Amended in Senate July 2, 2015

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 authorize an adult alcoholism or drug abuse recovery or treatment 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. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the department’s reasonable costs of regulating the provision of those services. 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 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 providingbegin delete alcoholism or
25drug abuse recovery or treatment services under this chapterend delete

26begin insert incidental medical services, as defined in subdivision (a) of Section
2711834.026,end insert
at a facility licensed by the department, the facility
28shall obtain from an applicant for services a signed certification
29described in subdivision (b) from a health care practitioner.

30(2) For purposes of this chapter, “health care practitioner” means
31a person duly licensed and regulated under Division 2
32(commencing with Section 500) of the Business and Professions
P3    1Code, who is acting within the scope of practice of his or her
2license or certificate.

3(b) The department shall develop a standard certification form
4for use by a health care practitioner. The form shall include, but
5not be limited to, a description of the alcoholism and drug abuse
6recovery or treatment services thatbegin delete a licensed alcoholism or drug
7abuse recovery or treatment facility may provide under state law,
8and a certification by the health care practitioner that the health
9condition or medical or psychiatric history of the applicant does
10not require a level of care that is higher than the level of care that
11may legally be provided by a licensed alcoholism or drug abuse
12recovery or treatment facility.end delete
begin insert an applicant needs.end insert

13(c) (1) The department shall adopt regulations, on or before
14July 1, 2017, to implement this section. The regulations shall be
15adopted in accordance with the Administrative Procedure Act
16(Chapter 3.5 (commencing with Section 11340) of Part 1 of
17Division 3 of Title 2 of the Government Code).

18(2) Notwithstanding the rulemaking provisions of the
19Administrative Procedure Act, the department may, if it deems
20appropriate, implement, interpret, or make specific this section by
21means of provider bulletins, written guidelines, or similar
22instructions from the department only until the department adopts
23regulations.

24

SEC. 3.  

Section 11834.026 is added to the Health and Safety
25Code
, to read:

26

11834.026.  

(a) As used in this section, “incidental medical
27services” means services, as specified by the department in
28regulations, to address physical and mental health issues associated
29with either detoxification from alcohol or drugs or the provision
30of alcoholism or drug abuse recovery or treatment services, that
31in the opinion of a physician are not required to be performed in
32a licensed clinicbegin delete or licensed health facility,end deletebegin insert or a general acute care end insert
33begin inserthospital,end insert as defined in Section 1200 or 1250,begin delete respectively.end delete
34begin insert respectively, or a medically managed inpatient treatment program.end insert

35(b) Notwithstanding any other law, a licensed alcoholism or
36drug abuse recovery or treatment facility may permit incidental
37medical services to be provided to a resident at the facility premises
38by one or more independent physicians and surgeons licensed by
39the Medical Board of California or the Osteopathic Medical Board
40who are knowledgeable about addiction medicine, or one or more
P4    1other health care practitioners acting within the scope of practice
2of his or her license and under the direction of a physician and
3surgeon, and who are also knowledgeable about addiction
4medicine, when all of the following conditions are met:

5(1) The facility, in the judgment of the department, has the
6ability to comply with the requirements of this chapterbegin insert, to provide
7any level of care between Level 3.1 and Level 3.7 of the ASAM
8criteria,end insert
andbegin insert to comply withend insert all other applicable laws and
9regulations to meet the needs of a resident receiving incidental
10medical services from a physician pursuant to this chapter. The
11department shall specify in regulations the minimum requirements
12that a facility shall meet in order to be approved to permit the
13provision of incidental medical services on its premises. The license
14of a facility approved to provide incidental medical services shall
15reflect that those services are permitted to be provided at the facility
16premises.

17(2) The physician and surgeon and any other health care
18practitioner has signed an acknowledgment on a form provided
19by the department that he or she has been advised of and
20understands the statutory and regulatory limitations on the services
21that may legally be provided by a licensed alcoholism or drug
22abuse recovery or treatmentbegin delete facility,end deletebegin insert facility that is providing any
23level of care between Level 3.1 and Level 3.7 of the ASAM criteria,end insert

24 and the statutory and regulatory requirements and limitations for
25the physician and surgeon or other health care protection and for
26the facility, related to providing incidental medical services. The
27licensee shall maintain a copy of the signed form at the facility for
28a physician and surgeon or other health care practitioner providing
29incidental medical services at the facility premises.

30(3) There is an agreed-upon written protocol between the
31physician and surgeon and the alcoholism or drug abuse recovery
32or treatment facility signed by the physician and surgeon and the
33licensee. The protocol shall address, at a minimum, the respective
34areas of responsibility of the physician and surgeon and the facility
35and the need for communicating and sharing resident information
36related to the physician and surgeon providing incidental medical
37services. The department shall specify by regulations the issues
38that shall be addressed and the information that shall be included
39in the protocol. The facility shall maintain a copy of the signed
40protocol at the facility.

P5    1(4) The facility in its admissions agreement with a client shall
2clearly identify the individual financially responsible for incidental
3medical services provided and the manner in which those services
4shall be billed.

5(5) There is ongoing communication between the physician and
6the alcoholism or drug abuse recovery or treatment facility about
7the services provided to the resident by the physician and surgeon
8and the frequency and duration of incidental medical services to
9be provided. Resident information shall be shared between the
10physician and surgeon and the alcoholism or drug abuse recovery
11or treatment facility regarding the resident's need for incidental
12medical services and the services to be provided to the resident by
13the physician and surgeon, including, but not limited to, medical
14information, as defined by the Confidentiality of Medical
15Information Act (Part 2.6 (commencing with Section 56) of
16Division 1 of the Civil Code). The department shall specify by
17regulations any other requirements or limitations on these
18communications.

19(6) There is initial and ongoing communication between the
20physician and surgeon or other health care practitioner and the
21resident’s health plan or health insurer prior to the provision of
22incidental medical services, to the extent allowable by state and
23federal privacy and confidentiality laws, to ensure coordination of
24care.

25(7) The facility does notbegin delete provide incidental medical services
26and does not assist with orend delete
interfere with the physician and surgeon
27or other health care practitioner providing incidental medical
28 services.

29(8) In addition to any other medical authorization that may be
30required before a facility resident receives incidental medical
31services, the resident is authorized by the physician and surgeon
32as medically appropriate to receive the incidental medical services
33at the premises of the licensed facility. A copy of the authorization,
34on a form provided by the department, shall be signed by the
35physician and surgeon and maintained in the resident’s file at the
36facility.

37(9) Before a facility resident receives incidental medical
38services, the resident has signed an acknowledgment and consent
39to receive those services on a form provided by the department.
40The form, at a minimum, shall describe the incidental medical
P6    1services that the facility may permit to be provided and shall state
2that the permitted incidental medical services will be provided by
3a physician and surgeon or other health care practitioner working
4under the direction of the physician andbegin delete surgeon and not by the
5facility staff.end delete
begin insert surgeon.end insert The department shall specify in regulations,
6at a minimum, the content and manner of providing the form, and
7any other information that the department deems appropriate. The
8facility shall maintain a copy of the signed acknowledgment and
9consent in the resident’s file.

10(10) Once incidental medical services are initiated for a resident,
11the physician and surgeon and facility shall continuously monitor
12the resident to ensure that the resident remains appropriate to
13receive those services. If the physician and surgeon determines
14that a change in the resident’s medical or psychiatric condition
15requires other medical or psychiatric services or that a higher level
16of care is required than the facility may legally provide, the
17physician and surgeon shall immediately notify the licensee and
18shall assist the licensee to initiate emergency care, urgent care, or
19other higher level of care, as appropriate. If the licensee believes
20that a resident requires a higher level of care than the facility can
21legally provide, the licensee shall immediately notify the physician
22and surgeon and the department. The department shall specify by
23regulations any other requirements or limitations pertaining to
24changes in condition of a resident who is receiving incidental
25medical services, and any other requirements the department deems
26appropriate.

27(11) The facility maintains in its files a copy of the physician
28and surgeon’s license or other written evidence of licensure to
29practice medicine in the state.

30(12) The physician and surgeon and the facility both maintain
31compliance with the department’s regulations relating to providing
32incidental medical services.

33(c) The facility shall report to the department in a timely manner
34any violationbegin delete or suspected violation by the physician and surgeonend delete
35 of the regulations relating to providing incidental medical services
36or the signed protocol described in paragraph (3) of subdivision
37(b). The department shall specify in regulations, at a minimum,
38the steps required to be taken when the department substantiates
39that information provided by the licensee.

P7    1(d) begin deleteThis end deletebegin insertNothing in this end insertsectionbegin delete does not requireend deletebegin insert requiresend insert a
2facility to provide incidental medical services or any services
3beyond thosebegin insert otherwiseend insert permitted by this chapter.

4(e) The department shall not evaluate or have any responsibility
5or liability with respect to evaluating incidental medical services
6provided. This section does not limit the department’s ability to
7report suspected misconduct by a physician and surgeon or other
8health care practitioner to the appropriate licensing entity or to law
9enforcement.

10(f) A facility licensed and approved by the department to allow
11provision of incidental medical services shall not by offering
12approved incidental medical services be considered a clinic or
13health facility within the meaning of Section 1200 or 1250,
14respectively.

15(g) Other than incidental medicalbegin delete services provided,end deletebegin insert services,
16including those provided at any level between Level 3.1 and Level
173.7 of the ASAM criteria,end insert
minor first aid, or in the case of a life
18threatening emergency, this section does not authorize the provision
19at the premises of the facility of any medical or health care services
20or any other services that require a higher level of care than the
21care that may be provided within a licensed alcoholism or drug
22abuse recovery or treatment facility.

23(h) (1) On or before July 1, 2017, the department shall adopt
24regulations to implement this section in accordance with the
25Administrative Procedure Act (Chapter 3.5 (commencing with
26Section 11340) of Part 1 of Division 3 of Title 2 of the Government
27Code).

28(2) Notwithstanding the rulemaking provisions of the
29 Administrative Procedure Act, the department may, if it deems
30appropriate, implement, interpret, or make specific this section by
31means of provider bulletins, written guidelines, or similar
32instructions from the department until regulations are adopted.

33

SEC. 4.  

Section 11834.03 of the Health and Safety Code is
34amended to read:

35

11834.03.  

(a) A person or entity applying for licensure shall
36file with the department, on forms provided by the department, all
37of the following:

38(1) A completed written application for licensure.

39(2) A fire clearance approved by the State Fire Marshal or local
40fire enforcement officer.

P8    1(3) A licensure fee, established in accordance with Chapter 7.3
2(commencing with Section 11833.01).

3(b) (1) If an applicant intends to permit services pursuant to
4Section 11834.026, the applicant shall submit a copy of the written
5protocol, evidence of a valid license of the physician and surgeon
6who will provide those services, and any other information the
7department deems appropriate, including, but not limited to, a copy
8of the alcoholism or drug abuse recovery or treatment facility’s
9accreditation by a nationally recognized accrediting organization.

10(2) The department shall establish and collect an additional
11licensure fee for an application that includes a request to provide
12detoxification services or services pursuant to Section 11834.026.
13The fee shall be set at an amount sufficient to cover the
14department’s reasonable costs of regulating the provision of those
15services.

16

SEC. 5.  

Section 11834.36 of the Health and Safety Code is
17amended to read:

18

11834.36.  

(a) The director may suspend or revoke any license
19issued under this chapter, or deny an application for licensure, for
20extension of the licensing period, or to modify the terms and
21conditions of a license, upon any of the following grounds and in
22the manner provided in this chapter:

23(1) Violation by the licensee of any provision of this chapter or
24regulations adopted pursuant to this chapter.

25(2) Repeated violation by the licensee of any of the provisions
26of this chapter or regulations adopted pursuant to this chapter.

27(3) Aiding, abetting, or permitting the violation of, or any
28repeated violation of, any of the provisions described in paragraph
29(1) or (2).

30(4) Conduct in the operation of an alcoholism or drug abuse
31recovery or treatment facility that is inimical to the health, morals,
32welfare, or safety of either an individual in, or receiving services
33from, the facility or to the people of the State of California.

34(5) Misrepresentation of any material fact in obtaining the
35alcoholism or drug abuse recovery or treatment facility license,
36including, but not limited to, providing false information or
37documentation to the department.

38(6) The licensee’s refusal to allow the department entry into the
39facility to determine compliance with the requirements of this
40chapter or regulations adopted pursuant to this chapter.

P9    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.



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