Amended in Senate August 31, 2015

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 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 medicalbegin delete servicesend deletebegin insert services, as defined,end insert to a resident of the facility at the facility premises under specified limitedbegin delete circumstances.end deletebegin insert circumstances, including, among others, that the resident signs an admission agreement and a physician and surgeon or other health care practitioner determines that it is medically appropriate for the resident to receive these services.end insert 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.begin insert The bill would require the department, on or before July 1, 2018, to adopt regulations to implement its provisions.end insert 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:

P3    1

11834.025.  

(a) (1) As a condition of providing incidental
2medical services, as defined in subdivision (a) of Section
311834.026, at a facility licensed by the department, thebegin delete facilityend delete
4begin insert facility, within a reasonable period of time, as defined by the
5department in regulations,end insert
shall obtain frombegin delete an applicant for
6servicesend delete
begin insert each program participant,end insert a signed certification described
7in subdivision (b) from a health care practitioner.

8(2) For purposes of this chapter, “health care practitioner” means
9a person duly licensed and regulated under Division 2
10(commencing with Section 500) of the Business and Professions
11Code, who is acting within the scope of practice of his or her
12license or certificate.

13(b) The department shall develop a standard certification form
14for use by a health care practitioner. The form shall include, but
15not be limited to, a description of the alcoholism and drug abuse
16recovery or treatment services that an applicant needs.

17(c) (1) The department shall adopt regulations, on or before
18July 1,begin delete 2017,end deletebegin insert 2018,end insert to implement this section. The regulations shall
19be adopted in accordance with the Administrative Procedure Act
20(Chapter 3.5 (commencing with Section 11340) of Part 1 of
21Division 3 of Title 2 of the Government Code).

22(2) Notwithstanding the rulemaking provisions of the
23Administrative Procedure Act, the department may, if it deems
24appropriate, implement, interpret, or make specific this section by
25means of provider bulletins, written guidelines, or similar
26instructions from the department only until the department adopts
27regulations.

28

SEC. 3.  

Section 11834.026 is added to the Health and Safety
29Code
, to read:

30

11834.026.  

(a) As used in this section, “incidental medical
31services” meansbegin delete services, as specified by the department in
32regulations,end delete
begin insert services that are in compliance with the community
33standard of practice and are not required to be performed in a
34licensed clinic or licensed health facility, as defined by Section
351200 or 1250, respectively,end insert
to addressbegin delete physical and mental healthend delete
36begin insert medicalend insert issues associated with either detoxification from alcohol
37or drugs or the provision of alcoholism or drug abuse recovery or
38treatment services,begin delete that in the opinion of a physician are not
39required to be performed in a licensed clinic or a general acute
40care hospital, as defined in Section 1200 or 1250, respectively, or
P4    1a medically managed inpatient treatment program.end delete
begin insert including all
2of the following categories of services that the department shall
3further define by regulation:end insert

begin insert

4(1) Obtaining medical histories.

end insert
begin insert

5(2) Monitoring health status to determine whether the health
6status warrants transfer of the patient in order to receive urgent
7or emergent care.

end insert
begin insert

8(3) Testing associated with detoxification from alcohol or drugs.

end insert
begin insert

9(4) Providing alcoholism or drug abuse recovery or treatment
10services.

end insert
begin insert

11(5) Overseeing patient self-administered medications.

end insert
begin insert

12(6) Treating substance abuse disorders, including detoxification.

end insert
begin insert

13(b) Incidental medical services do not include the provision of
14general primary medical care.

end insert
begin delete

15(b)

end delete

16begin insert(c)end insert Notwithstanding any other law, a licensed alcoholism or
17drug abuse recovery or treatment facility may permit incidental
18medical services to be provided to a resident at the facility premises
19begin delete byend deletebegin insert by, or under the supervision of,end insert one or morebegin delete independentend delete
20 physicians and surgeons licensed by the Medical Board of
21California or the Osteopathic Medical Board who are
22knowledgeable about addiction medicine, or one or more other
23health care practitioners acting within the scope of practice of his
24or her license and under the direction of a physician and surgeon,
25and who are also knowledgeable about addiction medicine,begin delete whenend delete
26begin insert ifend insert all of the following conditions are met:

27(1) The facility, in the judgment of the department, has the
28ability to comply with the requirements of thisbegin delete chapter, to provide
29any level of care between Level 3.1 and Level 3.7 of the American
30Society of Addiction Medicine criteria, and to comply withend delete
begin insert chapter
31andend insert
all other applicable laws and regulations to meet the needs of
32a resident receiving incidental medical servicesbegin delete from a physicianend delete
33 pursuant to this chapter. The department shall specify in regulations
34the minimum requirements that a facility shall meet in order to be
35approved to permit the provision of incidental medical services
36on its premises. The license of a facility approved tobegin delete provideend deletebegin insert permit
37the provision ofend insert
incidental medical services shall reflect that those
38services are permittedbegin delete to be providedend delete at the facility premises.

39(2) The physician and surgeon and any other health care
40practitioner has signed an acknowledgment on a form provided
P5    1by the department that he or she has been advised of and
2understands the statutory and regulatory limitations on the services
3that may legally be providedbegin delete byend deletebegin insert atend insert a licensed alcoholism or drug
4abuse recovery or treatment facility begin delete that is providing any level of
5care between Level 3.1 and Level 3.7 of the American Society of
6Addiction Medicine criteria,end delete
and the statutory and regulatory
7requirements and limitations for the physician and surgeon or other
8health carebegin delete protectionend deletebegin insert practitionerend insert and for the facility, related to
9providing incidental medical services. The licensee shall maintain
10a copy of the signed form at the facility for a physician and surgeon
11or other health care practitioner providing incidental medical
12services at the facility premises.

begin delete

13(3) There is an agreed-upon written protocol between the
14physician and surgeon and the alcoholism or drug abuse recovery
15or treatment facility signed by the physician and surgeon and the
16licensee. The protocol shall address, at a minimum, the respective
17areas of responsibility of the physician and surgeon and the facility
18and the need for communicating and sharing resident information
19related to the physician and surgeon providing incidental medical
20services. The department shall specify by regulations the issues
21that shall be addressed and the information that shall be included
22in the protocol. The facility shall maintain a copy of the signed
23protocol at the facility.

24(4) The facility in its admissions agreement with a client shall
25clearly identify the individual financially responsible for incidental
26medical services provided and the manner in which those services
27shall be billed.

28(5) There is ongoing communication between the physician and
29the alcoholism or drug abuse recovery or treatment facility about
30the services provided to the resident by the physician and surgeon
31and the frequency and duration of incidental medical services to
32be provided. Resident information shall be shared between the
33physician and surgeon and the alcoholism or drug abuse recovery
34or treatment facility regarding the resident's need for incidental
35medical services and the services to be provided to the resident by
36the physician and surgeon, including, but not limited to, medical
37information, as defined by the Confidentiality of Medical
38Information Act (Part 2.6 (commencing with Section 56) of
39Division 1 of the Civil Code). The department shall specify by
P6    1regulations any other requirements or limitations on these
2communications.

3(6) There is initial and ongoing communication between the
4physician and surgeon or other health care practitioner and the
5resident’s health plan or health insurer prior to the provision of
6incidental medical services, to the extent allowable by state and
7federal privacy and confidentiality laws, to ensure coordination of
8care.

9(7) The facility does not interfere with the physician and surgeon
10or other health care practitioner providing incidental medical
11 services.

12(8) In addition to any other medical authorization that may be
13required before a facility resident receives incidental medical
14services, the resident is authorized by the physician and surgeon
15as medically appropriate to receive the incidental medical services
16at the premises of the licensed facility. A

end delete

17begin insert(3)end insertbegin insertend insertbegin insertA physician and surgeon or other health care practitioner
18shall assess a resident, prior to that resident receiving incidental
19medical services, to determine whether it is medically appropriate
20for that resident to receive these services at the premises of the
21licensed facility. Aend insert
copy of thebegin delete authorization, on aend delete form provided
22by thebegin delete department,end deletebegin insert departmentend insert shall be signed by the physician
23and surgeon and maintained in the resident’s file at the facility.

begin delete

24(9) Before a facility resident receives incidental medical
25services, the resident

end delete

26begin insert(4)end insertbegin insertend insertbegin insertThe residentend insert has signed anbegin delete acknowledgment and consent to
27receive those services on a form provided by the department.end delete

28begin insert admission agreement.end insert Thebegin delete form,end deletebegin insert admission agreement,end insert at a
29minimum, shall describe the incidental medical services that the
30facility may permit to be provided and shall state that the permitted
31incidental medical services will be providedbegin delete byend deletebegin insert by, or under the
32supervision of,end insert
a physician andbegin delete surgeon or other health care
33practitioner working under the direction of the physician andend delete

34 surgeon. The department shall specify in regulations, at a minimum,
35 the content and manner of providing thebegin delete form,end deletebegin insert admission
36agreement,end insert
and any other information that the department deems
37appropriate. The facility shall maintain a copy of the signed
38begin delete acknowledgment and consentend deletebegin insert admission agreementend insert in the resident’s
39file.

begin delete

40(10)

end delete

P7    1begin insert(5)end insert Once incidental medical services are initiated for a resident,
2the physician and surgeon and facility shallbegin delete continuouslyend delete monitor
3the resident to ensure that the resident remains appropriate to
4receive those services. If the physician and surgeon determines
5that a change in the resident’s medicalbegin delete or psychiatricend delete condition
6requires other medicalbegin delete or psychiatricend delete services or that a higher level
7of care isbegin delete required than the facility may legally provide,end deletebegin delete the
8physician and surgeonend delete
begin insert required, the facilityend insert shall immediately
9begin delete notify the licensee and shall assist the licensee to initiate emergency
10care, urgent care, or otherend delete
begin insert arrange for the other medical services
11orend insert
higher level of care, as appropriate. begin delete If the licensee believes that
12a resident requires a higher level of care than the facility can legally
13provide, the licensee shall immediately notify the physician and
14surgeon and the department. The department shall specify by
15regulations any other requirements or limitations pertaining to
16changes in condition of a resident who is receiving incidental
17medical services, and any other requirements the department deems
18appropriate.end delete

begin delete

19(11)

end delete

20begin insert(6)end insert The facility maintains in its files a copy of thebegin delete physician and
21surgeon’s licenseend delete
begin insert relevant professional licenseend insert or other written
22evidence of licensure to practice medicinebegin delete in the state.end deletebegin insert or perform
23medical services in the state for the physician and surgeon and
24any other health care practitioner providing incidental medical
25services at the facility.end insert

begin delete

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)

end delete

39begin insert(d)end insert The departmentbegin delete shallend deletebegin insert isend insert notbegin insert required toend insert evaluate or have any
40responsibility or liability with respect to evaluatingbegin insert theend insert incidental
P8    1medical servicesbegin delete provided.end deletebegin insert provided by a physician and surgeon
2or other health care practitioner at a licensed facility.end insert
This section
3does not limit the department’s ability to report suspected
4misconduct by a physician and surgeon or other health care
5practitioner to the appropriate licensing entity or to law
6enforcement.

begin delete

7(f)

end delete

8begin insert(e)end insert A facility licensed and approved by the department to allow
9provision of incidental medical services shall not by offering
10approved incidental medical services bebegin delete consideredend deletebegin insert deemedend insert a clinic
11or health facility within the meaning of Section 1200 or 1250,
12respectively.

begin delete

13(g)

end delete

14begin insert(f)end insert Other than incidental medicalbegin delete services, including those
15provided at any level between Level 3.1 and Level 3.7 of the
16American Society of Addiction Medicine criteria, minor first aid,end delete

17begin insert services permitted to be providedend insert orbegin insert any urgent or emergent care
18requiredend insert
in the case of a life threatening emergency, this section
19does not authorize the provision at the premises of the facility of
20any medical or health care services or any other services that
21require a higher level of care than the care that may be provided
22within a licensed alcoholism or drug abuse recovery or treatment
23facility.

begin insert

24(g) This section does not require a residential treatment facility
25licensed by the department to provide incidental medical services
26or any services not otherwise permitted by law.

end insert

27(h) (1) On or before July 1,begin delete 2017,end deletebegin insert 2018,end insert the department shall
28adopt regulations to implement this section in accordance with the
29Administrative Procedure Act (Chapter 3.5 (commencing with
30Section 11340) of Part 1 of Division 3 of Title 2 of the Government
31Code).

32(2) Notwithstanding the rulemaking provisions of the
33 Administrative Procedure Act, the department may, if it deems
34appropriate, implement, interpret, or make specific this section by
35means of provider bulletins, written guidelines, or similar
36instructions from the department until regulations are adopted.

37

SEC. 4.  

Section 11834.03 of the Health and Safety Code is
38amended to read:

P9    1

11834.03.  

(a) A person or entity applying for licensure shall
2file with the department, on forms provided by the department, all
3of the following:

4(1) A completed written application for licensure.

5(2) A fire clearance approved by the State Fire Marshal or local
6fire enforcement officer.

7(3) A licensure fee, established in accordance with Chapter 7.3
8(commencing with Section 11833.01).

9(b) (1) If an applicant intends to permit services pursuant to
10Section 11834.026, the applicant shall submitbegin delete a copy of the written
11protocol,end delete
evidence of a valid license of the physician and surgeon
12who will providebegin insert or overseeend insert those services, and any other
13information the department deemsbegin delete appropriate, including, but not
14limited to, a copy of the alcoholism or drug abuse recovery or
15treatment facility’s accreditation by a nationally recognized
16accrediting organization that evaluates the level of services
17provided, if the facility is accredited.end delete
begin insert appropriate.end insert

18(2) The department shall establish and collect an additional
19licensure fee for an application that includes a request to provide
20 services pursuant to Section 11834.026. The fee shall be set at an
21amount sufficient to cover thebegin delete department’send delete reasonable costsbegin delete of
22regulating the provision of those services.end delete
begin insert to the department of the
23additional assessment and investigation necessary to license
24facilities to provide these services, including, but not limited to,
25processing applications, issuing licenses, and investigating reports
26of noncompliance with licensing regulations. end insert

27

SEC. 5.  

Section 11834.36 of the Health and Safety Code is
28amended to read:

29

11834.36.  

(a) The director may suspend or revoke any license
30issued under this chapter, or deny an application for licensure,begin delete forend delete
31 extension of the licensing period, orbegin delete to modify the terms and
32conditions ofend delete
begin insert modification toend insert a license, upon any of the following
33grounds and in the manner provided in this chapter:

34(1) Violation by the licensee of any provision of this chapter or
35regulations adopted pursuant to this chapter.

36(2) Repeated violation by the licensee of any of the provisions
37of this chapter or regulations adopted pursuant to this chapter.

38(3) Aiding, abetting, or permitting the violation of, or any
39repeated violation of, any of the provisions described in paragraph
40(1) or (2).

P10   1(4) Conduct in the operation of an alcoholism or drug abuse
2recovery or treatment facility that is inimical to the health, morals,
3welfare, or safety of either an individual in, or receiving services
4from, the facility or to the people of the State of California.

5(5) Misrepresentation of any material fact in obtaining the
6alcoholism or drug abuse recovery or treatment facility license,
7including, but not limited to, providing false information or
8documentation to the department.

9(6) The licensee’s refusal to allow the department entry into the
10facility to determine compliance with the requirements of this
11chapter or regulations adopted pursuant to this chapter.

12(7) Violation by the licensee of Section 11834.026 or the
13regulations adopted pursuant to that section.

14(8) Failure to pay any civil penalties assessed by the department.

15(b) The director may temporarily suspend any license prior to
16any hearing when, in the opinion of the director, the action is
17necessary to protect residents of the alcoholism or drug abuse
18recovery or treatment facility from physical or mental abuse,
19abandonment, or any other substantial threat to health or safety.
20The director shall notify the licensee of the temporary suspension
21and the effective date of the temporary suspension and at the same
22time shall serve the provider with an accusation. Upon receipt of
23a notice of defense to the accusation by the licensee, the director
24shall, within 15 days, set the matter for hearing, and the hearing
25shall be held as soon as possible. The temporary suspension shall
26remain in effect until the time the hearing is completed and the
27director has made a final determination on the merits. However,
28the temporary suspension shall be deemed vacated if the director
29fails to make a final determination on the merits within 30 days
30after the department receives the proposed decision from the Office
31of Administrative Hearings.



O

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