Amended in Assembly June 1, 2015

Amended in Assembly May 6, 2015

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, and to add Sections 11834.025 and 11834.026 to, 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 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 authorizebegin delete aend deletebegin insert an adult alcoholism or drug abuse recovery or treatmentend insert 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 insert The bill would require the department to establish and collect an additional fee from those facilities, inend insertbegin insert an amount sufficient to cover the department’s reasonable costs of regulating the provision of those services.end insert The bill would also make related findings and declarations.

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. 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 to 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 of his or her
33license or certificate.

P3    1(b) The department shall develop a standard certification form
2for use by a health care practitioner. The form shall include, but
3not be limited to, a description of the alcoholism and drug abuse
4recovery or treatment services that a licensed alcoholism or drug
5abuse recovery or treatment facility may provide under state law,
6and a certification by the health care practitioner that the health
7condition or medical or psychiatric history of the applicant does
8not require a level of care that is higher than the level of care that
9may legally be provided by a licensed alcoholism or drug abuse
10recovery or treatment facility.

begin delete

11(c) On or before January 1, 2017, the department shall adopt
12emergency regulations to implement this section. The regulations
13shall prescribe, among other things, the timeframe within which
14the certification described in subdivision (b) shall be provided to
15a facility.

16(1) (A) The initial adoption of emergency regulations pursuant
17to this section and each readoption of emergency regulations shall
18be deemed an emergency and necessary for the immediate
19preservation of the public peace, health, safety, or general welfare.
20Initial emergency regulations and any readoption of emergency
21regulations authorized by this section shall be exempt from review
22by the Office of Administrative Law. The initial emergency
23regulations and each readoption of emergency regulations
24authorized by this section shall be submitted to the Office of
25Administrative Law for filing with the Secretary of State and
26publication in the California Code of Regulations and each shall
27remain in effect only until the earlier of 180 days following the
28effective date of the emergency regulations or the effective date
29of final regulations adopted by the department.

30(B)

end delete

31begin insert(end insertbegin insertc)end insertbegin insert(1)end insertbegin insertend insert The department shall adoptbegin delete final regulationsend deletebegin insert regulations,end insert
32 on or before July 1,begin delete 2017.end deletebegin insert 2017, to implement this section.end insert The
33begin delete finalend delete regulations shall be adopted in accordance with the
34Administrative Procedure Act (Chapter 3.5 (commencing with
35Section 11340) of Part 1 of Division 3 of Title 2 of the Government
36Code).

37(2) Notwithstanding the rulemaking provisions of the
38Administrative Procedure Act, the department may, if it deems
39appropriate, implement, interpret, or make specific this section by
40means of provider bulletins, written guidelines, or similar
P4    1instructions from the department only until the department adopts
2begin delete emergencyend delete regulations.

3

SEC. 3.  

Section 11834.026 is added to the Health and Safety
4Code
, to read:

5

11834.026.  

(a) As used in this section, “incidental medical
6services” means services, as specified by the department in
7regulations, to address physical and mental health issues associated
8with either detoxification from alcohol or drugs or the provision
9of alcoholism or drug abuse recovery or treatment services, that
10in the opinion of a physician are not required to be performed in
11a licensed clinic or licensed health facility, as defined in Section
121200 or 1250, respectively.

13(b) Notwithstanding any other law, a licensed alcoholism or
14drug abuse recovery or treatment facility may permit incidental
15medical services to be provided to a resident at the facility premises
16by one or more independent physicians and surgeons licensed by
17the Medical Board of California or the Osteopathic Medical Board
18who are knowledgeable about addiction medicine, or one or more
19other health care practitioners acting within the scope of practice
20of his or her license and under the direction of a physician and
21surgeon, and who are also knowledgeable about addiction
22medicine, when all of the following conditions are met:

23(1) The facility, in the judgment of the department, has the
24ability to comply with the requirements of this chapter and all other
25applicable laws and regulations to meet the needs of a resident
26receiving incidental medical services from a physician pursuant
27to this chapter. The department shall specify in regulations the
28minimum requirements that a facility shall meet in order to be
29approved to permit the provision of incidental medical services
30on its premises. The license of a facility approved to provide
31incidental medical services shall reflect that those services are
32permitted to be provided at the facility premises.

33(2) The physician and surgeon and any other health care
34practitioner has signed an acknowledgment on a form provided
35by the department that he or she has been advised of and
36understands the statutory and regulatory limitations on the services
37that may legally be provided by a licensed alcoholism or drug
38abuse recovery or treatment facility, and the statutory and
39regulatory requirements and limitations for the physician and
40surgeon or other health care protection and for the facility, related
P5    1to providing incidental medical services. The licensee shall
2maintain a copy of the signed form at the facility for a physician
3and surgeon or other health care practitioner providing incidental
4medical services at the facility premises.

5(3) There is an agreed-upon written protocol between the
6physician and surgeon and the alcoholism or drug abuse recovery
7or treatment facility signed by the physician and surgeon and the
8licensee. The protocol shall address, at a minimum, the respective
9areas of responsibility of the physician and surgeon and the facility
10and the need for communicating and sharing resident information
11related to the physician and surgeon providing incidental medical
12services. The department shall specify by regulations the issues
13that shall be addressed and the information that shall be included
14in the protocol. The facility shall maintain a copy of the signed
15protocol at the facility.

16(4) The facility in its admissions agreement with a client shall
17clearly identify the individual financially responsible for incidental
18medical services provided and the manner in which those services
19shall be billed.

20(5) There is ongoing communication between the physician and
21the alcoholism or drug abuse recovery or treatment facility about
22the services provided to the resident by the physician and surgeon
23and the frequency and duration of incidental medical services to
24be provided. Resident information shall be shared between the
25physician and surgeon and the alcoholism or drug abuse recovery
26or treatment facility regarding the resident's need for incidental
27medical services and the services to be provided to the resident by
28the physician and surgeon, including, but not limited to, medical
29information, as defined by the Confidentiality of Medical
30Information Act (Part 2.6 (commencing with Section 56) of
31Division 1 of the Civil Code). The department shall specify by
32regulations any other requirements or limitations on these
33communications.

34(6) There is initial and ongoing communication between the
35physician and surgeon or other health care practitioner and the
36resident’s health plan or health insurer prior to the provision of
37incidental medical services, to the extent allowable by state and
38federal privacy and confidentiality laws, to ensure coordination of
39care.

P6    1(7) The facility does not provide incidental medical services
2and does not assist with or interfere with the physician and surgeon
3or other health care practitioner providing incidental medical
4services.

5(8) In addition to any other medical authorization that may be
6required before a facility resident receives incidental medical
7services, the resident is authorized by the physician and surgeon
8as medically appropriate to receive the incidental medical services
9at the premises of the licensed facility. A copy of the authorization,
10on a form provided by the department, shall be signed by the
11physician and surgeon and maintained in the resident’s file at the
12facility.

13(9) Before a facility resident receives incidental medical
14services, the resident has signed an acknowledgment and consent
15to receive those services on a form provided by the department.
16The form, at a minimum, shall describe the incidental medical
17services that the facility may permit to be provided and shall state
18that the permitted incidental medical services will be provided by
19a physician and surgeon or other health care practitioner working
20under the direction of the physician and surgeon and not by the
21facility staff. The department shall specify in regulations, at a
22minimum, the content and manner of providing the form, and any
23other information that the department deems appropriate. The
24facility shall maintain a copy of the signed acknowledgment and
25consent in the resident’s file.

26(10) Once incidental medical services are initiated for a resident,
27the physician and surgeon and facility shall continuously monitor
28the resident to ensure that the resident remains appropriate to
29receive those services. If the physician and surgeon determines
30that a change in the resident’s medical or psychiatric condition
31requires other medical or psychiatric services or that a higher level
32of care is required than the facility may legally provide, the
33physician and surgeon shall immediately notify the licensee and
34shall assist the licensee to initiate emergency care, urgent care, or
35other higher level of care, as appropriate. If the licensee believes
36that a resident requires a higher level of care than the facility can
37legally provide, the licensee shall immediately notify the physician
38and surgeon and the department. The department shall specify by
39regulations any other requirements or limitations pertaining to
40changes in condition of a resident who is receiving incidental
P7    1medical services, and any other requirements the department deems
2appropriate.

3(11) The facility maintains in its files a copy of the physician
4and surgeon’s license or other written evidence of licensure to
5practice medicine in the state.

6(12) The physician and surgeon and the facility both maintain
7compliance with the department’s regulations relating to providing
8incidental medical services.

9(c) The facility shall report to the department in a timely manner
10any violation or suspected violation by the physician and surgeon
11of the regulations relating to providing incidental medical services
12or the signed protocol described in paragraph (3) of subdivision
13(b). The department shall specify in regulations, at a minimum,
14the steps required to be taken when the department substantiates
15that information provided by the licensee.

16(d) This section does not require a facility to provide incidental
17medical services or any services beyond those permitted by this
18chapter.

19(e) The department shall not evaluate or have any responsibility
20or liability with respect to evaluating incidental medical services
21provided. This section does not limit the department’s ability to
22report suspected misconduct by a physician and surgeon or other
23health care practitioner to the appropriate licensing entity or to law
24enforcement.

25(f) A facility licensed and approved by the department to allow
26provision of incidental medical services shall not by offering
27approved incidental medical services be considered a clinic or
28health facility within the meaning of Section 1200 or 1250,
29respectively.

30(g) Other than incidental medical services provided, minor first
31aid, or in the case of a life threatening emergency, this section does
32not authorize the provision at the premises of the facility of any
33medical or health care services or any other services that require
34 a higher level of care than the care that may be provided within a
35licensed alcoholism or drug abuse recovery or treatment facility.

begin delete

36(h) The department shall promulgate regulations to implement
37this section.

38(1) The department shall adopt emergency regulations on or
39before January 1, 2017. Prior to adoption of emergency regulations,
40the department shall seek appropriate technical assistance from
P8    1stakeholders and shall allow interested stakeholders to provide
2comments through any means the department deems appropriate.

3(2) (A) The initial adoption of emergency regulations pursuant
4to this section and each readoption of emergency regulations shall
5be deemed an emergency and necessary for the immediate
6preservation of the public peace, health, safety, or general welfare.
7Initial emergency regulations and each readoption of emergency
8regulations authorized by this section shall be exempt from review
9by the Office of Administrative Law. The initial emergency
10regulations and each readoption of emergency regulations
11authorized by this section shall be submitted to the Office of
12Administrative Law for filing with the Secretary of State and
13publication in the California Code of Regulations and each shall
14remain in effect only until the earlier of 180 days following the
15effective date of the emergency regulations or the effective date
16of final regulations adopted by the department.

17(B)

end delete

18begin insert(h)end insertbegin insert(1)end insertbegin insertend insert On or before July 1, 2017, the department shall adopt
19begin delete finalend delete regulationsbegin insert to implement this sectionend insert in accordance with the
20Administrative Procedure Act (Chapter 3.5 (commencing with
21Section 11340) of Part 1 of Division 3 of Title 2 of the Government
22Code).

begin delete

23(3)

end delete

24begin insert(2)end insert Notwithstanding the rulemaking provisions of the
25 Administrative Procedure Act, the department may, if it deems
26appropriate, implement, interpret, or make specific this section by
27means of provider bulletins, written guidelines, or similar
28instructions from the department untilbegin delete emergencyend delete regulations are
29adopted.

30

SEC. 4.  

Section 11834.03 of the Health and Safety Code is
31amended to read:

32

11834.03.  

(a) A person or entity applying for licensure shall
33file with the department, on forms provided by the department, all
34of the following:

35(1) A completed written application for licensure.

36(2) A fire clearance approved by the State Fire Marshal or local
37fire enforcement officer.

38(3) A licensure fee, established in accordance with Chapter 7.3
39(commencing with Section 11833.01).

P9    1(b) begin insert(1)end insertbegin insertend insert If an applicant intends to permit services pursuant to
2Section 11834.026, the applicant shall submit a copy of the written
3protocol, evidence of a valid license of the physician and surgeon
4who will provide those services, and any other information the
5department deems appropriate, including, but not limited to, a copy
6of the alcoholism or drug abuse recovery or treatment facility’s
7accreditation by a nationally recognized accrediting organization.

begin delete

8(c)

end delete

9begin insert(end insertbegin insert2)end insert The departmentbegin delete mayend deletebegin insert shallend insert establishbegin insert and collectend insert an additional
10licensure fee for an application that includes a request to provide
11detoxification services or services pursuant to Section 11834.026.
12begin insert The fee shall be set at an amount sufficient to cover the
13department’s reasonable costs of regulating the provision of those
14services.end insert

15

SEC. 5.  

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 facility license,
35including, but not limited to, providing false information or
36documentation to the department.

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.

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

3(8) Failure to pay any civil penalties assessed by the department.

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



O

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