BILL ANALYSIS Ó
AB 1177
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
1177 (Gomez, et al.)
As Amended September 4, 2015
Majority vote
--------------------------------------------------------------------
|ASSEMBLY: |51-28 |(May 11, 2015) |SENATE: | |(September 9, |
| | | | |26-13 |2015) |
| | | | | | |
| | | | | | |
--------------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY: Prohibits a primary care clinic, notwithstanding
current regulations or any other law, from being required to
enter into a written transfer agreement with a nearby hospital
as a condition of licensure, and requires the Department of
Public Health (DPH) to repeal the regulation requiring primary
care clinics to enter into transfer agreements, no later than
July 1, 2016.
The Senate amendments require primary care clinics, when
transferring a patient to a hospital, to send copies of all
medical records related to the transfer with the patient, or in
the case of an emergency, as soon as possible, and specify that
a primary care clinic that provides services as an alternative
birth center must maintain a written transfer agreement with a
local hospital.
AB 1177
Page 2
EXISTING FEDERAL LAW: The Emergency Medical Treatment and
Active Labor Act, (EMTALA) is an act of the United States
Congress, passed in 1986 as part of the Consolidated Omnibus
Budget Reconciliation Act. It requires hospitals that accept
payments from Medicare to provide emergency health care
treatment to anyone needing it regardless of citizenship, legal
status, or ability to pay. There are no reimbursement
provisions. Participating hospitals may not transfer or
discharge patients needing emergency treatment except with the
informed consent or stabilization of the patient or when their
condition requires transfer to a hospital better equipped to
administer the treatment. EMTALA applies to "participating
hospitals." The statute defines participating hospitals as
those that accept payment from the Department of Health and
Human Services, Centers for Medicare and Medicaid Services under
the Medicare program. Because there are very few hospitals that
do not accept Medicare, the law applies to nearly all hospitals.
EXISTING STATE REGULATIONS: Require primary care clinics, as a
condition of licensure, to have a written transfer agreement
with a nearby hospital. Allow all licensed clinics, except for
those providing abortion services or birthing services, to
request that DPH waive the requirement to maintain a written
transfer agreement, if the clinic can show that no hospital
would agree to enter into a transfer agreement.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, under current California
law, clinics are obliged to obtain a hospital transfer agreement
(HTA) from a nearby hospital as a condition of licensure in
order to begin performing services. DPH regulations allow
clinics who cannot get an HTA from a nearby hospital to apply
for a waiver to this requirement. However, clinics that provide
abortions or birthing services are not allowed to apply for a
waiver, even if a local hospital won't agree to enter into an
HTA. The author states that this effectively allows a hospital
that does not want to enter into an HTA to prevent an abortion
AB 1177
Page 3
clinic from opening. The author notes that if this bill is
enacted, this regulation will be repealed and unenforceable, and
will give Californians equal access to reproductive services and
the ability to choose.
As required by California Code of Regulations Title 22, Division
5, Chapter 7, Article 6, primary care clinics must have an HTA
with a local hospital as a condition of licensure. Should a
patient undergoing a procedure at a clinic require transport to
the hospital, an HTA facilitates the timely transfer of the
patient between the hospital and the facility. The agreements
delineate the responsibilities of both the clinic and the
hospital, including the required sharing of vital information
such as the current medical findings regarding the patient,
diagnoses, and the transfer of medical records.
Planned Parenthood Affiliates of California (PPAC) are the
sponsors of this bill and they state by requiring hospital
transfer agreements as a condition of licensure, DPH has
essentially delegated some of its licensure authority to the
hospitals, because any hospital corporation with either a moral
objection or desire to secure a competitive edge can refuse to
sign a transfer agreement and bring a clinic's license
application to a halt. PPAC notes they believe the decision of
whether to grant a clinic a license should rest exclusively with
the state. PPAC also notes the existing transfer agreement
requirement acts as a targeted restriction on abortion
providers, or TRAP law, because only abortion clinics and
birthing centers are ineligible to receive a waiver from the
requirement, even in the event that they are unable to secure a
transfer agreement.
The California Right to Life Committee, Inc. (CRCL) is opposed
to this bill because it would remove the necessity of having a
written transfer agreement with one or more nearby hospital when
a primary care clinic seeks licensure. CRLC believes this would
be a very serious regulation change and would threaten the
physical safety of patients at these primary care clinics.
AB 1177
Page 4
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0002300