BILL ANALYSIS Ó
AB 848
Page 1
ASSEMBLY THIRD READING
AB
848 (Mark Stone)
As Amended June 1, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+---------------------|
|Business & |12-2 |Bonilla, Jones, |Gatto, Wilk |
|Professions | |Baker, Bloom, | |
| | |Campos, Chang, | |
| | |Dodd, Eggman, | |
| | |Holden, Mullin, | |
| | |Ting, Wood | |
| | | | |
|----------------+------+--------------------+---------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
AB 848
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| | |Santiago, | |
| | |Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+--------------------+---------------------|
|Appropriations |12-0 |Gomez, Bonta, | |
| | |Calderon, Daly, | |
| | |Eggman, | |
| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Quirk, Rendon, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Authorizes alcoholism and drug treatment facilities to
allow a licensed physician, or other health care practitioner, to
provide incidental medical services to a resident of the facility
and requires the Department of Health Care Services (DHCS) to
conduct an evaluation of the program on or before January 1, 2019,
and to report the results of the evaluation to the appropriate
fiscal and policy committees of the Legislature. Specifically,
this bill:
1)Specifies that a health care practitioner should submit a signed
certification form to a facility licensed by the DHCS where they
plan to provide alcoholism or drug abuse recovery or treatment
services.
2)Defines "health care practitioner" as a healing arts
professional, licensed under Business and Professions Code
Section 500, and who is acting within the scope of practice of
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his or her license or certificate.
3)Specifies that the DHCS shall develop a standard certification
form, for use by a health care practitioner, that:
a) Describes the alcoholism and drug abuse recovery or
treatment services provided, and
b) Certifies that the health condition or medical or
psychiatric history of the applicant does not require a level
of care that is higher than the level of care that may
legally be provided by a licensed facility.
4)Defines "incidental medical services" as services to address the
physical and mental health issues associated with either
detoxification from alcohol or drugs or the provisions 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 health facility.
5)Specifies that a facility may permit incidental medical services
to be provided to a resident at the facility 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 are also knowledgeable about addiction medicine.
6)States that the facility must comply with all other applicable
laws and regulations to meet the needs of a resident receiving
incidental medical services from a physician.
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7)Specifies that the physician and surgeon and any other health
care practitioner has signed an acknowledgment on a form
provided by the DHCS that he or she has been advised of and
understands the statutory and regulatory limitations on the
services that may legally be provided by the facility, and the
statutory and regulatory requirements and limitations for the
physician and surgeon or other health care professional and for
the facility.
8)Requires that there is an agreed-upon written protocol between
the physician and surgeon and the facility signed by the
physician and surgeon and the licensee.
9)Specifies that the facility, in its admissions agreement with a
client, shall clearly identify the individual financially
responsible for incidental medical services that are provided.
10)States there should be ongoing communication between the
physician and the 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.
11)Requires 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 ensure coordination of care.
12)Specifies that the facility will not provide incidental medical
services and will not assist with or interfere with the
physician and surgeon or other health care practitioner
providing incidental medical services.
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13)States that the resident must be authorized by the physician
and surgeon as medically appropriate to receive the incidental
medical services at the facility.
14)Requires that 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
DHCS.
15)Specifies that once incidental medical services are initiated
for a resident, the physician and surgeon, and the facility
shall continuously monitor the resident to ensure that the
services remain appropriate for the resident.
16)Requires the facility to maintain in its files a copy of the
physician's and surgeon's license or other written evidence of
licensure to practice medicine in the state.
17)Requires the facility to report, in a timely manner, to the
DHCS, any violation or suspected violation by the physician and
surgeon of the regulations relating to providing incidental
medical services.
18)Indicates that the DHCS shall not evaluate or have any
responsibility or liability with respect to evaluating
incidental medical services provided.
19)States that a facility licensed and approved by the DHCS to
allow for the provision of incidental medical services shall not
be considered a clinic or health facility.
20)Specifies that, other than incidental medical services, minor
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first aid, or in the case of a life threatening emergency,
provision of medical or health care services or services that
require a higher level of care than the care that is permitted
to be provided at a facility, is not permitted at a facility.
21)Indicates that if an applicant for facility licensure intends
to permit incidental medical services, the applicant shall
submit a copy of a valid license of the physician and surgeon
who will provide those services, and any other information the
DHCS deems appropriate, including, but not limited to, a copy of
the facility's accreditation by a nationally recognized
accrediting organization.
22)Allows the DHCS to establish and collect an additional
licensure fee for an application that includes a request for a
facility to provide detoxification services.
23)Further specifies that the fee shall be set at an amount
sufficient to cover the department's reasonable costs of
regulating the provision of those services.
24)Permits the director of DHCS to temporarily suspend any license
prior to any hearing when, in the opinion of the director, the
action is necessary to protect residents of the facility from
physical or mental abuse, abandonment, or any other substantial
threat to health or safety.
25)Makes other findings and declarations.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
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1)Costs to adopt regulations, likely in the range of $200,000 over
two years (licensing fees and Substance Abuse Prevention and
Treatment Block Grant).
2)Unknown ongoing costs to oversee this new requirement as a
component of licensure, possibly in the range of $100,000
annually (licensing fees).
COMMENTS:
Purpose. This bill is co-sponsored by the California Society of
Addiction Medicine, Elements Behavioral Health and JANUS of Santa
Cruz. According to the author, "AB 848 protects the physical and
mental health of people seeking alcohol and drug rehabilitation
services in residential treatment facilities. Under AB 848,
physicians and other appropriate medical personnel can be
available on-site to provide 24-hour medical services related to
clients' addictions. Clients of these facilities often have a
variety of medical needs related to their addictions. Because
clients' medical needs can affect and even interfere with their
recovery, they may have better recovery outcomes when they have
on-site access to medical care including vital sign monitoring,
seizure risk assessment, medication management, and psychiatric
therapy?The measure requires that facilities seeking licensure
adhere to protocol that protect client privacy, notify clients of
financial responsibility for medical care, and clearly define the
level of medical care to be provided. The measure requires DHCS
to promulgate final regulations by July 1, 2017, to implement the
policy. Additionally, the measure requires that DHCS perform an
evaluation of the law's effectiveness by 2019."
Background. Alcoholism or drug abuse recovery or treatment
facilities provide 24-hour non-medical care and specialize in
providing services to chemically dependent adults who do not
require treatment in an acute-care medical facility on an
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inpatient, intensive outpatient, outpatient, and partial
hospitalization basis. These facilities range in size from
six-bed facilities in residential neighborhoods to centers that
accommodate more than 100 beds (California Senate Office of
Oversight and Outcomes report, Rogue Rehabs: State failed to
police drug and alcohol homes, with deadly results, September
2012).
The basic services provided by facilities include group,
individual and educational sessions, alcoholism or drug abuse
recovery and treatment planning. Detoxification services are also
provided and are defined by the DHCS as, "? a service to support
and to assist and individual in the alcohol and/or drug withdrawal
process and to explore plans for continued service." These
services can be provided by a variety of health care providers
such as alcohol and drug counselors, mental health therapists,
social workers, psychologists, nurses and physicians.
Currently, the only medical care that facilities are allowed to
provide to clients is first aid and emergency care. If a patient
requires medical care, they must leave the facility to receive
care from a medical professional and the patient must pay the
medical professional directly for services.
Facility Licensing and Oversight. Prior to July 1, 2013, the
Department of Alcohol and Drug Programs (ADP) was responsible for
oversight of alcoholism or drug abuse recovery or treatment
facilities. Effective with the passage of the 2013-2014 Budget
Act and associated legislation, all ADP programs and staff, except
the Office of Problem Gambling, transferred to the DHCS. Now, the
DHCS is responsible for oversight. The DHCS licenses the
facilities and conducts reviews of their operations every two
years. As part of the review process, the DHCS checks for
compliance with a variety of requirements including, whether staff
has passed tuberculosis tests, that residents have completed
health questionnaires and if at least one staff member is
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certified in first aid and cardiopulmonary resuscitation (CPR).
The DHCS's Substance Use Disorder (SUD) Compliance Division
investigates complaints against facilities. The SUD Compliance
Division also investigates violations of the code of conduct of
registered or certified alcohol and drug counselors.
Additionally, facilities licensed or certified by DHCS are
required to report counselor misconduct to DHCS within 24 hours of
the violation. Facilities that do not comply with existing
requirements are subject to civil penalties and license suspension
or revocation.
Facility Accreditation. Two national organizations, the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
and the Joint Commission on Accreditation of Rehabilitation
Facilities (CARF), accredit facilities that provide behavioral
health care services such as addiction treatment, opioid treatment
and maintenance programs, crisis stabilization, case management
and care coordination, employment services and vocational
rehabilitation.
JCAHO and CARF each require facilities to demonstrate that their
programs meet the accrediting organizations' quality standards in
order to obtain accreditation. These quality standards evaluate
functions relating to client care and program management,
including administrative requirements, financial management,
personnel qualifications, client services, performance outcomes,
client safety and information privacy and security. JCAHO
requires accredited organizations to reapply for accreditation
every three years while CARF accreditation ranges from one to five
years, depending on the type of facility.
Senate Office of Oversight and Outcomes Report. In 2012, the
Senate Office of Oversight and Outcomes (SOOO) published a report,
Rogue Rehabs: State failed to police drug and alcohol homes, with
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deadly results. The report focused on "gaps" in the ADP's
regulation of residential programs as well as a review of the
state's ban on medical care at residential drug and alcohol
programs. The SOOO advised that state law be changed to "better
reflect current treatment practices?[there is a] mismatch between
the department's regulation and the industry's prevalent
practices. " The SOOO recommended, "?lifting the ban on medical
care as long as it is accompanied with more extensive oversight."
Other States. As part of the SOOO's aforementioned investigation
in 2012, it contacted nine other highly populous states. The SOOO
found, "California is unusual among populous states in prohibiting
medical care." All but one of the nine states allowed physicians
and other medical professionals to work in residential
rehabilitation facilities.
Implementation Issues:
As indicated above, there have been a number of bills that have
attempted to address the issue of removing the ban on provision of
medical services at alcoholism or drug abuse recovery or treatment
facilities. While there have been recent changes to these
facilities, e.g. the licensing and oversight of these facilities
was transferred to the DHCS in 2013, the Legislature may wish to
consider requiring additional implementation safeguards should
this bill pass.
As noted in the SOOO report, it is recommended that the DHCS, the
facility and/or the accrediting organization implement regulations
requiring that the credentials and malpractice insurance for
medical professionals providing medical treatment be checked
before they contract with the facility. It may also be beneficial
to set up a system to require a yearly review of the medical
professional's credentials and insurance to assure ongoing
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compliance and patient protection.
As is consistent with practices in other states, it may also be
beneficial for programs that offer any type of medical
detoxification to hire a medical director to oversee the
administration of this treatment.
To safeguard against the state's prohibition against the corporate
practice of medicine, physicians should contract with the
facilities instead of working directly for them. This would
necessitate that the employment contract specify that the program
cannot control or interfere with the physician's practice and that
the physician retains the ability to make decisions. The contract
should also clearly state that the physician is not paid for the
types or amount of services provided.
Analysis Prepared by:
Le Ondra Clark Harvey / B. & P. / (916) 319-3301
FN:
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