BILL ANALYSIS �
SB 1318
Page 1
SENATE THIRD READING
SB 1318 (Wolk)
As Amended August 24, 2012
Majority vote
SENATE VOTE : 23-9
HEALTH 15-0 APPROPRIATIONS 16-0
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|Ayes:|Monning, Logue, Atkins, |Ayes:|Gatto, Harkey, |
| |Bonilla, Eng, Garrick, | |Blumenfield, Bradford, |
| |Gordon, Hayashi, Roger | |Charles Calderon, Campos, |
| |Hern�ndez, Bonnie | |Davis, Fuentes, Hall, |
| |Lowenthal, Mansoor, | |Hill, Cedillo, Mitchell, |
| |Mitchell, Nestande, Pan, | |Nielsen, Norby, Solorio, |
| |Williams | |Wagner |
| | | | |
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SUMMARY : Requires clinics and licensed health care facilities
(health facilities) to institute measures designed to maximize
influenza vaccination rates and to prevent persons with
privileges on the medical staff and onsite health care workers
affiliated with the clinics or health care facilities from
contracting, and transmitting to patients, the influenza virus.
Specifically, this bill :
1)Requires clinics and health facilities to institute measures
designed to maximize influenza vaccination rates and to
prevent persons with privileges on the medical staff and
onsite health care workers affiliated with the clinic and
health care facilities from contracting and transmitting to
patients the influenza virus. States that these measures
shall include, but not be limited to, aerosol transmissible
diseases training, as specified.
2)Requires clinics and health facilities to annually offer
employees onsite influenza vaccinations, if available, at no
cost to the employee.
3)Requires clinics and health facilities to require all onsite
health care workers affiliated with the clinic and health care
facility and persons with privileges on the medical staff to
either annually receive an influenza vaccination or, as an
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alternative to the annual influenza vaccination if an onsite
health care worker affiliated with the clinic and health
facility or person with privileges on the medical staff elects
not to be vaccinated, he or she shall agree, in writing, to
adhere to the most effective measures determined by the clinic
and health facility in preventing health care workers from
contracting and transmitting the influenza virus.
4)Requires clinics and health facilities to annually record
their average vaccination rates, as specified, and make those
records available online or upon request of a government
agency, organization, or individual. Requires the records to
be maintained and made available during any inspection by the
Department of Public Health (DPH).
5)Requires a clinic and health facility, commencing on January
1, 2015, to have a 90% or higher vaccination rate. Provides
that for each year that a clinic and health facility does not
achieve the 90% or higher vaccination rate, the clinic and
health facility shall adopt for the following influenza
season, as defined by the State Public Health Officer the
model mandatory vaccination policy, as specified in 6) below,
to achieve the 90% or higher goal. Authorizes DPH or an
accrediting agency to waive the 90% vaccination rate
requirement for a clinic and health care facility that is in
substantial compliance.
6)Requires DPH, in consultation with the California Conference
of Local Health Officers, to develop a model mandatory
vaccination policy which has been determined to achieve the
90% or higher goal through a stakeholder process to be issued
through an all facilities letter no later than July 1, 2015.
7)Authorizes DPH or an accrediting agency to waive the 90%
vaccination rate requirement for a clinic during any
particular year if the clinic is able to show that it is
reasonably unable to access the appropriate influenza vaccines
necessary to achieve the 90% goal for that year.
8)Provides that in meeting the requirements of 3), 4) and 5)
above, clinics and health facilities:
a) Must maintain flu vaccination records of employees and
may maintain flu vaccination records of the other onsite
health care workers who are affiliated with, but are not
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employees of, the clinic and of persons with privileges on
the medical staff. If the clinic and health facility do
not have records of an onsite health care worker or person
with privileges on the medical staff being vaccinated
onsite, they may require the worker or medical staff person
to either provide documentation of vaccination or
documentation that he or she refused the vaccination; and,
b) Allow language to be included in its business contracts
to require a contract worker to maintain records of the
verification of offsite vaccination or documentation that
he or she refused the vaccination and require this
documentation be made available to the clinic and health
care facility upon request. The clinic and health facility
are not required to maintain separate vaccination records
or to provide vaccinations at no cost to a contract worker
who is not an employee of the clinic and health facility.
9)Requires each clinic and health facility to develop policies
to implement this bill and to ensure its onsite health care
workers are in compliance with the vaccination requirements.
Requires the medical staff to develop policies to ensure that
persons who have privileges on the medical staff are in
compliance with the vaccination requirements of this bill that
have been implemented by the clinic and health facility.
10)Provides that 8) and 9) above shall not apply to a dialysis
clinic which maintains an influenza vaccination log for its
patients, health care workers, and medical staff pursuant to
an infection control program in compliance with the Medicare
"Conditions for Coverage for End-Stage Renal Disease
Facilities," conditions that are promulgated by the Centers
for Medicare and Medicaid Services, if the immunization log is
available for review during routine department inspections or
during an inspection in response to a complaint.
11)Defines the following terms: employee, medical staff, onsite
health care worker affiliated with the clinic, health care
facility, and vaccination rate.
12)Allows DPH to implement this bill by sending letters or
similar instruction to all applicable facilities without
taking regulatory action.
13)Provides that this bill does not prevent a clinic or local
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jurisdiction from instituting additional measures or policies
to maximize influenza vaccination rates and to prevent health
care workers affiliated with the clinic from contracting and
transmitting the influenza virus.
14)Provides that this bill does not require DPH to perform any
additional surveillance for the purpose of ensuring compliance
with this bill that is above and beyond its routine licensing
survey schedule or other statutory requirements.
15)Indicates that implementation of this bill is exempt from the
rulemaking provisions of the Administrative Procedure Act.
16)Defines clinic to include a clinic licensed by DPH, a clinic
that is conducted, operated, or maintained as an outpatient
setting department of a hospital, and an outpatient setting
that is accredited by an accrediting agency approved by the
Medical Board of California (MBC).
17)Provides that accrediting agencies approved by the MBC to be
solely responsible for ensuring that outpatient settings, are
in compliance with specified provisions of this bill.
18)Requires, in addition to the other requirements of this bill,
general acute care hospitals to also do the following:
a) Institute respiratory hygiene and cough etiquette
protocols, develop and implement procedures for the
isolation of patients with influenza, and adopt a seasonal
influenza plan; and,
b) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. Requires the plan
to also document any actual or recommended collaboration
with local, regional, and state public health agencies or
officials in the event of an influenza pandemic.
19)Deletes existing law that requires DPH to require each
general acute care hospital to offer onsite flu vaccinations,
if available to all hospital employees at no cost to the
employee, as specified.
20)Exempts a correctional treatment center, as specified, from
the provisions of this bill.
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FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time fee-supported special fund costs of $50,000 to
$100,000 (Licensing and Certification Program Fund) to DPH to
conduct a stakeholder process.
2)DPH will incur costs of $350,000 annually to verify compliance
with new requirements in approximately 4,500 health
facilities. DPH enforcement processes include inspection for
deficient practices during periodic licensing surveys, and
during complaint investigations.
In future years, as facilities and DPH inspectors gain greater
experience and vaccination rates increase, particularly if
most facilities achieve 90% compliance rates, enforcement
costs may be reduced.
3)Unknown, indirect cost savings may be experienced by health
care facilities and health care payers, including the
California Public Employees' Retirement System and state
programs such as Medi-Cal, if improved vaccination rates at
health facilities reduce transmission of health care-acquired
flu. Literature suggests high vaccination rates will have
this effect.
COMMENTS : The California Medical Association, the Health
Officers Association of California, and the California
Association for Nurse Practitioners are the sponsors of this
bill. According to the author, this bill is an essential step
toward preventing the outbreak of influenza in California's
clinics and health facilities and protects vulnerable patients.
The author further points out that this bill would also apply to
outpatient settings. Accrediting agencies approved by the MBC
would ensure that outpatient settings comply with this bill's
provisions during their periodic inspections, as currently
required in statute. Similar to the inspection provisions
related to DPH, implementation of the requirements of this bill
does not require accrediting agencies to conduct any additional
inspections that are above and beyond their existing
requirements.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
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FN: 0005561