Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons.

This bill would require the board, in determining continuing education requirements, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, as specified.

Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons.

This bill would require the board, in determining continuing education requirements, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, as specified.

Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons.

This bill would require the board, in determining continuing education requirements, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, as specified.

Existing law, the Medical Practice Act, provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons.

This bill would require the board, in determining continuing education requirements, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, as specified.

 CONSENT  

Bill No: AB 1791

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 6/11/18

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Pan, Wilk

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 4/19/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

This bill requires the Medical Board of California (MBC), in determining its continuing education (CE) requirements for licensed physicians and surgeons, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings.

ANALYSIS:

Existing law:

1. Requires the MBC, in determining its CE requirements, to consider including a course in: (BPC § 2191)
   1. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
   2. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
   3. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
   4. Nutrition, for every physician and surgeon, as part of his or her continuing medical education (CME) particularly a physician and surgeon involved in primary care.
   5. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
   6. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
   7. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
   8. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
   9. Pain management.
   10. Geriatric care for emergency room physicians and surgeons.
   11. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
2. Requires MBC, in determining its CE requirements, to also consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. (BPC § 2191.5.)

This bill requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating HIV/AIDS PrEP and PEP medication maintenance and counseling in primary care settings, especially as it pertains to HIV testing, access to care, counseling, high-risk communities, patient concerns, exposure to HIV/AIDS, and the appropriate care and treatment referrals. Specifies that the course shall be consistent with the most recent guidelines on PrEP and PEP as published by the United States Public Health Service and the Centers for Disease Control and Prevention (CDC).

Background

PrEP and PEP. According to the CDC, PrEP is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada® (pronounced tru vá duh), is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who is positive. CDC notes that studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently. PrEP can be prescribed only by a health care provider.

CME requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 6/26/18)

APLA Health

Desert AIDS Project

Gilead Sciences, Inc.

The Los Angeles LGBT Center

The North County LGBTQ Resource Center

The San Diego LGBT Community Center

The San Francisco Aids Foundation

OPPOSITION: (Verified 6/26/18)

None received

ARGUMENTS IN SUPPORT: Supporters believe that the benefits of PrEP and PEP for individuals at high risk of HIV infection have been well documented, yet awareness and utilization of these interventions among medical providers remain limited.  According to supporters, ample research shows that PrEP and PEP awareness among primary care providers is inadequate and notes that this bill would remedy this inadequacy by requiring MBC to consider courses in PrEP and PEP medication maintenance and counseling in primary care settings when determining its continuing education requirements.

ASSEMBLY FLOOR: 71-0, 4/19/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk-Silva, Reyes, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Calderon, Cristina Garcia, Eduardo Garcia, Melendez, Mullin, Quirk, Rodriguez

Prepared by:

6/27/18 9:35:00

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: AB 1791 Hearing Date: June 11, 2018

Subject: Physicians and surgeons: continuing education

SUMMARY: Requires the Medical Board of California (MBC), in determining its continuing education (CE) requirements for licensed physicians and surgeons, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings.

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC). (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CME course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of
   12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
10. Requires the MBC, in determining its CE requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. Pain management.
20. Geriatric care for emergency room physicians and surgeons.
21. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
22. Requires MBC, in determining its CE requirements, to also consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. (BPC § 2191.5.)

This bill requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, especially as it pertains to HIV testing, access to care, counseling, high-risk communities, patient concerns, exposure to HIV/AIDS, and the appropriate care and treatment referrals. Specifies that the course shall be consistent with the most recent guidelines on PrEP and PEP as published by the United States Public Health Service and the Centers for Disease Control and Prevention (CDC).

FISCAL EFFECT: This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated April 11, 2018, this bill has negligible fiscal impact.

COMMENTS:

1. Purpose. The Author is the sponsor of this measure. According to the Author, PrEP has been FDA approved since 2012 and reduces HIV/AIDS infection by more than 90 percent and is beneficial in preventing infection in patients in high risk groups. The Author states that despite PrEP success, a 2017 survey of healthcare providers found that 32 percent of the doctors surveyed stated they were uncomfortable prescribing PrEP because they either lack sufficient knowledge about PrEP (72.5 percent of respondents), lacked experience in prescribing PrEP (56.3 percent of respondents), or they thought it was not covered by insurance (17.5 percent of respondents).

The Author states that “Additionally, studies show that a large number of health care providers have knowledge of PEP, but lacked training in PEP. Because PEP must be administered within 72 hours after exposure to HIV/AIDS, it is crucial for health care providers to have pre-existing knowledge of PEP to prevent potential infection.”

The Author notes that in order to correct treatment delays and denials for PrEP and PEP, the Department of Health Care Services (DHCS) issued a statement clarifying that treatment for beneficiaries enrolled in Managed Care Plans are covered. Additionally, DHCS encouraged providers “to take appropriate actions to ensure that all staff are equally well informed regarding the...procedures for providing and billing for the medications.” According to the Author, DHCS recognizes the benefits of these treatments.

1. PrEP and PEP. According to the CDC, pre-exposure prophylaxis (PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada® (pronounced tru vá duh), is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who is positive. CDC notes that studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently. PrEP can be prescribed only by a health care provider.
2. Continuing Medical Education (CME) Requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

1. Related Legislation This Year. SB 1109 (Bates) adds the risks of addiction associated with the use of Schedule II drugs to CE and CME requirements for dentists, physicians and surgeons, osteopathic physicians and surgeons, doctors of podiatric medicine, certified nurse midwives, nurse practitioners, physician assistants and optometrists. (Status: This bill is currently pending in the Assembly Committee on Business and Professions.)

AB 2487 (McCarty) requires every physician and surgeon to take one hour of training in medication-assisted treatment for opioid abuse disorders within six months of first receiving a federal Drug Enforcement Administration registration or within six months of their next renewal after January 1, 2019. (Status: This bill is currently pending in the Senate Committee on Rules.)

1. Prior Related Legislation. SB 75 (Committee on Budget and Fiscal Review, Chapter 18, Statutes of 2015) required the State Department of Public Health, upon an appropriation in the annual Budget Act, to establish PrEP Navigator Services Program to provide for specified activities relating to, among other things, funding for community-based organizations and local health departments to provide outreach and education services to populations affected by HIV.
2. Arguments in Support. APLA Health, a nonprofit, federally qualified health center (FHQC) states that “the benefits of PrEP and PEP for individuals at high risk of HIV infection have been well documented, yet awareness and utilization of these interventions among medical providers remain limited.”

Desert AIDS Project, the Los Angeles LGBT Center, the North County LGBTQ Resource Center, the San Diego LGBT Community Center, and the San Francisco Aids Foundation state that ample research shows that PrEP and PEP awareness among primary care providers is inadequate and notes that this bill would remedy this inadequacy by requiring MBC

Gilead Sciences Inc., the manufacturer of Truvada, calls this bill “a necessary step to help increase the awareness among the state’s physicians of this critical and effective prevention medication for those at high risk of acquiring HIV.”

1. Policy Consideration. Primary health care services are provided to Californians by licensees of a number of healing arts boards within the Department of Consumer Affairs, including, but not limited to, osteopathic physicians and surgeons under the Osteopathic Medical Board of California, physician assistants under the Physician Assistant Board and nurse practitioners under the Board of Registered Nursing. Many of these licensees likely interact with patients on a regular basis who could benefit from PrEP and PEP regimens and these licensees are likely included in the health care practitioner categories identified by studies as lacking sufficient knowledge about and training in PrEP and PEP protocols. As such, the Author may wish to expand CE and CME requirements to other health care practitioners who are also providing primary health care services.

SUPPORT AND OPPOSITION:

Support:

APLA Health

Desert AIDS Project

Gilead Sciences Inc.

The Los Angeles LGBT Center

The North County LGBTQ Resource Center

The San Diego LGBT Community Center

The San Francisco Aids Foundation

Opposition:

None on file as of June 5, 2018.

-- END --

Date of Hearing: April 11, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1791

Author:(Waldron) – As Amended Ver:April 2, 2018

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Medical Board of California (MBC) to consider including in its continuing education requirements a course in integrating pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings.

FISCAL EFFECT:

Negligible.

COMMENTS:

1. Purpose. This author-sponsored bill intends to encourage physician education about PrEP and PEP, two pharmaceutical methods of preventing human immunodeficiency virus (HIV) infection. It is supported by various HIV/AIDS and LGBTQ advocacy groups, and has no opposition.
2. Background. PrEP is prescribed as a preventive daily medication to those at high risk of contracting HIV, while PEP must be taken within 72 hours of exposure to the virus in order to reduce chances of transmission. Research demonstrates low uptake of PrEP among those who would benefit from it and that many primary care providers are not familiar with it and are uncomfortable prescribing it.

Current law requires physicians and surgeons licensed by the board to complete at least 50 hours of approved Continuing Medical Education during each two-year license renewal cycle. This bill does not require a course in integrating PrEP and PEP in primary care settings, but instead recommends the MBC consider a course on this topic when determining its continuing education requirements.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 1791

Author:(Waldron) – As Introduced Ver:January 8, 2018

SUBJECT: Physicians and surgeons: continuing education.

SUMMARY: Requires the Medical Board of California (MBC) to consider including a continuing education course for physician and surgeon licensees relating to the integration of HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care setting.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the MBC, a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members, including 7 public members. (BPC § 2001)
3. Includes among the MBC’s responsibilities the administration of a continuing medical education program. (BPC § 2004)
4. Requires the MBC to adopt and administer standards for the continuing education of its licensees; authorizes the MBC to set content standards for any education regarding the prevention and treatment of a chronic disease; and mandates that the board shall require each licensed physician and surgeon to demonstrate satisfaction of continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
5. Authorizes the MBC’s Division of Licensing to establish continuing medical education standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. (BPC § 2190.1)
6. Requires the MBC to consider including a course in human sexuality and nutrition in its continuing education requirements. (BPC § 2191)
7. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in pharmacology as part of his or her continuing education. (BPC § 2191.1)
8. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in geriatric medicine as part of his or her continuing education. (BPC § 2191.2)
9. Requires the MBC to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. (BPC § 2191.5)
10. Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients. (BPC § 2190.5)

THIS BILL:

1. Requires the MBC, in determining its continuing education requirements, to consider including a course in integrating HIV/AIDS PrEP and PEP medication maintenance and counseling in primary care settings, especially as it pertains to HIV testing, access to care, counseling, high-risk communities, patient concerns, exposure to HIV/AIDS, and the appropriate care and treatment referrals.

FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the Author. According to the Author:

Reducing the number of new HIV/AIDS infections requires prevention efforts and education. Ample research shows that PrEP and PEP awareness among primary care providers is inadequate. As a result, these lifesaving treatments are under-prescribed at the expense of patient care, especially for prevention treatment and counseling in high-risk communities. Including medical provider continuing education on PrEP and PEP for prevention of HIV/AIDS, medication maintenance and counseling in primary care settings is critical.

Background.

Continuing Medical Education. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved continuing medical education during each two-year license renewal cycle. This requirement can be met by taking a variety of continuing education courses approved by the MBC. The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. Otherwise, physician and surgeons have the discretion to select what courses to take to meet their education requirements.

When determining what continuing education courses to approve, the MBC’s Division of Licensing currently considers programs accredited by the American Medical Association, the Institute for Medical Quality/California Medical Association, and the Accreditation Council for Continuing Medical Education (ACCME), as well as programs that qualify for prescribed credit from the American Academy of Family Physicians. The MBC also has broad authority to consider other programs offered by organizations and institutions acceptable to the MBC. This bill would not require the MBC to requiring a continuing education course relating to HIV-AIDS pre- and post-exposure prophylaxis, but instead merely requires the MBC to consider doing so.

HIV/AIDS PrEP and PEP. “Prophylaxis” refers to the prevention of an infection or disease. Pre-exposure prophylaxis, or PrEP, is preventative daily medication recommended for individuals considered to be “high risk” for HIV/AIDS exposure. PrEP was approved by the federal Food and Drug Administration (FDA) in 2012 and includes medication marketed under the brand name Truvada. Post-exposure prophylaxis, or PEP, is medication intended for emergency situations and should be used no later than 72 hours following exposure to HIV/AIDS. This medication is often prescribed by emergency room physicians and is traditionally split into occupational and non-occupational exposure treatments.

According to the Author, health care provider surveys have revealed that that 32% of physicians stated they were uncomfortable prescribing PrEP because they either lack sufficient knowledge about PrEP (72.5%), lacked experience in prescribing PrEP (56.3%), or they thought it was not covered by insurance (17.5%). Additionally, studies show that while a decent percentage of health care providers are aware of PEP, physicians lack sufficient training. Because PEP must be administered within 72 hours after exposure to HIV/AIDS, there is a concern that more training and education must be provided to licensed physicians about how PEP may be used to prevent potential infection.

Current Related Legislation. AB 2487 (McCarty) would require physicians and surgeons to take mandatory continuing education relating to the treatment and management of opiate-dependent patients, including eight hours of training in buprenorphine treatment of opioid use disorders.

AB 1790 (Salas) would require physicians and surgeons to take mandatory continuing education relating to preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever.

SB 1109 (Bates) would, among other things, require physicians and surgeons to take mandatory continuing education on the risks of addiction associated with the use of Schedule II drugs.

Prior Related Legislation. AB 1340 (Maienschein) from 2017 similarly required the MBC to, when determining its continuing education requirements, consider including a course in integrating mental and physical health care in primary care settings, especially as pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.

AMENDMENTS:

To ensure that any approved continuing education course is based on current accepted standards for PrEP and PEP medication maintenance and counseling:

Amend Section 1 to add the following language: “The course shall be consistent with the most recent guidelines on PrEP and PEP as published by the United States Public Health Service and the Centers for Disease Control and Prevention.”

REGISTERED SUPPORT:

APLA Health

Desert AIDS Project

Los Angeles LGBT Center

North County LGBTQ Resource Center

San Diego LGBT Community Center

San Francisco AIDS Foundation

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301