NEW HEALTH LAWS The California Legislature had an active year passing many new laws affecting health care. Below are highlights of the new laws likely to impact physicians next year and beyond. For more details, see “Significant New California Laws of Interest to Physicians for 2014,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.
ALLIED HEALTH PROFESSIONALS AB 1000 (Wieckowski) – PHYSICAL THERAPISTS: DIRECT ACCESS TO SERVICES (CMA Position: Support / Co-Sponsored) Allows physical therapists to treat patients for 45 days or 12 visits without first seeing a physician. Requires a physical therapist to refer a patient to a physician if the condition is beyond the therapist’s scope of practice or if the patient is not progressing, to disclose to the patient any financial interest he or she has in treating the patient, and with the patient’s authorization, notify the patient’s physician that the physical therapist is treating the patient. Specifies that professional corporations, including medical corporations, are not limited to employing those licensed professionals that are listed in Corporations Code §13401.5. AB 1308 (Bonilla) – MIDWIFERY Removes physician supervision over licensed midwives. Specifies conditions of a normal pregnancy and childbirth and requires a licensed midwife to refer
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clients who do not meet these conditions to a physician for examination. Requires Medical Board to adopt regulations specifying those certain conditions. Authorizes a licensed midwife to directly obtain supplies and devices, obtain and administer drugs and diagnostic tests, order testing, and receive necessary reports consistent with the scope of practice. Requires disclosure to prospective clients of the specific arrangements for referral of complications to a physician and surgeon, and to obtain consent of those disclosures.
CONFIDENTIAL INFORMATION SB 46 (Corbett) – PERSONAL INFORMATION: PRIVACY Amends existing law that requires notification to individuals whose unencrypted computerized personal information was, or is reasonably believed to have been, acquired by an unauthorized person due to a breach of security of a computerized system or data. Revises certain data elements included within the definition of personal information by adding certain information that would permit access to an online account. Imposes
additional requirements on the disclosure of a breach of security of the system or data in situations where the breach involves personal information that would permit access to an online or email account. SB 138 (Hernandez, E.) – CONFIDENTIALITY OF MEDICAL INFORMATION Specifies the manner in which a health care service plan or health insurer would be required to maintain confidentiality of information regarding the treatment of an insured, including a requirement to accommodate requests to receive requests for confidential communication of medical information in situations involving sensitive services, including requests by dependents insured under a health insurance policy held by another person, or situations in which disclosure would endanger the individual. Authorizes a health care provider to communicate information regarding benefit cost-sharing arrangements to the health care service plan or health insurer. Prohibits health plans from conditioning enrollment in the plan or eligibility for benefits on the waiver for certain rights provided for in the bill.
DRUG PRESCRIBING AND DISPENSING AB 635 (Ammiano) – DRUG OVERDOSE TREATMENT: LIABILITY (CMA Position: Support) Authorizes a licensed health care provider, who is permitted by law to prescribe an opioid antagonist and is acting with reasonable care, to prescribe and subsequently dispense or distribute an opioid antagonist for the treatment of an opioid overdose. This is permitted to treat a person at risk of an opioid-related overdose or a specified person in a position to assist a person at risk of an opioid-related overdose. Authorizes these licensed health care providers to issue standing orders for the distribution of an opioid antagonist. SB 809 (DeSaulnier) – CONTROLLED SUBSTANCES: REPORTING (CMA Position: Support) Funds the Controlled Substance Utilization Review and Evaluation System (CURES) for the electronic monitoring of the prescribing and dispensing of controlled substances by assessing an annual fee on practitioners authorized to prescribe, order, administer, furnish or dispense controlled substances, non-governmental clinics and non-governmental pharmacies. Establishes the CURES Fund within the State Treasury. Requires the Medical Board to periodically develop and disseminate education materials relating to the assessment of a patient’s risk of abusing or diverting controlled substances and information related to CURES to physicians and general acute care hospitals. Eliminates notarization requirement for application process and requires health care practitioners and pharmacists to apply to obtain approval to access CURES after January 1, 2016. Requires the Department of Justice in conjunction with the Department of Consumer Affairs and relevant licensing boards to develop a streamlined application and approval process to access CURES and enable health care practitioners and pharmacists with access to CURES to delegate their authority to order reports from CURES. SB 28 (Hernandez, E.) – CALIFORNIA HEALTH BENEFIT EXCHANGE Requires the California Major Risk Medical Insurance Board to provide the California Health Benefit Exchange (Covered California) with specified
information to assist in conducting outreach to subscribers to notify them that they may be eligible for coverage through the Exchange or Medi-Cal. Implements various provisions of the Affordable Care Act relating to determining eligibility for the Medi-Cal program. Requires the Department of Health Care Services (DHCS) to authorize individuals to select MediCal managed care plans via the California Healthcare, Enrollment, and Retention System. CA SBX1 3 (Hernandez, E.) – HEALTH CARE COVERAGE: BRIDGE PLAN Requires the California Health Benefit Exchange (Covered California), by means of selective contracting, to make a bridge plan product available to specified eligible individuals, as a qualified health plan (QHP). Exempts the bridge plan product from certain requirements that apply to QHPs, relating to making the product available and marketing and selling to all individuals equally (guaranteed issue) outside the Exchange and selling products at other levels of coverage. Requires the Department of Health Care Services to include provisions relating to bridge plan products in its contracts with Medi-Cal managed care plans. Requires Covered California to evaluate three years of data from the bridge plan products, as specified.
HEALTH CARE COVERAGE SB 161 (Hernandez, E.) – STOP-LOSS INSURANCE COVERAGE (CMA Position: Support) Prohibits a stop-loss insurer from excluding any employee or dependent on the basis of specified actual or expected health status-related factors. Establishes regulatory requirements for stop-loss insurance policies for small employers, including requiring a stop-loss insurer to renew all stoploss insurance policies at the option of the small employer and prohibiting setting individual attachment point of $40,000 or greater and an aggregate attachment point of the greater of $5,000 times the total number of group members, 120% of expected claims, or $40,000 for a policy year or providing coverage for an employee or his or her dependents. Exempts small employer stop-loss insurance issued prior to September 1, 2013, from these attachment point requirements. CA ABX1 2 (Pan) – HEALTH CARE COVERAGE (CMA Position: Support if Amended) Establishes health insurance market reforms contained in the Affordable Care Act specific to individual purchasers, such as open enrollment, prohibiting insurers from denying coverage based on preexisting conditions, insured claims experience as part of a single risk pool, the use of certain factors in determining individual plan rates, insurance advertising and marketing, small employer enrollment periods and coverage effective date and premium rates, a risk adjustment program, insurance data reporting, and insurer disclosure requirements; and makes conforming changes to small employer health insurance laws resulting from final federal regulations. AB 980 (Pan) – PRIMARY CARE CLINICS: ABORTION Imposes the same licensing and building standards to all primary care clinics, including those that provide abortion services. Grants the Office of Statewide Health Planning and Development emergency regulatory authority to implement these provisions and requires the Department of
Public Health to repeal certain regulations relating to abortion services in primary clinics by July 1, 2014. AB 1202 (Skinner) – OCCUPATIONAL SAFETY AND HEALTH STANDARDS (CMA Position: Support) Requires the Occupational Safety and Health Standards Board to adopt a standard for the handling of antineoplastic drugs, primarily cancer drugs, in health care facilities regardless of the setting. Requires the standard to be consistent with and not exceed specific recommendations adopted by the National Institute for Occupational Safety and Health for preventing occupational exposures to those drugs in health care settings. SB 191 (Padilla) – EMERGENCY MEDICAL SERVICES (CMA Position: Co-Sponsored) Extends the operative date to January 1, 2017, of existing law that establishes the Maddy Emergency Medical Services Fund, which authorizes each county to establish an emergency medical services fund for reimbursement of costs related to emergency medical services and funding for pediatric trauma centers, and authorizes county boards of supervisors to elect to levy an additional penalty upon fines, penalties and forfeitures collected for criminal offenses. Makes technical, nonsubstantive changes to the provisions.
MEDI-CAL SB 94 (Senate Budget and Fiscal Review Committee) – MEDI-CAL: MANAGED CARE: LONG-TERM SERVICES AND SUPPORTS (CMA Position: Oppose) Amends existing law regarding the Coordinated Care Initiative (CCI) and separates CCI provisions to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual eligibles) into Medi-Cal managed care, the integration of long-term supports and services into managed care plans, and the commencement of the In-Home Supportive Services Statewide Public Authority, to proceed separately from the CCI Duals Demonstration Project (now called Cal MediConnect). SB 494 (Monning) – HEALTH CARE
PROVIDERS (CMA Position: Support ) Increases the number of beneficiaries assigned to the panel of a full-time equivalent primary care physician under a Medi-Cal managed care plan. Requires a health service plan to ensure that there is at least one full-time primary care physician for every 2,000 enrollees. Authorizes the assignment of up to an additional 1,000 enrollees to the primary care physician for every full-time non-physician medical practitioner supervised by that physician. Requires the MediCal program to evaluate the location, hours, and language capabilities of practitioners and adds non-physician medical practitioners (physician assistant or a nurse practitioner) to the definition of a primary care provider.
MEDICAL EDUCATION AB 94 (Committee on Budget) – EDUCATION FINANCE: HIGHER EDUCATION Higher education budget trailer bill that allocated $15 million dollars to the Regents of the University of California, Riverside School of Medicine. AB 565 (Salas) – CALIFORNIA PHYSICIAN CORPS PROGRAM (CMA Position: Sponsor) Amends the Steven M. Thompson Physician Corps Program to require the guidelines for the selection and placement of program applicants to include criteria that would give priority consideration to program applicants with experience providing health care services to medically underserved populations or in a medically underserved area. Gives priority to applicants who agree to practice in those areas and serve a medically underserved population, and give priority consideration to applicants from rural communities who agree to practice in a physician owned and operated medical practice. Amends the definition of “practice setting” to include a physician owned and operated medical practice setting that provides primary care located in a medically underserved area.
PROFESSIONAL LICENSING AND DISCIPLINE AB 1288 (Perez, V.) – STATE MEDICAL BOARDS: LICENSING: APPLICATION PROCESSING
(CMA Position: Sponsor) Requires the State Medical Board and the Osteopathic Medical Board of California to develop a process to give priority review status to the application of an applicant who can demonstrate that he or she intends to practice in a medically underserved area or serve in a medical underserved population. SB 304 (Lieu) – HEALING ARTS: BOARDS This bill is the sunset extension bill for the Medical Board containing statutory and technical changes to provisions relating to Medical Board review by appropriate legislative committees, issuance of a license to a physician and surgeon who has acquired any part of his or her education from an unrecognized medical school who has held licensure in another state or Canada, reporting an electronic address to the Board, licensed midwives, adverse event reporting, fines for failure to provide health care records by a facility, and Medical Board investigations. SB 670 (Steinberg) – PHYSICIANS AND SURGEONS: DRUG PRESCRIBING PRIVILEGES (CMA Position: Support) Authorizes the Medical Board, in any investigation that involves the death of a patient, to inspect and copy the records of the deceased patient without authorization of the beneficiary or personal representative of the deceased patient or a court order to determine the extent to which the cause of death was the result of the physician and surgeon’s violation of the Medical Practice Act, if the board provides a written request to the physician that includes a declaration that the board was unsuccessful in locating or contacting the deceased patient’s beneficiary or personal representative after reasonable efforts. Revises definition of unprofessional conduct to include repeated failures by a licensee who is the subject of an investigation, in absence of good cause, to attend and participate in an interview by the board. Clarifies the authority of the administrative law judge to issue an interim order limiting the authority to prescribe, furnish, administer or dispense controlled substances.
PUBLIC HEALTH AB 446 (Mitchell) – HIV TESTING (CMA Position: Support)
Requires a medical care provider or a person administering a HIV test to provide a patient with information about risk reduction strategies and information regarding test results. Requires oral or written informed consent as specified for the HIV test except when a person independently requests an HIV test from an HIV counseling and testing site and requires the person administering the test to document the person’s independent request for the test. Exempts clinical laboratories from the informed consent requirements. Requires an HIV test to be offered to any patient having blood drawn at a primary care clinic and consents to the test. Authorizes disclosure of HIV test results by secure Internet website posting.
REPRODUCTIVE ISSUES AB 154 (Atkins) – ABORTION (CMA Position: Support) Allows nurse practitioners, certified nurse midwives and physician assistants to perform an abortion by medication or aspiration techniques
in the first trimester of pregnancy if he or she completes training and validation of clinical competency and is working pursuant to specified standardized procedures that specify the extent of physician supervision, and procedures for transferring patients to the care of a physician or a hospital, obtaining assistance and consultation of the physician and providing emergency care until physician assistance and consultation is available. Deletes references to nonsurgical abortions. AB 460 (Ammiano) – HEALTH CARE COVERAGE: INFERTILITY (CMA Position: Support) Requires that health care service plan and health insurer coverage for the treatment of infertility be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex or sexual orientation.
SB 460 (Pavley) – PRENATAL TESTING PROGRAM: EDUCATION (CMA Position: Support if Amended) Requires the Department of Public Health to include prescribed information regarding environmental health in the California Prenatal Screening Program patient educational information and to post that information on the department’s website. Requires the Department of Public Health to send a notice to all distributors of the patient educational information that informs them of that change and encourages obstetrician-gynecologists and midwives to discuss environmental health with their patients. These are just a sampling of the new laws impacting health care in 2014 and beyond. For a complete list, see “Significant New California Laws of Interest to Physicians for 2014,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.