Senate Bill 1406, Chapter 352, Statutes of 2008, significantly expanded the scope of practice for optometrists licensed in California. A provision of the bill outlines a means for establishing requirements for glaucoma certification that would 1) adequately protect glaucoma patients; 2) ensure that applicant optometrists will be certified to treat glaucoma on an appropriate and timely basis; and 3) be consistent with the Department of Consumer Affairs and the California State Board of Optometry's (hereafter "Board") examination validation for licensure and occupational analyses policies adopted pursuant to subdivision (b) of Section 139.

The frequently asked questions below will answer any additional questions you may have regarding glaucoma certification in California (Click on the topic below to view the corresponding questions and answers):

History

Out of State

Case Management Course

Preceptorship Program

Didactic Course

Application and Documentation Form

General Questions

History

Q. How did all of this come about?

A. Please go to www.optometry.ca.gov/lawsregs/newlaws2009.shtml to read about SB 1406 and the process mandated by the legislature for glaucoma certification for California optometrists.

Q. Where is the Board in the process so far?

A. The Board has completed the rulemaking process and the regulations for glaucoma certification became effective on January 8, 2011. Below is a timeline of the events leading the adoption of the new glaucoma certification process:

* Dates and procedures mandated by SB 1406

• September 26, 2008 - Governor Arnold Schwarzenegger signs Senate Bill 1406 (Chapter 352, Statutes 2008) making significant changes to Business and Professions Code Section 3041 regarding the scope of practice for optometrists.
• * November 20, 2008 - The Board appoints the Glaucoma Diagnosis Treatment and Advisory Committee (GDTAC).
• January 1, 2009 - Senate Bill 1406 becomes effective.
• February 5, 2009 - GDTAC Public Meeting.
• February 26, 2006 - GDTAC Public Meeting.
• March 5, 2009 - GDTAC Public Meeting.
• March 27, 2009 - GDTAC Public Meeting. (CANCELLED)
• * April 1, 2009 - GDTAC submits its recommendations via two separate reports, one from the optometrists and one from the ophthalmologists, to the Office of Professional Examination Services (OPES) for review.
• * July 1, 2009 - The final report from OPES is submitted to the Board.
• * July 16, 2009 - The Board approves the Report of the OPES pertaining to the recommended curriculum and case management requirements for optometrists licensed in California to diagnose and treat glaucoma.
• July 31, 2009 - Representatives from the three California schools and colleges of optometry meet to discuss and develop a curriculum for glaucoma certification and potential regulations based on the recommendations in the report by OPES.
• August 24, 2009 - The Board reviews, makes edits and approves the proposed language for California Code of Regulations 1571. Requirements for Glaucoma Certification. The Board also makes a motion directing Board staff to begin the rulemaking file.
• September 21, 2009 - Board staff submits the proposed language, Notice for Publication,  Initial Statement of Reason and Economic/Fiscal Impact State Form 399 to Department of Consumer Affairs, Division of Legislative & Policy Review and Legal Affairs to begin the internal review process.
• September 22, 2009 to October 14, 2009 - Filing of Notices postponed while the Office of Administrative Law (OAL) considers whether or not to allow waiver of signature on Form 399 Economic and Fiscal Impact Statement.
• October 14, 2009 - Waiver obtained to allow Notices for Publications to be filed without Agency signatures.
• October 22, 2009 - Staff presents the glaucoma regulation proposed language for Board's approval due to a few non-substantial changes made to the language. The Board approves language and directs staff to continue on with the rulemaking package.
• October 27, 2009 - Staff submits the rulemaking package for publication.
• November 6, 2009 - The Notice and Initial Statement of Reasons is published for notification of the regulatory action in the California Regulatory Notice Register. This prompts the beginning of the 45-day comment period where the public has the opportunity provide their input on the proposed regulation.
• December 21, 2009 - The 45-day comment period ends.
• December 22, 2009 - The Board holds a hearing to receive comments from the public regarding the proposed glaucoma regulations.
• December 31, 2009 – (CANCELLED) The Board was to reconvene and respond to the comments received in the hearing but this meeting was cancelled. Board staff found that more time was needed in order to provide thoughtful and thorough responses to the comments received so that the best decision could be made in regards to this issue. The Board meeting to address the comments received is still pending a rescheduled date.
• March 16, 2010 - The Board meets in order to discuss and consider the comments received during the 45-day comment period. Based on the comments received, the Board modifies the text of the regulation and votes to move forward with the rulemaking package.
• March 24 - April 8, 2010 - The modified text and additional materials relied upon are posted on the Board's web site to allow for a 15-day comment period.
• May 11, 2010 - The Board meets in order to review the comments received during the 15-day modified text comment period. There are no changes made to the proposed language and the Board moves to continue forward with the rulemaking package.
• May 17, 2010 - Board staff submits the rulemaking package to the Department of Consumer Affairs (DCA) for review.
• June 17, 2010 - DCA approves the rulemaking package and forwards it on to the California State and Consumer Services Agency (SCSA) for approval.
• June 30, 2010 - SCSA approves the rulemaking package and forwards it on the California Department of Finance for approval.
• August 23, 2010 - The Department of Finance approves the rulemaking package and forwards it back to the Department of Consumer Affairs.
• August 25, 2010 - Board staff submits the completed rulemaking package to the Office of Administrative Law. The Office has 30 business days to approve or disapprove the package. If the package is approved, the regulation will become effective upon filing with the Secretary of State.
• September 24, 2010 – The Board votes to withdraw the regulation from the Office of Administrative Law after reviewing the Office's concerns with the regulation.
• September 27, 2010 – The Board withdraws the regulation.
• October 4, 2010 – The Board meets to discuss and approve the modified text of the regulation which addresses the Office of Administrative Law's concerns.
• October 5, 2010 – October 19, 2010 – The modified text and additional materials relied upon are posted on the Board's web site to allow for a second 15-day comment period.
• October 22, 2010 – The Board meets in order to review the comments received during the second 15-day modified text comment period. There are no further changes made to the proposed language and the Board moves to re-submit the rulemaking package to OAL.
• October 28, 2010 – Board staff submits the rulemaking package to DCA and the Director for review.
• November 2, 2010 – Board staff receives the rulemaking package back from DCA with the Director's approval.
• November 3, 2010 – Board staff re-submits the completed rulemaking package to OAL. The Office has 30 business days to approve or disapprove the package. If the package is approved, the regulation will become effective upon filing with the Secretary of State.
• December 9, 2010 – The Office of Administrative Law approves California Code of Regulations (CCR) Section 1571, Requirements for Glaucoma Certification and files it with the Secretary of State.
• January 8, 2011 – CCR Section 1571 becomes effective (30 days after filing with the Secretary of State).
• February 23, 2011 – The Board is served the jointed lawsuit filed by the California Medical Association (CMA) and the California Academy of Eye Physicians and Surgeons (CAEPS) on January 11, 2011. The legal filing challenges the glaucoma regulations by asking the court to intervene. To see a copy of the complaint, please click here. The glaucoma regulations stay in effect unless the courts decides to grant an injunction, which can take three to four months
• April 11, 2011 – The Board approves the Case Management Requirement for Glaucoma Certification developed by the California schools and colleges of optometry.
• May 2, 2011 - The Board's demurrer (a motion to dismiss) to the joint lawsuit filed by the CMA and CAEPS was sustained without leave to amend. The judge sustained the demurrer on the grounds that: (1) the Board acted within its rulemaking authority under Business and Professions Code Section 3025 and no abuse of discretion was shown; and (2) CMA and CAEPS have not demonstrated standing. This ruling effectively ends the case at the trial court level. CMA and CAEPS have 60 days to appeal the judge's ruling once the Notice of Entry of Judgment is served and filed.

Out of State

Q. I am currently certified to treat glaucoma in a state outside of California. If I decide to become licensed by the California State Board of Optometry, would my glaucoma certification be recognized?

A. In order to treat glaucoma in the state of California, an out-of state optometrist must first obtain the following: (1) a license to practice in California (see B&P section 3057); and (2) TPA certification (see B&P section 3041.3(d)). For glaucoma certification, there is no special "out-of-state" status or category. You will need to meet the requirements for whatever category you fit under in B&P section 3041(f), before you may treat glaucoma in the state of California.

Case Management Course

Q. Can I take the case management course at SCCO and then take it again at UC Berkeley? I would be taking the course at two different schools, so that should be okay, right?

A. No. You are still taking the same course twice and there is no educational value in repeating a course.

Q. Can I take the case management course twice in a row or the grand rounds program twice in a row to meet the 25-patient requirement?

A. No. There would be no educational value in repeating a course.

The following are the Board's recommended combinations to meet the 25-patient case management requirement:

Preceptorship Program

Can I use glaucoma suspects in the preceptorship program?

A. No. The patient must be diagnosed with glaucoma.

Q. I noticed that in the proposed regulations, a preceptor can be either an ophthalmologist or a glaucoma certified optometrist. I've just hired an optometrist who graduated after May 1, 2008. Because she is TLG certified, I want to have her be my preceptor so I can become glaucoma certified. Is that okay?

A. No. A glaucoma certified optometrist must have been glaucoma certified for 2 or more year prior to becoming a preceptor.

Q. Do the 25 glaucoma patients need to begin being seen effective January 8, 2011? I've been following glaucoma patients in nursing homes this past year under the supervision of an ophthalmology group so I'm not sure if I can use those residents and their initial dates of treatment since they are earlier than January 8, 2011.

A. Yes, the 25 patients must be seen starting January 8, 2011 or after for 12 consecutive months. Between the dates of January 1, 2010 to January 7, 2011, (about 1 year) there was no provision in law for California licensed optometrists to become glaucoma certified unless you graduated from one of the schools/colleges of optometry on May 1, 2008 or after. Optometrists who began the co-management program (50 patients for 2 years with an ophthalmologist) under Senate Bill 929 (Polanco, Chapter 676, Statutes of 2000) between the dates of January 1, 2001 and December 31, 2009 may be given credit for patients that were co-managed with an ophthalmologist. There are two groups of optometrists that can choose to do the preceptorship program:

Group One: Optometrists who began the co-management program (50 patients for 2 years with an ophthalmologist) under SB 929 between the dates of January 1, 2001 and December 31, 2009.

Pursuant to the recently approved regulations California Code of Regulations (CCR) Section 1571 (f), licensees who started the process for certification to treat glaucoma under SB 929 but will not complete the requirements by December 31, 2009, may apply all patients who have been co-managed prospectively for at least 12 consecutive months towards the Case Management Required indicated in subsection (a) of CCR Section 1571.

Group Two: Optometrists who have not started any sort of co-management program. This group needs to begin counting patients and 12 consecutive months on January 8, 2011 or after.

Q. I am an optometrist that has been glaucoma certified for three years. There are four other optometrists in my office who are not glaucoma certified and would like me to be their preceptor. Since we all work in the same practice, can we share the same patients?

A. Although the law does not indicate that this is not possible, remember that each optometrist must do all the steps required in the preceptorship program when treating the patient. A minimum of 25 individual patients must each be prospectively treated for a minimum of 12 consecutive months. The preceptorship option is not another version of the Grand Rounds Program. The intention of the preceptorship program is for an optometrist to treat 25 of their own individual patients each in order to maximize the learning experience.

Q. I have an active license in California and Texas, but I currently live and work in Texas. Can I do the preceptorship program in Texas with a Texas glaucoma certified optometrist or ophthalmologist?

A. No. The preceptor must be:
1) A California licensed, Board certified ophthalmologist in good standing; or
2) A California licensed optometrists in good standing, who has been glaucoma certified for two or more years. (CCR Section 1571 (A)(4)(C))

Q. My preceptor is a Glaucoma Certified optometrist. Who writes the prescriptions for the patients?

A. Your preceptor must write all prescriptions throughout the preceptorship program. You may only "treat" as defined in CCR Section 1571 (A)(4):

"For purposes of this section, "treat" means properly evaluating the patient, performing all necessary tests, diagnosing the patient, recognizing the type of glaucoma within a licensee's scope of practice, creating a treatment plan with proposed medications and target pressures, ongoing monitoring and reevaluation of the patient's condition, and making timely referrals to an ophthalmologist when appropriate."

Didactic Course

Q. If I graduated from the Southern California College of Optometry on May 1, 2003, do I have to take the didactic course?

A. No, you don't have to take the didactic course. According to CCR Section 1571 (d), licensees who graduated from an accredited school or college of optometry after May 1, 2000 are exempt from the didactic course.

Q. Do I have to provide proof of completion of the 24-hour didactic course with my application for glaucoma certification?

A. You don't have to provide a copy of your certificate of completion, but you will have to indicate on the application if you took the course or not, where you took the course and when you completed it. You will also have to sign the application and certify by penalty of perjury that what you are claiming on the application is true and correct. Be prepared to provide a copy of your certification of completion of the 24-hour didactic course in the event the Board conducts an audit at a later date.

Q. I completed a 24-hour didactic course out of state. Can I apply that to the didactic course requirement or do I need to take it again in California?

A. If you graduated from an accredited school or college of optometry any where in the United States on or after May 1, 2000, you would be exempt from the 24-hour didactic course. If you graduated from an accredited school or college of optometry any where in the United States but did not take the 24-hour didactic course, then you will have to take the course, and it can be taken in California or anywhere the course is offered.

Q. I am an ophthalmologist who is interested in becoming a preceptor. Can I charge to be a preceptor?

A. At this time there is nothing in law that prevents a preceptor from requesting payment for their services.

Application and Documentation Form

Q. On the Documentation of Co-Management Form, regarding the Date of Initial Evaluation, Date of Diagnosis Confirmed and Treatment Planned Approved, and the Date of the Therapeutic Goals and Management Plan Approved, can they all be the same date? My preceptor usually sees the patient and sends out a report that day with confirmation of all of the above.

A. Yes, this is fine, as it does not specify in CCR Section 1571 otherwise.

Q. For the consultation dates on the Documentation of Co-Management Form, do we only indicate the intervals between consultation dates that the preceptor and I have agreed upon as clinically appropriate for the patient? For example, 3 or 4 months?

A. No. You will need to document the actual dates that you consulted with the patient i.e., Visit 1 - May 1, 2011; Visit 2 - July 1, 2011 etc.

Q. I began the glaucoma certification process established under SB 929 and was only able to treat 45 patients before the process became obsolete on December 31, 2009. I already filled out the old form and application and have been saving them in order to submit it to the Board when the new law came into effect. Can I turn in the old form and application, or do I have to fill out the new documentation form and application?

A. You will have to fill out the new documentation form and application.

General Questions

Q. Now that I am glaucoma certified, I'm thinking about working for a private or HMO plan in California. All I need is my glaucoma certification to bill for my services right?

A. No. In order to bill for services provided for glaucoma, California private and HMO plans would have to allow optometrists to be on a medical panel. Very few, if any plans, are allowing this at this time. If you treat patients under the Medi-Cal program, you may bill any procedure necessary to treat the patient. Please check with each plan you are a provider for to obtain the full details, as this information may not apply to all private and HMO plans.