BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 503|
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THIRD READING
Bill No: AB 503
Author: Rodriguez (D)
Amended: 7/7/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/1/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE JUDICIARY COMMITTEE: 7-0, 7/14/15
AYES: Jackson, Moorlach, Anderson, Hertzberg, Leno, Monning,
Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 78-0, 4/23/15 - See last page for vote
SUBJECT: Emergency medical services
SOURCE: California Hospital Association
DIGEST: This bill permits a hospital to release
patient-identifiable medical information to an emergency medical
services provider, to the local emergency medical services
agency, or to the Emergency Medical Services Authority, for
quality assessment and improvement purposes.
ANALYSIS:
Existing law:
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1)Establishes the Emergency Medical Services Authority (EMSA),
which is responsible for the coordination and integration of
all state activities concerning emergency medical services
(EMS), including the establishment of minimum standards,
policies, and procedures.
2)Requires EMSA to develop planning and implementation
guidelines for EMS systems which address specified components,
including communications, system organization and management,
and data collection and evaluation.
3)Authorizes counties to develop an EMS program and designate a
local emergency medical services agency (LEMSA) responsible
for planning and implementing an EMS system, which includes
day-to-day EMS system operations.
This bill:
1)Permits a general acute care or psychiatric hospital to
release patient-identifiable medical information under the
following circumstances:
a) To an EMS provider, information regarding a patient who
was treated, or transported to the hospital by, that EMS
provider, to the extent that specific data elements are
requested for quality assessment and improvement purposes;
and,
b) To EMSA or to the LEMSA, to the extent that specific
data elements are requested for quality assessment and
improvement purposes.
2)Defines an "EMS provider," for purposes of this bill, as an
organization employing an Emergency Medical Technician-I,
Advanced Emergency Medical Technician, Emergency Medical
Technician-Paramedic, registered nurse, or physician, for the
delivery of emergency medical care to the sick and injured at
the scene of an emergency, during transport, or during an
interfacility transfer.
3)Limits an EMS provider, LEMSA, or EMSA to requesting only
those data elements that are minimally necessary, in
compliance with specified provisions of federal regulations
governing the Health Insurance Portability and Accountability
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Act (HIPAA) Privacy Rule.
4)Permits EMSA to develop minimum standards for the
implementation of data collection for system operation,
patient outcome, and performance quality improvement.
5)States the intent of the Legislature to encourage data sharing
between EMS providers and hospitals in order to improve system
effectiveness, quality of care, and the impact of EMS on death
and disability.
Comments
1)Author's statement. According to the author, pre-hospital EMS
providers, such as ambulance companies, need
patient-identifiable outcome information to evaluate the
effectiveness of their clinical and operational procedures in
order to improve patient care outcomes. Hospitals also rely
on such information to improve their patient safety and
quality outcomes, particularly for emergency service programs
such as trauma, stroke, and heart attacks. HIPAA regulations
permit hospitals to release patient-identifiable medical
information to pre-hospital emergency medical services
providers for quality assessment and improvement purposes
about a patient that the hospital and the pre-hospital
provider have in common. HIPAA regulations also permit
hospitals to release patient-identifiable medical information
to government health care oversight agencies. However, state
law does not explicitly permit such disclosures to EMS
providers. This bill seeks to explicitly permit these EMS
disclosures in state law.
2)HIPAA Privacy Rule. HIPAA was enacted in 1996 in order to
improve portability and continuity of health insurance
coverage, to combat waste, fraud, and abuse in health
insurance and health care delivery, and to simplify the
administration of health insurance, among other purposes.
Title II of HIPAA, and its ensuing implementing regulations,
focused on combatting waste fraud and abuse, as well as
administrative simplification. One of the major set of
provisions of Title II is known as the "Privacy Rule," which
regulates the use and disclosure of "protected health
information" (PHI, which is basically any information
concerning health or health care that can be linked to an
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individual) that is held by "covered entities" (which include
health insurers and medical service providers, among others).
The Privacy Rule governs when covered entities are permitted
to use or disclose PHI, and specifies that a covered entity is
permitted to use or disclose PHI for treatment, payment, or
"health care operations." In the case of disclosure for health
care operations, the entity that receives the information must
be another covered entity that has had a relationship with the
individual who is the subject of the PHI. Health care
operations are defined as, among other activities, "conducting
quality assessment and improvement activities, including
outcomes evaluation and development of clinical guidelines."
3)Confidentiality of Medical Information Act (CMIA). The
California Civil Code contains an extensive body of law on
medical privacy, known as the CMIA. While the HIPAA Privacy
Rule preempts state law where state law is contrary to federal
regulations, the HIPAA Privacy Rule does provide for an
exception to this preemption where state law is more
protective of privacy rights. Under the CMIA, a health care
provider, health plan, or contractor is prohibited from
disclosing medical information without first obtaining an
authorization from the patient, with specified exceptions.
Among the various exceptions in the CMIA that permit the
disclosure of medical information, are the following:
a) Information may be disclosed to providers of health
care, health plans, contractors, or other health care
professionals or facilities for the purposes of diagnosis
or treatment, and this specifically includes, in an
emergency situation, the communication of patient
information between emergency medical personnel at the
scene of an emergency, and emergency medical personnel at a
health facility.
b) Information may be disclosed to organized committees and
agents of professional societies or of medical staffs of
licensed hospitals, licensed health care service plans,
professional standards review organizations, independent
medical review organizations, utilization and quality
control peer review organizations, if these entities are
engaged in reviewing the competence or qualifications of
health care professionals or in reviewing health care
services with respect to medical necessity, level of care,
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or justification of charges.
c) Information may be disclosed to public agencies,
clinical investigators, health care research organizations,
and accredited public or private educational or health care
institutions for bona fide research purposes.
d) Information in the possession of a provider of health
care or health plan may be reviewed by a private or public
body responsible for licensing or accrediting the provider
or health plan, however, no patient-identifying medical
information can be removed from the premises.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified8/18/15)
California Hospital Association (source)
Association of California Healthcare Districts
California Ambulance Association
California Professional Firefighters
Dignity Health
Paramedics Plus
OPPOSITION: (Verified8/18/15)
Emergency Medical Services Administrators Association of
California
ARGUMENTS IN SUPPORT: This bill is sponsored by the
California Hospital Association (CHA), which states that public
policy should permit and encourage quality improvement
activities between providers and hospitals to improve quality
and patient safety and ultimately improve emergency patient
survival rates. CHA states that this bill permits hospitals to
release patient-identifiable medical information to pre-hospital
EMS providers, such as ambulance companies, and the LEMSA, for
quality assessment and patient care improvement purposes. CHA
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states that improved pre-hospital care from continuous quality
improvement initiatives will result in patients needing less
expensive emergency and inpatient care, leading to potential
cost savings. The California Ambulance Association states in
support that obtaining this data would help the patient by
improving the quality of care provided, and that state law does
not explicitly permit these disclosures.
ARGUMENTS IN OPPOSITION: The Emergency Medical Services
Administrators Association of California (EMSAAC) states in
opposition that it is concerned that this bill will actually
limit a LEMSA's access to hospital data. EMSAAC states that
LEMSAs rely extensively on dispatch, prehospital care records,
hospital records, and trauma registries to fulfil their
statutory mandate to evaluate the local EMS system and improve
the speed and effectiveness of prehospital, receiving hospital,
and specialty care center services. According to EMSAAC, if this
bill becomes law, hospitals may choose not to provide LEMSAs
with the hospital patient treatment data needed to effectively
evaluate the EMS system, including critical trauma registry
data.
ASSEMBLY FLOOR: 78-0, 4/23/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner,
Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Campos, Salas
Prepared by:Vince Marchand / HEALTH /
8/19/15 20:39:04
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