BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 235|
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THIRD READING
Bill No: AB 235
Author: Hayashi (D)
Amended: 6/11/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-2, 6/17/09
AYES: Alquist, Strickland, Cedillo, DeSaulnier, Leno,
Maldonado, Pavley, Wolk
NOES: Aanestad, Cox
NO VOTE RECORDED: Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : 10-1, 6/29/09
AYES: Kehoe, Corbett, Leno, Oropeza, Price, Runner,
Walters, Wolk, Wyland, Yee
NOES: Cox
NO VOTE RECORDED: Denham, Hancock
ASSEMBLY FLOOR : 78-0, 5/11/09 - See last page for vote
SUBJECT : Emergency services and care
SOURCE : California Hospital Association
DIGEST : This bill extends the definition of emergency
services and care to include additional screening,
examination, and evaluation by appropriate medical
professionals to determine if a psychiatric emergency
medical condition exists, and clarifies hospital and health
plan responsibilities regarding psychiatric emergencies.
CONTINUED
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ANALYSIS : Existing federal law, under the Emergency
Medical Treatment and Active Labor Act (EMALA), requires
hospital emergency departments to provide emergency
screening and stabilization services without regard to the
patient's insurance status or ability to pay.
Existing State Law
1.Provides, under the Knox-Keene Act, for the licensure and
regulation of health care service plans and specialized
health care service plans, including specialized plans
covering mental health services, by the Department of
Managed Health Care (DMHC).
2.Requires licensed hospitals which maintain and operate an
emergency department to provide emergency are and
services to any person requesting the emergency services
or care, or for whom emergency services or care is
requested, for any life-threatening or serious injury or
illness.
3.Prohibits a hospital from conditioning the provision of
emergency services on the person's ethnicity,
citizenship, age, pre-existing medical condition,
insurance status, economic status, ability to pay, or
other specified characteristics.
4.Establishes the obligation of health plans and insurers
to pay for emergency care and services, including
psychiatric emergencies.
5,Defines emergency care and services to mean 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
exists. The definition also provides for treatment and
surgery by a physician, necessary to relieve or eliminate
an emergency medical condition, within the capability of
the facility. It also specifies those capabilities which
the hospital is required to have as a condition of its
emergency medical services permit.
6.Defines emergency care and services to include screening,
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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.
7.Defines emergency care and services to include care and
treatment necessary to relieve or eliminate that
psychiatric emergency medical condition, within the
capacity of the facility.
8.Defines a patient as stabilized, 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 specified.
This bill:
1.Defines a psychiatric emergency medical condition as a
mental disorder that manifests itself by acute symptoms
of sufficient severity that it renders the patient as
being either an immediate danger to himself or herself or
to others, or immediately unable to provide for, or
utilize, food, shelter, or clothing, due to the mental
disorder.
2.Clarifies that the treatment necessary to relieve or
eliminate a psychiatric emergency medical condition may
require admission or transfer to a psychiatric unit
within a general acute care hospital or an acute care
psychiatric hospital.
3.Specifies that a patient with a psychiatric emergency
medical condition may be transferred for treatment
provided that the treating provider determines that there
will not be any risk to the patient's condition as a
result of the transfer.
4.Creates a process for the hospital to notify the health
plan of the need to transfer a patient with a psychiatric
medical condition and when a transfer has occurred.
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5.Allows a health plan to further transfer the patient to a
contracting facility, if not initially, transferred to
such a facility, provided that the treating provider
determines that there will not be any risk to the
patient's condition as a result of the transfer.
Background
The federal EMTALA governs when and how a patient may be
refused treatment or be transferred from one hospital to
another when he or she is in an unstable medical condition.
EMTALA applies to hospitals participating in the federal
Medicare program. In practical terms, this means that it
applies to all hospitals in the United States, with the
exception of the Shriners' Hospital for Crippled Children
and many military hospitals. Under EMTALA, any patient who
comes to the emergency department requesting examination or
treatment for a medical condition must be provided with an
appropriate medical screening examination to determine if
he or she is suffering from an emergency medical condition.
If the person has an emergency medical condition, the
hospital is obligated to wither provide the person with
treatment until stable, or to transfer the person to
another hospital in conformance with EMTALA provisions.
EMTALA prohibits the practice of patient dumping, treatment
denial, and patient discharge based on anticipated high
emergency treatment costs.
Comments
AB 2861 (Hayashi), of the 2007-08 Session, which was
substantially similar to this bill, was vetoed by the
Governor. AB 2861 would have revised, and made more
specific, the obligation of hospitals with emergency
departments to provide emergency care and services for
psychiatric emergency medical conditions and, by reference,
the obligations of health plans in such cases. In his veto
message, the Governor stated, "This bill contains numerous
drafting errors that render its provisions confusing at
best and potentially harmful to patients at worst. I would
encourage the author and stakeholders to fix these errors
in future legislation. At that time, I will consider this
legislation again."
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
DMHC oversight $60 $0
$0 Special*
*Managed Care Fund
SUPPORT : (Verified 6/30/09)
California Hospital Association (source)
American Federation of State, County and Municipal
Employees, AFL-CIO
American Association for Marriage and Family Therapy
Area Agency on Aging of Lake and Mendocino Counties PSA 26
California Mental Health Directors Association
California Psychiatric Association
California Senior Legislature
Disability Rights California
Emergency Nurses Association
NAMI California
National Association of Social Workers
ARGUMENTS IN SUPPORT : The California Hospital
Association, the sponsor of this bill, states that
oftentimes, in order to treat a patient with a psychiatric
emergency, a hospital may need to admit or transfer the
patient for admission to a psychiatric unit within a
general acute hospital or an acute psychiatric hospital.
The California Hospital Association further states that
some HMOs and other health plans have mistakenly denied
payment for these services on the basis that the hospital
did not have a prior authorization for admission. The
California Hospital Association contends that since these
services are for emergency care, prior authorization is not
required under current law.
The California Psychiatric Association states that this
bill reaffirms the obligation of health plans and insurers
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to cover emergency mental health services and care, which
they are obliged to do within the Mental Health Insurance
Parity article of the Knox-Keene Act.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,
Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,
Nava, Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Price, Ruskin, Salas, Saldana, Silva,
Skinner, Smyth, Solorio, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Bass
NO VOTE RECORDED: Duvall, Yamada
CTW:cm 6/30/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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