BILL ANALYSIS                                                                                                                                                                                                    

                                                                    AB 1177

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          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. 


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          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  


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          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.  


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          Analysis Prepared by:                                             
                          Lara Flynn / HEALTH / (916) 319-2097  FN: