California Legislature—2015–16 Regular Session

Assembly BillNo. 848


Introduced by Assembly Member Mark Stone

February 26, 2015


An act to amend Sections 11834.03 and 11834.36 of, to add Sections 11834.025 and 11834.026 to, and to add and repeal Section 11834.05 of, the Health and Safety Code, relating to alcohol and drug treatment programs.

LEGISLATIVE COUNSEL’S DIGEST

AB 848, as introduced, Mark Stone. Alcoholism and drug abuse treatment facilities.

Existing law requires the State Department of Health Care Services to license adult alcoholism and drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.

This bill would authorize a facility to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to conduct an evaluation of that program, and, on or before January 1, 2019, to report that evaluation to the appropriate fiscal and policy committees of the Legislature. The bill would also make related findings and declarations.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

The Legislature hereby finds and declares all of
2the following:

3(a) Substance abuse is a medical condition requiring
4interdisciplinary treatment including, when medically necessary,
5treatment by a licensed physician and surgeon.

6(b) Subsequent to the enactment of state law licensing and
7regulating residential facilities providing alcohol and other drug
8detoxification treatment, public knowledge of addiction and
9treatment has advanced significantly.

10(c) Lack of scientific understanding at the time of enactment of
11those state laws prevents the State Department of Health Care
12Services from licensing a residential treatment facility that uses a
13California-licensed physician and surgeon to provide necessary
14evaluation and treatment at the facility premises.

15(d) This prohibition has been found to endanger persons in
16treatment, can result in treatment below the recognized standard
17of care, jeopardizes patient health, and delays patient recovery.

18(e) To resolve this problem, it is the intent of the Legislature to
19enact this act in order to modernize and update state law and allow
20those in treatment be protected and to receive modern medical
21treatment for a medical condition.

22

SEC. 2.  

Section 11834.025 is added to the Health and Safety
23Code
, to read:

24

11834.025.  

(a) (1) As a condition of providing alcoholism or
25drug abuse recovery or treatment services under this chapter at a
26facility licensed by the department, the facility shall obtain from
27an applicant for services a signed certification described in
28subdivision (b) from a health care practitioner.

29(2) For purposes of this chapter, “health care practitioner” means
30a person duly licensed and regulated under Division 2
31(commencing with Section 500) of the Business and Professions
32Code, who is acting within the scope of practice his or her license
33or certificate.

34(b) The department shall develop a standard certification form
35for use by a health care practitioner. The form shall include, but
36not be limited to, a description of the alcoholism and drug abuse
37recovery or treatment services that a licensed alcoholism or drug
38abuse recovery or treatment facility may provide under state law,
P3    1and a certification by the health care practitioner that the health
2condition or medical or psychiatric history of the applicant does
3not require a level of care that is higher than the level of care that
4may legally be provided by a licensed alcoholism or drug abuse
5recovery or treatment facility.

6(c) On or before January 1, 2017, the department shall adopt
7emergency regulations to implement this section. The regulations
8shall prescribe, among other things, the timeframe within which
9the certification described in subdivision (b) shall be provided to
10a facility.

11(1) (A) The initial adoption of emergency regulations pursuant
12to this section and each readoption of emergency regulations shall
13be deemed an emergency and necessary for the immediate
14preservation of the public peace, health, safety, or general welfare.
15Initial emergency regulations and any readoption of emergency
16regulations authorized by this section shall be exempt from review
17by the Office of Administrative Law. The initial emergency
18regulations and each readoption of emergency regulations
19authorized by this section shall be submitted to the Office of
20Administrative Law for filing with the Secretary of State and
21publication in the California Code of Regulations and each shall
22remain in effect only until the earlier of 180 days following the
23effective date of the emergency regulations or the effective date
24of final regulations adopted by the department.

25(B) The department shall adopt final regulations on or before
26July 1, 2016. The final regulations shall be adopted in accordance
27with the Administrative Procedure Act (Chapter 3.5 (commencing
28with Section 11340) of Part 1 of Division 3 of Title 2 of the
29Government Code).

30(2) Notwithstanding the rulemaking provisions of the
31Administrative Procedure Act, the department may, if it deems
32appropriate, implement, interpret, or make specific this section by
33means of provider bulletins, written guidelines, or similar
34instructions from the department only until the department adopts
35emergency regulations.

36

SEC. 3.  

Section 11834.026 is added to the Health and Safety
37Code
, to read:

38

11834.026.  

(a) As used in this section, “incidental medical
39services” means services, as specified by the department in
40regulations, to address physical and mental health issues associated
P4    1with either detoxification from alcohol or drugs or the provision
2of alcoholism or drug abuse recovery or treatment services, that
3in the opinion of a physician are not required to be performed in
4a licensed clinic or licensed health facility, as defined in Section
51200 or 1250, respectively.

6(b) Notwithstanding any other law, a licensed alcoholism or
7drug abuse recovery or treatment facility may permit incidental
8medical services to be provided to a resident at the facility premises
9by one or more independent physicians and surgeons licensed by
10the Medical Board of California or the Osteopathic Medical Board
11who are knowledgeable about addiction medicine, or one or more
12other health care practitioner acting within the scope of practice
13of his or her license and under the direction of a physician and
14surgeon, and also knowledgeable about addiction medicine, when
15all of the following conditions are met:

16(1) The facility, in the judgment of the department, has the
17ability to comply with the requirements of this chapter and all other
18applicable laws and regulations to meet the needs of a resident
19receiving incidental medical services from a physician pursuant
20to this chapter. The department shall specify in regulations the
21minimum requirements that a facility shall meet in order to be
22approved to permit the provision of incidental medical services
23on its premises. The license of a facility approved to provide
24incidental medical services shall reflect that those services are
25permitted to be provided at the facility premises.

26(2) The physician and surgeon and any other health care
27practitioner has signed an acknowledgment on a form provided
28by the department that he or she has been advised of and
29understands the statutory and regulatory limitations on the services
30that may legally be provided by licensed alcoholism or drug abuse
31recovery or treatment facility, and the statutory and regulatory
32requirements and limitations for the physician and surgeon or other
33health care protection and for the facility, related to providing
34incidental medical services. The licensee shall maintain a copy of
35the signed form at the facility for a physician and surgeon or other
36health care practitioner providing incidental medical services at
37the facility premises.

38(3) There is an agreed-upon written protocol between the
39physician and surgeon and the alcoholism or drug abuse recovery
40or treatment facility signed by the physician and surgeon and the
P5    1licensee. The protocol shall address, at a minimum, the respective
2areas of responsibility of the physician and surgeon and the facility
3and the need for communication and sharing resident information
4related to the physician and surgeon providing incidental medical
5services. The department shall specify by regulations the issues
6that shall be addressed and the information that shall be included
7in the protocol. The facility shall maintain a copy of the signed
8protocol at the facility.

9(4) The facility in its admissions agreement with a client shall
10clearly identify the individual financially responsible for incidental
11medical services provided and the manner in which those services
12shall be billed.

13(5) There is ongoing communication between the physician and
14the alcoholism or drug abuse recovery or treatment facility about
15the services provided to the resident by the physician and surgeon
16and the frequency and duration of incidental medical services to
17be provided. Resident information shall be shared between the
18physician and surgeon and the alcoholism or drug abuse recovery
19or treatment facility regarding the resident's need for incidental
20medical services and the services to be provided to the resident by
21the physician and surgeon, including, but not limited to, medical
22information, as defined by the Confidentiality of Medical
23Information Act (Part 2.6 (commencing with Section 56) of
24Division 1 of the Civil Code). The department shall specify by
25regulations any other requirements or limitations on these
26communications.

27(6) There is initial and ongoing communication between the
28physician and surgeon or other health care practitioner and the
29resident’s health plan or health insurer prior to the provision of
30incidental medical services, to the extent allowable by state and
31federal privacy and confidentiality laws, to ensure coordination of
32care.

33(7) The facility does not provide incidental medical services
34and does not assist with or interfere with the physician and surgeon
35or other health care practitioner providing incidental medical
36services.

37(8) In addition to any other medical authorization that may be
38required before a facility resident receives incidental medical
39services, the resident is authorized by the physician and surgeon
40as medically appropriate to receive the incidental medical services
P6    1at the premises of the licensed facility. A copy of the authorization,
2on a form provided by the department, shall be signed by the
3physician and maintained in the resident’s file at the facility.

4(9) Before a facility resident receives incidental medical
5services, the resident has signed an acknowledgment and consent
6to receive those services on a form provided by the department.
7The form, at a minimum, shall describe the incidental medical
8services that the facility may permit to be provided and shall state
9that the permitted incidental medical services will be provided by
10a physician and surgeon or other health care practitioner working
11under the direction of the physician and surgeon and not by the
12facility staff. The department shall specify in regulations, at a
13minimum, the content and manner of providing the form, and any
14other information that the department deems appropriate. The
15facility shall maintain a copy of the signed acknowledgment and
16consent in the resident’s file.

17(10) Once incidental medical services are initiated for a resident,
18the physician and surgeon and facility shall continuously monitor
19the resident to ensure that the resident remains appropriate to
20receive those services. If the physician and surgeon determines
21that a change in the resident’s medical or psychiatric condition
22requires other medical or psychiatric services or that a higher level
23of care is required than the facility may legally provide, the
24physician and surgeon shall immediately notify the licensee and
25shall assist the licensee to initiate emergency care, urgent care, or
26other higher level of care, as appropriate. If the licensee believes
27that a resident requires a higher level of care than the facility can
28legally provide, the licensee shall immediately notify the physician
29and surgeon and the department. The department shall specify by
30regulations any other requirements or limitations pertaining to
31changes in condition of a resident who is receiving incidental
32medical services, and any other requirements the department deems
33appropriate.

34(11) The facility maintains in its files a copy of the physician
35and surgeon’s license or other written evidence of licensure to
36practice medicine in the state.

37(12) The physician and surgeon and the facility both maintain
38compliance with the department’s regulations relating to providing
39incidental medical services.

P7    1(c) The facility shall timely report to the department any
2violation or suspected violation by the physician and surgeon of
3the regulations relating to providing incidental medical services
4or the signed protocol described in paragraph (3) of subdivision
5(b). The department shall specify in regulations, at a minimum,
6the steps required to be taken when the department substantiates
7that information provided by the licensee.

8(d) This section does not require a facility to provide incidental
9medical services or any services beyond those permitted by this
10chapter.

11(e) The department shall not evaluate or have any responsibility
12or liability with respect to evaluating incidental medical services
13provided. This section does not limit the department’s ability to
14report suspected misconduct by a physician and surgeon or other
15health care practitioner to the appropriate licensing entity or to law
16enforcement.

17(f) A facility licensed and approved by the department to allow
18provision of incidental medical services shall not by offering
19approved incidental medical services be considered a clinic or
20health facility within the meaning of Section 1200 or 1250,
21respectively.

22(g) Other than incidental medical services provided, minor first
23aid, or in the case of a life threatening emergency, this section does
24not authorize the provision at the premises of the facility of any
25medical or health care services or any other services that require
26 a higher level of care than the care that may be provided within a
27licensed alcoholism or drug abuse recovery or treatment facility.

28(h) The department shall promulgate regulations to implement
29this section.

30(1) The department shall adopt emergency regulations on or
31before January 1, 2017. Prior to adoption of emergency regulations,
32the department shall seek appropriate technical assistance from
33stakeholders and shall allow interested stakeholders to provide
34comments through any means the department deems appropriate.

35(2) (A) The initial adoption of emergency regulations pursuant
36to this section and each readoption of emergency regulations shall
37be deemed an emergency and necessary for the immediate
38preservation of the public peace, health, safety, or general welfare.
39Initial emergency regulations and each readoption of emergency
40regulations authorized by this section shall be exempt from review
P8    1by the Office of Administrative Law. The initial emergency
2regulations and each readoption of emergency regulations
3authorized by this section shall be submitted to the Office of
4Administrative Law for filing with the Secretary of State and
5publication in the California Code of Regulations and each shall
6remain in effect only until the earlier of 180 days following the
7effective date of the emergency regulations or the effective date
8of final regulations adopted by the department.

9(B) On or before July 1, 2017, the department shall adopt final
10regulations in accordance with the Administrative Procedure Act
11(Chapter 3.5 (commencing with Section 11340) of Part 1 of
12Division 3 of Title 2 of the Government Code).

13(3) Notwithstanding the rulemaking provisions of the
14 Administrative Procedure Act, the department may, if it deems
15appropriate, implement, interpret, or make specific this section by
16means of provider bulletins, written guidelines, or similar
17instructions from the department until emergency regulations are
18adopted.

19

SEC. 4.  

Section 11834.03 of the Health and Safety Code is
20amended to read:

21

11834.03.  

begin deleteAny end deletebegin insert(a)end insertbegin insertend insertbegin insertA end insertperson or entity applying for licensure
22shall file with the department, on forms provided by the
23department, all of the following:

begin delete

24(a)

end delete

25begin insert(1)end insert A completed written application for licensure.

begin delete

26(b)

end delete

27begin insert(2)end insert A fire clearance approved by the State Fire Marshal or local
28fire enforcement officer.

begin delete

29(c)

end delete

30begin insert(3)end insert A licensure fee, established in accordance with Chapter 7.3
31(commencing with Section 11833.01).

begin insert

32(b) If an applicant intends to permit services pursuant to Section
3311834.026, the applicant shall submit a copy of the written
34protocol, evidence of a valid license of the physician and surgeon
35who will provide those services, and any other information the
36department deems appropriate, including, but not limited to, a
37copy of the alcoholism or drug abuse recovery or treatment
38facility’s accreditation by a nationally recognized accrediting
39organization.

end insert
begin insert

P9    1(c) The department may establish an additional licensure fee
2for an application that includes a request to provide detoxification
3services or services pursuant to Section 11834.026.

end insert
4

SEC. 5.  

Section 11834.05 is added to the Health and Safety
5Code
, to read:

6

11834.05.  

(a) The department shall conduct an evaluation of
7the program licensing those alcoholism or drug abuse recovery or
8treatment facilities identified Section 11834.026. On or before
9January 1, 2019, the department shall submit a report on that
10evaluation to the appropriate policy and fiscal committees of the
11Legislature.

12(b) This section shall remain in effect only until January 1, 2020,
13and as of that date is repealed, unless a later enacted statute, that
14is enacted before January 1, 2020, deletes or extends that date.

15

SEC. 6.  

Section 11834.36 of the Health and Safety Code is
16amended to read:

17

11834.36.  

(a) The director may suspend or revoke any license
18issued under this chapter, or deny an application for licensure, for
19extension of the licensing period, or to modify the terms and
20conditions of a license, upon any of the following grounds and in
21the manner provided in this chapter:

22(1) Violation by the licensee of any provision of this chapter or
23regulations adopted pursuant to this chapter.

24(2) Repeated violation by the licensee of any of the provisions
25of this chapter or regulations adopted pursuant to this chapter.

26(3) Aiding, abetting, or permitting the violation of, or any
27repeated violation of, any of the provisions described in paragraph
28(1) or (2).

29(4) Conduct in the operation of an alcoholism or drug abuse
30recovery or treatment facility that is inimical to the health, morals,
31welfare, or safety of either an individual in, or receiving services
32from, the facility or to the people of the State of California.

33(5) Misrepresentation of any material fact in obtaining the
34alcoholism or drug abuse recovery or treatment facilitybegin delete license.end delete
35begin insert license, including, but not limited to, providing false information
36or documentation to the department.end insert

begin insert

37(6) The licensee’s refusal to allow the department entry into the
38facility to determine compliance with the requirements of this
39chapter or regulations adopted pursuant to this chapter.

end insert
begin insert

P10   1(7) Violation by the licensee of Section 11834.026 or the
2regulations adopted pursuant to that section.

end insert
begin delete

3(6)

end delete

4begin insert(8)end insert Failure to pay any civil penalties assessed by the department.

5(b) The director may temporarily suspend any license prior to
6any hearing when, in the opinion of the director, the action is
7necessary to protect residents of the alcoholism or drug abuse
8recovery or treatment facility from physical or mental abuse,
9abandonment, or any other substantial threat to health or safety.
10The director shall notify the licensee of the temporary suspension
11and the effective date of the temporary suspension and at the same
12time shall serve the provider with an accusation. Upon receipt of
13a notice of defense to the accusation by the licensee, the director
14shall, within 15 days, set the matter for hearing, and the hearing
15shall be held as soon as possible. The temporary suspension shall
16remain in effect until the time the hearing is completed and the
17director has made a final determination on the merits. However,
18the temporary suspension shall be deemed vacated if the director
19fails to make a final determination on the merits within 30 days
20after the department receives the proposed decision from the Office
21of Administrative Hearings.



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