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