BILL ANALYSIS Ó
AB 614
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CONCURRENCE IN SENATE AMENDMENTS
AB
614 (Brown)
As Amended June 2, 2015
Majority vote
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|ASSEMBLY: | 77-0 | (May 7, 2015) |SENATE: |37-0 | (August 17, |
| | | | | |2015) |
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Original Committee Reference: HEALTH
SUMMARY: Authorizes the California Department of Public Health
(DPH) to use a streamlined administrative process to update
regulatory references to health care standards of practice
adopted by a state or national association when outdated
standards are referenced in the California Code of Regulations
(CCR).
The Senate amendments update the definition of eating disorders
to reference the Diagnostic and Statistical Manual of Mental
Disorders, as published by the American Psychiatric Association.
EXISTING LAW: Establishes DPH to license health facilities and
requires DPH to adopt, amend or repeal, as specified, any
reasonable rules and regulations as may be necessary or proper
to carry out the exercise of its power. Establishes, under the
Administrative Procedures Act (APA), a process for adopting,
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amending, or repealing regulations.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, this bill will eliminate the
need to revise regulations simply to update references to the
most recent standards of practice when applicable. The author
states that this will result in an efficient and cost effective
method for ensuring that health facilities and DPH are
referencing standards and providing care that is consistent with
the most current nationally recognized professional standards,
improving the quality of patient care provided in licensed
health facilities.
The regulatory process, governed by the APA and enforced by the
Office of Administrative Law (OAL) is designed to provide the
public with a meaningful opportunity to participate in the
adoption of regulations or rules that have the force of law and
to ensure the creation of an adequate record for the public,
OAL, and judicial review.
Generally, there are two types of rulemaking procedures that a
state agency can pursue: regular or emergency. The regular
rulemaking process requires that a state agency meet certain
public hearing and notice requirements. The emergency
rulemaking process has different requirements, which generally
include a brief public notice period, a finding of emergency, a
brief public comment period, review by OAL and an OAL decision.
For the regular rulemaking process, once a state agency decides
to conduct a rulemaking action, it develops four documents
required during the preliminary stage: 1) the proposed text; 2)
the Initial Statement of Reasons; 3) the Fiscal Impact
Statement; and, 4) the Notice of Proposed Regulatory Action
(notice).
The APA requires at a minimum a 45-day opportunity to comment to
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the agency, in writing, on the proposed regulation. An agency
has the option as to whether it will hold a public hearing on a
proposed rulemaking action. However, if an agency does not
schedule a public hearing, any interested person can submit a
written request within a specified timeframe requesting one to
be held, and the agency must then give notice and hold a public
hearing.
A rulemaking agency must summarize and respond on the record to
timely comments that are directed at the proposal or at the
procedures followed by the agency during the regulatory action.
With each comment, the agency must either: 1) explain how it
has amended the proposal to accommodate the comment; or, 2)
explain the reasons for making no change to the proposal. The
summary and response to comments is included as part of the
rulemaking file in the Final Statement of Reasons.
According to DPH, their experience is that a relatively simple
regulation packet could move through the process in as few as 15
months to 18 months, regulations pertaining to more complicated
subject matter can sometimes take several years, depending on
the volume of public comments.
Nationally recognized professional organizations use industry
expertise, information gathered through research, patient
outcomes, and best practices to develop standards that are
accepted in various medical professions for providing the
highest quality of care possible. For example, the American
Academy of Pediatrics publishes a wide variety of clinical
practice guidelines on a range of subjects including: The
Diagnosis, Management, and Prevention of Bronchiolitis,
Management of Newly Diagnosed Type 2 Diabetes Mellitus in
Children and Adolescents, and Treatment of the School-Aged Child
With Attention-Deficit/Hyperactivity Disorder, to name a few.
There are approximately 30 references to outdated standards of
practice in CCR Title 22 (which apply to various health
facilities, including clinics, and general acute care
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hospitals), some of which are referenced in more than one place,
and dating as far back as 1961. The American Dietetic
Association standards of practice referenced for educational
programs for dietetic service staff in general acute care
hospitals were adopted in June 1974. DPH is currently in the
process of updating Title 22. Some of the regulatory packets
could be completed later this year, other more complex packets
will take several years to complete, and due to the volume
(Title 22 effects up to 30 different types of health facilities)
DPH estimates that the entire update will not be complete until
sometime in 2025. Currently, health facilities affected by
regulations which reference outdated standards of practice are
requesting program flexibility from DPH to allow them to operate
using more current medical standards.
DPH is the sponsor of this bill and notes they are the
enforcement and regulatory agency for approximately 30 different
types of health care facilities and clinics, and they have a
backlog of regulations that are subject to the APA. DPH
contends that in order to remain compliant with up-to-date
clinical practices instead of being errantly held to antiquated
practices in state regulations, facilities must request program
flexibility from DPH, and this additional step creates hurdles
for health facilities and clinics. DPH concludes that this bill
will eliminate the need to revise regulations simply to update
references to the most recent standards of practice.
There is no known opposition to this bill.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0001201
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