget for fiscal year 2017/2018 is set at of 1.647 million dollars but is scheduled to change on 1/1/2018 due to the release of the Governor’s budget. Changes typically increase the appropriation for the year due to such items as employee compensation, retirement and cost of living.

Month thirteen for fiscal year 2016/2017 depicts expenditures of 1.7 million dollars but after reimbursements the final number is 1.6 million dollars.

In response to Mr. Grant’s question as to why the projected Attorney General’s cost of $375,000 is so much smaller than the current budgeted cost of $500,000, Mr. Rumbaoa stated that typically they ask for the board’s help to realign expenditures to align with what the board is going to spend; any deficiency is addressed by a Budget Change Proposal (BCP). Mr. Rumbaoa stated that this year he worked on increasing the $375,000 line item by submitting an Attorney General BCP, which was approved, so the $375,000 line item will be increased by $90,000 for the next fiscal year.

In response to Ms. Earley’s question on how overages are addressed, Mr. Rumbaoa stated there is no going over budget. Ms. Schieldge advised that if expenses go over the current appropriation the executive officer and board members are liable and that is why the board is apprised at every board meeting where the budget stands.

Mr. Grant stated there are a lot of expenses in the 2016/2017 fiscal budget but aren’t addressed in the 2017/2018 and that is concerning.

In response to Mr. Sachs question on whether any current expenditures are available for 2017/2018 fiscal year, Mr. Rumbaoa stated in July 2017, the department transitioned from CalStars to the new statewide accounting system, FISCAL, and the transition has presented some challenges. He is able to run queries but they’re not true fiscal month reports. His department is working on creating a standardized format and hopes that by November to have closed fiscal month one and two. He stated the board will have a better idea what the current fiscal year’s budget looks like by the next board meeting.

In response to Mr. Alexander’s question on whether the board has an adequate budget, Mr. Rumbaoa replied “yes, at this point in time the board has an adequate budget”. He elaborated by stating if he were to compare reports for both the current fiscal year and last fiscal year at this time the trends are the same.

In response to Ms. Schieldge on whether there is a schedule for repayment of the 1.5 million dollar GF loan, Mr. Rumbaoa stated he believes is it scheduled to be repaid in 2021-2022. Ms. Schieldge stated if the board were to go into “the red”, then the repayment would be immediately, Mr. Rumbaoa concurred.

18.Report by the Legislative Committee; Discussion and Possible Action

Ms. Hazelton stated there were four bills discussed in the last meeting that were moving forward and they were all chaptered (signed into law) by the governor.

17

• AB 40 (Santiago) CURES database: health information technology system This bill would make it easier for PA and other medical professionals to access CURES by allowing for the integration of CURES information into existing software that is used or the creation of new software. By October 2018 the Department of Justice will make CURES more readily available through new software.

• SB 554 (Stone) Nurse practitioners: physician assistants: buprenorphine This bill was also chaptered. This law will bring the state into compliance with the federal Comprehensive Addiction and Recovery Act of 2016 which allows for PAs to furnish or order buprenorphine.

• SB 244 (Lara) Privacy: Agencies: Personal Information This has been pulled to the inactive file. Ms. Schieldge stated that even though it is inactive she asks that the board continues to monitor anything related to that bill or a similar bill because would have restricted the board’s ability to share information on pending cases with any other regulatory agency. This would seriously hamper the board’s ability work with other agencies such as the Medical Board, law enforcement agencies, district attorney’s offices and the department.

19.Agenda Items for Next Meeting

1) Rulemaking training 2) Review of the current fees assessed by the Board to determine if they support the actual costs.

3) MAXIMUS presentation 4) Strategic plan 5) Optimal Team Practice 6) Workforce Committee 7) Petition Hearing training 8) Discussion on separation of services from the Medical Board.

20.Adjournment

With no further business the meeting was adjourned at 2:57p.m.

Minutes do not reflect the order in which agenda items were presented at the Board meeting.

18

meeting minutes - physician assistant2017/10/30 · meeting minutes october 30, 2017 physician...

Documents