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:
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 incidental
25medical services, as defined in subdivision (a) of Section
2611834.026, at a facility licensed by the department, the facility
27shall obtain from an applicant for services a signed certification
28described in subdivision (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
P3 1(commencing with Section 500) of the Business and Professions
2Code, who is acting within the scope of practice of his or her
3license or certificate.
department shall develop a standard certification form
5for use by a health care practitioner. The form shall include, but
6not be limited to, a description of the alcoholism and drug abuse
7recovery or treatment services that an applicant needs.
8(c) (1) The department shall adopt regulations, on or before
9July 1, 2017, to implement this section. The regulations shall be
10adopted 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(2) Notwithstanding the rulemaking provisions of the
14Administrative 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 only until the department adopts
Section 11834.026 is added to the Health and Safety
20Code, to read:
(a) As used in this section, “incidental medical
22services” means services, as specified by the department in
23regulations, to address physical and mental health issues associated
24with either detoxification from alcohol or drugs or the provision
25of alcoholism or drug abuse recovery or treatment services, that
26in the opinion of a physician are not required to be performed in
27a licensed clinic or a general acute care hospital, as defined in
28Section 1200 or 1250, respectively, or a medically managed
29inpatient treatment program.
30(b) Notwithstanding any other law, a licensed alcoholism or
31drug abuse recovery or treatment facility may permit incidental
32medical services to be provided to a resident at the facility premises
33by one or more independent physicians and surgeons licensed by
34the Medical Board of California or the Osteopathic Medical Board
35who are knowledgeable about addiction medicine, or one or more
36other health care practitioners acting within the scope of practice
37of his or her license and under the direction of a physician and
38surgeon, and who are also knowledgeable about addiction
39medicine, when all of the following conditions are met:
P4 1(1) The facility, in the judgment of the department, has the
2ability to comply with the requirements of this chapter, to provide
3any level of care between Level 3.1 and Level 3.7 of the
begin delete ASAMend delete
4 criteria, and to comply
5with all other applicable laws and regulations to meet the needs
6of a resident receiving incidental medical services from a physician
7pursuant to this chapter. The department shall specify in regulations
8the minimum requirements that a facility shall meet in order to be
9approved to permit the provision of incidental medical services
10on its premises. The license of a facility approved to provide
11incidental medical services shall reflect that those services are
12permitted to be provided at the facility premises.
13(2) The physician and surgeon and any other health care
14practitioner has signed an acknowledgment on a form provided
15by the department that he or she has been advised of and
16understands the statutory and regulatory limitations on the services
17that may legally be provided by a licensed alcoholism or drug
18abuse recovery or treatment facility that is providing any level of
19care between Level 3.1 and Level 3.7 of the
begin delete ASAMend delete criteria, and the statutory and
21regulatory requirements and limitations for the physician and
22surgeon or other health care protection and for the facility, related
23to providing incidental medical services. The licensee shall
24maintain a copy of the signed form at the facility for a physician
25and surgeon or other health care practitioner providing incidental
26medical services at the facility premises.
27(3) There is an agreed-upon written protocol between the
28physician and surgeon and the alcoholism or drug abuse recovery
29or treatment facility signed by the physician and surgeon and the
30licensee. The protocol shall address, at a minimum, the respective
31areas of responsibility of the physician and surgeon and the facility
32and the need for communicating and sharing resident information
33related to the physician and surgeon providing incidental medical
34services. The department shall specify by regulations the issues
35that shall be addressed and the information that shall be included
36in the protocol. The facility shall maintain a copy of the signed
37protocol at the facility.
38(4) The facility in its admissions agreement with a client shall
39clearly identify the individual financially responsible for incidental
P5 1medical services provided and the manner in which those services
2shall be billed.
3(5) There is ongoing communication between the physician and
4the alcoholism or drug abuse recovery or treatment facility about
5the services provided to the resident by the physician and surgeon
6and the frequency and duration of incidental medical services to
7be provided. Resident information shall be shared between the
8physician and surgeon and the alcoholism or drug abuse recovery
9or treatment facility regarding the resident's need for incidental
10medical services and the services to be provided to the resident by
11the physician and surgeon, including, but not limited to, medical
12information, as defined by the Confidentiality of Medical
13Information Act (Part 2.6 (commencing with Section 56) of
14Division 1 of the Civil Code). The department shall specify by
15regulations any other requirements or limitations on these
17(6) There is initial and ongoing communication between the
18physician and surgeon or other health care practitioner and the
19resident’s health plan or health insurer prior to the provision of
20incidental medical services, to the extent allowable by state and
21federal privacy and confidentiality laws, to ensure coordination of
23(7) The facility does not interfere with the physician and surgeon
24or other health care practitioner providing incidental medical
26(8) In addition to any other medical authorization that may be
27required before a facility resident receives incidental medical
28services, the resident is authorized by the physician and surgeon
29as medically appropriate to receive the incidental medical services
30at the premises of the licensed facility. A copy of the authorization,
31on a form provided by the department, shall be signed by the
32physician and surgeon and maintained in the resident’s file at the
34(9) Before a facility resident receives incidental medical
35services, the resident has signed an acknowledgment and consent
36to receive those services on a form provided by the department.
37The form, at a minimum, shall describe the incidental medical
38services that the facility may permit to be provided and shall state
39that the permitted incidental medical services will be provided by
40a physician and surgeon or other health care practitioner working
P6 1under the direction of the physician and surgeon. The department
2shall specify in regulations, at a minimum, the content and manner
3of providing the form, and any other information that the
4department deems appropriate. The facility shall maintain a copy
5of the signed acknowledgment and consent in the resident’s file.
6(10) Once incidental medical services are initiated for a resident,
7the physician and surgeon and facility shall continuously monitor
8the resident to ensure that the resident remains appropriate to
9receive those services. If the physician and surgeon determines
10that a change in the resident’s medical or psychiatric condition
11requires other medical or psychiatric services or that a higher level
12of care is required than the facility may legally provide, the
13physician and surgeon shall immediately notify the licensee and
14shall assist the licensee to initiate emergency care, urgent care, or
15other higher level of care, as appropriate. If the licensee believes
16that a resident requires a higher level of care than the facility can
17legally provide, the licensee shall immediately notify the physician
18and surgeon and the department. The department shall specify by
19regulations any other requirements or limitations pertaining to
20changes in condition of a resident who is receiving incidental
21medical services, and any other requirements the department deems
23(11) The facility maintains in its files a copy of the physician
24and surgeon’s license or other written evidence of licensure to
25practice medicine in the state.
26(12) The physician and surgeon and the facility both maintain
27compliance with the department’s regulations relating to providing
28incidental medical services.
29(c) The facility shall report to the department in a timely manner
30any violation of the regulations relating to providing incidental
31medical services or the signed protocol described in paragraph (3)
32of subdivision (b). The department shall specify in regulations, at
33a minimum, the steps required to be taken when the department
34substantiates that information provided by the licensee.
35(d) Nothing in this section requires a facility to provide
36incidental medical services or any services beyond those otherwise
37permitted by this chapter.
38(e) The department shall not evaluate or have any responsibility
39or liability with respect to evaluating incidental medical services
40provided. This section does not limit the department’s ability to
P7 1report suspected misconduct by a physician and surgeon or other
2health care practitioner to the appropriate licensing entity or to law
4(f) A facility licensed and approved by the department to allow
5provision of incidental medical services shall not by offering
6approved incidental medical services be considered a clinic or
7health facility within the meaning of Section 1200 or 1250,
9(g) Other than incidental medical services, including those
10provided at any level between Level 3.1 and Level 3.7 of the
begin delete ASAMend delete criteria, minor
12first aid, or in the case of a life threatening emergency, this section
13does not authorize the provision at the premises of the facility of
14any medical or health care services or any other services that
15require a higher level of care than the care that may be provided
16within a licensed alcoholism or drug abuse recovery or treatment
18(h) (1) On or before July 1, 2017, the department shall adopt
19regulations to implement this section 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
23(2) Notwithstanding the rulemaking provisions of the
24 Administrative Procedure Act, the department may, if it deems
25appropriate, implement, interpret, or make specific this section by
26means of provider bulletins, written guidelines, or similar
27instructions from the department until regulations are adopted.
Section 11834.03 of the Health and Safety Code is
29amended to read:
(a) A person or entity applying for licensure shall
31file with the department, on forms provided by the department, all
32of the following:
33(1) A completed written application for licensure.
34(2) A fire clearance approved by the State Fire Marshal or local
35fire enforcement officer.
36(3) A licensure fee, established in accordance with Chapter 7.3
37(commencing with Section 11833.01).
38(b) (1) If an applicant intends to permit services pursuant to
39Section 11834.026, the applicant shall submit a copy of the written
40protocol, evidence of a valid license of the physician and surgeon
P8 1who will provide those services, and any other information the
2department deems appropriate, including, but not limited to, a copy
3of the alcoholism or drug abuse recovery or treatment facility’s
4accreditation by a nationally recognized accrediting
begin delete organization.end delete
7(2) The department shall establish and collect an additional
8licensure fee for an application that includes a request to provide
begin delete detoxification services orend delete
services pursuant to Section 11834.026.
10The fee shall be set at an amount sufficient to cover the
11department’s reasonable costs of regulating the provision of those
Section 11834.36 of the Health and Safety Code is
14amended to read:
(a) The director may suspend or revoke any license
16issued under this chapter, or deny an application for licensure, for
17extension of the licensing period, or to modify the terms and
18conditions of a license, upon any of the following grounds and in
19the manner provided in this chapter:
20(1) Violation by the licensee of any provision of this chapter or
21regulations adopted pursuant to this chapter.
22(2) Repeated violation by the licensee of any of the provisions
23of this chapter or regulations adopted pursuant to this chapter.
24(3) Aiding, abetting, or permitting the violation of, or any
25repeated violation of, any of the provisions described in paragraph
26(1) or (2).
27(4) Conduct in the operation of an alcoholism or drug abuse
28recovery or treatment facility that is inimical to the health, morals,
29welfare, or safety of either an individual in, or receiving services
30from, the facility or to the people of the State of California.
31(5) Misrepresentation of any material fact in obtaining the
32alcoholism or drug abuse recovery or treatment facility license,
33including, but not limited to, providing false information or
34documentation to the department.
35(6) The licensee’s refusal to allow the department entry into the
36facility to determine compliance with the requirements of this
37chapter or regulations adopted pursuant to this chapter.
38(7) Violation by the licensee of Section 11834.026 or the
39regulations adopted pursuant to that section.
40(8) Failure to pay any civil penalties assessed by the department.
P9 1(b) The director may temporarily suspend any license prior to
2any hearing when, in the opinion of the director, the action is
3necessary to protect residents of the alcoholism or drug abuse
4recovery or treatment facility from physical or mental abuse,
5abandonment, or any other substantial threat to health or safety.
6The director shall notify the licensee of the temporary suspension
7and the effective date of the temporary suspension and at the same
8time shall serve the provider with an accusation. Upon receipt of
9a notice of defense to the accusation by the licensee, the director
10shall, within 15 days, set the matter for hearing, and the hearing
11shall be held as soon as possible. The temporary suspension shall
12remain in effect until the time the hearing is completed and the
13director has made a final determination on the merits. However,
14the temporary suspension shall be deemed vacated if the director
15fails to make a final determination on the merits within 30 days
16after the department receives the proposed decision from the Office
17of Administrative Hearings.