BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 946
S
AUTHOR: Committee on Health
B
AMENDED: As Introduced
HEARING DATE: May 4, 2011
9
CONSULTANT:
4
Orr
6
SUBJECT
Public health
SUMMARY
Makes various technical and substantive changes in
provisions of law regarding telemedicine, Emergency Medical
Services funds, food handling, HIV reporting, the Office of
HIPAA Implementation, health insurance, and mental health
services payments.
CHANGES TO EXISTING LAW
Telemedicine existing law:
For the purpose of health practitioner requirements,
community college training programs, health plan
requirements, and medical payments, defines "telemedicine"
to mean the practice of health care delivery, diagnosis,
consultation, treatment, transfer of medical data, and
education using interactive audio, video, or data
communications.
Requires that the Department of Health Care Services (DHCS)
report to the Legislature by January 1, 2008, on the number
and type of services provided and the Medi-Cal payments
made related to the application of store-and-forward
Continued---
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
Page 2
telemedicine.
This bill:
Replaces references to "telemedicine" with "telehealth."
Deletes the reporting requirement.
Emergency Medical Services existing law:
Authorizes counties to establish a Maddy Emergency Medical
Services (EMS) fund and to deposit specified penalties,
forfeitures, and fines into the fund to reimburse
physicians and hospitals for losses from providing
uncompensated emergency care, and for other EMS purposes as
determined by each county.
Requires each county establishing a Maddy EMS fund (Maddy
fund) to report to the Legislature on the implementation
and status of the Maddy fund beginning January 1, 1989 and
on each April 15 thereafter. The report must include the
total amount of fines and forfeitures collected, the total
amount of penalty assessments collected, the total amount
of penalty assessments deposited into the Maddy fund, the
fund balance, and the amount of moneys disbursed under the
program to physicians and surgeons, to hospitals and to
other emergency purposes.
This bill:
Requires county Maddy fund reports to include additional
information on the types of funds received, administrative
costs, fee schedules and methodologies for reimbursing
physicians and hospitals, and contact information for
county personnel involved in administration of the fund, as
specified.
Retail food existing law:
Under the California Retail Food Code (CalCode), provides
for the regulation of health and sanitation standards for
retail food facilities by the California Department of
Public Health (CDPH) and vests local health agencies with
primary responsibility for enforcing this code. Specifies
hand-washing procedures and glove usage guidelines for food
handlers.
This bill:
Specifies that hands must be washed by employees prior to
donning gloves for working with food or replacing gloves
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
Page 3
that were changed or replaced due to specified
circumstances. Prohibits single-use gloves from being
washed.
Provides that an employee with a lesion or wound that is
open or draining is prohibited from handling food.
Specifies precautions that an employee with a cut, sore,
rash, lesion or wound must take when contacting food and
food-contact surfaces.
HIV reporting in existing law:
Requires health care providers and clinical laboratories to
report HIV infection by patient name to the local health
officer, and mandates local health officers to report
unduplicated HIV cases by patient name to CDPH. Existing
regulations mandate the use of CDPH HIV/AIDS Confidential
Case Report form, Adult (CDPH 8641A (05/07)) or Pediatric
(CDPH 8641P (05/07).
This bill:
Authorizes CDPH to develop a form to be used to report
cases of HIV infection to the local health department and
to the department, and allows the form to be implemented
without promulgating new regulations.
Office of HIPAA Implementation existing law:
Establishes the federal Health Insurance Portability and
Accountability Act (HIPAA).
Establishes the Office of HIPAA Implementation within the
California Health and Human Services Agency (CHHSA).
Establishes a director of the Office and requires the
director to establish an advisory committee to obtain
information on statewide HIPAA implementation activities
that must meet at least twice per year. Requires all state
entities subject to HIPAA to complete an assessment by
January 1, 2001 to determine the impact of HIPAA on their
operations.
This bill:
Renames the office the Office of Health Information
Integrity (CalOHII). Deletes a redundant code section that
specifies that the Office be under supervision of a
director appointed by the Secretary of Health and Human
Services Agency. Deletes the outdated requirement to
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
Page 4
complete the assessment. Revises the frequency with which
the advisory committee meets to as needed.
Health insurance coverage existing law:
Licenses and regulates health plans, by the Department of
Managed Health Care (DMHC), and health insurers, by the
California Department of Insurance (CDI).
Prohibits a carrier or solicitor from encouraging or
directing a child or responsible party for a child from
applying for coverage with a carrier because of health
status, claims experience, industry, occupation, or
geographic location, provided that the location is within
the carrier's approved service area. Prohibits a carrier
from entering into a contract, agreement, or arrangement
with a solicitor that provides for or results in payment to
the solicitor for the sale of a health benefit plan that is
varied because of the health status, claims experience,
industry, occupation, or geographic location of the child.
This bill:
Replaces references to "solicitor" with "agent or broker"
or "agent or broker of the carrier" in specified sections
of the Insurance Code.
Corrects drafting errors, grammatical errors, and code
references.
Mental health existing law:
Authorizes the Department of Mental Health (DMH) to approve
negotiated rates and incentive payments for the provision
of Short Doyle/Medi-Cal reimbursable community mental
health services (SD/MC services).
This bill:
Conforms state law to existing federal regulations and
current DMH practice by repealing the authorization to
approve negotiated rates and incentive payments for SD/MC
services.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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BACKGROUND AND DISCUSSION
Telehealth provisions
Telemedicine is currently described in statute as the
practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using
interactive audio, video, or data communications. According
to the California Telemedicine and eHealth Center,
telemedicine generally refers to the provision of clinical
services from a distance, whereas telehealth more commonly
refers to a broader scope of services that includes
telemedicine, but also includes other services that can be
provided remotely using communication technologies. To
reflect this shift in terminology used in common practice,
SB 946 changes references in existing law from
"telemedicine" to "telehealth."
SB 946 also deletes an outdated requirement that DHCS
report to the Legislature on the number and type of
services provided and the Medi-Cal payments made related to
the application of store-and-forward telemedicine.
Store-and-forward telemedicine is technology that allows a
provider or technician at the patient site to capture
diagnostic information such as medical images, video and
audio clips, and transmits the data to a clinician at a
remote site for assessment. These provisions were requested
by the California State Rural Health Association and the
California Primary Care Association.
Emergency Medical Services Fund provisions
Beginning in 1987, the state enacted a series of bills to
compensate physicians and medical facilities for emergency
medical services provided to patients who do not have
health insurance and cannot pay for their medical care. SB
12 (Maddy), Chapter 1240, Statutes of 1987, allows counties
to establish Maddy EMS funds (also known as Maddy funds).
Revenue sources for Maddy funds are penalty assessments on
certain criminal and traffic violations, and a portion of
the fees from people attending traffic violator schools.
Funds from penalty assessments must be used to reimburse
physicians and hospitals for patients who do not make
payment for EMS services and have no third-party or
government source of payment.
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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Counties with Maddy funds are required to report specified
information to the Legislature on the status of their
funds. SB 946 requires county Emergency Medical Services
Fund reports to include additional information in these
reports, including:
Reasons for the lack of deposits, if no moneys were
deposited into the fund;
The amount of funds collected from additional
assessments levied by counties on fines, penalties, or
forfeitures imposed and collected by the courts for
criminal offenses, including violations relating to
the control of alcoholic beverages and violations of
the Vehicle Code;
The amount of money disbursed for actual
administrative costs;
Fee schedules and methodologies for reimbursing
physicians and hospitals;
The amount of moneys available to be disbursed to
hospitals, and the amount of claims submitted by
hospitals, along with the percentage of those claims
that were reimbursed; and
The name and contact information for county
personnel involved in the administration of the fund.
The purpose of these provisions is to provide more
transparency and allow a better understanding of how these
funds are collected and distributed at the local level.
This provision was requested by the California Chapter of
the American College of Emergency Physicians (CAL/ACEP).
Retail Food Code provisions
CalCode was established through SB 144 (Runner), Chapter
23, Statutes of 2006, in order to create uniformity between
California's retail food safety laws and those of other
states, as well as to enhance food safety laws based on the
best available science. CalCode is modeled after the
federal Model Food Code, which is drafted by the United
States Food and Drug Administration and updated every two
years. CalCode is more than 90 percent equivalent to the
Model Food Code in terms of its substantive food safety and
sanitation content.
SB 946 provides clarifying language on hand-washing
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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procedures and glove use when working with food, in order
to ensure consistency with the federal code. SB 946 also
adds provisions outlining precautions an employee with a
cut, sore, rash, lesion or wound must take when contacting
food, and prohibits an employee with an open or draining
wound or lesion from handling food. These provisions were
requested by the California Retail Food Safety Coalition.
HIV reporting provisions
The CDC is expected to release a new HIV/AIDS case report
this year which will necessitate CDPH Office of AIDS
(CDPH/OA) to amend its HIV/AIDS case report form. The form
is used by health care providers, laboratories and local
health officers to report unduplicated HIV cases by name to
the CDPH/OA. CDPH/OA staff then enters the data from these
case report forms into the California HIV/AIDS surveillance
database system provided by the CDC.
Currently CDPH/OA cannot update the department's HIV/AIDS
case report form without amending the California Code of
Regulations (CCR) because the case report form is
incorporated in CCR, Title 17, Section 2641.55. Amending
regulation is a lengthy process and will hamper efficient
HIV/AIDS case reporting and cause delays in the
implementation of CDC HIV/AIDS surveillance guidance. SB
946 authorizes CDPH to make revisions to the HIV/AIDS case
reporting form outside of the regulatory process
Administrative Procedures Act, in order to coordinate with
the new case reporting form being released by the CDC.
Matching the forms will reduce data entry errors and
increase the accuracy of collected HIV/AIDS surveillance
information.
Office of HIPAA Implementation provisions
The California Office of HIPAA Implementation (CalOHI) was
established within CHHSA in 2001. In August 2008, this
office was renamed the California Office of Health
Information Integrity (CalOHII) to reflect the Office's
expanding new role supporting the Health and Human Services
Agency's health information exchange initiatives. SB 946
renames this office in statute, deletes a redundant code
section that specifies that the office be under supervision
of a director appointed by the CHHSA Secretary, and deletes
a past reporting requirement. SB 946 also amends the
frequency the advisory committee to the director of CalOHI
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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must meet from a minimum of twice per year to as needed.
Health insurance coverage provisions
SB 946 corrects a drafting error in last year's AB 2244
(Feuer, Chapter 656, Statutes of 2010). The intent of AB
2244, among other things, was to prohibit the exclusion or
limitation of coverage for children due to any preexisting
condition by individual health insurance plans that are not
grandfathered plans, as specified under the federal health
reform law. The law, as signed last year, mistakenly
omitted the word "not" from this section. Also, AB 2244
specified that individual health insurance plans offered to
a child or on behalf of a child must conform to certain
requirements in state law, as specified. However, one of
the cross-references provided in the bill mistakenly refers
to group health insurance requirements. SB 946 corrects the
reference to have it apply to individual policies.
SB 946 also replaces the term "solicitor" with "agent" to
be consistent with language used in the Insurance Code.
"Solicitor" is a defined term under the Knox-Keene Act
which regulates DMHC plans, but is not a defined term in
the Insurance Code. These provisions were requested by CDI.
Mental health provisions
In 1985, in order to maximize federal funding to
California, DMH began entering into negotiated rate
contracts with county mental health departments (counties)
under the Short-Doyle Act (Chapter 989, Statutes of 1968).
In Fiscal Year 1993-94, the same year DMH began contracting
with mental health plans for SD/MC Services, the California
Department of Health Care Services (DHCS) and DMH amended
the Medicaid State Plan to begin making negotiated rate
incentive payments to counties for the provision of SD/MC
Services. In 2008, CMS published a review that determined
that the state's negotiated rate process was not consistent
with federal regulations. The state receives federal
matching funds based on county certified public
expenditures, and since the incentive payment was not
supported by the true costs of providing services, the
state was drawing down federal funds without appropriate
certified public expenditures.
DMH stopped the practice of providing negotiated rates and
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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incentive payments when the federal government instituted
regulations requiring negotiated rates for community mental
health services to be based on actual costs. SB 946 deletes
language authorizing DMH to approve negotiated rates and
incentive payments for the provision of Short
Doyle/Medi-Cal reimbursable community mental health
services, in order to conform to federal law and to current
practice. These provisions were requested by DMH.
Prior legislation
AB 2244 (Feuer) Chapter 656, Statutes of 2010, prohibits
the exclusion or limitation of coverage for children due to
any preexisting condition, except as specified. Requires
plans and insurers offering coverage in the individual
market to offer coverage for a child subject to specified
requirements.
SB 144 (Runner) Chapter 23, Statutes of 2006, repealed and
reenacted the California Uniform Retail Food Facilities Law
as the California Retail Food Code.
SB 699 (Soto) Chapter 20, Statutes of 2006, required health
care providers and laboratories to report HIV cases by the
patient's name rather than code in order to comply with
federal funding requirements.
SB 1665 (Thompson), Chapter 864, Statutes of 1996, enacts
the Telemedicine Development Act of 1996, setting
standards for the use of telemedicine by health care
practitioners and insurers. The bill prohibits health
insurers from requiring face-to-face
contact between a health care provider and patient for
services appropriately provided through telemedicine,
subject to the terms of the contract.
AB 1288 (Bronzon), Chapter 89, Statutes of 1991, enacted a
major realignment of health and mental health programs from
the state to the counties. Among other things, provided
for negotiated rates for services provided under the
Short-Doyle Act.
SB 12 (Maddy), Chapter 1240, Statutes of 1987, authorizes
counties to establish an EMS Fund, to provide reimbursement
to physicians and hospitals for patients who do not make
payments for emergency medical services, and for other
STAFF ANALYSIS OF SENATE BILL 946 (Committee on Health)
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emergency medical services. Among other things, requires
each county that establishes an EMS Fund to report to the
Legislature specified information concerning fines and
assessments collected and deposited into the Fund, provider
payments, and Fund policies and procedures, as specified.
COMMENTS
1. Additional amendment. The California Retail Food Safety
Coalition has requested the committee amend an additional
section of the CalCode, to provide a definition for "hot
dog" to mean "a whole, cured, cooked sausage that is
skinless or stuffed in a casing and that is also known as a
frankfurter, frank, further, wiener, red hot, Vienna,
bologna, garlic bologna, or knockwurst, and that may be
served in a bun or roll."
POSITIONS
Support: None received
Oppose: None received
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