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