BILL ANALYSIS �
SB 946
Page 1
Date of Hearing: July 5, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 946 (Committee on Health) - As Amended: May 10, 2011
SENATE VOTE : 39-0
SUBJECT : Public health.
SUMMARY : Makes various technical and non-controversial changes
to statutes governing telemedicine, emergency medical services
(EMS) funds, food safety, HIV reporting, health information
privacy, health insurance, and mental health services payments.
Specifically, this bill :
1)Deletes references to "telemedicine" in various statutes and
replaces them with the term "telehealth."
2)Deletes obsolete reporting requirements imposed on the
Department of Health Care Services (DHCS) related to the
application of telemedicine, including store-and-forward
telemedicine.
3)Requires each county that has established a Maddy EMS Fund to
include a description of each disbursement for other EMS
purposes in its annual report to the Legislature, if funds
were disbursed for these purposes, and other additional
information, as specified, regarding the monies collected and
disbursed.
4)Updates the California Retail Food Code (CRFC) to define the
term "hot dog;" require food service employees to wash their
hands prior to donning gloves for working with food or
replacing gloves that need to be changed or replaced; prohibit
single-use gloves from being washed; and, establish sanitation
requirements for food service employees with lesions or open
wounds.
5)Authorizes the Department of Public Health (DPH) to develop a
form to be used to report cases of HIV infection to the local
health department and permits the form to be implemented
without promulgating new regulations.
6)Renames the Office of Health Insurance Portability and
SB 946
Page 2
Accountability Act (HIPAA) Implementation as the California
Office of Health Information Integrity (CalOHII).
7)Deletes a redundant code section requiring CalOHII to be under
the supervision of a director appointed by the Secretary of
Health and Human Services Agency and eliminates obsolete
reporting requirements.
8)Modifies the frequency with which the existing advisory
committee on statewide HIPAA implementation meets from at
least twice a year to an "as required" basis.
9)Revises specified sections of the Insurance Code relating to
coverage for a child to replace references to "solicitor" with
"agent or broker" or "agent or broker of the carrier."
10)Conforms state law to existing federal regulations and
current practice of the Department of Mental Health (DMH) with
regard to negotiated rates and incentive payments for the
provision of Medi-Cal reimbursable community mental health
services.
11)Makes other minor technical changes to correct drafting and
grammatical errors.
EXISTING LAW :
1)Defines "telemedicine" generally to mean the practice of
health care delivery, diagnosis, consultation, treatment,
transfer of medical data, and education using interactive
audio, video, or data communications.
2)Requires DHCS to report to the Legislature by January 1, 2000,
on the application of telemedicine to provide home health
care; emergency care; and, critical and intensive care as
potential Medi-Cal benefits.
3)Requires DHCS to report to the Legislature by January 1, 2008,
on the number and types of services provided and the payments
made related to the application of store-and-forward
telemedicine as a Medi-Cal benefit.
4)Authorizes counties to establish a Maddy EMS Fund and to
deposit specified penalties, forfeitures, and fines into the
fund to reimburse physicians and hospitals for losses from
SB 946
Page 3
providing uncompensated emergency care, and for other EMS
purposes as determined by each county.
5)Requires each county with a Maddy EMS Fund to provide an
annual report to the Legislature that must include the total
amount of fines and forfeitures collected, the total amount of
penalty assessments collected, the total amount of penalty
assessments deposited into the Maddy fund, the fund balance,
and the amount of monies disbursed under the program to
physicians and surgeons, to hospitals, and to other emergency
purposes.
6)Establishes the CRFC to govern all aspects of retail food
safety and sanitation in California and makes local
environmental health departments primarily responsible for
enforcing CRFC through local food safety inspection programs.
7)Directs health care providers and clinical laboratories to
report HIV infection by patient name to the local health
officer, and requires local health officers to report
unduplicated HIV cases by patient name to DPH.
8)Establishes the Office of HIPAA Implementation overseen by an
appointed Director and requires the Director to establish an
advisory committee that must meet twice a year to obtain
information on statewide HIPAA implementation activities.
9)Requires all state entities subject to HIPAA to complete an
assessment by January 1, 2001, to determine the impact of
HIPAA on their operations.
10)Provides for the licensure and regulation of health plans and
specialized health plans by the Department of Managed Health
Care (DMHC) and the regulation of health insurers by the
California Department of Insurance (CDI).
11)Authorizes DMH to approve negotiated rates and incentive
payments for the provision of Medi-Cal reimbursable community
mental health services.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . This bill is authored by the Senate
SB 946
Page 4
Committee on Health as omnibus legislation containing
technical, conforming, or non-controversial changes to laws
affecting various health agencies, programs, and services.
2)TELEHEALTH . According to the California Telemedicine and
eHealth Center, telemedicine usually refers to the provision
of clinical services from a distance, whereas telehealth more
commonly refers to a broader scope of services that includes
telemedicine, and other services that can be provided remotely
using communication technologies. To reflect this shift in
terminology used in common practice, this bill changes
references in existing law from "telemedicine" to
"telehealth." This bill also deletes outdated requirements for
DHCS to report to the Legislature on the application of
telemedicine, including the application of store-and-forward
telemedicine. Store-and-forward telemedicine is technology
that allows a provider or technician at the patient site to
capture diagnostic information, such as medical images and
video and audio clips, and transmits the data to a clinician
at a remote site for assessment. These provisions were
requested by the California State Rural Health Association and
the California Primary Care Association.
3)EMS PROVISIONS . Maddy EMS funds are used to compensate
physicians and medical facilities for EMS provided to patients
who do not have health insurance and cannot pay for their
medical care. Revenue sources for Maddy funds are comprised
of penalty assessments from certain criminal and traffic
violations and a portion of the fees associated with attending
traffic violator schools. Counties with Maddy funds are
required to report specified information to the Legislature on
the status of their funds. This bill requires county EMS fund
reports to include additional information, such as reasons for
the lack of deposits, if no monies were deposited into the
fund; the amount of funds collected from additional
assessments levied by counties; the amount of money disbursed
for actual administrative costs; fee schedules and
methodologies for reimbursing physicians and hospitals; the
amount of monies available to be disbursed to hospitals along
with the amount of claims submitted by hospitals; and, the
name and contact information for county personnel involved in
the administration of the fund. These provisions were
requested by the California Chapter of the American College of
Emergency Physicians to provide more transparency and allow a
better understanding of how these funds are collected and
SB 946
Page 5
distributed at the local level.
4)CRFC BACKGROUND . The CRFC is modeled after the federal Food
and Drug Administration's Model Food Code, which is updated
every four years to enhance food safety laws based on the best
available science. This bill includes clarifying provisions
in the CRFC related to hand-washing procedures and glove use
when working with food to provide consistency with the Model
Food Code. This bill also establishes sanitary precautions
that an employee with a cut, sore, rash, lesion, or wound must
take when coming into contact with food. These provisions
were requested by the California Retail Food Safety Coalition.
5)HIV REPORTING . According to background information provided
by DPH, the federal Centers for Disease Control and Prevention
(CDC) is expected to release a new HIV/AIDS case report this
year which will require DPH's Office of AIDS (OA) to amend its
HIV/AIDS case report form. This form is currently used by
health care providers, laboratories, and local health officers
to report unduplicated HIV cases by name to the OA. OA staff
then enters the data from these case report forms into the
California HIV/AIDS surveillance database system provided by
the CDC.
Currently OA cannot update DPH's HIV/AIDS case report form
without amending the California Code of Regulations. DPH
notes that amending regulation is a lengthy process that will
hamper efficient HIV/AIDS case reporting and cause delays in
the implementation of CDC HIV/AIDS surveillance guidance.
This bill authorizes DPH to revise the HIV/AIDS case reporting
form outside of the administrative regulatory process, in
order to coordinate with the new case reporting form being
released by the CDC. DPH states that matching the forms will
reduce data entry errors and increase the accuracy of
collected HIV/AIDS surveillance information.
6)CalOHII . The Office of HIPPAA Implementation was created in
2001 and renamed CalOHII in 2008 to reflect its expanding new
role supporting the state's health information exchange
initiatives. This bill renames CalOHII in statute, deletes a
redundant code section that specifies that it be under
supervision of an appointed director, and deletes a past
reporting requirement. Lastly, the bill also amends the
frequency that a specified advisory committee must meet from a
minimum of twice per year to on an "as needed" basis.
SB 946
Page 6
7)HEALTH INSURANCE PROVISIONS . This bill corrects drafting
errors and cross references in statutes affecting individual
health insurance policies and replaces the term "solicitor"
with "agent" to be consistent with language used in the
Insurance Code. "Solicitor" is a defined term under the
Knox-Keene Health Care Services Plan Act of 1975 which
regulates DMHC plans, but it is not defined in the Insurance
Code. These provisions were requested by CDI.
8)DMH PROVISIONS . According to background information provided
by DMH, in fiscal year 1993-94, the same year DMH began
contracting with mental health plans for community mental
health services, DHCS and DMH amended the state's Medicaid
(Medi-Cal in California) Plan to begin making negotiated rate
incentive payments to counties for the provision of these
services. In 2008, the federal Centers for Medicare and
Medicaid Services (CMS) published a review that found that
California's negotiated rate process was inconsistent with
federal regulations. The state receives federal matching
funds based on county certified public expenditures (CPEs),
and since the incentive payment was not supported by the true
costs of providing services, the state was drawing down
federal funds without appropriate CPEs.
When CMS instituted regulations requiring negotiated rates for
community mental health services to be based on actual costs,
DMH ceased its practice of providing negotiated rates and
incentive payments. This bill deletes language authorizing
DMH to approve negotiated rates and incentive payments for the
provision of these reimbursable community mental health
services in order to conform to federal law and current
practice. These provisions were requested by DMH.
9)PREVIOUS LEGISLATION .
a) AB 2248 (Ed Hernandez) of 2010, which contained the
provisions of this bill relating to EMS, was vetoed by
Governor Schwarzenegger who stated that the bill would have
created a reimbursable state mandate and he could not
support additional cost pressure on the state's General
Fund.
b) SB 144 (George Runner), Chapter 23, Statutes of 2006,
repeals and reenacts the California Uniform Retail Food
SB 946
Page 7
Facilities Law as the CRFC.
c) SB 699 (Soto), Chapter 20, Statutes of 2006, requires
health care providers and laboratories to report HIV cases
by the patient's name rather than code in order to comply
with federal funding requirements.
d) SB 12 (Maddy), Chapter 1240, Statutes of 1987,
authorizes counties to establish a Maddy EMS Fund to
reimburse to physicians and hospitals for patients who do
not make payments for EMS and also requires, among other
things, each county that establishes a Maddy EMS fund to
report to the Legislature specified information concerning
fines and assessments collected and deposited into the
fund, provider payments, and fund policies and procedures.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097