Amended in Senate June 14, 2016

Amended in Senate April 14, 2016

Amended in Senate March 28, 2016

Senate Bill No. 994

Introduced by begin delete Senator Hill end delete begin insert Senators Hill and Allen end insert

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(Principal coauthors: Assembly Members Hadley and Mullin)

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February 10, 2016

An act to begin delete amend the heading of Article 2.6 (commencing with Section 1645) of Chapter 4 of Division 2 of, to amend the heading of Article 10 (commencing with Section 2190) of Chapter 5 of Division 2 of, and to add Sections 1645.5, 2197, 2454.6, and 2496.5 to, the Business and Professions Code, and to add Article 2.7 (commencing with Section 1223) of Chapter 1 of Division 2 to the Health and Safety Code, relating to antimicrobial stewardship. end delete begin insert add and repeal Sections 32132.9 and 32132.95 of the Health and Safety Code, relating to health care districts, and declaring the urgency thereof, to take effect immediately. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 994, as amended, Hill. begin delete Antimicrobial stewardship policies. end delete begin insert Health care districts: design-build. end insert

begin insert

Existing law authorizes certain health care districts to use the design-build process when contracting for the construction of a building or improvements directly related to construction of a hospital or health facility building in those districts, as specified. Existing law sets forth the procurement process for design-build projects, as specified, and requires specified information submitted by design-build entities to be certified under penalty of perjury.

end insert begin insert

This bill would authorize, until January 1, 2022, the Beach Cities Health District and the Peninsula Health Care District to use the design-build process for the construction of facilities or other buildings in those districts, as specified. Because the bill would expand the application of the procurement process to additional design-build entities, the bill would expand the crime of perjury, thereby imposing a state-mandated local program.

end insert begin insert

This bill would make legislative findings and declarations as to the necessity of a special statute for the Beach Cities Health District and the Peninsula Health Care District.

end insert begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert begin insert

This bill would declare that it is to take effect immediately as an urgency statute.

end insert begin delete

(1) Under the existing Dental Practice Act, the Dental Board of California licenses and regulates the practice of dentistry. The act provides that an applicant may obtain an initial 2-year license to practice dentistry and a 2-year renewal 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 delete begin delete

Under the existing 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. The act authorizes these boards to discipline a licensee for specified unprofessional conduct.

end delete begin delete

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 that the failure of a covered licensee to comply with those requirements during the renewal period constitutes unprofessional conduct.

end delete begin delete

(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.

end delete begin delete

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.

end delete begin delete

(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.

end delete begin delete

This bill would provide that no reimbursement is required by this act for a specified reason.

end delete

Vote:  begin delete majority end delete begin insert ²⁄₃ end insert . Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert

begin insert Section 32132.9 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

begin insert 32132.9. end insert   

(a) Notwithstanding Section 32132 or any other law,
upon approval by the board of directors of the Beach Cities Health
District, the design-build process described in Chapter 4
(commencing with Section 22160) of Part 3 of Division 2 of the
Public Contract Code may be used to assign contracts for the
construction of facilities or other buildings in that district.

(b) For purposes of this section, all references in Chapter 4
(commencing with Section 22160) of Part 3 of Division 2 of the
Public Contract Code to “local agency” shall mean the Beach
Cities Health District and its board of directors.

(c) To the extent that any project utilizing the design-build
process authorized by subdivision (a) is otherwise required to
comply with the standards and requirements of the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983 (Chapter 1
(commencing with Section 129675) of Part 7 of Division 107), this
section shall not be construed as an exemption from that act.

(d) This section shall remain in effect only until January 1, 2022,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2022, deletes or extends that date.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 32132.95 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

begin insert 32132.95. end insert   

(a) Notwithstanding Section 32132 or any other
law, upon approval by the board of directors of the Peninsula
Health Care District, the design-build process described in Chapter
4 (commencing with Section 22160) of Part 3 of Division 2 of the
Public Contract Code may be used to assign contracts for the
construction of facilities or other buildings in that district.

(b) For purposes of this section, all references in Chapter 4
(commencing with Section 22160) of Part 3 of Division 2 of the
Public Contract Code to “local agency” shall mean the Peninsula
Health Care District and its board of directors.

(c) To the extent that any project utilizing the design-build
process authorized by subdivision (a) is otherwise required to
comply with the standards and requirements of the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983 (Chapter 1
(commencing with Section 129675) of Part 7 of Division 107), this
section shall not be construed as an exemption from that act.

(d) This section shall remain in effect only until January 1, 2022,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2022, deletes or extends that date.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert begin insert

The Legislature finds and declares that a special law
is necessary and that a general law cannot be made applicable
within the meaning of Section 16 of Article IV of the California
Constitution because of the unique circumstances relating to the
Beach Cities Health District and the Peninsula Health Care
District.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

end insert

begin insert

begin insert SEC. 5. end insert   

end insert begin insert

This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:

end insert begin insert

In order for the Beach Cities Health District and the Peninsula
Health Care District to facilitate construction of facilities or other
buildings in those districts at the earliest possible time pursuant
to design-build authority, and to ensure the expedient provision
of health care services in those districts at the earliest possible
time, it is necessary that this act take immediate effect.

end insert

begin delete

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) The overuse and misuse of antibiotics can lead to the
development of antibiotic-resistant infections, a major public health
threat.

(b) The federal Centers for Disease Control and Prevention
(CDC) estimates that at least 2,000,000 Americans are infected
with, and at least 23,000 Americans die as a result of,
antibiotic-resistant infections every year, resulting in at least $20
billion in direct health care costs and at least $35 billion in lost
productivity in the United States.

(c) Antibiotic resistance is a growing threat. A recent study
commissioned by the United Kingdom determined that by 2050,
worldwide, more people will die from antibiotic-resistant infections
than from cancer.

(d) The overuse and misuse of antibiotics in human medicine
is a significant factor driving the development of antibiotic
resistance, and a majority of antibiotics are prescribed in outpatient
settings, including primary care physician offices, outpatient
settings where physician assistants and nurse practitioners work,
dentist offices, and other specialty health care providers.

(e) According to the CDC, in one year, 262.5 million courses
of antibiotics are written in outpatient settings. This equates to
more than five prescriptions written each year for every six people
in the United States. The CDC estimates that over one-half of the
antibiotics prescribed in outpatient settings are unnecessary.

(f) More than 10 million courses of antibiotics are prescribed
each year for viral conditions that do not benefit from antibiotics.

(g) Antibiotic stewardship programs, which are already required
in general acute care hospitals and skilled nursing facilities in the
state, but not in outpatient settings, are an effective way to reduce
inappropriate antibiotic use and the prevalence of
antibiotic-resistant infections.

(h) The President’s National Action Plan for Combating
Antibiotic-Resistant Bacteria calls for the establishment of
antibiotic stewardship activities in all health care delivery settings,
including outpatient settings, by 2020.

SEC. 2.  

The heading of Article 2.6 (commencing with Section
1645) of Chapter 4 of Division 2 of the Business and Professions
Code is amended to read:

 

Article 2.6.  Continuing Education and Antimicrobial
Stewardship

 

SEC. 3.  

Section 1645.5 is added to the Business and Professions
Code, to read:

1645.5.  

(a) For purposes of this section the following
definitions apply:

(1) “Antimicrobial stewardship policy” means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing
the development of antimicrobial resistant infections, that is
consistent with one of the following parameters:

(A) Antimicrobial stewardship guidelines published by the
federal Centers for Disease Control and Prevention, the federal
Centers for Medicare and Medicaid Services, the Society for
Healthcare Epidemiology of America, the Infectious Diseases
Society of America, or similar recognized professional
organizations.

(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.

(2) A “covered licensee” means a dentist who practices dentistry
in a setting other than a clinic licensed pursuant to Section 1204
of the Health and Safety Code, a general acute care hospital as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, or a skilled nursing facility as defined in subdivision (c) of
Section 1250 of the Health and Safety Code.

(3) “Evidence-based methods” means antimicrobial prescribing
intervention methods that have been proven effective through
outcome evaluations or studies, including, but not limited to, audit
and feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.

(b) A covered licensee shall adopt and implement an
antimicrobial stewardship policy before applying for a renewal
license.

(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and
is in compliance with that policy.

(d) (1) The board shall audit during each year a random sample
of covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.

(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.

(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the
following renewal period. If the covered licensee fails to comply
within that renewal period,that failure constitutes unprofessional
conduct subject to discipline pursuant to Section 1670.

SEC. 4.  

The heading of Article 10 (commencing with Section
2190) of Chapter 5 of Division 2 of the Business and Professions
Code is amended to read:

 

Article 10.  Continuing Medical Education and Antimicrobial
Stewardship

 

SEC. 5.  

Section 2197 is added to the Business and Professions
Code, to read:

2197.  

(a) For purposes of this section the following definitions
apply:

(1) “Antimicrobial stewardship policy” means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing
the development of antimicrobial resistant infections, that is
consistent with one of the following parameters:

(A) Antimicrobial stewardship guidelines published by the
federal Centers for Disease Control and Prevention, the federal
Centers for Medicare and Medicaid Services, the Society for
Healthcare Epidemiology of America, the Infectious Diseases
Society of America, or similar recognized professional
organizations.

(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.

(2) A “covered licensee” means a physician and surgeon who
practices medicine in a setting other than a clinic licensed pursuant
to Section 1204 of the Health and Safety Code, a general acute
care hospital as defined in subdivision (a) of Section 1250 of the
Health and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.

(3) “Evidence-based methods” means antimicrobial prescribing
intervention methods that have been proven effective through
outcome evaluations or studies, including, but not limited to, audit
and feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.

(b) A covered licensee shall adopt and implement an
antimicrobial stewardship policy before applying for a renewal
license.

(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and
is in compliance with that policy.

(d) (1) The board shall audit during each year a random sample
of covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.

(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.

(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the
following renewal period. If the covered licensee fails to comply
within that renewal period, that failure constitutes unprofessional
conduct subject to discipline pursuant to Section 2234.

SEC. 6.  

Section 2454.6 is added to the Business and Professions
Code, to read:

2454.6.  

(a) For purposes of this section the following
definitions apply:

(1) “Antimicrobial stewardship policy” means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing
the development of antimicrobial resistant infections, that is
consistent with one of the following parameters:

(A) Antimicrobial stewardship guidelines published by the
federal Centers for Disease Control and Prevention, the federal
Centers for Medicare and Medicaid Services, the Society for
Healthcare Epidemiology of America, the Infectious Diseases
Society of America, or similar recognized professional
organizations.

(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.

(2) A “covered licensee” means an osteopathic physician and
surgeon who practices osteopathic medicine in a setting other than
a clinic licensed pursuant to Section 1204 of the Health and Safety
Code, a general acute care hospital as defined in subdivision (a)
of Section 1250 of the Health and Safety Code, or a skilled nursing
facility as defined in subdivision (c) of Section 1250 of the Health
and Safety Code.

(3) “Evidence-based methods” has the same meaning as in
paragraph (3) of subdivision (a) of Section 2197.

(b) A covered licensee shall adopt and implement an
antimicrobial stewardship policy before applying for a renewal
license.

(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and
is in compliance with that policy.

(d) (1) The board shall audit during each year a random sample
of covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.

(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.

(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
renewal period, that failure constitutes unprofessional conduct
subject to discipline pursuant to Section 2234.

SEC. 7.  

Section 2496.5 is added to the Business and Professions
Code, to read:

2496.5.  

(a) For purposes of this section the following
definitions apply:

(1) “Antimicrobial stewardship policy” means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing
the development of antimicrobial resistant infections, that is
consistent with one of the following parameters:

(A) Antimicrobial stewardship guidelines published by the
federal Centers for Disease Control and Prevention, the federal
Centers for Medicare and Medicaid Services, the Society for
Healthcare Epidemiology of America, the Infectious Diseases
Society of America, or similar recognized professional
organizations.

(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.

(2) A “covered licensee” means a podiatrist who practices
podiatric medicine in a setting other than a clinic licensed pursuant
to Section 1204 of the Health and Safety Code, a general acute
care hospital as defined in subdivision (a) of Section 1250 of the
Health and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.

(3) “Evidence-based methods” has the same meaning as in
paragraph (3) of subdivision (a) of Section 2197.

(b) A covered licensee shall adopt and implement an
antimicrobial stewardship policy before applying for a renewal
license.

(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and
is in compliance with that policy.

(d) (1) The board shall audit during each year a random sample
of covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.

(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.

(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
renewal period, that failure constitutes unprofessional conduct
subject to discipline pursuant to Section 2234.

SEC. 8.  

Article 2.7 (commencing with Section 1223) is added
to Chapter 1 of Division 2 of the Health and Safety Code, to read:

 

Article 2.7.  Antimicrobial Stewardship Guidelines

 

1223.  

(a) For purposes of this article the following definitions
apply.

(1) “Antimicrobial stewardship policy” means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing
the development of antimicrobial resistant infections.

(2) “Evidence-based methods” means antimicrobial prescribing
intervention methods that have been proven effective through
outcome evaluations or studies, including, but not limited to, audit
and feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.

(b) On or before January 1, 2018, a primary care clinic or
specialty clinic, licensed pursuant to Section 1204, shall adopt and
implement an antimicrobial stewardship policy that is consistent
with one of the following parameters:

(1) Antimicrobial stewardship guidelines published by the
federal Centers for Disease Control and Prevention, the federal
Centers for Medicare and Medicaid Services, the Society for
Healthcare Epidemiology of America, the Infectious Diseases
Society of America, or similar recognized professional
organizations.

(2) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.

SEC. 9.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

end delete