BILL NUMBER: AB 285	ENROLLED
	BILL TEXT

	PASSED THE ASSEMBLY   SEPTEMBER 10, 1999
	PASSED THE SENATE   SEPTEMBER 9, 1999
	AMENDED IN SENATE   SEPTEMBER 8, 1999
	AMENDED IN SENATE   AUGUST 24, 1999
	AMENDED IN SENATE   JULY 2, 1999
	AMENDED IN ASSEMBLY   APRIL 28, 1999
	AMENDED IN ASSEMBLY   MARCH 25, 1999

INTRODUCED BY   Assembly Member Corbett

                        FEBRUARY 4, 1999

   An act to add Chapter 15 (commencing with Section 4999) to
Division 2 of the Business and Professions Code, to add Section
1348.8 to the Health and Safety Code, and to add Section 10279 to the
Insurance Code, relating to health care services.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 285, Corbett.  Health care coverage:  medical advice services.
   Under existing law, the Knox-Keene Health Care Service Plan Act of
1975, health care service plans are regulated by the Department of
Corporations.  Under existing law, the willful violation of these
provisions is a crime.  Existing law also provides for the regulation
of insurers by the Department of Insurance.
   This bill would require every health care service plan, and every
disability insurer that provides coverage for hospital, medical, and
surgical expenses, that provides, operates, or contracts for
telephone medical advice services to require that the staff employed
to provide the services hold a valid license, registration, or
certification, in any of specified health professions.  The bill
would require that a physician and surgeon be available to the
telephone medical advice service on an on-call basis at all times the
service is advertised to be available.
   The bill would prohibit a health care service plan and certain
disability insurers from operating, or contracting with an in-state
or out-of-state telephone medical advice service to operate, a
telephone medical advice service unless the service is registered as
provided under the bill and if certain other conditions are met.
   Existing law provides for the licensure, certification, or
regulation of physicians and surgeons and other health care
professionals by various boards under the jurisdiction of the
Department of Consumer Affairs.
   This bill would provide for the registration of telephone medical
advice services with the department and would authorize the Director
of Consumer Affairs to set fees for this purpose.  The bill would
prohibit, on and after January 1, 2000, an in-state or out-of-state
business entity from providing telephone medical advice services to a
patient at a California address unless the person is registered with
the department.
   The bill would also impose various related duties upon health care
service plans and disability insurers, as well as the state agencies
charged with their regulation.
   Because this bill would change the requirements of health care
service plans, this bill would change the definition of a crime,
thereby imposing a state-mandated local program.
  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.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Chapter 15 (commencing with Section 4999) is added to
Division 2 of the Business and Professions Code, to read:

      CHAPTER 15.  TELEPHONE MEDICAL ADVICE SERVICES

   4999.  (a) On and after January 1, 2000, no in-state or
out-of-state business entity shall engage in the business of
providing telephone medical advice services to a patient at a
California address unless the business is registered with the
Department of Consumer Affairs.
   (b) Any in-state or out-of-state business entity required to be
registered under subdivision (a) that submits proof of accreditation
by the American Accreditation Healthcare Commission, URAC, the
National Committee for Quality Assurance, the National Quality Health
Council, or the Joint Commission on Accreditation of Healthcare
Organizations shall be deemed provisionally registered by the board
until the earlier of the following:
   (1) December 31, 2000.
   (2) The granting or denial of an application for registration
pursuant to subdivision (a).
   (c) This article shall not apply to individuals licensed pursuant
to any other provision of this division who provide telephone medical
advice that is incidental to the primary focus of their medical
advice activities in their professional practices.
   4999.1.  Application for registration as an in-state or
out-of-state telephone medical advice service shall be made on a form
prescribed by the department, accompanied by the fee prescribed
pursuant to Section 4999.5.  The department shall make application
forms available no later than July 1, 2000.  Applications shall
contain all of the following:
   (a) The signature of the individual owner of the in-state or
out-of-state telephone medical advice service, or of all of the
partners if the service is a partnership, or of the president or
secretary if the service is a corporation.  The signature shall be
accompanied by a resolution or other written communication
identifying the individual whose signature is on the form as owner,
partner, president, or secretary.
   (b) The name under which the person applying for the in-state or
out-of-state telephone medical advice service proposes to do
business.
   (c) The physical address, mailing address, and telephone number of
the business entity.
   (d) The designation of an agent for service of process in
California.
   (e) A list of all in-state or out-of-state staff providing
telephone medical advice services that are required to be licensed,
registered, or certified pursuant to this chapter.  This list shall
be submitted to the department on a quarterly basis on a form to be
prescribed by the department and shall include, but not be limited
to, the name, address, state of licensure, category of license, and
license number.
   (f) The department shall be notified within 30 days of any change
of name, location of business, corporate officer, or agent of
service.
   4999.2.  (a) In order to obtain and maintain a registration,
in-state or out-of-state telephone medical advice services shall
comply with the requirements established by the department.  Those
requirements shall include, but shall not be limited to, all of the
following:
   (1) (A) Ensuring that all staff who provide medical advice
services are appropriately licensed, certified, or registered as a
physician and surgeon pursuant to Chapter 5 (commencing with Section
2000), as a dentist pursuant to Chapter 4 (commencing with Section
1600), as a dental hygienist pursuant to Section 1758 et seq., as a
psychologist pursuant to Chapter 6.6 (commencing with Section 2900),
as a marriage, family and child counselor pursuant to Chapter 13
(commencing with Section 4980), as an optometrist pursuant to Chapter
7 (commencing with Section 3000), as a chiropractor pursuant to the
Chiropractic Initiative Act or as an osteopath pursuant to the
Osteopathic Initiative Act, and operating consistent with the laws
governing their respective scopes of practice in the state within
which they provide telephone medical advice services, except as
provided in paragraph (2).
   (B) Ensuring that all staff who provide telephone medical advice
services from an out-of-state location are health care professionals
as identified in subparagraph (A) that are licensed, registered, or
certified in the state within which they are providing the telephone
medical advice services and operating consistent with the laws
governing their respective scopes of practice.
   (2) Ensuring that all registered nurses providing telephone
medical advice services to both in-state and out-of-state business
entities registered pursuant to this chapter shall be licensed
pursuant to Chapter 6 (commencing with Section 2700).
   (3) Ensuring that the telephone medical advice provided is
consistent with good professional practice.
   (4) Maintaining records of telephone medical advice services,
including records of complaints, provided to patients in California
for a period of at least five years.
   (5) Complying with all directions and requests for information
made by the department.
   (b) To the extent permitted by Article VII of the California
Constitution, the department may contract with a private nonprofit
accrediting agency to evaluate the qualifications of applicants for
registration pursuant to this chapter, and to make recommendations to
the department.
   4999.3.  (a) The department may suspend, revoke, or otherwise
discipline a registrant or deny an application for registration as an
in-state or out-of-state telephone medical advice service based on
any of the following:
   (1) Incompetence, gross negligence, or repeated similar negligent
acts performed by the registrant or any employee of the registrant.
   (2) An act of dishonesty or fraud by the registrant or any
employee of the registrant.
   (3) The commission of any act, or being convicted of a crime, that
constitutes grounds for denial or revocation of licensure pursuant
to any provision of this division.
   (b) The proceedings shall be conducted in accordance with Chapter
5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2
of the Government Code, and the department shall have all powers
granted therein.
   (c) Copies of any complaint against an in-state or out-of-state
telephone medical advice service shall be forwarded to the Department
of Managed Care.
   (d) The department shall forward a copy of any complaint submitted
to the department pursuant to this chapter to the entity that issued
the license to the licensee involved in the advice provided to the
patient.
   4999.4.  (a) Every registration issued to an in-state or
out-of-state telephone medical advice service shall expire 24 months
after the initial date of issuance.
   (b) To renew an unexpired registration, the registrant shall,
before the time at which the license registration would otherwise
expire, apply for renewal on a form prescribed by the department, and
pay the renewal fee authorized by Section 4999.5.
   4999.5.  The department may set fees for registration, as an
in-state or out-of-state telephone medical advice service sufficient
to pay the costs of administration of this chapter.
   4999.6.  The department may adopt, amend, or repeal any rules and
regulations that are reasonably necessary to carry out this chapter.

   4999.7.  (a) Nothing in this section shall limit, preclude, or
otherwise interfere with the practices of other persons licensed or
otherwise authorized to practice, under any other provision of this
division, telephone medical advice services consistent with the laws
governing their respective scopes of practice, or licensed under the
Osteopathic Initiative Act or the Chiropractic Initiative Act and
operating consistent with the laws governing their respective scopes
of practice.
   (b) For the purposes of this section, "medical advice" means any
activity that would require licensure under this division, the
Osteopathic Initiative Act, or the Chiropractic Initiative Act.
   4999.8.  (a) The department shall conduct a study of issues
pertaining to the provision of telephone medical advice services
provided by registered and provisionally registered telephone medical
advice services providers to patients in California by health care
professionals licensed, certified, or registered in other states.
All data required for the study shall be submitted to the department
within 30 days of the end of each calendar quarter.  The study shall
be based upon information of telephone medical advice service
activities occurring between January 1, 2000, and December 31, 2000.
The study shall include, and not be limited to, all of the
following:
   (1) The number of complaints that were filed with the telephone
medical advice service.
   (2) The number of complaints that involved health care
professionals licensed in other states.
   (3) The number of complaints referred to licensing entities in
California and other states.
   (4) The disposition of complaints filed with the department
pursuant to this chapter.
   (5) Complaint information submitted by the Director of the
Department of Managed Care pursuant to subdivision (b) of Section
1348.8.
   (6) Any other information the department determines to be
necessary to evaluate the impact of out-of-state licensees providing
telephone medical advice services on the quality of care provided to
patients in California.
   (b) On or before March 1, 2001, the department shall deliver a
report summarizing the findings of the study to both the Assembly
Committee on Rules and the Senate Committee on Rules, which shall
refer the report to appropriate policy committees.  The report shall
be prepared utilizing existing agency resources.
   (c) The department shall conduct a study of issues pertaining to
the provision of medical advice services provided by registered
telephone medical advice services to patients in California by health
care professionals licensed, certified, or registered in other
states.  All data required for the study shall be submitted to the
department within 30 days of the end of each calendar quarter.  The
study shall be based upon information of telephone medical advice
service activities occurring between January 1, 2001, and December
31, 2001, and shall include, but not limited to, the following:
   (1) The number of complaints that were filed with the telephone
medical advice service.
   (2) The number of complaints that were filed with the department
pursuant to this chapter.
   (3) The number of complaints that involved health care
professionals licensed in other states.
   (4) The number of complaints referred to licensing entities in
California and other states.
   (5) The disposition of complaints filed with the department
pursuant to this chapter.
   (6) Complaint information submitted by the Director of the
Department of Managed Care pursuant to subdivision (b) of Section
1348.8.
   (7) Any other information the department determines to be
necessary to evaluate the impact of out-of-state licensees providing
telephone medical advice services on the quality of care provided to
patients in California.
   (d) On or before March 1, 2002, the department shall deliver a
report summarizing the findings of the study to both the Assembly
Committee on Rules and the Senate Committee on Rules, which shall
refer the report to appropriate policy committees.  The report shall
be prepared from then existing agency resources.
   4999.9.  The director shall, on or before June 30, 2000, adopt
emergency regulations to implement this chapter in accordance with
the Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code).
   The adoption of emergency regulations described in this section
shall be deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, or general
welfare.  Emergency regulations adopted pursuant to this section
shall be exempt from review by the Office of Administrative Law.  The
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and publication in the California Code of Regulations and shall
remain in effect for no more than 180 days.
  SEC. 2.  Section 1348.8 is added to the Health and Safety Code, to
read:
   1348.8.  (a) Every health care service plan that provides,
operates, or contracts for, telephone medical advice services to its
enrollees and subscribers shall do all of the following:
   (1) Ensure that the in-state or out-of-state telephone medical
advice service is registered pursuant to Chapter 15 (commencing with
Section 4999) of Division 2 of the Business and Professions Code.
   (2) Ensure that the staff providing telephone medical advice
services for the in-state or out-of-state telephone medical advice
service are licensed as follows:
   (A) For full service health care service plans, the staff hold a
valid California license as a registered nurse or a valid license in
the state within which they provide telephone medical advice services
as a physician and surgeon or physician assistant and are operating
consistent with the laws governing their respective scopes of
practice.
   (B) (i) For specialized health care service plans providing,
operating, or contracting with a telephone medical advice service in
California, the staff shall be appropriately licensed, registered, or
certified as a physician and surgeon pursuant to Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code, as a registered nurse pursuant to Chapter 6
(commencing with Section 2700) of Division 2 of the Business and
Professions Code, as a dentist pursuant to Chapter 4 (commencing with
Section 1600) of Division 2 of the Business and Professions Code, as
a dental hygienist pursuant to Section 1758 et seq. of the Business
and Professions Code, as a psychologist pursuant to Chapter 6.6
(commencing with Section 2900) of Division 2 of the Business and
Professions Code, as a marriage, family and child counselor pursuant
to Chapter 13 (commencing with Section 4980) of Division 2 of the
Business and Professions Code, as an optometrist pursuant to Chapter
7 (commencing with Section 3000) of Division 2 of the Business and
Professions Code, as a chiropractor pursuant to the Chiropractic
Initiative Act, or as an osteopath pursuant to the Osteopathic
Initiative Act and operating consistent with the laws governing their
respective scopes of practice.
   (ii) For specialized health care service plans providing,
operating, or contracting with an out-of-state telephone medical
advice service, the staff shall be health care professionals, as
identified in clause (i) that are licensed, registered, or certified
in the state within which they are providing the telephone medical
advice services and operating consistent with the laws governing
their respective scopes of practice.  All registered nurses providing
telephone medical advice services to both in-state and out-of-state
business entities registered pursuant to this chapter shall be
licensed pursuant to Chapter 6 (commencing with Section 2700) of
Division 2 of the Business and Professions Code.
   (3) Ensure that every full service health care service plan
provides for a physician and surgeon who is available on an on-call
basis at all times the service is advertised to be available to
enrollees and subscribers.
   (4) Ensure that the in-state or out-of-state telephone medical
advice service designates an agent for service of process in
California and files this designation with the director.
   (5) Requires that the in-state or out-of-state telephone medical
advice service makes and maintains records for a period of five years
after the telephone medical advice services are provided, including,
but not limited to, oral or written transcripts of all medical
advice conversations with the health care service plan's enrollees or
subscribers in California and copies of all complaints.  If the
records of telephone medical advice services are kept out of state,
the health care service plan shall, upon the request of the director,
provide the records to the director within 10 days of the request.
   (6) Ensures that the telephone medical advice services are
provided consistent with good professional practice.
   (b) The director shall forward to the Department of Consumer
Affairs, within 30 days of the end of each calendar quarter, data
regarding complaints filed with the department concerning telephone
medical advice services.
  SEC. 3.  Section 10279 is added to the Insurance Code, to read:
   10279.  (a) Every disability insurer that provides group or
individual policies of disability, or both, that provides, operates,
or contracts for, telephone medical advice services to its insureds
shall do all of the following:
   (1) Ensure that the in-state or out-of-state telephone medical
advice service is registered pursuant to Chapter 15 (commencing with
Section 4999) of Division 2 of the Business and Professions Code.
   (2) Ensure that the staff providing telephone medical advice
services for the in-state or out-of-state telephone medical advice
service hold a valid California license as a registered nurse or a
valid license in the state within which they provide telephone
medical advice services as a physician and surgeon or physician
assistant and are operating consistent with the laws governing their
respective scopes of practice.
   (3) Ensure that a physician and surgeon is available on an on-call
basis at all times the service is advertised to be available to
enrollees and subscribers.
   (4) Ensure that the in-state or out-of-state telephone medical
advice service designates an agent for service of process in
California and files this designation with the commissioner.
   (5) Require that the in-state or out-of-state telephone medical
advice service makes and maintains records for a period of five years
after the telephone medical advice services are provided, including,
but not limited to, oral or written transcripts of all medical
advice conversations with the disability insurer's insureds in
California and copies of all complaints.  If the records of telephone
medical advice services are kept out of state, the insurer shall,
upon the request of the director, provide the records to the director
within 10 days of the request.
   (6) Ensure that the telephone medical advice services are provided
consistent with good professional practice.
   (b) The commissioner shall forward to the Department of Consumer
Affairs, within 30 days of the end of each calendar quarter, data
regarding complaints filed with the department concerning telephone
medical advice services.
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB 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 XIIIB of the California Constitution.