Amended in Senate June 18, 2014

Amended in Assembly May 23, 2014

Amended in Assembly May 6, 2014

Amended in Assembly April 8, 2014

Amended in Assembly March 20, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2452

Introduced by Assembly Member Pan

February 21, 2014

An act to amend Sections 4800, 4801, 4802, and 4806 of, and to add Sections 4801.5 and 4807 to, the Probate Code, relating to advance health care directives.

LEGISLATIVE COUNSEL’S DIGEST

AB 2452, as amended, Pan. Advance health care directive registry.

Existing law directs the Secretary of State to establish an Advance Health Care Directive Registry to receive and release specified information from a person who has executed a written advance health care directive. Existing law requires the Secretary of State to charge a fee to each registrant in an amount such that, when all fees charged to registrants are aggregated, the aggregated fees do not exceed the actual cost of establishing and maintaining the registry. Existing law provides that failure to register with the Secretary of State does not affect the validity of an advance health care directive.

This bill would begin delete require, commencing end delete begin insert require the Secretary of State to transfer the contents of its Advance Health Care Directive’s Registry to the State Department of Public Health on January 1, 2016. The bill would require the department to maintain a health care decision registry, to be referred to as the California Health Care Decisions Online Registry, and commencing end insert on January 1, 2016, begin delete the Secretary of State end delete to establish and maintain access, as specified, to a secure portion of the begin delete Secretary of State’s end delete begin insert department’s end insert Internet Web site that provides an electronic reproduction of an advance health care directive and other specified documents submitted to the registry system. The bill would require this access to include the ability to view the electronic reproduction on the Internet Web site, as well as download, print, and otherwise retrieve a copy of the electronic reproduction. The bill would, among other things, require the begin delete secretary end delete begin insert department end insert to establish procedures to register, replace, and remove an advance health care directive, as specified. The bill would require that on or before January 1, 2020, the registry be fully supported by fees charged by the begin delete Secretary of end delete State begin insert Department of Public Health end insert to each registrant. The bill would require the begin delete Secretary of end delete State begin insert Department of Public Health end insert to develop and submit to the Legislature a financial sustainability plan, as specified, on or before January 1, 2018.

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.  

Section 4800 of the Probate Code is amended to
read:

4800.  

(a) (1) The begin delete Secretary of end delete State begin insert Department of Public
Health end insert shall establish a registry system through which a person
who has executed a written advance health care begin delete directive end delete begin insert directive,
physician order for life-sustaining treatment form, a durable power
of attorney document, or any other legally recognized and executed
instrument for conveying a patient’s health care intentions, end insert may
register in a central information begin delete center, end delete begin insert center end insert information
regarding the begin delete advance directive, end delete begin insert health care decision, end insert making that
information available begin insert electronically end insert upon request to any health
care provider, the public guardian, begin delete or end delete the legal representative of
the begin delete registrant. end delete begin insert registrant, or other entity as determined by the State
Department of Public Health. end insert

(2) Commencing on January 1, 2016, the begin delete Secretary of end delete State
begin insert Department of Public Health end insert shall establish and maintain access,
as prescribed by this part, to a secure portion of the begin delete Secretary of
State’s end delete begin insert State Department of Public Health’s end insert Internet Web site that
provides an electronic reproduction of an advance health care
directive and other documents described in subdivision (c)
submitted to the registry system. This access shall include the
ability to view the electronic reproduction on the Internet Web
site, as well as download, print, and otherwise retrieve a copy of
the electronic reproduction.

begin insert

(3) The registry shall be referred to as the California Health
Care Decisions Online Registry or the registry.

end insert begin insert

(4) It is the intent of the Legislature that the department contract
with the Regents of the University of California to develop and
maintain the registry.

end insert begin insert

(5) Funds appropriated to the department for the development
and maintenance of the registry shall be distributed to the Health
System, University of California, Davis.

end insert

(b) Commencing on January 1, 2016, the begin delete Secretary of end delete State
begin insert Department of Public Health end insert shall establish a process to register
an advance health care directive and submit personal information
and documents to the registry either by electronic submission or
submission of paper documents. Commencing on January 1, 2016,
the begin delete Secretary of end delete State begin insert Department of Public Health end insert shall establish
a process to merge documents in the registry prior to January 1,
2016, with the access system established in paragraph (2) of
subdivision (a). This process shall require a person who registers
an advance health care directive or other document described in
paragraph (2) to submit to the Secretary of State all of the
following:

(1) An application in a form prescribed by the begin delete Secretary of end delete State
begin insert Department of Public Health end insert .

(2) A copy or electronic reproduction of any of the following:

(A) The registrant’s advance health care directive.

(B) A values statement, questionnaire, or other document that
supplements the advance health care directive.

(C) Durable power of attorney form.

(D) A physician orders for life-sustaining treatment (POLST)
form.

(E) The intended place of deposit or safekeeping of a written
advance health care directive and any other document described
in this paragraph.

(F) The name and telephone number of the agent and any
alternative agent.

(3) Any fee established by the begin delete Secretary of end delete State begin insert Department
of Public Health end insert pursuant to subdivision (f).

(c) Information that may be received shall be limited to all of
the following regarding the registrant:

(1) Name.

(2) Social security number.

(3) Driver’s license number, or other state-issued individual
identifying number established by law, if any.

(4) Address.

(5) Date and place of birth.

(d) When the begin delete Secretary of end delete State begin insert Department of Public Health end insert
receives the items described in subdivision (b) from a registrant,
the begin delete secretary end delete begin insert department end insert shall do all of the following:

(1) Assign a registration number and password to access the
registry to the registrant.

(2) Issue the registrant an Advance Health Care Directive
Registry registration card indicating that an advance health care
directive, or information regarding an advance health care directive,
has been deposited with the registry. The information on the card
shall include, but not be limited to, the registrant’s name,
registration number, and password to access the registry. Costs
associated with issuance of the card shall be offset by the fee
charged by the begin delete Secretary of end delete State begin insert Department of Public Health end insert to
receive and register information at the registry.

(3) Make or transfer an electronic reproduction of the advance
health care directive and other documents described in paragraph
(2) of subdivision (b) and post it to the registry.

(e) The begin delete Secretary of end delete State begin insert Department of Public Health end insert , at the
request of the registrant or his or her legal representative, shall
transmit the information received regarding the written advance
health care directive to the registry system of another jurisdiction
as identified by the registrant, or his or her legal representative.

(f) The begin delete Secretary of end delete State begin insert Department of Public Health end insert shall
charge a fee to each registrant in an amount such that, when all
fees charged to registrants are aggregated, the aggregated fees do
not exceed the actual cost of establishing and maintaining the
registry. On or before January 1, 2020, the registry shall be fully
supported by fees charged pursuant to this subdivision.

(g) On or before January 1, 2018, the begin delete Secretary of end delete State
begin insert Department of Public Health end insert shall develop and submit to the
Legislature a financial sustainability plan detailing all of the
following:

(1) The amount of revenue generated by the fee charged pursuant
to subdivision (f).

(2) The estimated ongoing costs of maintaining the registry.

(3) The number of participants in the registry and the projected
participation in future years.

(4) A plan for ensuring that the revenue from fees charged
pursuant to subdivision (f) fully support the ongoing costs of
maintaining the registry.

(h) (1) The requirement for submitting a report imposed under
subdivision (g) is inoperative on January 1, 2022, pursuant to
Section 10231.5 of the Government Code.

(2) A report submitted pursuant to subdivision (g) shall be
submitted in compliance with Section 9795 of the Government
Code.

SEC. 2.  

Section 4801 of the Probate Code is amended to read:

4801.  

(a) Notwithstanding any other law, the begin delete Secretary of end delete
State begin insert Department of Public Health end insert shall limit access to the registry,
including a registrant’s advance health care directive, personal
information, and other documents received, to when all of the
following occur:

(1) The assigned registration number and password are provided.

(2) Access to the advance health care directive is required
pursuant to a lawful order of a court of competent jurisdiction,
requested by the registrant or the registrant’s legal representative,
requested by the public guardian, or requested by a provider of
health care to the registrant only for the purpose of providing health
care to the registrant.

(3) The begin delete Secretary of end delete State begin insert Department of Public Health end insert
determines that providing access to the advance health care
directive is in the best interest of the registrant. However, a
registrant or legal representative of the registrant may access the
advance health care directive of the registrant for any purpose.

(b) The begin delete Secretary of end delete State begin insert Department of Public Health end insert shall
establish procedures to verify the identities of health care providers,
the public guardian, and other authorized persons requesting
information pursuant to Section 4800. No fee shall be charged to
any health care provider, the public guardian, or other authorized
person requesting information pursuant to Section 4800.

(c) A request for access pursuant to this part shall state the need
for the information.

(d) The begin delete Secretary of end delete State begin insert Department of Public Health end insert shall
respond by the close of business on the next business day to a
request for information made pursuant to Section 4717 by the
emergency department of a general acute care hospital when the
request is made by means other than through the begin delete Secretary of
State’s end delete begin insert State Department of Public Health’s end insert Internet Web site.

(e) Information that may be released upon request shall not
include the registrant’s social security number except when
necessary to verify the identity of the registrant.

begin insert

(f) The registry and the information it contains shall be the
property of the state and any disclosure of information in the
system shall be made in a manner consistent with the federal
Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191).

end insert begin insert

(g) A health care provider who completes any health care
decision document with a patient or his or her legally recognized
health care decisionmaker shall include the document in the
patient’s official medical record and submit a copy of the document
to the registry unless the patient or the decisionmaker chooses not
to participate in the registry.

end insert begin insert

(h) For the purposes of Section 4740, a health care decision or
advance health care directive obtained from the registry shall
include a physician order for life sustaining treatment form, a
durable power of attorney document, or any other legally
recognized and executed instrument for conveying a patient’s
health care intentions.

end insert

SEC. 3.  

Section 4801.5 is added to the Probate Code, to read:

4801.5.  

The begin delete Secretary of end delete State begin insert Department of Public Health end insert
shall establish procedures for all of the following:

(a) The registration of an advance health care directive or other
document described in Section 4800 that replaces an advance
health care directive or other document that is posted on the
registry.

(b) The removal from the registry of an advance health care
directive or other document described in Section 4800 that has
been revoked following the revocation of the advance health care
directive or other document or the death of the registrant.

(c) The issuance of a duplicate registration card or the provision
of other access to the registrant’s registration number and password
if a registration card issued pursuant to this section is lost, stolen,
destroyed, or otherwise unavailable.

SEC. 4.  

Section 4802 of the Probate Code is amended to read:

4802.  

The begin delete Secretary of end delete State begin insert Department of Public Health end insert shall
establish procedures to advise each registrant of the following:

(a) A health care provider may not honor a written advance
health care directive until it receives a copy from the registrant or
accesses the advance health care directive from the registry.

(b) Each registrant must notify the registry upon revocation of
the advance health care directive.

(c) Each registrant must reregister upon execution of a
subsequent advance health care directive.

SEC. 5.  

Section 4806 of the Probate Code is amended to read:

4806.  

(a) The begin delete Secretary of end delete State begin insert Department of Public Health end insert
shall work with the begin delete State Department of Public Health and the
office end delete begin insert Office end insert of the Attorney General to develop information about
end-of-life care, advance health care directives, and registration
of the advance health care directives at the registry established
pursuant to subdivision (a) of Section 4800. This information shall
be developed utilizing existing information developed by the office
of the Attorney General.

(b) Links to the information specified in subdivision (a) and to
the registry shall be available on the Internet Web sites of the
Secretary of State, the State Department of Public Health, the
Department of Motor Vehicles, the office of the Attorney General,
the Department of Managed Health Care, the Department of
Insurance, the Board of Registered Nursing, and the Medical Board
of California.

SEC. 6.  

Section 4807 is added to the Probate Code, to read:

4807.  

Commencing on January 1, 2016, the begin delete Secretary of end delete State
begin insert Department of Public Health end insert shall, while establishing and
maintaining electronic access to the registry and to the extent
practicable, consult with any entity licensed pursuant to Division
2 (commencing with Section 1200) of the Health and Safety Code,
to integrate a process for retrieving documents and information
stored in the Advance Health Care Directive Registry from a
statewide health information exchange system.

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Commencing on January 1, 2016, the Secretary of
State shall transfer all of the contents of its Advance Health Care
Directive’s Registry to the State Department of Public Health. The
Advance Health Care Directives Registry shall be excluded from
the California Business Connect Project in the Office of the
Secretary of State. end insert