BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
235 (Hayashi)
Hearing Date: 6/29/2009 Amended: 6/11/2009
Consultant: Katie Johnson Policy Vote: Health 8-2
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BILL SUMMARY: AB 235 would extend the definition of emergency
services and care to include additional screening, examination,
and evaluation by medical professionals to determine if a
psychiatric emergency medical condition exists. The bill would
also clarify hospital and health plan responsibilities regarding
psychiatric emergencies.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
DMHC oversight $60 $0 $0 Special*
*Managed Care Fund
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STAFF COMMENTS:
Existing federal law, the Emergency Medical Treatment and Active
Labor Act (EMTALA), requires hospital emergency rooms to provide
emergency screening and stabilization services without regard to
a patient's ability to pay for services rendered.
Existing law provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care
(DMHC). It would cost DMHC approximately $60,000 one-time to
update the filings of health plans as a result of this bill. Any
ongoing costs would be minor and absorbable.
Existing law provides for the licensure and regulation of health
facilities by the California Department of Public Health (CDPH).
There would be no cost to CDPH to continue its oversight of
health facilities as a result of this bill.
Existing state law requires health plans and insurers to pay for
emergency care and services. Existing law defines an "emergency
medical condition" as a condition that, absent immediate medical
attention, could result in placing the patient's health in
serious jeopardy, serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part.
Existing law defines "emergency services and care" to mean
medical screening, examination, and evaluation by a physician or
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.
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AB 235 (Hayashi)
This bill would further define "emergency services and care" to
mean an additional screening, examination, and evaluation by a
physician, or other personnel to the extent permitted by law and
within their scope of practice, to determine if a psychiatric
emergency medical condition exists, and the care and treatment
necessary to relieve or eliminate the psychiatric emergency
medical condition.
This bill would define a "psychiatric emergency medical
condition" means a mental disorder that manifests itself by
acute symptoms of sufficient severity that it would render the
patient to be an immediate danger to himself or herself or to
others and unable to provide for, or utilize, food, shelter, or
clothing.
Existing law provides that a patient is "stabilized" or that
"stabilization" has occurred when, in the opinion of the
treating provider, the patient's medical condition is such that
no material deterioration of the patient's condition is likely
to result from, or occur during, the release or transfer of the
patient.
This bill would clarify that the care and treatment necessary to
relieve or eliminate a psychiatric emergency medical condition
could include admission or transfer to a psychiatric unit within
a general acute care hospital or to an acute psychiatric
hospital. This bill would permit the transfer of a patient for
admission to a psychiatric unit within a general acute care
hospital or to an acute psychiatric hospital for care and
treatment that is necessary to relieve or eliminate a
psychiatric emergency medical condition provided that there
would be no material deterioration of the patient's psychiatric
emergency medical condition as a result of, or during, the
transfer.
This bill would clarify that the emergency services and care
specified in this bill's provisions do not apply to Medi-Cal
managed care plan contracts to the extent that such services are
excluded from coverage under those contracts.
This bill would specify a process by which the hospital would
notify an individual's health plan of the need to transfer a
patient with a psychiatric medical condition and when the
transfer occurred.
This bill would permit a health plan to transfer a patient from
a noncontracting facility to a contracting general acute care
hospital or psychiatric hospital provided that in the opinion of
the treating provider the patient's psychiatric emergency
medical condition is such that no material deterioration of the
patient's psychiatric emergency medical condition is likely to
result, or occur during, the transfer.
This bill would require a hospital to which a patient was
transferred to notify the patient's health plan of the transfer,
provided the facility has the name of the health plan.
This bill would state that these provisions should not be
construed to require providers to seek authorization to provide
emergency services and care to a patient who has a psychiatric
emergency medical condition that is not otherwise required by
law.
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AB 235 (Hayashi)
Any costs to hospitals and health plans to implement the
provisions of this bill would be absorbable.
This bill is substantially similar to AB 2861 (Hayashi) of 2008,
which the Governor vetoed, stating, "this bill contains numerous
drafting errors that render its provisions confusing at best and
potentially harmful to patients at worst." This bill has been
redrafted into its current form, which differs from AB 2861, and
thus addresses the Governor's veto message.