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 alcoholism or 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 that is licensed under those provisions 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.
begin delete 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.end delete
The bill would also make related findings and declarations.
begin deleteyes end delete.
State-mandated local program: no.
The people of the State of California do enact as follows:
The Legislature hereby finds and declares all of
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 to be protected and to receive modern medical
21treatment for a medical condition.
Section 11834.025 is added to the Health and Safety
23Code, to read:
(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 of 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
P3 1not be limited to, a description of the alcoholism and drug abuse
2recovery or treatment services that a licensed alcoholism or drug
3abuse recovery or treatment facility may provide under state law,
4and a certification by the health care practitioner that the health
5condition or medical or psychiatric history of the applicant does
6not require a level of care that is higher than the level of care that
7may legally be provided by a licensed alcoholism or drug abuse
8recovery or treatment facility.
9(c) On or before January 1, 2017, the department shall adopt
10emergency regulations to implement this section. The regulations
11shall prescribe, among other things, the timeframe within which
12the certification described in subdivision (b) shall be provided to
14(1) (A) The initial adoption of emergency regulations pursuant
15to this section and each readoption of emergency regulations shall
16be deemed an emergency and necessary for the immediate
17preservation of the public peace, health, safety, or general welfare.
18Initial emergency regulations and any readoption of emergency
19regulations authorized by this section shall be exempt from review
20by the Office of Administrative Law. The initial emergency
21regulations and each readoption of emergency regulations
22authorized by this section shall be submitted to the Office of
23Administrative Law for filing with the Secretary of State and
24publication in the California Code of Regulations and each shall
25remain in effect only until the earlier of 180 days following the
26effective date of the emergency regulations or the effective date
27of final regulations adopted by the department.
28(B) The department shall adopt final regulations on or before
29July 1, 2017. The final regulations shall be adopted in accordance
30with the Administrative Procedure Act (Chapter 3.5 (commencing
31with Section 11340) of Part 1 of Division 3 of Title 2 of the
33(2) Notwithstanding the rulemaking provisions of the
34Administrative Procedure Act, the department may, if it deems
35appropriate, implement, interpret, or make specific this section by
36means of provider bulletins, written guidelines, or similar
37instructions from the department only until the department adopts
Section 11834.026 is added to the Health and Safety
40Code, to read:
(a) As used in this section, “incidental medical
2services” means services, as specified by the department in
3regulations, to address physical and mental health issues associated
4with either detoxification from alcohol or drugs or the provision
5of alcoholism or drug abuse recovery or treatment services, that
6in the opinion of a physician are not required to be performed in
7a licensed clinic or licensed health facility, as defined in Section
81200 or 1250, respectively.
9(b) Notwithstanding any other law, a licensed alcoholism or
10drug abuse recovery or treatment facility may permit incidental
11medical services to be provided to a resident at the facility premises
12by one or more independent physicians and surgeons licensed by
13the Medical Board of California or the Osteopathic Medical Board
14who are knowledgeable about addiction medicine, or one or more
15other health care practitioners acting within the scope of practice
16of his or her license and under the direction of a physician and
17surgeon, and who are also knowledgeable about addiction
18medicine, when all of the following conditions are met:
19(1) The facility, in the judgment of the department, has the
20ability to comply with the requirements of this chapter and all other
21applicable laws and regulations to meet the needs of a resident
22receiving incidental medical services from a physician pursuant
23to this chapter. The department shall specify in regulations the
24minimum requirements that a facility shall meet in order to be
25approved to permit the provision of incidental medical services
26on its premises. The license of a facility approved to provide
27incidental medical services shall reflect that those services are
28permitted to be provided at the facility premises.
29(2) The physician and surgeon and any other health care
30practitioner has signed an acknowledgment on a form provided
31by the department that he or she has been advised of and
32understands the statutory and regulatory limitations on the services
33that may legally be provided by a licensed alcoholism or drug
34abuse recovery or treatment facility, and the statutory and
35regulatory requirements and limitations for the physician and
36surgeon or other health care protection and for the facility, related
37to providing incidental medical services. The licensee shall
38maintain a copy of the signed form at the facility for a physician
39and surgeon or other health care practitioner providing incidental
40medical services at the facility premises.
P5 1(3) There is an agreed-upon written protocol between the
2physician and surgeon and the alcoholism or drug abuse recovery
3or treatment facility signed by the physician and surgeon and the
4licensee. The protocol shall address, at a minimum, the respective
5areas of responsibility of the physician and surgeon and the facility
6and the need for communicating and sharing resident information
7related to the physician and surgeon providing incidental medical
8services. The department shall specify by regulations the issues
9that shall be addressed and the information that shall be included
10in the protocol. The facility shall maintain a copy of the signed
11protocol at the facility.
facility in its admissions agreement with a client shall
13clearly identify the individual financially responsible for incidental
14medical services provided and the manner in which those services
15shall be billed.
16(5) There is ongoing communication between the physician and
17the alcoholism or drug abuse recovery or treatment facility about
18the services provided to the resident by the physician and surgeon
19and the frequency and duration of incidental medical services to
20be provided. Resident information shall be shared between the
21physician and surgeon and the alcoholism or drug abuse recovery
22or treatment facility regarding the resident's need for incidental
23medical services and the services to be provided to the resident by
24the physician and surgeon, including, but not limited to, medical
25information, as defined by the Confidentiality of Medical
26Information Act (Part 2.6 (commencing with Section 56) of
27Division 1 of the Civil Code). The department shall specify by
28regulations any other requirements or limitations on these
30(6) There is initial and ongoing communication between the
31physician and surgeon or other health care practitioner and the
32resident’s health plan or health insurer prior to the provision of
33incidental medical services, to the extent allowable by state and
34federal privacy and confidentiality laws, to ensure coordination of
36(7) The facility does not provide incidental medical services
37and does not assist with or interfere with the physician and surgeon
38or other health care practitioner providing incidental medical
P6 1(8) In addition to any other medical authorization that may be
2required before a facility resident receives incidental medical
3services, the resident is authorized by the physician and surgeon
4as medically appropriate to receive the incidental medical services
5at the premises of the licensed facility. A copy of the authorization,
6on a form provided by the department, shall be signed by the
7physician and surgeon and maintained in the resident’s file at the
9(9) Before a facility resident receives incidental medical
10services, the resident has signed an acknowledgment and consent
11to receive those services on a form provided by the department.
12The form, at a minimum, shall describe the incidental medical
13services that the facility may permit to be provided and shall state
14that the permitted incidental medical services will be provided by
15a physician and surgeon or other health care practitioner working
16under the direction of the physician and surgeon and not by the
17facility staff. The department shall specify in regulations, at a
18minimum, the content and manner of providing the form, and any
19other information that the department deems appropriate. The
20facility shall maintain a copy of the signed acknowledgment and
21consent in the resident’s file.
22(10) Once incidental medical services are initiated for a resident,
23the physician and surgeon and facility shall continuously monitor
24the resident to ensure that the resident remains appropriate to
25receive those services. If the physician and surgeon determines
26that a change in the resident’s medical or psychiatric condition
27requires other medical or psychiatric services or that a higher level
28of care is required than the facility may legally provide, the
29physician and surgeon shall immediately notify the licensee and
30shall assist the licensee to initiate emergency care, urgent care, or
31other higher level of care, as appropriate. If the licensee believes
32that a resident requires a higher level of care than the facility can
33legally provide, the licensee shall immediately notify the physician
34and surgeon and the department. The department shall specify by
35regulations any other requirements or limitations pertaining to
36changes in condition of a resident who is receiving incidental
37medical services, and any other requirements the department deems
P7 1(11) The facility maintains in its files a copy of the physician
2and surgeon’s license or other written evidence of licensure to
3practice medicine in the state.
4(12) The physician and surgeon and the facility both maintain
5compliance with the department’s regulations relating to providing
6incidental medical services.
7(c) The facility shall report to the department in a timely manner
8any violation or suspected violation by the physician and surgeon
9of the regulations relating to providing incidental medical services
10or the signed protocol described in paragraph (3) of subdivision
11(b). The department shall specify in regulations, at a minimum,
12the steps required to be taken when the department substantiates
13that information provided by the licensee.
14(d) This section does not require a facility to provide incidental
15medical services or any services beyond those permitted by this
17(e) The department shall not evaluate or have any responsibility
18or liability with respect to evaluating incidental medical services
19provided. This section does not limit the department’s ability to
20report suspected misconduct by a physician and surgeon or other
21health care practitioner to the appropriate licensing entity or to law
23(f) A facility licensed and approved by the department to allow
24provision of incidental medical services shall not by offering
25approved incidental medical services be considered a clinic or
26health facility within the meaning of Section 1200 or 1250,
28(g) Other than incidental medical services provided, minor first
29aid, or in the case of a life threatening emergency, this section does
30not authorize the provision at the premises of the facility of any
31medical or health care services or any other services that require
32 a higher level of care than the care that may be provided within a
33licensed alcoholism or drug abuse recovery or treatment facility.
34(h) The department shall promulgate regulations to implement
36(1) The department shall adopt emergency regulations on or
37before January 1, 2017. Prior to adoption of emergency regulations,
38the department shall seek appropriate technical assistance from
39stakeholders and shall allow interested stakeholders to provide
40comments through any means the department deems appropriate.
P8 1(2) (A) The initial adoption of emergency regulations pursuant
2to this section and each readoption of emergency regulations shall
3be deemed an emergency and necessary for the immediate
4preservation of the public peace, health, safety, or general welfare.
5Initial emergency regulations and each readoption of emergency
6regulations authorized by this section shall be exempt from review
7by the Office of Administrative Law. The initial emergency
8regulations and each readoption of emergency regulations
9authorized by this section shall be submitted to the Office of
10Administrative Law for filing with the Secretary of State and
11publication in the California Code of Regulations and each shall
12remain in effect only until the earlier of 180 days following the
13effective date of the emergency regulations or the effective date
14of final regulations adopted by the department.
15(B) On or before July 1, 2017, the department shall adopt final
16regulations in accordance with the Administrative Procedure Act
17(Chapter 3.5 (commencing with Section 11340) of Part 1 of
18Division 3 of Title 2 of the Government Code).
19(3) Notwithstanding the rulemaking provisions of the
20 Administrative Procedure Act, the department may, if it deems
21appropriate, implement, interpret, or make specific this section by
22means of provider bulletins, written guidelines, or similar
23instructions from the department until emergency regulations are
Section 11834.03 of the Health and Safety Code is
26amended to read:
(a) A person or entity applying for licensure shall
28file with the department, on forms provided by the department, all
29of the following:
30(1) A completed written application for licensure.
31(2) A fire clearance approved by the State Fire Marshal or local
32fire enforcement officer.
33(3) A licensure fee, established in accordance with Chapter 7.3
34(commencing with Section 11833.01).
35(b) If an applicant intends to permit services pursuant to Section
3611834.026, the applicant shall submit a copy of the written
37protocol, evidence of a valid license of the physician and surgeon
38who will provide those services, and any other information the
39department deems appropriate, including, but not limited to, a copy
P9 1of the alcoholism or drug abuse recovery or treatment facility’s
2accreditation by a nationally recognized accrediting organization.
3(c) The department may establish an additional licensure fee
4for an application that includes a request to provide detoxification
5services or services pursuant to Section 11834.026.
Section 11834.05 is added to the Health and Safety
7Code, to read:
(a) The department shall conduct an evaluation of
9the program licensing those alcoholism or drug abuse recovery or
10treatment facilities identified in Section 11834.026. On or before
11January 1, 2019, the department shall submit a report on that
12evaluation to the appropriate policy and fiscal committees of the
14(b) This section shall remain in effect only until January 1, 2020,
15and as of that date is repealed, unless a later enacted statute, that
16is enacted before January 1, 2020, deletes or extends that date.
Section 11834.36 of the Health and Safety Code is
19amended to read:
(a) The director may suspend or revoke any license
21issued under this chapter, or deny an application for licensure, for
22extension of the licensing period, or to modify the terms and
23conditions of a license, upon any of the following grounds and in
24the manner provided in this chapter:
25(1) Violation by the licensee of any provision of this chapter or
26regulations adopted pursuant to this chapter.
27(2) Repeated violation by the licensee of any of the provisions
28of this chapter or regulations adopted pursuant to this chapter.
29(3) Aiding, abetting, or permitting the violation of, or any
30repeated violation of, any of the provisions described in paragraph
31(1) or (2).
32(4) Conduct in the operation of an alcoholism or drug abuse
33recovery or treatment facility that is inimical to the health, morals,
34welfare, or safety of either an individual in, or receiving services
35from, the facility or to the people of the State of California.
36(5) Misrepresentation of any material fact in obtaining the
37alcoholism or drug abuse recovery or treatment facility license,
38including, but not limited to, providing false information or
39documentation to the department.
P10 1(6) The licensee’s refusal to allow the department entry into the
2facility to determine compliance with the requirements of this
3chapter or regulations adopted pursuant to this chapter.
4(7) Violation by the licensee of Section 11834.026 or the
5regulations adopted pursuant to that section.
6(8) Failure to pay any civil penalties assessed by the department.
7(b) The director may temporarily suspend any license prior to
8any hearing when, in the opinion of the director, the action is
9necessary to protect residents of the alcoholism or drug abuse
10recovery or treatment facility from physical or mental abuse,
11abandonment, or any other substantial threat to health or safety.
12The director shall notify the licensee of the temporary suspension
13and the effective date of the temporary suspension and at the same
14time shall serve the provider with an accusation. Upon receipt of
15a notice of defense to the accusation by the licensee, the director
16shall, within 15 days, set the matter for hearing, and the hearing
17shall be held as soon as possible. The temporary suspension shall
18remain in effect until the time the hearing is completed and the
19director has made a final determination on the merits. However,
20the temporary suspension shall be deemed vacated if the director
21fails to make a final determination on the merits within 30 days
22after the department receives the proposed decision from the Office
23of Administrative Hearings.