Amended in Senate July 16, 2015

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 Bill No. 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:

SECTION 1.  

The Legislature hereby finds and declares all of
the following:

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

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

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

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

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

SEC. 2.  

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

11834.025.  

(a) (1) As a condition of providing incidental
medical services, as defined in subdivision (a) of Section
11834.026, at a facility licensed by the department, the facility
shall obtain from an applicant for services a signed certification
described in subdivision (b) from a health care practitioner.

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

(b) The department shall develop a standard certification form
for use by a health care practitioner. The form shall include, but
not be limited to, a description of the alcoholism and drug abuse
recovery or treatment services that an applicant needs.

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

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

SEC. 3.  

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

11834.026.  

(a) As used in this section, “incidental medical
services” means services, as specified by the department in
regulations, to address physical and mental health issues associated
with either detoxification from alcohol or drugs or the provision
of alcoholism or drug abuse recovery or treatment services, that
in the opinion of a physician are not required to be performed in
a licensed clinic or a general acute care hospital, as defined in
Section 1200 or 1250, respectively, or a medically managed
inpatient treatment program.

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

(1) The facility, in the judgment of the department, has the
ability to comply with the requirements of this chapter, to provide
any level of care between Level 3.1 and Level 3.7 of the begin delete ASAM end delete
begin insert American Society of Addiction Medicine end insert criteria, and to comply
with all other applicable laws and regulations to meet the needs
of a resident receiving incidental medical services from a physician
pursuant to this chapter. The department shall specify in regulations
the minimum requirements that a facility shall meet in order to be
approved to permit the provision of incidental medical services
on its premises. The license of a facility approved to provide
incidental medical services shall reflect that those services are
permitted to be provided at the facility premises.

(2) The physician and surgeon and any other health care
practitioner has signed an acknowledgment on a form provided
by the department that he or she has been advised of and
understands the statutory and regulatory limitations on the services
that may legally be provided by a licensed alcoholism or drug
abuse recovery or treatment facility that is providing any level of
care between Level 3.1 and Level 3.7 of the begin delete ASAM end delete begin insert American
Society of Addiction Medicine end insert criteria, and the statutory and
regulatory requirements and limitations for the physician and
surgeon or other health care protection and for the facility, related
to providing incidental medical services. The licensee shall
maintain a copy of the signed form at the facility for a physician
and surgeon or other health care practitioner providing incidental
medical services at the facility premises.

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

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

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

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

(7) The facility does not interfere with the physician and surgeon
or other health care practitioner providing incidental medical
services.

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

(9) Before a facility resident receives incidental medical
services, the resident has signed an acknowledgment and consent
to receive those services on a form provided by the department.
The form, at a minimum, shall describe the incidental medical
services that the facility may permit to be provided and shall state
that the permitted incidental medical services will be provided by
a physician and surgeon or other health care practitioner working
under the direction of the physician and surgeon. The department
shall specify in regulations, at a minimum, the content and manner
of providing the form, and any other information that the
department deems appropriate. The facility shall maintain a copy
of the signed acknowledgment and consent in the resident’s file.

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

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

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

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

(d) Nothing in this section requires a facility to provide
incidental medical services or any services beyond those otherwise
permitted by this chapter.

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

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

(g) Other than incidental medical services, including those
provided at any level between Level 3.1 and Level 3.7 of the
begin delete ASAM end delete begin insert American Society of Addiction Medicine end insert criteria, minor
first aid, or in the case of a life threatening emergency, this section
does not authorize the provision at the premises of the facility of
any medical or health care services or any other services that
require a higher level of care than the care that may be provided
within a licensed alcoholism or drug abuse recovery or treatment
facility.

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

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

SEC. 4.  

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

11834.03.  

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

(1) A completed written application for licensure.

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

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

(b) (1) If an applicant intends to permit services pursuant to
Section 11834.026, the applicant shall submit a copy of the written
protocol, evidence of a valid license of the physician and surgeon
who will provide those services, and any other information the
department deems appropriate, including, but not limited to, a copy
of the alcoholism or drug abuse recovery or treatment facility’s
accreditation by a nationally recognized accrediting begin delete organization. end delete
begin insert organization that evaluates the level of services provided, if the
facility is accredited. end insert

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

SEC. 5.  

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

11834.36.  

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

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

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

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

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

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

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

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

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

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