BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 503| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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: AB 503 Page 2 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 AB 503 Page 3 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 AB 503 Page 4 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, AB 503 Page 5 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 AB 503 Page 6 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 **** END **** AB 503 Page 7