BILL NUMBER: SB 349	ENROLLED
	BILL TEXT

	PASSED THE SENATE   SEPTEMBER 10, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 8, 1999
	AMENDED IN ASSEMBLY   SEPTEMBER 7, 1999
	AMENDED IN ASSEMBLY   AUGUST 30, 1999
	AMENDED IN ASSEMBLY   JULY 2, 1999
	AMENDED IN ASSEMBLY   JUNE 17, 1999
	AMENDED IN SENATE   APRIL 14, 1999
	AMENDED IN SENATE   APRIL 5, 1999

INTRODUCED BY   Senator Figueroa
   (Coauthors:  Assembly Members Corbett and Dutra)

                        FEBRUARY 9, 1999

   An act to amend Section 1317.1 of the Health and Safety Code,
relating to emergency services.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 349, Figueroa.  Emergency services and care.
   Existing law provides for the regulation of health facilities,
including general acute care hospitals and acute psychiatric
hospitals.  For purposes of these provisions, existing law defines
emergency services and care as medical screening, examination, and
evaluation by a physician, or, to the extent permitted by applicable
law, by other appropriate personnel under the supervision of a
physician, to determine if an emergency medical condition or active
labor exists and, if it does, the care, treatment, or surgery by a
physician necessary to relieve or eliminate the emergency medical
condition, within the capability of the facility.
   This bill would define emergency services and care to include
additional screening, examination, and evaluation by a physician, or
other personnel to the extent permitted by applicable law and within
the scope of their licensure and clinical privileges, to determine if
a psychiatric emergency medical condition exists as provided under
the bill.  The bill would provide that this definition of emergency
services and care shall not apply to services provided under managed
care contracts with the Medi-Cal program to the extent those services
are excluded from coverage under the contract.
   This bill would state that these provisions defining emergency
services and care are a clarification of the definition of emergency
services and care and a clarification of an existing responsibility
and not the addition of a new responsibility.  This bill would also
provide that those provisions defining emergency services and care do
not affect the scope of licensure or clinical privileges for
clinical psychologists or other medical personnel.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans administered by the Commissioner of Corporations.  Willful
violation of any of these provisions is a crime.
   Existing law requires a health care service plan to reimburse
providers for emergency services and care provided to its enrollees
until the care results in stabilization of the enrollee, except under
certain conditions, and requires the health care service plan to
assume responsibility for the care of the patient if there is a
disagreement between the plan and the provider regarding the need for
necessary medical care.  For purposes of this provision, emergency
services and care is as defined under the provisions governing health
facilities.
   This bill, as discussed above, would change the definition of
emergency care and services.  Since the willful violation of the
provisions governing a health care service plan is a crime, this bill
would impose a state-mandated local program by changing the
definition of a crime.
  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.  Section 1317.1 of the Health and Safety Code is amended
to read:
   1317.1.  Unless the context otherwise requires, the following
definitions shall control the construction of this article and
Section 1371.4:
   (a) (1) "Emergency services and care" means medical screening,
examination, and evaluation by a physician, or, to the extent
permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical
condition or active labor exists and, if it does, the care,
treatment, and surgery by a physician necessary to relieve or
eliminate the emergency medical condition, within the capability of
the facility.
   (2) (A) "Emergency services and care" also means an additional
screening, examination, and evaluation by a physician, or other
personnel to the extent permitted by applicable law and within the
scope of their licensure and clinical privileges, to determine if a
psychiatric emergency medical condition exists, and the care and
treatment necessary to relieve or eliminate the psychiatric emergency
medical condition, within the capability of the facility.
   (B) For the purposes of Section 1371.4, emergency services and
care as defined in this paragraph shall not apply to services
provided under managed care contracts with the Medi-Cal program to
the extent that those services are excluded from coverage under the
contract.
   (C) This paragraph does not expand, restrict, or otherwise affect,
the scope of licensure or clinical privileges for clinical
psychologists or other medical personnel.
   (b) "Emergency medical condition" means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in any of the
following:
   (1) Placing the patient's health in serious jeopardy.
   (2) Serious impairment to bodily functions.
   (3) Serious dysfunction of any bodily organ or part.
   (c) "Active labor" means a labor at a time at which either of the
following would occur:
   (1) There is inadequate time to effect safe transfer to another
hospital prior to delivery.
   (2) A transfer may pose a threat to the health and safety of the
patient or the unborn child.
   (d) "Hospital" means all hospitals with an emergency department
licensed by the state department.
   (e) "State department" means the State Department of Health
Services.
   (f) "Medical hazard" means a material deterioration in medical
condition in, or jeopardy to, a patient's medical condition or
expected chances for recovery.
   (g) "Board" means the Medical Board of California.
   (h) "Within the capability of the facility" means those
capabilities which the hospital is required to have as a condition of
its emergency medical services permit and services specified on
Services Inventory Form 7041 filed by the hospital with the Office of
Statewide Health Planning and Development.
   (i) "Consultation" means the rendering of an opinion, advice, or
prescribing treatment by telephone and, when determined to be
medically necessary jointly by the emergency and specialty
physicians, includes review of the patient's medical record,
examination, and treatment of the patient in person by a specialty
physician who is qualified to give an opinion or render the necessary
treatment in order to stabilize the patient.
   (j) A patient is "stabilized" or "stabilization" has occurred
when, in the opinion of the treating provider, the patient's medical
condition is such that, within reasonable medical probability, no
material deterioration of the patient's condition is likely to result
from, or occur during, a transfer of the patient as provided for in
Section 1317.2, Section 1317.2a, or other pertinent statute.
  SEC. 2.  (a) It is the intent of the Legislature in amending
Section 1317.1 of the Health and Safety Code in Section 1 of this act
to clarify the meaning of Section 1317.1 of the Health and Safety
Code.
   (b) The Legislature finds and declares all of the following:
   (1) Many health care service plans, their subcontractors,
emergency physicians, and emergency departments have been
interpreting Section 1317.1 of the Health and Safety Code to define
emergency services and care to include evaluation and care to assess
and stabilize a psychiatric medical emergency.  This interpretation
is also being followed by state regulatory agencies and the federal
government.
   (2) However, some health care service plans and their
subcontractors have denied reimbursement for a psychiatric evaluation
if the patient also had an evaluation for a nonpsychiatric medical
emergency during the same emergency department visit.
   (c) The amendments to Section 1317.1 of the Health and Safety Code
in Section 1 of this act do both of the following:
   (1) Constitute a clarification of the definition of emergency
services and care contained in Section 1317.1 of the Health and
Safety Code so that health care service plans and their
subcontractors do not misinterpret the statute in a manner that
justifies acts similar to those described in paragraph (2) of
subdivision (b).
   (2) Constitute a clarification of an existing responsibility and
not the addition of a new responsibility.
  SEC. 3.  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.