SB 994, as amended, Hill. Antimicrobial stewardship policies.
(1) Underbegin insert theend insert existingbegin delete law, theend delete Dentalbegin insert Practice Act, the Dentalend insert Board ofbegin delete California, among other things, establishes requirements pursuant to which anend deletebegin insert California licenses and regulates the practice of dentistry. The act provides that anend insert applicant may obtain an initial 2-year license to practice dentistry and a 2-year renewalbegin delete license, including that the board may require successful completion of continuing education as a condition to license renewal.end deletebegin insert
license. The act also makes certain conduct unprofessional conduct and authorizes the board to revoke or suspend a license or reprimand or place on probation a dentist for that unprofessional conduct.end insert
Underbegin insert theend insert existingbegin delete law, theend delete Medical Practice Act, the Medical Board of California, the Osteopathic Medical Board of California, and the California Board of Podiatric Medicine establish requirements pursuant to which an applicant may obtain an initial 2-year license or subsequent 2-year renewal license to practice medicine as a podiatrist, as a physician and surgeon, osteopathic medicine as an osteopathic physician and surgeon, or podiatric medicine as a podiatrist, respectively. Under existing law, the Medical Board of California is required to adopt
and administer standards for the continuing education of physicians and surgeons and each year audits a random sample of physicians and surgeons who have reported compliance with those requirements and requires a noncompliant licensee to make up the deficiency during the next renewal period. Under existing law, a licensee who fails to so comply is ineligible for a subsequent renewal license until he or she documents compliance to the board. Existing law provides for similar continuing education requirements as a condition of obtaining a renewal license to practice osteopathic medicine and podiatric medicine.begin insert The act authorizes these boards to discipline a licensee for specified unprofessional conduct.end insert
This bill would require a “covered licensee,” defined as a dentist, physician and surgeon, osteopathic physician and surgeon, or person licensed to practice
podiatric medicine, who practices in a setting other than a clinic, general acute care hospital, or skilled nursing facility, to adopt and implement an antimicrobial stewardship policy consistent with specified guidelines or methods of intervention, as defined, before applying for a renewal license and, upon applying for a renewal license, to certify in writing, on a form prescribed by the respective licensing board, that he or she has both adopted an antimicrobial stewardship policy and is in compliance with that policy. The bill would require those licensing boards to audit, during each year, a random sample of covered licensees who have certified compliance with these requirements and would limit the audit of an individual covered licensee to once every 4 years. The bill would require a covered licensee who is selected for audit to submit to the board, on a form prescribed by the board, a copy of his or her antimicrobial stewardship policy. The bill would require the respective licensing board, that
determines that its audited covered licensee has failed to comply with these requirements, to require that covered licensee to comply with these requirements during the following renewal period. The bill would provide thatbegin insert the failure ofend insert
a covered licenseebegin delete who fails to comply is ineligible for license renewal until he or she has documented compliance.end deletebegin insert to comply with those requirements during the renewal period constitutes unprofessional conduct.end insert
(2) Under existing law, health facilities, including, among others, general acute care hospitals, skilled nursing facilities, primary care clinics, and specialty clinics, are licensed and regulated by the State Department of Public Health, and a violation of those provisions is a crime. Existing law requires that each general acute care hospital, on or before July 1, 2015, adopt and implement an antimicrobial stewardship policy in accordance with guidelines established by the federal government and professional organizations that includes a process to evaluate the judicious use of antibiotics, as specified. Existing law requires each skilled nursing facility, on or before January 1, 2017, to adopt and implement an antimicrobial stewardship policy consistent with guidelines developed by the federal Centers for Disease Control and Prevention and other specified entities.
This bill would, beginning January 1, 2018, require a clinic to adopt and implement an antimicrobial stewardship policy consistent with specified guidelines or methods of intervention, as defined. Because this bill would create new crimes, the bill would impose a state-mandated local program.
(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
The Legislature finds and declares all of the
2following:
3(a) The overuse and misuse of antibiotics can lead to the
4development of antibiotic-resistant infections, a major public health
5threat.
6(b) The federal Centers for Disease Control and Prevention
7(CDC) estimates that at least 2,000,000 Americans are infected
8with, and at least 23,000 Americans die as a result of,
9antibiotic-resistant infections every year, resulting in at least $20
10billion in direct health care costs and at least $35 billion in lost
11productivity in the United States.
P4 1(c) Antibiotic resistance is a growing threat. A recent study
2
commissioned by the United Kingdom determined that by 2050,
3worldwide, more people will die from antibiotic-resistant infections
4than from cancer.
5(d) The overuse and misuse of antibiotics in human medicine
6is a significant factor driving the development of antibiotic
7resistance, and a majority of antibiotics are prescribed in outpatient
8settings, including primary care physician offices, outpatient
9settings where physician assistants and nurse practitioners work,
10dentist offices, and other specialty health care providers.
11(e) According to the CDC, in one year, 262.5 million courses
12of antibiotics are written in outpatient settings. This equates to
13more than five prescriptions written each year for every six people
14in the United States. The CDC estimates that over one-half of the
15antibiotics prescribed in outpatient settings are unnecessary.
16(f) More than 10 million courses of antibiotics are prescribed
17each year for viral conditions that do not benefit from antibiotics.
18(g) Antibiotic stewardship programs, which are already required
19in general acute care hospitals and skilled nursing facilities in the
20state, but not in outpatient settings, are an effective way to reduce
21inappropriate antibiotic use and the prevalence of
22antibiotic-resistant infections.
23(h) The President’s National Action Plan for Combating
24Antibiotic-Resistant Bacteria calls for the establishment of
25antibiotic stewardship activities in all health care delivery settings,
26including outpatient settings, by 2020.
The heading of Article 2.6 (commencing with Section
281645) of Chapter 4 of Division 2 of the Business and Professions
29Code is amended to read:
30
Section 1645.5 is added to the Business and Professions
35Code, to read:
(a) For purposes of this section the following
37definitions apply:
38(1) “Antimicrobial stewardship policy” means efforts to promote
39the appropriatebegin delete and optimal selection, dosage, and durationend delete
40begin insert prescribingend insert of antimicrobials for patients, with the goal of reducing
P5 1antimicrobial overuse and misuse and minimizing the development
2of antimicrobial resistant infections, that is consistent with one of
3the following parameters:
4(A) Antimicrobial stewardship guidelines published by the
5federal Centers for
Disease Control and Prevention, the federal
6Centers for Medicare and Medicaid Services, the Society for
7Healthcare Epidemiology of America, the Infectious Diseases
8Society of America, or similar recognized professional
9organizations.
10(B) Evidence-based methods. To the extent practicable,
11antimicrobial stewardship policies based on proven, evidence-based
12methods should include more than one intervention or component.
13(2) A “covered licensee” means a dentist who practices dentistry
14in a setting other than a clinic licensed pursuant to Section 1204
15of the Health and Safety Code, a general acute care hospital as
16defined in subdivision (a) of Section 1250 of the Health and Safety
17Code, or a skilled nursing facility as defined in subdivision (c) of
18Section 1250 of the Health and Safety Code.
19(3) “Evidence-based methods”
means antimicrobial prescribing
20intervention methods that have been proven effective through
21outcome evaluations or studies, including, but not limited to, audit
22and feedback, academic detailing, clinical decision support, delayed
23prescribing practices, poster-based interventions, accountable
24justification, and peer comparison.
25(b) A covered licensee shall adopt and implement an
26antimicrobial stewardship policy before applying for a renewal
27license.
28(c) Upon filing an application with the board for a renewal
29license, a covered licensee shall certify in writing, on a form
30prescribed by the board, that he or she has both adopted an
31antimicrobial stewardship policy pursuant to subdivision (b) and
32is in compliance with that policy.
33(d) (1) The board shall audit during each year a random sample
34of
covered licensees who have certified compliance pursuant to
35subdivision (c). The board shall not audit an individual covered
36licensee more than once every four years.
37(2) A covered licensee who is selected for audit shall submit to
38the board, on a form prescribed by the board, a copy of his or her
39antimicrobial stewardship policy.
P6 1(e) If the board determines that an audited covered licensee has
2failed to comply with subdivision (b), the board shall require that
3covered licensee to comply with subdivision (b) during the
4following renewal period. If the covered licensee fails to comply
5within thatbegin insert renewalend insert period,begin delete he or she is ineligible for a subsequent begin insertthat
6license renewal until he or she has documented compliance.end delete
7failure constitutes unprofessional conduct subject to discipline
8pursuant to Section 1670.end insert
The heading of Article 10 (commencing with Section
102190) of Chapter 5 of Division 2 of the Business and Professions
11Code is amended to read:
12
Section 2197 is added to the Business and Professions
17Code, to read:
(a) For purposes of this section the following definitions
19apply:
20(1) “Antimicrobial stewardship policy” means efforts to promote
21the appropriatebegin delete and optimal selection, dosage, and durationend delete
22begin insert prescribingend insert of antimicrobials for patients, with the goal of reducing
23antimicrobial overuse and misuse and minimizing the development
24of antimicrobial resistant infections, that is consistent with one of
25the following parameters:
26(A) Antimicrobial stewardship guidelines published by the
27federal Centers for
Disease Control and Prevention, the federal
28Centers for Medicare and Medicaid Services, the Society for
29Healthcare Epidemiology of America, the Infectious Diseases
30Society of America, or similar recognized professional
31organizations.
32(B) Evidence-based methods. To the extent practicable,
33antimicrobial stewardship policies based on proven, evidence-based
34methods should include more than one intervention or component.
35(2) A “covered licensee” means a physician and surgeon who
36practices medicine in a setting other than a clinic licensed pursuant
37to Section 1204 of the Health and Safety Code, a general acute
38care hospital as defined in subdivision (a) of Section 1250 of the
39Health and Safety Code, or a skilled nursing facility as defined in
40subdivision (c) of Section 1250 of the Health and Safety Code.
P7 1(3) “Evidence-based methods” means antimicrobial prescribing
2intervention methods that have been proven effective through
3outcome evaluations or studies, including, but not limited to, audit
4and feedback, academic detailing, clinical decision support, delayed
5prescribing practices, poster-based interventions, accountable
6justification, and peer comparison.
7(b) A covered licensee shall adopt and implement an
8antimicrobial stewardship policy before applying for a renewal
9license.
10(c) Upon filing an application with the board for a renewal
11license, a covered licensee shall certify in writing, on a form
12prescribed by the board, that he or she has both adopted an
13antimicrobial stewardship policy pursuant to subdivision (b) and
14is in compliance with that policy.
15(d) (1) The board shall
audit during each year a random sample
16of covered licensees who have certified compliance pursuant to
17subdivision (c). The board shall not audit an individual covered
18licensee more than once every four years.
19(2) A covered licensee who is selected for audit shall submit to
20the board, on a form prescribed by the board, a copy of his or her
21antimicrobial stewardship policy.
22(e) If the board determines that an audited covered licensee has
23failed to comply with subdivision (b), the board shall require that
24covered licensee to comply with subdivision (b) during the
25following renewal period. If the covered licensee fails to comply
26within thatbegin insert renewalend insert period,begin delete he or she is ineligible for a subsequent begin insert
that
27license renewal until he or she has documented compliance.end delete
28failure constitutes unprofessional conduct subject to discipline
29pursuant to Section 2234.end insert
Section 2454.6 is added to the Business and Professions
31Code, to read:
(a) For purposes of this section the following
33definitions apply:
34(1) “Antimicrobial stewardship policy” means efforts to promote
35the appropriatebegin delete and optimal selection, dosage, and durationend delete
36begin insert prescribingend insert of antimicrobials for patients, with the goal of reducing
37antimicrobial overuse and misuse and minimizing the development
38of antimicrobial resistant infections, that is consistent with one of
39the following parameters:
P8 1(A) Antimicrobial stewardship guidelines published by the
2federal Centers for
Disease Control and Prevention, the federal
3Centers for Medicare and Medicaid Services, the Society for
4Healthcare Epidemiology of America, the Infectious Diseases
5Society of America, or similar recognized professional
6organizations.
7(B) Evidence-based methods. To the extent practicable,
8antimicrobial stewardship policies based on proven, evidence-based
9methods should include more than one intervention or component.
10(2) A “covered licensee” means an osteopathic physician and
11surgeon who practices osteopathic medicine in a setting other than
12a clinic licensed pursuant to Section 1204 of the Health and Safety
13Code, a general acute care hospital as defined in subdivision (a)
14of Section 1250 of the Health and Safety Code, or a skilled nursing
15facility as defined in subdivision (c) of Section 1250 of the Health
16and Safety Code.
17(3) “Evidence-based methods” has the same meaning as in
18paragraph (3) of subdivision (a) of Section 2197.
19(b) A covered licensee shall adopt and implement an
20antimicrobial stewardship policy before applying for a renewal
21license.
22(c) Upon filing an application with the board for a renewal
23license, a covered licensee shall certify in writing, on a form
24prescribed by the board, that he or she has both adopted an
25antimicrobial stewardship policy pursuant to subdivision (b) and
26is in compliance with that policy.
27(d) (1) The board shall audit during each year a random sample
28of covered licensees who have certified compliance pursuant to
29subdivision (c). The board shall not audit an individual covered
30licensee more than once every four years.
31(2) A covered licensee who is selected for audit shall submit to
32the board, on a form prescribed by the board, a copy of his or her
33antimicrobial stewardship policy.
34(e) If the board determines that an audited covered licensee has
35failed to comply with subdivision (b), the board shall require that
36licensee to comply with subdivision (b) during the following
37renewal period. If the covered licensee fails to comply within that
38begin insert renewalend insert period,begin delete he or she is ineligible for a subsequent license begin insert
that failure
39renewal until he or she has documented compliance.end delete
P9 1constitutes unprofessional conduct subject to discipline pursuant
2to Section 2234.end insert
Section 2496.5 is added to the Business and Professions
4Code, to read:
(a) For purposes of this section the following
6definitions apply:
7(1) “Antimicrobial stewardship policy” means efforts to promote
8the appropriatebegin delete and optimal selection, dosage, and durationend delete
9begin insert prescribingend insert of antimicrobials for patients, with the goal of reducing
10antimicrobial overuse and misuse and minimizing the development
11of antimicrobial resistant infections, that is consistent with one of
12the following parameters:
13(A) Antimicrobial stewardship guidelines published by the
14federal Centers for
Disease Control and Prevention, the federal
15Centers for Medicare and Medicaid Services, the Society for
16Healthcare Epidemiology of America, the Infectious Diseases
17Society of America, or similar recognized professional
18organizations.
19(B) Evidence-based methods. To the extent practicable,
20antimicrobial stewardship policies based on proven, evidence-based
21methods should include more than one intervention or component.
22(2) A “covered licensee” means a podiatrist who practices
23podiatric medicine in a setting other than a clinic licensed pursuant
24to Section 1204 of the Health and Safety Code, a general acute
25care hospital as defined in subdivision (a) of Section 1250 of the
26Health and Safety Code, or a skilled nursing facility as defined in
27subdivision (c) of Section 1250 of the Health and Safety Code.
28(3) “Evidence-based
methods” has the same meaning as in
29paragraph (3) of subdivision (a) of Section 2197.
30(b) A covered licensee shall adopt and implement an
31antimicrobial stewardship policy before applying for a renewal
32license.
33(c) Upon filing an application with the board for a renewal
34license, a covered licensee shall certify in writing, on a form
35prescribed by the board, that he or she has both adopted an
36antimicrobial stewardship policy pursuant to subdivision (b) and
37is in compliance with that policy.
38(d) (1) The board shall audit during each year a random sample
39of covered licensees who have certified compliance pursuant to
P10 1subdivision (c). The board shall not audit an individual covered
2licensee more than once every four years.
3(2) A covered
licensee who is selected for audit shall submit to
4the board, on a form prescribed by the board, a copy of his or her
5antimicrobial stewardship policy.
6(e) If the board determines that an audited covered licensee has
7failed to comply with subdivision (b), the board shall require that
8licensee to comply with subdivision (b) during the following
9renewal period. If the covered licensee fails to comply within that
10begin insert renewalend insert period,begin delete he or she is ineligible for a subsequent license begin insert
that failure
11renewal until he or she has documented compliance.end delete
12constitutes unprofessional conduct subject to discipline pursuant
13to Section 2234.end insert
Article 2.7 (commencing with Section 1223) is added
15to Chapter 1 of Division 2 of the Health and Safety Code, to read:
16
(a) For purposes of this article the following definitions
20apply.
21(1) “Antimicrobial stewardship policy” means efforts to promote
22the appropriatebegin delete and optimal selection, dosage, and durationend delete
23begin insert prescribingend insert of antimicrobials for patients, with the goal of reducing
24antimicrobial overuse and misuse and minimizing the development
25of antimicrobial resistant infections.
26(2) “Evidence-based methods” means antimicrobial prescribing
27intervention methods that have been proven effective through
28outcome
evaluations or studies, including, but not limited to, audit
29and feedback, academic detailing, clinical decision support, delayed
30prescribing practices, poster-based interventions, accountable
31justification, and peer comparison.
32(b) On or before January 1, 2018, a primary care clinic or
33specialtybegin delete clinicend deletebegin insert clinic, licensed pursuant to Section 1204,end insert shall
34adopt and implement an antimicrobial stewardship policy that is
35consistent with one of the following parameters:
36(1) Antimicrobial stewardship guidelines published by the
37federal Centers for Disease Control and Prevention, the federal
38Centers for Medicare and Medicaid Services, the Society for
39Healthcare Epidemiology of America, the Infectious
Diseases
P11 1Society of America, or similar recognized professional
2organizations.
3(2) Evidence-based methods. To the extent practicable,
4antimicrobial stewardship policies based on proven, evidence-based
5methods should include more than one intervention or component.
No reimbursement is required by this act pursuant to
7Section 6 of Article XIII B of the California Constitution because
8the only costs that may be incurred by a local agency or school
9district will be incurred because this act creates a new crime or
10infraction, eliminates a crime or infraction, or changes the penalty
11for a crime or infraction, within the meaning of Section 17556 of
12the Government Code, or changes the definition of a crime within
13the meaning of Section 6 of Article XIII B of the California
14Constitution.
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97