BILL NUMBER: AB 848 AMENDED
BILL TEXT
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
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 services, as defined, to a resident of
the facility at the facility premises under specified limited
circumstances. 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. 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 require the
department, on or before July 1, 2018, to adopt regulations to
implement its provisions. 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
facility, within a reasonable period of time, as defined by the
department in regulations, shall obtain from an
applicant for services each program participant,
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, 2018, 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, services that are in compliance with the
community standard of practice and are not required to be performed
in a licensed clinic or licensed health facility, as defined by
Section 1200 or 1250, respectively, to address
physical and mental health medical 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. including all of the
following categories of services that the department shall further
define by regulation:
(1) Obtaining medical histories.
(2) Monitoring health status to determine whether the health
status warrants transfer of the patient in order to receive urgent or
emergent care.
(3) Testing associated with detoxification from alcohol or drugs.
(4) Providing alcoholism or drug abuse recovery or treatment
services.
(5) Overseeing patient self-administered medications.
(6) Treating substance abuse disorders, including detoxification.
(b) Incidental medical services do not include the provision of
general primary medical care.
(b)
(c) 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 by, or under the
supervision of, 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
if 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
American Society of Addiction Medicine criteria, and to comply with
chapter and 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
permit the provision of 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 at 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
American Society of Addiction Medicine criteria, and the
statutory and regulatory requirements and limitations for the
physician and surgeon or other health care protection
practitioner 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
(3) A physician and s urgeon
or other health care practitioner shall assess a resident, prior to
that resident receiving incidental medical services, to
determine whether it is medically appropriate for that resident to
receive these services at the premises of the licensed facility. A
copy of the authorization, on a form provided
by the department, 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
(4) The resident has signed an
acknowledgment and consent to receive those services on a
form provided by the department. admission agreement.
The form, admission agreement, 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
by, or under the supervision of, 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, admission agreement, and any
other information that the department deems appropriate. The facility
shall maintain a copy of the signed acknowledgment and
consent admission agreement in the resident's
file.
(10)
(5) 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
required, the facility shall immediately notify the
licensee and shall assist the licensee to initiate emergency care,
urgent care, or other arrange for the other medical
services or 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)
(6) The facility maintains in its files a copy of the
physician and surgeon's license relevant
professional license or other written evidence of licensure to
practice medicine in the state. or perform
medical services in the state for the physician and surgeon and any
other health care practitioner providing incidental medical services
at the facility.
(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)
(d) The department shall is
not required to evaluate or have any
responsibility or liability with respect to evaluating the
incidental medical services provided.
provided by a physician and surgeon or other health care practitioner
at a licensed facility. 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)
(e) 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
deemed a clinic or health facility within the
meaning of Section 1200 or 1250, respectively.
(g)
(f) Other than incidental medical services,
including those provided at any level between Level 3.1 and Level 3.7
of the American Society of Addiction Medicine criteria, minor first
aid, services permitted to be provided or
any urgent or emergent care required 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.
(g) This section does not require a residential treatment facility
licensed by the department to provide incidental medical services or
any services not otherwise permitted by law.
(h) (1) On or before July 1, 2017, 2018,
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 or oversee 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 organization that evaluates the
level of services provided, if the facility is accredited.
appropriate.
(2) The department shall establish and collect an additional
licensure fee for an application that includes a request to provide
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. to the department of the additional
assessment and investigation necessary to license facilities to
provide these services, including, but not limited to, processing
applications, issuing licenses, and investigating reports of
noncompliance with licensing regulations.
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 modification to
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.