Amended in Assembly April 6, 2015

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 amended, Mark Stone. Alcoholism and drug abuse treatment facilities.

Existing law requires the State Department of Health Care Services to license adult alcoholismbegin delete andend deletebegin insert orend insert 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 facilitybegin insert that is licensed under those provisionsend insert 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 treatmentbegin insert toend insert 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 practicebegin insert ofend insert his or her
33license or 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,begin delete 2016end deletebegin insert 2017end insert. The final regulations shall be adopted in
27accordance with the Administrative Procedure Act (Chapter 3.5
28(commencing with Section 11340) of Part 1 of Division 3 of Title
292 of the Government 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 carebegin delete practitionerend deletebegin insert practitionersend insert acting within the scope
13of practice of his or her license and under the direction of a
14physician and surgeon, andbegin insert who areend insert also knowledgeable about
15addiction medicine, when all 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 bybegin insert aend insert licensed alcoholism or drug
31abuse recovery or treatment facility, and the statutory and
32regulatory requirements and limitations for the physician and
33surgeon or other health care protection and for the facility, related
34to providing incidental medical services. The licensee shall
35maintain a copy of the signed form at the facility for a physician
36and surgeon or other health care practitioner providing incidental
37medical services at the 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 forbegin delete communicationend deletebegin insert communicatingend insert and sharing
4resident information related to the physician and surgeon providing
5incidental medical services. The department shall specify by
6regulations the issues that shall be addressed and the information
7that shall be included in the protocol. The facility shall maintain
8a copy of the signed protocol 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
3physicianbegin insert and surgeonend insert and maintained in the resident’s file at the
4facility.

5(9) Before a facility resident receives incidental medical
6services, the resident has signed an acknowledgment and consent
7to receive those services on a form provided by the department.
8The form, at a minimum, shall describe the incidental medical
9services that the facility may permit to be provided and shall state
10that the permitted incidental medical services will be provided by
11a physician and surgeon or other health care practitioner working
12under the direction of the physician and surgeon and not by the
13facility staff. The department shall specify in regulations, at a
14minimum, the content and manner of providing the form, and any
15other information that the department deems appropriate. The
16facility shall maintain a copy of the signed acknowledgment and
17consent in the resident’s file.

18(10) Once incidental medical services are initiated for a resident,
19the physician and surgeon and facility shall continuously monitor
20the resident to ensure that the resident remains appropriate to
21receive those services. If the physician and surgeon determines
22that a change in the resident’s medical or psychiatric condition
23requires other medical or psychiatric services or that a higher level
24of care is required than the facility may legally provide, the
25physician and surgeon shall immediately notify the licensee and
26shall assist the licensee to initiate emergency care, urgent care, or
27other higher level of care, as appropriate. If the licensee believes
28that a resident requires a higher level of care than the facility can
29legally provide, the licensee shall immediately notify the physician
30and surgeon and the department. The department shall specify by
31regulations any other requirements or limitations pertaining to
32changes in condition of a resident who is receiving incidental
33medical services, and any other requirements the department deems
34appropriate.

35(11) The facility maintains in its files a copy of the physician
36and surgeon’s license or other written evidence of licensure to
37practice medicine in the state.

38(12) The physician and surgeon and the facility both maintain
39compliance with the department’s regulations relating to providing
40incidental medical services.

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

(a) A person or entity applying for licensure shall
22file with the department, on forms provided by the department, all
23of the following:

24(1) A completed written application for licensure.

25(2) A fire clearance approved by the State Fire Marshal or local
26fire enforcement officer.

27(3) A licensure fee, established in accordance with Chapter 7.3
28(commencing with Section 11833.01).

29(b) If an applicant intends to permit services pursuant to Section
3011834.026, the applicant shall submit a copy of the written
31protocol, evidence of a valid license of the physician and surgeon
32who will provide those services, and any other information the
33department deems appropriate, including, but not limited to, a copy
34of the alcoholism or drug abuse recovery or treatment facility’s
35accreditation by a nationally recognized accrediting organization.

36(c) The department may establish an additional licensure fee
37for an application that includes a request to provide detoxification
38services or services pursuant to Section 11834.026.

39

SEC. 5.  

Section 11834.05 is added to the Health and Safety
40Code
, to read:

P9    1

11834.05.  

(a) The department shall conduct an evaluation of
2the program licensing those alcoholism or drug abuse recovery or
3treatment facilities identifiedbegin insert inend insert Section 11834.026. On or before
4January 1, 2019, the department shall submit a report on that
5evaluation to the appropriate policy and fiscal committees of the
6Legislature.

7(b) This section shall remain in effect only until January 1, 2020,
8and as of that date is repealed, unless a later enacted statute, that
9is enacted before January 1, 2020, deletes or extends that date.

10

SEC. 6.  

Section 11834.36 of the Health and Safety Code is
11amended to read:

12

11834.36.  

(a) The director may suspend or revoke any license
13issued under this chapter, or deny an application for licensure, for
14extension of the licensing period, or to modify the terms and
15conditions of a license, upon any of the following grounds and in
16the manner provided in this chapter:

17(1) Violation by the licensee of any provision of this chapter or
18regulations adopted pursuant to this chapter.

19(2) Repeated violation by the licensee of any of the provisions
20of this chapter or regulations adopted pursuant to this chapter.

21(3) Aiding, abetting, or permitting the violation of, or any
22repeated violation of, any of the provisions described in paragraph
23(1) or (2).

24(4) Conduct in the operation of an alcoholism or drug abuse
25recovery or treatment facility that is inimical to the health, morals,
26welfare, or safety of either an individual in, or receiving services
27from, the facility or to the people of the State of California.

28(5) Misrepresentation of any material fact in obtaining the
29alcoholism or drug abuse recovery or treatment facility license,
30including, but not limited to, providing false information or
31documentation to the department.

32(6) The licensee’s refusal to allow the department entry into the
33facility to determine compliance with the requirements of this
34chapter or regulations adopted pursuant to this chapter.

35(7) Violation by the licensee of Section 11834.026 or the
36regulations adopted pursuant to that section.

37(8) Failure to pay any civil penalties assessed by the department.

38(b) The director may temporarily suspend any license prior to
39any hearing when, in the opinion of the director, the action is
40necessary to protect residents of the alcoholism or drug abuse
P10   1recovery or treatment facility from physical or mental abuse,
2abandonment, or any other substantial threat to health or safety.
3The director shall notify the licensee of the temporary suspension
4and the effective date of the temporary suspension and at the same
5time shall serve the provider with an accusation. Upon receipt of
6a notice of defense to the accusation by the licensee, the director
7shall, within 15 days, set the matter for hearing, and the hearing
8shall be held as soon as possible. The temporary suspension shall
9remain in effect until the time the hearing is completed and the
10director has made a final determination on the merits. However,
11the temporary suspension shall be deemed vacated if the director
12fails to make a final determination on the merits within 30 days
13after the department receives the proposed decision from the Office
14of Administrative Hearings.



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