BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 946|
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                                 THIRD READING


          Bill No:  SB 946
          Author:   Senate Health Committee 
          Amended:  5/10/11
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  9-0, 5/4/11
          AYES:  Hernandez, Strickland, Alquist, Anderson, Blakeslee, 
            De León, DeSaulnier, Rubio, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8


           SUBJECT  :    Public health

           SOURCE  :     Author


           DIGEST  :    This bill 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.

           ANALYSIS  :    

           Telemedicine  

          Existing law:

          1. For the purpose of health practitioner requirements, 
             community college training programs, health plan 
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             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.

          2. 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 telemedicine.

          This bill:

          1. Replaces references to "telemedicine" with "telehealth." 
               

          2. Deletes the reporting requirement. 

           Emergency Medical Services  

          Existing law:

          1. 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. 

          2. 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, 

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          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 
          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:

          1. Specifies that hands must be washed by employees prior 
             to donning gloves for working with food or replacing 
             gloves that were changed or replaced due to specified 
             circumstances.  Prohibits single-use gloves from being 
             washed. 

          2. 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  

          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.


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           Office of HIPAA Implementation  

          Existing law:

          1. Establishes the federal Health Insurance Portability and 
             Accountability Act (HIPAA). 

          2. Establishes the Office of HIPAA Implementation within 
             the Health and Human Services Agency (HHSA).  
             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.   Deletes a redundant code section 
          that specifies that the Office be under supervision of a 
          director appointed by the Secretary of HHSA.  Deletes the 
          outdated requirement to complete the assessment.  Revises 
          the frequency with which the advisory committee meets to as 
          needed.

           Health Insurance Coverage  

          Existing law:

          1. Licenses and regulates health plans, by the Department 
             of Managed Health Care (DMHC), and health insurers, by 
             the Department of Insurance (CDI).

          2. 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 

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             geographic location of the child.

          This bill:

          1. Replaces references to "solicitor" with "agent or 
             broker" or "agent or broker of the carrier" in specified 
             sections of the Insurance Code.

          2. Defines "hotdog" 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."

          3. 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. 

           Background  

           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 

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          "telehealth." 

          This bill 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.

          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;


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           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).

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  Yes



          CTW:mw  5/19/11   Senate Floor Analyses 

                       SUPPORT/OPPOSITION:  NONE RECEIVED

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