BILL ANALYSIS �
AB 2452
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Date of Hearing: May 14, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 2452 (Pan) - As Amended: May 6, 2014
Policy Committee: HealthVote:18-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires, by January 1, 2016, the Secretary of State
to establish and maintain access to a secure internet portal
that collects advance health care directives (AHCDs) and related
documentation, and requires the SOS to establish related
processes that allow individuals and health care providers to
access the documents. This bill also:
1)Requires SOS to respond by the close of business on the next
business day to a request for information made pursuant to
existing law by the emergency department of a general acute
care hospital when the request is made by means other than
through the Secretary of State's Internet website.
2)Requires, by January 1, 2016, SOS to consult with licensed
health care facilities to integrate a process for retrieving
documents and information stored in the AHCD Registry from a
statewide health information exchange system.
FISCAL EFFECT
1)Estimated one-time costs of $2.5 million (GF/fee revenue) for
information technology (IT) planning and development,
regulations, and secure storage of records.
2)Unknown ongoing staff costs to SOS to maintain and operate the
system, likely under $1 million annually (GF/fee revenue).
3)Current law allows the SOS to charge a fee to each registrant
in an amount such that, when all fees charged to registrants
are aggregated, the aggregated fees do not exceed the actual
cost of establishing and maintaining the registry. The SOS
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currently charges a fee of $10 per registration. Fee revenue
is currently minor, as there are only about 5,000 registrants
and only a few hundred new registrants annually. To the
extent the new system was more efficient and effective, fee
revenue could increase.
COMMENTS
1)Purpose . According to the author, this bill is needed because
the current AHCD database is outdated and impractical for use
by doctors and other health care providers in a timely manner.
The current system relies on hardcopies and faxing to provide
requesting medical professionals with information. Because
patients are often in critical condition or incapacitated when
these decisions must be made, doctors require immediate
notification about the AHDCs of their patients. The author
argues modernizing the system to primarily operate as an
online portal where all AHDCs are available quickly will allow
doctors to know more about their patients in emergency
situations and better understand their patients' desires.
2)Background . An AHDC is a set of written instructions that a
person gives that specifies what actions should be taken for
their health, if they are no longer able to make decisions
because of illness or incapacity. The California Probate Code
defines AHDC as an individual health care instruction or a
power of attorney for health care. Current law codifies a
statutory AHDC form that includes an explanation of each part,
an explanation of the duties of a designated agent, and
instructions for signing the form, including an explanation of
witnessing requirements or notarization requirements. The use
of this form is optional, and does not preclude the use of
additional or different forms.
3)California Health and Human Services Agency (CHHSA)
Initiative . This bill appears to align with an initiative
being coordinated by the CHHSA, which has convened
stakeholders to make transformational improvements to the
health care system through California's State Innovation Model
(CalSIM) grant proposal to the federal government. The CalSIM
effort has identified improving end-of-life care as one of
four initiatives for improving the health care system.
Specifically, the CalSIM plan notes that one key reason for
the misalignment of patient preferences with care received
toward the end of life is a lack of advanced care planning,
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including determining and documenting individual goals and
wishes for specific treatments based on medical conditions and
personal preferences. The CalSIM end-of-life care initiative
is designed to encourage the use of palliative care when
patients prefer it to more intensive care options.
4)Prior Legislation . AB 2445 (Canciamilla), Chapter 882,
Statutes of 2004, authorized issuing an identification card
and allowed the SOS to charge a fee for the AHDC registry.
AB 891 (Alquist), Chapter 658, Statutes of 1999, established the
Health Care Decisions Law, which also governs AHDCs, including
establishing the program at the SOS.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081