• Home
• |
• Professionals
  • Attorneys
  • Management
• |
• Practice Areas
• |
• News
  • Firm News
  • Recent Cases
  • Upcoming Events
• |
• Resources
  • Publications
  • HIPAA Resources
  • Practice Technology
• |
• Diversity
• |
• Contact
  • Offices
  • Directions
• |
• Search

Publications

Print

• Publications
• Health Care Updates
• HIPAA Resources
• Practice Technology

New laws passed in 2003 will require hospitals, managed care plans, physicians and other health care professionals to take affirmative action, including but not limited to establishing or modifying policies and procedures to obtain informed consent for certain procedures, limit use of patient information for "marketing" purposes, continue care with terminated providers for specified time periods, assess and address the linguistic needs of patients, and prohibit the use of certain types of physical restraints. A summary of the significant legislation affecting hospitals, managed care plans, physicians and other health care professionals is provided below.

Hospitals

Standards for Informed Consent. AB 1371 increases the standards for informed consent relating to participation in clinical research. This bill requires that research institutions conducting medical experiments on humans disclose their material financial stake in the outcome of the experiment to participants. It also increases or establishes minimum and maximum liabilities and penalties when knowledge of risks and hazards are withheld, or when a person who is primarily responsible for conduct of clinical research fails to obtain informed consent.

The Payers' Bill of Rights. AB 1627 requires hospitals (except rural hospitals) to make available for inspection and file with the Office of Statewide Health Planning and Development (OSHPD), a written or electronic copy of their chargemasters starting July 1, 2004. Hospitals must also compile a list of charges for 25 services or procedures commonly charged to patients, and make the list of charges available to patients upon request.

Nonprofit Corporations. SB 932 prohibits the state attorney general from consenting to an agreement or transaction involving the sale of a health facility owned by a nonprofit corporation to a for-profit corporation, a mutual benefit corporation or another nonprofit corporation, if the seller restricts the type of level of medical services that may be provided at the facility.

Physical Restraints. SB 130 prohibits psychiatric units of general acute-care hospitals, acute psychiatric hospitals and skilled-nursing facilities from using certain restraint techniques known to increase the risk of injury or death to patients. This bill also:

• Requires facilities to do an initial medical risk assessment of patients regarding the use of seclusion and restraints
• Prohibits the use of certain restraint techniques on patients with medical risk factors such as a heart condition or pregnancy
• Requires facilities to report each death or serious injury of a patient occurring during, or related to, the use of seclusion or behavioral restraints
• Requires facilities to conduct reviews for each episode of the use of seclusion or behavioral restraint, to conduct debriefings, and to document the incident

Managed Care Plans

Noncontracting Hospitals. AB 1628 requires non-contracting hospitals to contact an enrollee's health care service plan to obtain the enrollee's medical record information prior to admitting the enrollee as an inpatient for post-stabilization care; transferring an enrollee to a non-contracting hospital for post-stabilization care; or providing post-stabilization care to an enrollee admitted for medically necessary care. The bill requires a non-contracting hospital that admits an enrollee who is not stabilized to contact the enrollee's health plan as soon as reasonably possible after the condition is stabilized. The bill prohibits a hospital that is required to contact the patient's health plan, and fails to do so, from billing the patient for post-stabilization care.

Confidentiality of Medical Information/Marketing. AB 715 amends the Confidentiality of Medical Information Act to include a prohibition against the use of medical information for marketing purposes not necessary to provide health care services to the patient. "Marketing" is defined as "a communication about a product or service that encourages recipients of the communication to purchase or use the product or service."

Continuity of Care. AB 1286 contains a number of new and modified provisions designed to ensure continuity of care. The bill increases from 30 to 60 days the advance notice required to enrollees when a plan's contract with a provider group or acute care hospital, under certain circumstances, is about to terminate. The bill also requires the plan to file the proposed enrollee notice with the DMHC at least 75 days prior to the contract termination date. If the plan later reaches agreement with a terminated provider following issuance of the notice, the plan must offer enrollees the option to return to, or remain with, their current provider. Plans are also required to file by March 1, 2004, as a material modification, a continuity of care policy for new enrollees. AB 1286 expands upon the conditions under which enrollees may continue care with terminated or non-contracted providers, and adds time periods during which the continuation shall last: e.g., continuing care for an acute condition shall last for the duration of the condition, continuing care for a pregnancy shall continue for the duration of the pregnancy and the immediate postpartum period, continuing care for a terminal illness shall continue for the duration of the illness, etc.

Linguistic Needs of Health Plan Enrollees. SB 853 requires the DMHC to adopt regulations by January 1, 2006 requiring all health plans to assess the linguistic needs of their enrollees, excluding Medi-Cal enrollees, and to provide for translation and interpretation services. Among other things, the regulations will require the translation of vital documents into indicated languages. "Vital documents" will include at least the following: applications; consent forms; letters regarding eligibility and participation criteria; notices pertaining to the denial, reduction, modification or termination of services and the right to file a grievance; and notices advising limited-English proficient members of the availability of free language assistance. The regulations will also provide that a plan is in compliance if the plan is required to meet the same or similar standards by the Medi-Cal program, so long as the standards provide as much access to cultural and linguistic services as the standards established by SB 853 for an equal or higher number of enrollees.

Healthy Families Members/Federally Qualified or Rural Clinic Assignment. AB 373 requires that Healthy Families members who are assigned to a primary care clinic, federally qualified health center, or rural health clinic, or physician who is an employee of the clinic or center, shall be deemed assigned to the clinic or center, and not to any individual provider who performs services for the clinic or center. This bill parallels AB 2674, which went into effect in 2003 and provides for the essentially the same with respect to Medi-Cal enrollees.

Social Security Numbers. AB 763 modifies existing requirements that restrict the printing of an individual's social security number on any mailed materials, except in very limited circumstances. The new law would additionally prohibit a social security number that is otherwise permitted to be mailed from being printed, in whole or in part, on a postcard or other mailer not requiring an envelope or visible on the envelope or without the envelope having being opened.

Independent Medical Review. AB 1496 expands the independent medical review program to allow for retrospective review in cases where prior authorization by the plan was not required or provided. Under this bill, DMHC-licensed PPO enrollees will be eligible for independent medical review when the plan denies payment for rendered services on the basis that they were not medically necessary.

Telephone Medical Advice. SB 969 requires plans that provide telephone medical advice services to ensure that only staff who are licensed, certified or registered in a specific health care profession provide medical advice to plan members.

Physicians and Health Care Professionals

Fictitious Names/Advertising. SB 1077 eliminates the existing requirement that fictitious names include specific designations such as "medical group," "medical clinic," "medical corporation," "medical associates," "medical center," or "medical office." The bill also exempts physicians who are employed by a partnership, group or professional corporation holding a fictitious name permit, or ambulatory surgery center that has been granted a certificate of accreditation from the requirement to obtain a fictitious name permit.

Naturopathic Doctors. SB 907 creates a new type of licensed health care professional: the Doctor of Naturopathic Medicine. This bill establishes a new Naturopathic Doctors Act (outlining this professional's scope of practice) and a new Bureau of Naturopathic Medicine. The bill specifies standards for the licensure and regulation of naturopathic medicine that the bureau will enforce. "Naturopathic medicine" is defined to mean a distinct and comprehensive system of primary health care practiced by a naturopathic doctor for the diagnosis, treatment, and prevention of human health conditions, injuries, and disease.

Nurse Practitioners. Nurse practitioners are now authorized to furnish or order Schedule II controlled substances pursuant to a patient-specific protocol approved by the treating or supervising physician. (AB 1196)

Informed Consent for Pelvic Examinations. Physicians and medical students may not perform a pelvic examination on an anesthetized or unconscious female patient, unless: (1) the patient gave informed consent; or (2) examination is within the scope of care for the surgical procedure or diagnostic examination, or (3) for the unconscious patient, the pelvic exam is required for diagnostic purposes. (AB 663)

HIV Blood Tests for Pregnant Women. As early as possible during prenatal care, the blood specimen, if obtained, must also be tested for the presence of HIV after obtaining and documenting the patient's informed consent. (AB 1676)

Patients' Rights. AB 348 (Chapter 94) permits a psychologist or a psychiatrist, in situations when both a psychiatrist and a psychologist have personally evaluated a person, to release a person prior to completion of a 72-hour, 14-day or 30-day treatment and evaluation hold pursuant to the Lanterman-Petris-Short Act. However, both the psychiatrist and psychologist must determine that the person no longer requires evaluation and treatment, and the psychologist and psychiatrist must consult with one another before either may recommend the person's release.

Registered Sex Offenders Barred From Licensure. AB 236 bars a registered sex offender from obtaining a physician and surgeon's license, unless the registration results solely from a misdemeanor conviction for indecent exposure. Similarly, the license of any physician who becomes a registered sex offender must be "promptly revoked" unless the crime was indecent exposure.

If you require our assistance or have any questions please contact Michael Dowell at mdowell@tocounsel.com or the lawyer in the firm who generally handles your health care legal matters.