BILL NUMBER: AB 648 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 15, 2009
INTRODUCED BY Assembly Member Chesbro
(Coauthor: Assembly Member Swanson)
FEBRUARY 25, 2009
An act to add and repeal Chapter 6.5 (commencing with
Section 124871) to of Part 4 of
Division 106 of the Health and Safety Code, relating to rural
hospitals.
LEGISLATIVE COUNSEL'S DIGEST
AB 648, as amended, Chesbro. Rural hospitals: physician services.
Existing law generally provides for the licensure of health
facilities, including rural general acute care hospitals, by the
State Department of Public Health.
Existing law requires the department to provide expert technical
assistance to strategically located, high-risk rural hospitals, as
defined, to assist the hospitals in carrying out an assessment of
potential business and diversification of service opportunities.
Existing law also requires the department to continue to provide
regulatory relief when appropriate through program flexibility for
such items as staffing, space, and physical plant requirements.
This bill would authorize , until January
1, 2020, establish a demonstration project authorizing a rural
hospital, as defined, to employ a physician
up to 10 physicians and surgeons at one time, except as provided,
to provide medical services at the rural hospital or other
health facility that the rural hospital owns or operates and retain
all or part of the income generated by the physician
physicians and surgeons for these
medical services and billed and
collected by the rural hospital if the physician and surgeon in
whose name the charges are made approves the charges .
It The bill would require a rural hospital that
employs a physician and surgeon pursuant to this bill
its provisions to develop and implement a policy
regarding the independent medical judgment of the physician and
surgeon .
The bill would require these physicians and surgeons to
biennially sign a specified statement.
The bill would impose various duties on the department and the
Medical Board of California including, not later than January 1,
2019, a requirement that the board deliver a report to the
Legislature regarding the demonstration project .
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Many hospitals in the state are having great difficulty
recruiting and retaining physicians.
(b) There is a shortage of physicians in communities across
California, particularly in rural areas, and this shortage limits
access to health care for Californians in these communities.
(c) Allowing rural hospitals to directly employ physicians will
allow rural hospitals to provide economic security adequate for a
physician to relocate and reside in the communities served by the
rural hospitals and will help rural hospitals recruit physicians to
provide medically necessary services in these communities and
further enhance technological developments such as the adoption of
electronic medical records .
(d) Allowing rural hospitals to directly employ physicians will
provide physicians with the opportunity to focus on the delivery of
health services to patients without the burden of administrative,
financial, and operational concerns associated with the establishment
and maintenance of a medical office , thereby giving the
physicians a reasonable professional and personal lifestyle .
(e) It is the intent of the Legislature by enacting this act to
authorize establish a demonstration project
authorizing a rural hospital that meets the conditions set
forth in Chapter 6.5 (commencing with Section 124871) of the Health
and Safety Code to be able to employ physicians
directly and to charge for their professional services.
(f) It is the further intent of the Legislature to prevent a rural
hospital that employs a physician from interfering with,
controlling, or otherwise directing the physician's medical judgment
or medical treatment of patients.
SEC. 2. Chapter 6.5 (commencing with Section 124871) is added to
Part 4 of Division 106 of the Health and Safety Code, to read:
CHAPTER 6.5. RURAL HOSPITAL PHYSICIAN AND SURGEON SERVICES
DEMONSTRATION PROJECT
124871. For purposes of this chapter, a rural hospital means all
of the following:
(a) A general acute care hospital located in an area designated as
nonurban by the United States Census Bureau.
(b) A general acute care hospital located in a rural-urban
commuting area code of 4 or greater as designated by the United
States Department of Agriculture.
(c) A rural general acute care hospital, as defined in subdivision
(a) of Section 1250.
124872. (a) Notwithstanding Article 18
(commencing with Section 2400) of Chapter 5 of Division 2 of the
Business and Professions Code and in addition to other
applicable laws , a rural hospital may employ a
physician and surgeon one or more physicians and
surgeons, not to exceed 10 physicians and surgeons at one time,
except as provided in subdivision (b), to provide medical
services at the rural hospital or other health facility, as defined
in Section 1250, that the rural hospital owns or operates. The rural
hospital may retain all or part of the income generated by the
physician and surgeon for these medical services
and billed and collected by the rural hospital
, if the physician and surgeon in whose name the charges are
made approves the charges .
(b) The total number of licensees employed by the rural hospital
at one time shall not exceed 10, unless the employment of additional
physicians and surgeons is deemed appropriate by the Medical Board of
California on a case-by-case basis. In making this determination the
board shall take into consideration whether access to care is
improved for the community served by the hospital by increasing the
number of physicians and surgeons employed.
124873. (a) A rural hospital that employs a physician and surgeon
pursuant to Section 124872 shall develop and implement a written
policy to ensure that each employed physician and surgeon exercises
his or her independent medical judgment in providing care to
patients.
(b) Each physician and surgeon employed by a rural hospital
pursuant to Section 124872 shall sign a statement biennially
indicating that the physician and surgeon:
(1) Voluntarily desires to be employed by the hospital.
(2) Will exercise independent medical judgment in all matters
relating to the provision of medical care to his or her patients.
(3) Will report immediately to the Medical Board of California any
action or event that the physician and surgeon reasonably and in
good faith believes constitutes a compromise of his or her
independent medical judgment in providing care to patients in a rural
hospital or other health care facility owned or operated by the
rural hospital.
(c) The signed statement required by subdivision (b) shall be
retained by the rural hospital for a period of at least three years.
A copy of the signed statement shall be submitted by the rural
hospital to the Medical Board of California within 10 working days
after the statement is signed by the physician and surgeon.
(d) A rural hospital shall not interfere in a physician
with, control, or direct a physician's and
surgeon's exercise of his or her independent medical judgment in
providing medical care to patients. If, pursuant to a report to the
Medical Board of California required by paragraph (3) of subdivision
(a), the Medical Board of California believes that a rural hospital
has violated this prohibition, the Medical Board of California shall
refer the matter to the State Department of Public Health, which
shall investigate the matter. If the department believes
concludes that the rural hospital has violated
the prohibition, it shall notify the rural hospital. The rural
hospital shall have 20 working days to respond in writing to the
department's notification, following which the department shall make
a final determination. If the department finds that the rural
hospital violated the prohibition, it shall assess a civil penalty of
five thousand dollars ($5,000) for the first violation and
twenty-five thousand dollars ($25,000) for any subsequent violation
that occurs within three years of the first violation. If no
subsequent violation occurs within three years of the most recent
violation, the next civil penalty, if any, shall be assessed at the
five thousand dollar ($5,000) level. If the rural hospital disputes a
determination by the department regarding a violation of the
prohibition, the rural hospital may request a hearing pursuant to
Section 131071. Penalties, if any, shall be paid when all appeals
have been exhausted and the department's position has been upheld.
(e) Nothing in this chapter shall exempt a rural hospital from a
reporting requirement or affect the authority of the board to take
action against a physician's and surgeon's license.
124874. (a) Not later than January 1, 2019, the board shall
deliver a report to the Legislature regarding the demonstration
project established pursuant to this chapter. The report shall
include an evaluation of the effectiveness of the demonstration
project in improving access to health care in rural and medically
underserved areas and the demonstration project's impact on consumer
protection as it relates to intrusions into the practice of medicine.
(b) This chapter shall remain in effect only until January 1,
2020, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2020, deletes or extends
that date.