BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1540
A
AUTHOR: Committee on Health
B
AMENDED: July 2, 2009
HEARING DATE: July 8, 2009
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REFERRAL: Environmental Quality
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CONSULTANT:
4
Bain/
0
SUBJECT
Health
SUMMARY
Makes numerous changes to a variety of health programs and
statutes affecting the Office of Statewide Health Planning
and Development (OSHPD), Department of Managed Health Care
(DMHC), Department of Health Care Services (DHCS),
Department of Public Health (DPH), and the University of
California (UC).
CHANGES TO EXISTING LAW
Existing law:
Existing law requires OSHPD to publish risk-adjusted
outcome reports by hospital and by surgeon for coronary
artery bypass graft surgeries, as specified.
Existing law, the Knox-Keene Health Care Service Plan Act
of 1975 (Act), authorizes the director of DMHC to adopt,
amend, and rescind any rules necessary to carry out the
Act, and requires health care service plans regulated under
the Act to provide certain notices.
Continued---
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Existing law, until January 1, 2011, requests UC to
establish the California Health Benefit Review Program
(CHBRP) to assess and prepare a written analysis on the
medical, economic and public health impact of legislation
proposing a mandated health benefit or service required to
be offered or provided by health plans and health insurers.
Existing law requests UC to submit a report to the
Governor and the Legislature by January 1, 2010 regarding
the implementation of these provisions. Existing law, for
fiscal years 2006-07 to 2009-10, assesses a fee on health
plans and health insurers, which is capped at $2 million
annually, to fund UC in implementing CHBRP.
Existing law requires DPH to maintain a program for the
control of tuberculosis (TB). Existing law requires a
local health department that elects to participate in the
TB program to provide for certification by the local health
officer of TB skin test technicians (TB technicians), who
can perform skin tests for TB and measure but not interpret
the test result. This certification authority sunsets
January 1, 2011.
Existing law, known as the California Safe Drinking Water
Act (CSDWA), requires DPH to administer provisions relating
to the regulation of drinking water to protect public
health. Existing law requires DPH to adopt regulations it
determines to be necessary to carry out the purposes of the
California Safe Drinking Water Act. Existing law requires
regulations adopted by DPH to include requirements
governing the use of point-of-entry treatment by public
water systems in lieu of centralized treatment, as
specified.
Existing law requires DHCS to amend the Medicaid state plan
with respect to the billing option for services by local
education agencies (LEA) to ensure that schools are
reimbursed for all eligible services that they provide that
are not precluded by federal requirements. Existing law
would sunset these provisions on January 1, 2010.
This bill:
This bill exempts patient medical record numbers and any
other data elements that OSHPD has, in producing a
specified risk-adjusted outcome report, from the disclosure
STAFF ANALYSIS OF ASSEMBLY BILL 1540 (Committee on Health)
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requirements of the Public Records Act (PRA).
Additionally, this bill permits OSHPD to make specified
data items available to DPH and DHCS by deleting an
obsolete reference to the Department of Health Services
under existing law.
This bill authorizes the director of DMHC, through
regulation, to modify the wording of any notice required by
the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene) for purposes of clarity, readability, and
accuracy. Prohibits a modification from changing the
substantive meaning of the notice.
This bill makes permanent (by repealing the sunset date in
existing law) provisions allowing certified TB technicians
employed by, or contracted with, a local public health
department to administer TB tests under the direction of
the local health officer or TB controller. Under current
law, this authority sunsets January 1, 2011.
This bill extends the sunset date of CHBRP from January 1,
2010 to January 1, 2014, extends the requirement that
health plans and health insurers be assessed a fee to
support CHBRP until the 2014-15 fiscal year (current law
has fee authority until the 2009-10 fiscal year), and
requires a report to the Legislature and the Governor by
January 1, 2014 (current law requires a report by January
1, 2010), on the implementation of CHBRP.
This bill would require water-related regulations adopted
by DPH to include requirements governing the use of
point-of- use treatment by public water systems in lieu of
centralized treatment, where it can be demonstrated that
centralized treatment is not economically feasible. Under
existing law, DPH regulations must include requirements for
point-of- entry treatment by public water systems in lieu of
centralized treatment under this criteria.
This bill eliminates the ability of residential or similar
users of a water system to certify water as achieving the
equivalent level of public health protection provided by
the applicable primary drinking water regulation when it is
providing alternative water for drinking or cooking for
residential or similar uses with water from a water
district meeting specified criteria. Under current law,
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either the water district or the residential or similar
users can make this certification in order to not be
considered a public water system.
This bill permits DPH to assess violations of primary
drinking standards involving turbidity (turbidity is the
cloudiness or haziness of water caused by individual
particles that are generally invisible, and is a test of
water quality).
This bill extends the sunset date for the Local Education
Agency (LEA) Medi-Cal billing option from January 1, 2010
until January 1, 2013 and makes technical changes to
correct cross-references in the Medi-Cal provider
enrollment statutes.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of a previous version of this bill:
By ensuring continued compliance with federal SDWA
requirements, California will continue receiving the
state's share of two federal grants, $74 million (100
percent federal), combined, in the current year.
Annual fee-supported special fund costs of $2 million to
extend CHBRP until 2015. CHBRP is financed by annual
assessments on health plans and insurers.
BACKGROUND AND DISCUSSION
This bill is authored by the Assembly Committee on Health
as omnibus legislation containing numerous technical or
non-controversial changes to the laws affecting various
health and human services agencies including OSHPD, DMHC,
DHCS, and DPH. Many of the provisions make minor,
technical, and conforming changes, while other provisions
are substantive changes that extend sunset dates, or are
intended to improve the ability of the various agencies to
efficiently and effectively administer their respective
programs.
Provisions affecting DMHC and CDI
This bill authorizes the director of DMHC, through
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regulation, to modify the wording of any notice required by
the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene) for purposes of clarity, readability, and
accuracy. The Act requires health plans to issue various
notices containing important information for consumers,
including their rights as enrollees or to notify them of
the DMHC's Independent Medical Review (IMR) process for
resolving disputes with health plans.
DMHC requested the change in this bill because the content
of these notices is dictated by statute, and often
formulated in language that is complicated, difficult to
read, and confusing. Under current law, this language
cannot be altered by either the DMHC or the health plans
that issue the notice. DMHC indicates this bill would
authorize the Director to amend these texts by regulation.
DMHC states that this increased flexibility would allow for
greater clarity, readability, and accuracy in consumer
notices, and would better equip it to address unforeseen
issues as they arise.
Provisions affecting CHBRP
This bill would extend the CHBRP sunset date and the
fee-related funding provisions for CHBRP at the request of
CHBRP. CHBRP indicates these provisions would simply
change the sunset date of CHBRP and the fee-related
provisions to support the program, and would make a
technical fix to align the program's operations with the
fiscal year so that it is not operating during a six-month
period with no corresponding funding. This proposal does
not include a change in the program's scope of work or an
increase in the maximum fee amounts levied on health plans.
Provisions affecting OSHPD
This bill, at the request of OSHPD, would clarify that that
OSHPD has the authority to share patient discharge data
with DHCS and DPH by deleting an outdated reference to the
Department of Health Services. Additionally, this bill
would conform the confidentiality provisions of an outcomes
report involving coronary artery bypass graft surgery data
with the confidentiality provisions of OSHPD's other data
programs.
Provisions affecting public health
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This bill makes permanent (by repealing the January 1, 2011
sunset date in existing law) provisions allowing certified
TB technicians to administer TB tests under the direction
of the local health officer or TB controller. This
provision was originally enacted by SB 843 (Perata),
Chapter 763, Statutes of 2002 with a January 1, 2006 sunset
date, which was then extended by SB 1847 (Perata), Chapter
283, Statutes of 2004 until January 1, 2012.
This provision was included in this bill at the request of
the Health Officers Association of California (HOAC), which
indicates there are currently five local health
jurisdictions (Alameda, Fresno, San Diego, San Mateo, and
San Francisco) using these technicians for TB skin tests.
HOAC states that, since 2005, approximately 37 technicians
have been trained to place and measure TB skin tests, and
they have placed and measured approximately 7,100 tests.
HOAC states there have been no reports of adverse events
from these placements and measurements, and without these
technicians placing and measuring TB tests, nursing staff
would have been pulled from other public health nursing
duties to place and measure these tests. HOAC states
public health departments cannot spare their nursing staff
for work that can be done by others trained for these
specific tasks during a TB case contact investigation, and
due to the certification program's success, it makes sense
to remove the sunset date.
The water-related provisions were included at the request
of DPH to conform existing state statutes to federal laws.
The U.S. Environmental Protection Agency (EPA) delegates
its authority to California to implement a drinking water
program. As a primacy state (having federally delegated
authority), California must enact laws and regulations
related to drinking water that conform to the federal Safe
Drinking Water Act (SDWA) and that are no less stringent
than the federal regulations. DPH states, should
California's laws or regulations fail to comply with the
federal SDWA, California could lose its primacy, which
would result in the loss of significant federal funds.
To achieve SDWA conformance, DPH indicates this bill
addresses three primary issues. The first relates to the
authority to certify alternative water. In certain
circumstances, statutory and regulatory relief may be
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provided to a water system if alternative water is provided
for drinking water and cooking, and the alternative water
is certified to meet drinking water standards. The federal
SDWA allows only a water system to certify the alternative
water, but current state law allows the water district
(water system) or "the residential or similar users of the
system" to certify the alternative water. This bill would
clarify that only water systems would be allowed to certify
alternative water.
The second issue relates to violations of standards for
turbidity, which is a water quality measurement that
indicates the presence of acute contaminants that may lead
to severe illness or even death. The federal SDWA requires
the same penalty for violations of drinking water turbidity
standards as with any other primary drinking water
standard. Although the state may impose a penalty for a
"noncontinuing" violation of other primary drinking water
standards, it does not currently have the authority to do
so for noncontinuing turbidity violations. This bill would
remove the penalty exemption for turbidity, which DPH
indicates would conform penalties for turbidity violations
with the federal SDWA.
The third conformance issue relates to point-of-use
devices. In certain cases, the federal SDWA allows a
public water system to use point-of-use devices for water
treatment to meet drinking water standards. California law
does not allow the use of these devices, which DPH states
offers a feasible solution for ensuring a safe domestic
water supply when other solutions are technically and/or
economically impractical. This bill would provide for the
use of these devices. Although conformance on this issue
is not required to maintain primacy, the EPA has identified
that California law does not currently provide the
authority needed for compliance with federal water quality
laws and regulations.
DPH states that a failure by the state to comply with the
federal SDWA could result in a loss of California's
primacy, which would then result in the loss of significant
federal funds. EPA could reduce or withhold DPH's annual
Public Water System Supervision grant of approximately $6
million and its annual federal capitalization grant for
loans and grants (Safe Drinking Water State Revolving Fund)
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to public water systems (this grant is currently $68
million). DPH states a loss of California's primacy would
also leave enforcement of drinking water standards to EPA
and would adversely affect the quality of California's
drinking water, as California has numerous unique, more
stringent, standards.
Provisions affecting Medi-Cal
This bill would extend the LEA sunset date from January 1,
2010 until January 1, 2013. According to DHCS' website,
the LEA program provides the federal share of reimbursement
for health assessment and treatment for Medi-Cal eligible
children and family members within the school environment.
An LEA provider (generally a school district or county
office of education) employs or contracts with qualified
medical practitioners to render certain health services.
This bill would have originally made the LEA program
permanent, but it was recently amended to extend the
current law sunset by three years.
Arguments in support
The California Hospital Association and the California
Society for Clinical Social Work support the provisions of
this bill that address the protection of patient specific
data collected by OSHPD from the PRA, stating that patient
specific identifying information should be excluded from
the PRA and only be provided when required in clinical and
care settings. The California Health and Human Services
Agency writes in support that it is pleased to sponsor many
of the provisions of this bill to protect the privacy of
medical records, to ensure continuation of federal funds
for existing programs, and to make technical amendments to
correct cross references.
PRIOR ACTIONS
Assembly Floor: 78-0
Assembly Appropriations: 17-0
Assembly Environmental Safety and Toxic Materials: 7-0
Assembly Health: 17-0
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POSITIONS
Support (prior version):
California Department of Public Health
California Health and Human Services Agency
California Hospital Association
California Medical Association
California Society for Clinical Social Work
Department of Health Care Services
Department of Managed Health Care
Health Officers Association of California
Oppose: None received.
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