BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 396|
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UNFINISHED BUSINESS
Bill No: SB 396
Author: Hill (D)
Amended: 6/29/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/20/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/1/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 8/20/15 (Consent) - See last page for
vote
SUBJECT: Health care: outpatient settings and surgical
clinics: facilities: licensure and enforcement
SOURCE: Author
DIGEST: This bill requires a Medicare-certified clinic and an
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Page 2
accredited outpatient setting, as specified, to request a report
from the appropriate healthcare regulatory board regarding the
filing of a peer review report; requires licensees who perform
procedures in outpatient settings to be subject to peer review
every two years and that the governing body review the findings
of those reports; and, specifies that inspections of accredited
outpatient surgical centers may be unannounced with a 60-day
warning of the pending inspection.
Assembly Amendments:
1)Strike requirements that an outpatient setting and a facility
certified to participate in the federal Medicare Program as an
ambulatory surgical center are required to report specified
information and a fee to the Office of Statewide Health
Planning and Development.
2)Strike provisions permitting a physician, podiatrist, or
dentist to apply for licensure by the Department of Public
Health (DPH) and strike provisions stating that a surgical
clinic shall be eligible for licensure by the DPH regardless
of physician, podiatrist, or dentist ownership.
3)Require that the findings of the peer review be reported to
the governing body instead of the accrediting agency. Require
that the peer review process that results in the findings be
reviewed by the accrediting agency at the next survey to
determine if the outpatient setting meets applicable
accreditation standards.
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4)Permit, rather than require, that visits subsequent to the
initial accreditation inspection be unannounced. Require the
accrediting agency to notify the outpatient setting that such
inspections will occur within 60 days.
ANALYSIS:
Existing law:
1)Defines an "outpatient setting" to mean any facility, clinic,
unlicensed clinic, center, office, or other setting that is
not part of a general acute care facility, as specified, and
where anesthesia or peripheral nerve blocks, or both, is used
when in compliance with the community standard of practice, in
doses that, when administered have the probability of placing
a patient at risk for loss of the patient's life-preserving
protective reflexes; and, specifies that "outpatient setting"
also means facilities that include in vitro fertilization.
(Health and Safety Code (HSC) § 1248(b).
2)Defines an "accreditation agency" to mean a public or private
organization that is approved to issue certificates of
accreditation to outpatient settings by the Medical Board of
California (MBC), as specified. (HSC § 1248(c))
3)Requires the MBC to adopt standards for accreditation and, in
approving accreditation agencies to perform accreditation of
outpatient settings, must ensure that the certification
program meet specified standards and requirements. (HSC §
1248.15)
4)Defines "peer review" to mean a process in which a peer review
body reviews the basic qualifications, staff privileges,
employment, medical outcomes, or professional conduct of
licentiates to make recommendations for quality improvement
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and education, if necessary, in order to determine whether a
licentiate may practice or continue to practice in a health
care facility, clinic, or other setting providing medical
services, and, if so, to determine the parameters of that
practice and assess and improve the quality of care rendered
in a health care facility, clinic, or other setting providing
medical services. (Business and Professions Code (BPC) §
805(a)(1)(A))
5)Requires the chief of staff of a medical or professional staff
or other chief executive officer, medical director, or
administrator of any peer review body and the chief executive
officer or administrator of any licensed health care facility
or clinic to file an "805 report" with the relevant agency
within 15 days after the effective date on which any of the
following occurs as a result of an action of a peer review
body:
a) A licentiate's application for staff privileges or
membership is denied or rejected for a medical disciplinary
cause or reason;
b) A licentiate's membership, staff privileges, or
employment is terminated or revoked for a medical
disciplinary cause or reason; or,
c) Restrictions are imposed, or voluntarily accepted, on
staff privileges, membership, or employment for a
cumulative total of 30 days or more for any 12-month
period, for a medical disciplinary cause or reason. (BPC §
805(b))
6)Requires a health facility, health care service plan, medical
care foundation, or medical staff , as specified, request a
report prior to granting or renewing staff privileges for any
physician and surgeon, psychologist, podiatrist, or dentist,
from the MBC, the Board of Psychology, the Osteopathic Medical
Board, or the Dental Board of California to determine if any
805 report indicating that the applying physician and surgeon,
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psychologist, podiatrist, or dentist has been denied staff
privileges, been removed from a medical staff, or had his or
her staff privileges restricted, as specified. (BPC §
805.5(a))
This bill:
1) Requires an ambulatory surgery center (ASC) certified to
participate in the federal Medicare program and an accredited
outpatient setting, as specified, to request a report from
the appropriate regulatory board prior to granting or
renewing staff privileges for any physician and surgeon,
psychologist, podiatrist, or dentist to determine if any
report has been made indicating that the applicant has been
denied staff privileges, been removed from a medical staff,
or had his or her staff privileges restricted.
2) Extends by one year, until March 1, 2016, the due date for
the report regarding the vertical enforcement and prosecution
model required of the MBC, in consultation with the
Department of Justice and the Department of Consumer Affairs.
3)Requires each licensee who performs procedures in an
outpatient setting that requires accreditation to be peer
reviewed at least every two years. The peer review shall be a
process in which the basic qualifications, staff privileges,
employment, medical outcomes, or professional conduct of a
licensee is reviewed to make recommendations for quality
improvement and education, if necessary, including when the
outpatient setting has only one licensee. The peer review
shall be performed by licensees who are qualified by education
and experience to perform the same types of, or similar,
procedures.
4)Requires that the findings of the peer review be reported to
the governing body.
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5)Requires that the accrediting agency review the peer review
process at the next survey to determine if the outpatient
setting meets applicable accreditation standards.
6)Permits visits subsequent to the initial accreditation
inspection to be unannounced. Requires the accrediting agency
to notify the outpatient setting that such inspections will
occur within 60 days.
7) Makes technical and minor clarifying changes.
Background
ASC regulation. ASCs are facilities for surgical patients who do
not need to be admitted to a hospital and remain on site for
less than 24 hours. As medical care continues to shift from
inpatient (hospital) type settings to clinics, many patients are
using ASCs or "same-day" surgery centers for a wide variety of
procedures.
According to a study of ASCs by the California Healthcare
Foundation there are at least 750 ASCs in California. This
number is likely larger because there is no centralized source
for data on ASCs due to their diffuse regulation. Generally,
ASCs which are non-physician owned are regulated by DPH, and
physician-owned ASCs are regulated by the MBC, which, in turn,
requires accreditation by one of four approved accrediting
agencies.
Peer Review. Peer review is a process in which physicians
evaluate colleagues' work to determine compliance with the
standard of care. A negative peer review report triggers the
filing of an "805 report" to the appropriate regulatory body.
This bill will expand the list of entities which must request an
805 report to include a facility certified to participate in the
Medicare program as an ASC or an accredited outpatient setting,
as specified, to determine if a report has been made indicating
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that a licensee has had staff privileges revoked or restricted.
This bill will also require physicians working in accredited
outpatient settings to be subjected to the peer review process
every two years, and requires the findings from those reports to
be reported to the governing body.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Appropriations Committee, there are
minor and absorbable costs to the MBC (Contingent Fund of the
MBC).
SUPPORT: (Verified8/24/15)
California Ambulatory Surgery Association
Medical Board of California
OPPOSITION: (Verified8/24/15)
None received
ARGUMENTS IN SUPPORT: The Medical Board of California writes in
support, "[This bill] would require peer review evaluations
every two years for physicians and surgeons working in
ambulatory surgery centers and would allow the accredited
outpatient setting facility inspections performed by
accreditation agencies to be unannounced (after the initial
inspection) and would require at least a 60 day window to be
given to facilities for unannounced inspections?The [MBC]
believes that for consumer protection, physicians working in
[ambulatory surgery centers] should be subject to peer review
evaluations, which would be given to the governing body of the
outpatient setting and be reviewed by the accreditation agency
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at the next inspection of the outpatient setting"
ASSEMBLY FLOOR: 79-0, 8/20/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chu
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
8/24/15 13:21:59
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