AB 2576: Emergencies: health care.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-09-23
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
(2)Existing law, the Pharmacy Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record-keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
(2)Existing law, the Pharmacy Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record-keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
(2)Existing law, the Pharmacy Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record keeping record-keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(3)Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law provides that in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patients physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would authorize the department to apply this provision to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by one of those entities during or immediately following a state of emergency, as specified.This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
(2)Existing law, the Pharmacy Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(3)Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law provides that in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patients physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would authorize the department to apply this provision to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by one of those entities during or immediately following a state of emergency, as specified.
This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the money was moneys were originally appropriated.
(2)Existing law, the Pharmacy Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(3)Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program program provisions.
Existing law provides that in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patients physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would authorize the department to apply this provision to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by an enrolled community clinic one of those entities during or immediately following a state of emergency. emergency, as specified.
This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the money was originally appropriated.
(2)Existing law, the Pharmacy Law, the knowing violation of which is a crime, Law provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
The Pharmacy Law authorizes certain clinics to purchase drugs at wholesale for administration or dispensing, under the direction of a physician or surgeon, to patients registered for care at the clinic, provided those clinics obtain a license from the board and comply with various requirements.
This bill would require the board, during or immediately following a proclaimed state of emergency described above, to issue, upon request, a temporary pharmacy clinic permit to further the health and safety of the public. The bill would require a pharmacy or clinic who receives such a permit to use best efforts to keep certain records, but would require the permit holder to maintain the name, strength, and quantity of any drug or device furnished. The bill would provide a temporary pharmacy or clinic permit issued under these provisions to remain valid until 90 calendar days after the termination of the emergency, except as provided. The bill would require the board, during the expand the emergency provision described above to authorize a clinic licensed by the board to purchase drugs at wholesale for administration or dispensing to patients to furnish dangerous drugs or devices in reasonable quantities without a prescription during a federal, state, or local emergency, subject to the standards that apply to pharmacists as described above. The bill would also require the board, during an emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions. The bill would require the board, during the emergency, to waive any application fees for a temporary or mobile pharmacy or clinic permit, and to waive any other requirement if either the board, or the Governor, the waiver will aid in the protection of public health or the provision of patient care. specified conditions that are similar to the conditions that apply to a mobile pharmacy. The bill would authorize the board to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the emergency if, in the boards opinion, the continued waiver will aid in the protection of public health or the provision of patient care. The bill would also make conforming changes.
(3)Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
Existing law provides that in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patients physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by an enrolled community clinic during a state of emergency.
This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.
(1)Existing law, the California Emergency Services Act, authorizes the Governor to proclaim a state of emergency, and local officials and local governments to proclaim a local emergency, when specified conditions of disaster or extreme peril to the safety of persons and property exist, and authorizes the Governor or the appropriate local government to exercise certain powers in response to that emergency. Existing law authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Existing law authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity.
This bill would authorize the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency. The bill would authorize any agency directed by the Governor to perform those activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the money was originally appropriated.
(2)Existing law, the Pharmacy Law, the knowing violation of which is a crime, provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy. Existing law authorizes a pharmacy to furnish dangerous drugs only to specified persons or entities, and subjects certain pharmacies and persons who violate the provision to specified fines. Existing law authorizes a pharmacist to, in good faith, furnish a dangerous drug or device in reasonable quantities without a prescription during a federal, state, or local emergency, in order to further the health and safety of the public by complying with certain record keeping requirements, and authorizes the board to waive any application of the Pharmacy Law during an emergency if the board determines that the waiver will aid in the protection of the public health or the provision of patient care. Existing law requires the board, during a declared federal, state, or local emergency, to allow for the employment of a mobile pharmacy in impacted areas under specified conditions, and authorizes the board to allow the temporary use of a mobile pharmacy when a pharmacy is destroyed or damaged under specified conditions.
This bill would require the board, during or immediately following a proclaimed state of emergency described above, to issue, upon request, a temporary pharmacy clinic permit to further the health and safety of the public. The bill would require a pharmacy or clinic who receives such a permit to use best efforts to keep certain records, but would require the permit holder to maintain the name, strength, and quantity of any drug or device furnished. The bill would provide a temporary pharmacy or clinic permit issued under these provisions to remain valid until 90 calendar days after the termination of the emergency, except as provided. The bill would require the board, during the emergency, to allow for the employment of a mobile pharmacy clinic in impacted areas under specified conditions. The bill would require the board, during the emergency, to waive any application fees for a temporary or mobile pharmacy or clinic permit, and to waive any other requirement if either the board, or the Governor, the waiver will aid in the protection of public health or the provision of patient care.
(3)Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
Existing law provides that in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patients physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by an enrolled community clinic during a state of emergency.
This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of health care regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support health care providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following during a proclaimed state of emergency:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(c)Notwithstanding any other law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of health care regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support health care providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following during a proclaimed state of emergency:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(c)Notwithstanding any other law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of health care regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support health care providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following during a proclaimed state of emergency:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(c)Notwithstanding any other law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
SEC. 6.Section 14132.723 is added to the Welfare and Institutions Code, to read:14132.723.(a)(1)Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patients physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.(2)Notwithstanding any other law, and only to the extent that federal financial participation is available, the department may apply paragraph (1) to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.(b)For purposes of this section, the following terms shall have the following meanings:(1)Enrolled community clinic shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health and Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinics provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.(2)Immediately following shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, or the destruction of a Medi-Cal provider site, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a), the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.(3)Premises shall mean either of the following, as applicable:(A)A site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.(B)A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, at the address listed on its license or listed in the provider master file.(4)Telehealth shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.(c)The following services shall be reimbursable when provided by an enrolled community clinic during or immediately following a state of emergency:(1)Telehealth services.(2)Telephonic services.(3)All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinics premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.(d)For an enrolled fee-for-service Medi-Cal provider, clinic, or facility that has been approved by the department pursuant to paragraph (2) of subdivision (a), the following services shall be reimbursable when provided by that provider, clinic, or facility during or immediately following a state of emergency:(1)Telehealth services.(2)Telephonic services.(3)All covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility but that are provided somewhere other than on the providers, clinics, or facilitys premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.(e)For purposes of paragraph (1) of subdivision (c) and paragraph (1) of subdivision (d), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to permit reimbursement for all telehealth services appropriately provided by an enrolled community clinic, or, if approved by the department pursuant to paragraph (2) of subdivision (a), by an enrolled fee-for-service Medi-Cal provider, clinic, or facility, respectively, during or immediately following a state of emergency. Nothing in this subdivision is intended to limit reimbursement for, or coverage of, or to reduce access to, services provided through telehealth on or before the enactment of this section.(f)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.(g)The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of health care regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support health care providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following: following during a proclaimed state of emergency:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(c)Notwithstanding any other law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
SEC. 6.Section 14132.723 is added to the Welfare and Institutions Code, to read:14132.723.(a)(1)Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patients physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(2)Notwithstanding any other law, and only to the extent that federal financial participation is available, the department may apply paragraph (1) to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.
(b)For purposes of this section, the following terms shall have the following meanings:
(1)Enrolled community clinic shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health and Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinics provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2)Immediately following shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, or the destruction of a Medi-Cal provider site, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a), the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3)Premises shall mean either of the following, as applicable:
(A)A site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(B)A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, at the address listed on its license or listed in the provider master file.
(4)Telehealth shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c)The following services shall be reimbursable when provided by an enrolled community clinic during or immediately following a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinics premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d)For an enrolled fee-for-service Medi-Cal provider, clinic, or facility that has been approved by the department pursuant to paragraph (2) of subdivision (a), the following services shall be reimbursable when provided by that provider, clinic, or facility during or immediately following a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility but that are provided somewhere other than on the providers, clinics, or facilitys premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(e)For purposes of paragraph (1) of subdivision (c) and paragraph (1) of subdivision (d), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to permit reimbursement for all telehealth services appropriately provided by an enrolled community clinic, or, if approved by the department pursuant to paragraph (2) of subdivision (a), by an enrolled fee-for-service Medi-Cal provider, clinic, or facility, respectively, during or immediately following a state of emergency. Nothing in this subdivision is intended to limit reimbursement for, or coverage of, or to reduce access to, services provided through telehealth on or before the enactment of this section.
(f)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.
(g)The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual healthcare health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, healthcare health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of healthcare health care regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support healthcare health care providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(c)Notwithstanding any other law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the state State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
SEC. 6.Section 14132.723 is added to the Welfare and Institutions Code, to read:14132.723.(a)(1)Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patients physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(2)Notwithstanding any other law, and only to the extent that federal financial participation is available, the department may apply paragraph (1) to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.
(b)For purposes of this section, the following terms shall have the following meanings:
(1)Enrolled community clinic shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health and Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinics provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2)Immediately following shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, or the destruction of a Medi-Cal provider site, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a), the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3)Premises shall mean a either of the following, as applicable:
(A)A site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(B)A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, at the address listed on its license or listed in the provider master file.
(4)Telehealth shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c)The following services shall be reimbursable when provided by an enrolled community clinic during or immediately following a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinics premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d)For an enrolled fee-for-service Medi-Cal provider, clinic, or facility that has been approved by the department pursuant to paragraph (2) of subdivision (a), the following services shall be reimbursable when provided by that provider, clinic, or facility during or immediately following a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility but that are provided somewhere other than on the providers, clinics, or facilitys premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(e)For purposes of paragraph (1) of subdivision (c) and paragraph (1) of subdivision (d), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to permit reimbursement for all telehealth services appropriately provided by an enrolled community clinic, or, if approved by the department pursuant to paragraph (2) of subdivision (a), by an enrolled fee-for-service Medi-Cal provider, clinic, or facility, respectively, during or immediately following a state of emergency. Nothing in this subdivision is intended to limit reimbursement for, or coverage of, or to reduce access to, services provided through telehealth on or before the enactment of this section.
(d)(f)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.
(e)(g)The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual healthcare providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, healthcare is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of healthcare regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support healthcare providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062.5 is added to the Business and Professions Code, to read:4062.5.(a)(1)Notwithstanding any other law, during or immediately following a proclaimed state of emergency, a pharmacy or a clinic, as described in Section 4180, may request, and the board shall immediately issue, a temporary pharmacy or clinic permit to further the health and safety of the public.(2)For purposes of this subdivision, immediately following shall mean within 30 calendar days after the conclusion of the proclaimed state of emergency.(b)A pharmacy or clinic issued a temporary permit under this section shall use best efforts to keep a record containing the date, name, and address of each person to whom a drug or device is furnished during a proclaimed state of emergency. However, a pharmacy or clinic issued a temporary permit under this section shall maintain the name, strength, and quantity of any drug or device furnished during the emergency.(c)A temporary pharmacy or clinic permit issued under this section shall be valid until 90 calendar days after the termination of the proclaimed state of emergency. In cases of extraordinary circumstances, such as the destruction of a permitted pharmacy or clinic, and at the discretion of the board or by the direction of the Governor, a temporary pharmacy or clinic permit issued under this section shall be valid for a period of time longer than 90 calendar days and as long as is necessary for the health and safety of the public.(d)During a proclaimed state of emergency, the board shall allow for the employment of a mobile pharmacy or mobile clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (b).(3)A licensed pharmacist or professional director is on the premises and the mobile pharmacy or clinic is under the control and management of a pharmacist or professional director while the drugs are being dispensed.(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy.(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.(e)During a proclaimed state of emergency, the board shall waive any application fees for a temporary or mobile pharmacy or clinic permit that may apply. The board shall waive any other provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, or at the Governors direction, the waiver will aid in the protection of public health or the provision of patient care.(f)For purposes of this section, proclaimed state of emergency means a state of emergency described in Section 8628.5 of the Government Code.SEC. 2.Section 4062 of the Business and Professions Code is amended to read:4062.(a)Notwithstanding Section 4059 or any other provision of law, a pharmacist or a clinic licensed and acting under Section 4180 may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. A record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. The pharmacist or clinic shall communicate this information to the patients attending physician as soon as possible. Notwithstanding Section 4060 or any other provision of law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(b)During a declared federal, state, or local emergency, the board may waive application of any provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, the waiver will aid in the protection of public health or the provision of patient care.
(c)During a declared federal, state, or local emergency, the board shall allow for the employment of a mobile pharmacy or clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (a).
(3)A licensed pharmacist pharmacist, or, in the case of a clinic, a professional director, is on the premises and the mobile pharmacy is under the control and management of a pharmacist pharmacist, or, in the case of a clinic, a professional director, while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy. pharmacy or clinic.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(d)Notwithstanding any other law, the board may elect to continue to waive application of any provision of this chapter for up to 90 days following the termination of the declared emergency if, in the boards opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
SEC. 3.Section 4064 of the Business and Professions Code is amended to read:4064.(a)A prescription for a dangerous drug or dangerous device may be refilled without the prescribers authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacists professional judgment, failure to refill the prescription might interrupt the patients ongoing care and have a significant adverse effect on the patients well-being.
(b)The pharmacist shall inform the patient that the prescription was refilled pursuant to this section.
(c)The pharmacist shall inform the prescriber within a reasonable period of time of any refills dispensed pursuant to this section.
(d)Prior to refilling a prescription pursuant to this section, the pharmacist shall make every reasonable effort to contact the prescriber. The pharmacist shall make an appropriate record, including the basis for proceeding under this section.
(e)The prescriber shall not incur any liability as the result of a refilling of a prescription pursuant to this section.
(f)Notwithstanding Section 4060 or any other law, a person may possess a dangerous drug or dangerous device furnished without prescription pursuant to this section.
(g)During a proclaimed state of emergency, nothing in either this section or any other provision of this chapter prohibits a pharmacist, a clinic licensed under Section 4180, or a mobile pharmacy or clinic described in subdivision (c) of Section 4062 from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
SEC. 4.Section 4126.5 of the Business and Professions Code is amended to read:4126.5.(a)A pharmacy may furnish dangerous drugs only to the following:
(1)A wholesaler owned or under common control by the wholesaler from whom the dangerous drug was acquired.
(2)The pharmaceutical manufacturer from whom the dangerous drug was acquired.
(3)A licensed wholesaler acting as a reverse distributor.
(4)Another pharmacy or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A pharmacy furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(5)A patient or to another pharmacy pursuant to a prescription or as otherwise authorized by law.
(6)A health care provider that is not a pharmacy but that is authorized to purchase dangerous drugs.
(7)To another pharmacy under common control. During a proclaimed state of emergency, another pharmacy as used in this paragraph shall include a mobile pharmacy, as described in subdivision (c) of Section 4062.
(b)Notwithstanding subdivision (a), or any other law, a clinic licensed under Section 4180 may furnish dangerous drugs to any of the following:
(1)Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. A clinic furnishing dangerous drugs pursuant to this paragraph may only furnish a quantity sufficient to alleviate the temporary shortage.
(2)A patient pursuant to a prescription or as otherwise authorized by law.
(3)A health care provider that is not a clinic but that is authorized to purchase dangerous drugs.
(4)To another clinic under common control, including a mobile clinic, as described in subdivision (c) of Section 4062.
(b)(c)Notwithstanding any other provision of law, a violation of this section may subject the person or persons who committed the violation to a fine not to exceed the amount specified in Section 125.9 for each occurrence pursuant to a citation issued by the board.
(c)(d)Amounts due from any person under this section on or after January 1, 2005, shall be offset as provided under Section 12419.5 of the Government Code. Amounts received by the board under this section shall be deposited into the Pharmacy Board Contingent Fund.
(d)(e)For purposes of this section, common control means the power to direct or cause the direction of the management and policies of another person whether by ownership, by voting rights, by contract, or by other means.
SEC. 3.SEC. 5.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the state Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
SEC. 4.SEC. 6.Section 14132.723 is added to the Welfare and Institutions Code, to read:14132.723.(a)Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patients physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(b)For purposes of this section, the following terms shall have the following meanings:
(1)Enrolled community clinic shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinics provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2)Immediately following shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3)Premises shall mean a site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(4)Telehealth shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c)The following services shall be reimbursable when provided by an enrolled community clinic during a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinics premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.
(e)The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.
The Legislature finds and declares all of the following:
(a)The Legislature has previously granted broad authority to the Governor to direct state agencies to take various actions in order to facilitate the immediate provision of emergency necessities and resources to the public throughout disruptions caused by natural disasters and other declared emergencies.
(b)Ensuring that both institutional and individual healthcare providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety.
(c)In the case of a natural disaster or other emergency situations, healthcare is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters. However, given the complexities of healthcare regulation and reimbursement, often neither the state nor local jurisdictions are able to readily advise and support healthcare providers who are trying to help patients under these circumstances.
(d)Community clinics and health centers are crucial to emergency response and recovery efforts by doing all of the following: providing patients with necessary resources, such as how to apply for CalFresh, and information on local assistance centers; information on how to apply for assistance from the Federal Emergency Management Agency (FEMA) and other state and federal resources; information on how to obtain emergency refills for prescription drugs; and information on disaster services from the Employment Development Department for patients who have lost their jobs as a result of the fires. Community clinics and health centers are responsible to the most vulnerable in our state; those individuals who have been hit the hardest by these natural disasters.
(e)The purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
SEC. 2.Section 4062.5 is added to the Business and Professions Code, to read:4062.5.(a)(1)Notwithstanding any other law, during or immediately following a proclaimed state of emergency, a pharmacy or a clinic, as described in Section 4180, may request, and the board shall immediately issue, a temporary pharmacy or clinic permit to further the health and safety of the public.
(2)For purposes of this subdivision, immediately following shall mean within 30 calendar days after the conclusion of the proclaimed state of emergency.
(b)A pharmacy or clinic issued a temporary permit under this section shall use best efforts to keep a record containing the date, name, and address of each person to whom a drug or device is furnished during a proclaimed state of emergency. However, a pharmacy or clinic issued a temporary permit under this section shall maintain the name, strength, and quantity of any drug or device furnished during the emergency.
(c)A temporary pharmacy or clinic permit issued under this section shall be valid until 90 calendar days after the termination of the proclaimed state of emergency. In cases of extraordinary circumstances, such as the destruction of a permitted pharmacy or clinic, and at the discretion of the board or by the direction of the Governor, a temporary pharmacy or clinic permit issued under this section shall be valid for a period of time longer than 90 calendar days and as long as is necessary for the health and safety of the public.
(d)During a proclaimed state of emergency, the board shall allow for the employment of a mobile pharmacy or mobile clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
(1)The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing.
(2)The mobile pharmacy or clinic retains records of dispensing, as required by subdivision (b).
(3)A licensed pharmacist or professional director is on the premises and the mobile pharmacy or clinic is under the control and management of a pharmacist or professional director while the drugs are being dispensed.
(4)Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy.
(5)The mobile pharmacy or clinic is located within the declared emergency area or affected areas.
(6)The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
(e)During a proclaimed state of emergency, the board shall waive any application fees for a temporary or mobile pharmacy or clinic permit that may apply. The board shall waive any other provisions of this chapter or the regulations adopted pursuant to it if, in the boards opinion, or at the Governors direction, the waiver will aid in the protection of public health or the provision of patient care.
(f)For purposes of this section, proclaimed state of emergency means a state of emergency described in Section 8628.5 of the Government Code.
SEC. 3.Section 8628.5 is added to the Government Code, to read:8628.5.(a)During a state of emergency, the Governor may direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
(1)To issue permits.
(2)To expedite application processing timelines.
(3)To direct, to the extent necessary, the state Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
(4)To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
(b)Any agency directed by the Governor to perform activities pursuant to subdivision (a) may expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
SEC. 4.Section 14132.723 is added to the Welfare and Institutions Code, to read:14132.723.(a)Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patients physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(b)For purposes of this section, the following terms shall have the following meanings:
(1)Enrolled community clinic shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinics provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2)Immediately following shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3)Premises shall mean a site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(4)Telehealth shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c)The following services shall be reimbursable when provided by an enrolled community clinic during a state of emergency:
(1)Telehealth services.
(2)Telephonic services.
(3)All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinics premises, including, but not limited to, services provided at a temporary shelter, a patients home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.
(e)The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.
|
Date
|
Status
|
|---|---|
| Sep 23, 2018 | Chaptered by Secretary of State - Chapter 716, Statutes of 2018. |
| Sep 23, 2018 | Approved by the Governor. |
| Sep 7, 2018 | Enrolled and presented to the Governor at 2:30 p.m. |
| Aug 29, 2018 | Assembly Rule 77 suspended. |
| Aug 28, 2018 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 30 pursuant to Assembly Rule 77. |
| Aug 28, 2018 | Read third time. Passed. Ordered to the Assembly. |
| Aug 27, 2018 | Read second time. Ordered to third reading. |
| Aug 24, 2018 | Read third time and amended. Ordered to second reading. |
| Aug 20, 2018 | Read second time. Ordered to third reading. |
| Aug 17, 2018 | From committee: Amend, and do pass as amended. (Ayes 7. Noes 0.) (August 16). |
| Aug 6, 2018 | In committee: Referred to APPR. suspense file. |
| Jun 27, 2018 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 26, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 25). |
| Jun 21, 2018 | From committee: Do pass and re-refer to Com. on B., P. & E.D. (Ayes 9. Noes 0.) (June 20). Re-referred to Com. on B., P. & E.D. |
| Jun 7, 2018 | Referred to Coms. on HEALTH and B., P. & E.D. |
| May 25, 2018 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 25, 2018 | Read third time. Passed. Ordered to the Senate. |
| May 17, 2018 | Read second time. Ordered to Consent Calendar. |
| May 16, 2018 | From committee: Do pass. To Consent Calendar. (Ayes 17. Noes 0.) (May 16). |
| Apr 30, 2018 | Re-referred to Com. on APPR. |
| Apr 26, 2018 | Read second time and amended. |
| Apr 25, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 24). |
| Apr 11, 2018 | From committee: Do pass and re-refer to Com. on B. & P. (Ayes 15. Noes 0.) (April 10). Re-referred to Com. on B. & P. |
| Mar 8, 2018 | Referred to Coms. on HEALTH and B. & P. |
| Feb 16, 2018 | From printer. May be heard in committee March 18. |
| Feb 15, 2018 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 29, 2018 | AB 2576 AGUIAR-CURRY Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Aug 28, 2018 | Assembly 3rd Reading AB2576 Aguiar-Curry et al. By Jackson | Senate Floor |
Passed |
|
| Aug 16, 2018 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 6, 2018 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 25, 2018 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| Jun 20, 2018 | Do pass, but first be re-referred to the Committee on [Business, Professions and Economic Development] | Senate Standing Committee on Health |
Passed |
|
| May 25, 2018 | AB 2576 AGUIAR-CURRY Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| May 16, 2018 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 24, 2018 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
|
| Apr 10, 2018 | Do pass and be re-referred to the Committee on [Business and Professions] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Alameda Health Consortium | ** Support | Aug 27, 2018 |
| Asian Health Services | ** Support | Aug 27, 2018 |
| Borrego Community Health Foundation | ** Support | Aug 27, 2018 |
| Borrego Health | ** Support | Aug 27, 2018 |
| California Pharmacists Association | ** Support | Aug 27, 2018 |
| California School-Based Health Alliance | ** Support | Aug 27, 2018 |
| California State Board of Pharmacy | ** Support | Aug 27, 2018 |
| CaliforniaHealth+ Advocates | ** Support | Aug 27, 2018 |
| Capitol Health Network | ** Support | Aug 27, 2018 |
| clinicas de salud del pueblo | ** Support | Aug 27, 2018 |
| Coalition Of Orange Community Health Centers | ** Support | Aug 27, 2018 |
| Coastal Health Alliance | ** Support | Aug 27, 2018 |
| Communicare Health Centers | ** Support | Aug 27, 2018 |
| Community Clinic Association of Los Angeles County | ** Support | Aug 27, 2018 |
| Community Clinic Consortium | ** Support | Aug 27, 2018 |
| Community Health Improvement Partners | ** Support | Aug 27, 2018 |
| Community Health Systems, Inc. | ** Support | Aug 27, 2018 |
| County Health Executives Association Of California | ** Support | Aug 27, 2018 |
| Department Of Finance | ** Against | Aug 27, 2018 |
| East Valley Community Health Center | ** Support | Aug 27, 2018 |
| Health Alliance of Northern California | ** Support | Aug 27, 2018 |
| Health Center Partners of Southern California | ** Support | Aug 27, 2018 |
| Imperial Beach Community Clinic | ** Support | Aug 27, 2018 |
| Indian Health Center of Santa Clara Valley | ** Support | Aug 27, 2018 |
| indian health council, inc. | ** Support | Aug 27, 2018 |
| la maestra health centers | ** Support | Aug 27, 2018 |
| Lifelong Medical Care | ** Support | Aug 27, 2018 |
| Marin Community Clinics | ** Support | Aug 27, 2018 |
| Mendocino Coast Clinics | ** Support | Aug 27, 2018 |
| Mountain Health And Community Services | ** Support | Aug 27, 2018 |
| Neighborhood Healthcare | ** Support | Aug 27, 2018 |
| North Coast Clinics Network | ** Support | Aug 27, 2018 |
| North County Health Services | ** Support | Aug 27, 2018 |
| North East Medical Services | ** Support | Jun 22, 2018 |
| Northeast Valley Health Corporation | ** Support | Aug 27, 2018 |
| OCHIN | ** Support | Aug 27, 2018 |
| OLE Health | ** Support | Aug 27, 2018 |
| Operation Samahan | ** Support | Aug 27, 2018 |
| Planned Parenthood Affiliates Of California | ** Support | Aug 27, 2018 |
| Planned Parenthood of the Pacific Southwest | ** Support | Aug 27, 2018 |
| Redwood Community Health Coalition | ** Support | Aug 27, 2018 |
| San Diego American Indian Health Council | ** Support | Aug 27, 2018 |
| san diego family care | ** Support | Aug 27, 2018 |
| San Francisco Community Clinic Consortium | ** Support | Aug 27, 2018 |
| San Ysidro Health | ** Support | Aug 27, 2018 |
| San Ysidro Health Center | ** Support | Aug 27, 2018 |
| Santa Rosa Community Health | ** Support | Aug 27, 2018 |
| Shasta Community Health Center | ** Support | Aug 27, 2018 |
| Sonoma Valley Community Health Center | ** Support | Aug 27, 2018 |
| Southern Indian Health Council | ** Support | Aug 27, 2018 |
| Sycuan Medical Dental Center | ** Support | Aug 27, 2018 |
| Vista Community Clinic | ** Support | Aug 27, 2018 |
| West County Health Centers, Inc. | ** Support | Aug 27, 2018 |
| Westside Family Health Center | ** Support | Aug 27, 2018 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 2576
Author:(Aguiar-Curry)
As Amended Ver:August 24, 2018
Majority vote
ASSEMBLY: | 70-0 | (May 25, 2018) | SENATE: | 77-0 | (August 29, 2018) |
Original Committee Reference: HEALTH
SUMMARY: Authorizes a community clinic licensed by the Board of Pharmacy (BOP) to furnish drugs or devices without a prescription during a state of emergency, and authorizes the BOP to waive specified provisions of the Pharmacy Practice Act for up to 90 days following the termination of a declared emergency. Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment and facilities to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following an emergency, as specified. Specifically, this bill:
- Authorizes the following pharmacies or clinics, during or immediately following a proclaimed state of emergency, to furnish dangerous drugs or devices:
- A licensed nonprofit community clinic or free clinic, as defined;
- A primary care clinic owned or operated by a county, as specified;
- A clinic operated by a federally recognized Indian tribe or tribal organization, as specified;
- A clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic, that is open no more than 20 hours per week, as specified;
- A student health center clinic operated by a public institution or higher education, as specified; and,
- A nonprofit multispecialty clinic, as specified.
- Permits the BOP during a declared emergency to allow for the employment of a mobile clinic in impacted areas under existing conditions.
- Permits the BOP to waive application of any provision of the Pharmacy Practice Act for up to 90 days following the termination of the declared emergency.
- Provides that during a proclaimed state of emergency, the Pharmacy Practice Act does not prohibit a pharmacist, the clinics specified in 1), above, or a mobile pharmacy or clinic, from refilling a prescription if a prescriber is unavailable, or if after a reasonable effort has been made, the prescriber cannot be contacted.
- Authorizes the clinics specified in 1), above, during a proclaimed state of emergency, to furnish dangerous drugs to any of the following:
- Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. Limits the quantity a clinic could furnish to that which is sufficient to alleviate the temporary shortage.
- A patient with a prescription or as authorized by law;
- A health care provider that is not a clinic but is authorized to purchase dangerous drugs; or,
- To another clinic under common control, including a mobile clinic as described.
- Authorizes the Governor to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, the Department of Health Care Services or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Authorizes any agency directed by the Governor to perform activities pursuant to 6), above, to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
- Specifies the purpose of this bill is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
The Senate amendments delete the provisions expanding the types of services that are reimbursable under Medi-Cal when provided by a community clinic during a state of emergency and federal approval is obtained, and make other, technical and conforming changes.
EXISTING LAW:
- Licenses and regulates various clinics, including community and primary clinics under the Department of Public Health.
- Provides that the Governor may proclaim a state of emergency in an area affected or likely to be affected, as defined in existing law; and either:
- The Governor is requested to do so in the case of a city by the mayor or chief executive, or in the case of a county by the chairman of the board of supervisors or the county administrative officer; or,
- The Governor finds that local authority is inadequate to cope with the emergency.
- Establishes the BOP to regulate the practice of pharmacy. Allows BOP to waive any application fee during a declared federal, state, or local emergency, if, in its opinion, the waiver will aid in the protection of public health or the provision of patient care.
- Authorizes a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. Requires a record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained.
- Requires, during a federal, state or local emergency, the BOP to allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- The mobile pharmacy shares common ownership with at least one currently licensed pharmacy in good standing;
- The mobile pharmacy retains records of dispensing, as specified;
- A licensed pharmacist is on the premises and the mobile pharmacy is under the control and management of a pharmacist while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy is located within the declared emergency area or affected areas; and,
- The mobile pharmacy ceases the provision of services within 48 hours following the termination of the declared emergency.
FISCAL EFFECT: The Senate Appropriations Committee notes the estimate includes a degree of uncertainty, as an event's magnitude and duration are unknowable. Initial administrative workload is needed to engage with federal partners to gain federal financial participation to implement the bill's provisions, and to receive necessary state plan amendment or waiver approvals.
- Potentially significant costs (likely, low millions General Fund/federal fund) related to clinics and Medi-Cal reimbursement rates for telehealth, telephone, and all other covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility, that were provided at a temporary shelter, a patient's home, or any other location, if the services were provided within the boundaries of the emergency proclamation.
It should be noted that the provisions expanding the types of services that community clinics could be reimbursed under Medi-Cal during a state of emergency were amended out of the bill on August 24, 2018.
- One-time costs of $7,500 (Pharmacy Board Contingent Fund) for enforcement workload.
COMMENTS: According to the author, the 2017 wildfire season was one of the worst in California's history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients' care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims.
This bill is critical to ensure that communities continue to receive timely access to health care during an emergency situation. This bill will ease and standardize the process for clinics and their providers to deliver health care when the physical clinic may not be accessible. By clearly authorizing expedited temporary pharmacy licenses, telephone appointments, home care visits, and health services in shelters during declared emergencies, this bill will remove barriers to continuity of care when disaster strikes.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0005373
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2576
Amended: 8/24/18 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/20/18
AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/25/18
AYES: Hill, Fuller, Allen, Dodd, Galgiani, Glazer, Hernandez, Pan, Wilk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/16/18
AYES: Portantino, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 70-0, 5/25/18 (Consent) - See last page for vote
SUBJECT: Emergencies: health care
SOURCE: CaliforniaHealth+ Advocates
Redwood Community Health Coalition
DIGEST:
This bill permits specified clinics to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public.
Senate Floor Amendments of 8/24/18 delete the Medi-Cal provisions from this bill.
Existing law:
- Authorizes the Governor, under the California Emergency Services Act, to proclaim a state of emergency when specified conditions of disaster or extreme peril to the safety of persons and property exist. [GC §8625]
- Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out the provisions of the California Emergency Services Act, requires the orders and regulations to have the force and effect of law, and requires orders and regulations, or amendments or rescissions to orders and regulations, issued during a state of war emergency or state of emergency to be in writing and to take effect immediately upon their issuance.
[GC §8567] - Permits a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. [BP §4062]
- Permits the Board of Pharmacy (Board), during a declared federal, state, or local emergency, to waive application of any provisions of the Pharmacy Law or the regulations adopted pursuant to it if, in the Board’s opinion, the waiver will aid in the protection of public health or the provision of patient care. [BP §4062]
- Requires the Board to allow, during a declared federal, state, or local emergency, for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if specified conditions are met. [BP §4062]
- Permits a prescription for a dangerous drug or dangerous device to be refilled without the prescriber’s authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacist’s professional judgment, failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on the patient’s well-being. [BP §4064]
This bill:
State of Emergency Provisions
- Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, DHCS, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Permits any agency directed by the Governor to perform activities pursuant to 1) above to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
Pharmacy Law
- Permits a licensed nonprofit community clinic, a free clinic, a county-owned or operated primary care clinic, a clinic operated by a federally recognized Indian tribe or tribal organization, an intermittent clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic and that is open no more than 20 hours per week, and a student health center clinic operated by a public institution of higher education, and a nonprofit multispecialty clinic to:
- In good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public.
- Furnish, during a state of emergency, dangerous drugs to any of the following:
- Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. Permits a clinic furnishing dangerous drugs under this provision to only furnish a quantity sufficient to alleviate the temporary shortage;
- A patient pursuant to a prescription or as otherwise authorized by law;
- A health care provider that is not a clinic but that is authorized to purchase dangerous drugs; and,
- To another clinic under common control, including a mobile clinic during a declared federal, state or local emergency.
- States that, during a proclaimed state of emergency, nothing in the Pharmacy Law prohibits a pharmacist, a licensed clinic licensed, or a specified mobile pharmacy or clinic from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
- Expands the existing requirement that the Board, during a declared federal, state, or local emergency, allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care to also allow for the employment of a mobile clinic, if specified conditions currently applicable to mobile pharmacies are met.
- Permits the Board to elect to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the declared emergency if, in the Board’s opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
- Permits a pharmacy to furnish dangerous drugs to a mobile pharmacy during a proclaimed state of emergency.
Comments
- Author’s statement. According to the author, the 2017 wildfire season was one of the worst in California’s history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients’ care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims. AB 2576 is critical to ensure that communities continue to receive timely access to health care during an emergency situation by clearly authorizing expedited temporary pharmacy licenses, AB 2576 will remove barriers to continuity of care when disaster strikes.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- One-time costs of $7,500 (Pharmacy Board Contingent Fund) for enforcement workload.
CaliforniaHealth+ Advocates (co-source)
Redwood Community Health Coalition (co-source)
Alameda Health Consortium
Asian Health Services
Borrego Community Health Foundation
Borrego Health
California Pharmacists Association
California School-Based Health Alliance
California State Board of Pharmacy
Capitol Health Network
Clinicas de Salud del Pueblo
Coalition of Orange Community Health Centers
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Improvement Partners
Community Health Systems, Inc.
County Health Executives Association of California
East Valley Community Health Center
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Indian Health Council, Inc.
La Maestra Health Centers
Lifelong Medical Care
Marin Community Clinics
Mendocino Coast Clinics
Mountain Health and Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
OCHIN
OLE Health
Operation Samahan
Planned Parenthood Affiliates of California
Planned Parenthood of the Pacific Southwest
San Diego American Indian Health Council
San Diego Family Care
San Francisco Community Clinic Consortium
San Ysidro Health
San Ysidro Health Center
Santa Rosa Community Health
Shasta Community Health Center
Sonoma Valley Community Health Center
Southern Indian Health Council
Sycuan Medical Dental Center
Vista Community Clinic
West County Health Centers, Inc.
Westside Family Health Center
OPPOSITION: (Verified 8/24/18)
Department of Finance
ARGUMENTS IN SUPPORT: This bill is jointly sponsored by CaliforniaHealth+ Advocates (CH+A) and Redwood Community Health Coalition, which argue the 2017 fire season was one of the worst in history and took a devastating toll on impacted communities, including community health centers.
CH+A writes that this bill is critical to ensure that communities continue to receive timely access to care by establish a Board of Pharmacy temporary permitting process when a health center that has been destroyed or impacted cannot operate their pharmacy and dispense medication to patients.
ARGUMENTS IN OPPOSITION: The Department of Finance writes in opposition to the prior version of this bill that existing state law allows the Board broad authority to waive provisions of the Pharmacy Act.
ASSEMBLY FLOOR: 70-0, 5/25/18
AYES: Acosta, Aguiar-Curry, Baker, Berman, Bigelow, Bloom, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Mark Stone, Thurmond, Ting, Voepel, Weber, Wood, Rendon
NO VOTE RECORDED: Travis Allen, Arambula, Bonta, Brough, Levine, Mullin, Steinorth, Waldron
8/27/18 19:47:20
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2576
Amended: 8/17/18 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/20/18
AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/25/18
AYES: Hill, Fuller, Allen, Dodd, Galgiani, Glazer, Hernandez, Pan, Wilk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/16/18
AYES: Portantino, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 70-0, 5/25/18 (Consent) - See last page for vote
SUBJECT: Emergencies: health care
SOURCE: CaliforniaHealth+ Advocates
Redwood Community Health Coalition
DIGEST:
This bill prohibits face-to-face contact or a patient’s physical presence on the premises from being required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during a state of emergency, or for 90 calendar days after the conclusion of the state of emergency, unless extended by the Governor. Requires specified services to be Medi-Cal reimbursable during a state of emergency, including telephone services.
Existing law:
- Authorizes the Governor, under the California Emergency Services Act, to proclaim a state of emergency when specified conditions of disaster or extreme peril to the safety of persons and property exist. [GC §8625]
- Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out the provisions of the California Emergency Services Act, requires the orders and regulations to have the force and effect of law, and requires orders and regulations, or amendments or rescissions to orders and regulations, issued during a state of war emergency or state of emergency to be in writing and to take effect immediately upon their issuance.
[GC §8567] - Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. Outpatient clinic, Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services are covered benefits under the Medi-Cal program. [WIC §14000, et seq. §14132]
- Requires FQHCs and RHCs to be reimbursed on a per-visit basis. Defines a “visit” as a face-to-face encounter between an FQHC or RHC patient and specified health care providers. [WIC §14132.100]
- Permits a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. [BP §4062]
- Permits the Board of Pharmacy (Board), during a declared federal, state, or local emergency, to waive application of any provisions of the Pharmacy Law or the regulations adopted pursuant to it if, in the Board’s opinion, the waiver will aid in the protection of public health or the provision of patient care. [BP §4062]
- Requires the Board to allow, during a declared federal, state, or local emergency, for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if specified conditions are met. [BP §4062]
- Permits a prescription for a dangerous drug or dangerous device to be refilled without the prescriber’s authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacist’s professional judgment, failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on the patient’s well-being. [BP §4064]
This bill:
Medi-Cal Provisions
- Prohibits face-to-face contact or a patient’s physical presence on the premises from being required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during a state of emergency, or for 90 calendar days after the conclusion of the state of emergency, to the extent federal financial participation is available.
- Defines an “enrolled community clinic” to mean:
- A community clinic licensed by the Department of Public Health;
- An FQHC;
- An RHC;
- An intermittent clinic exempt from licensure;
- A tribal clinic exempt from licensure; and,
- An outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinic’s provider master file.
- Permits the Governor or DHCS, under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, to extend the state of emergency beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
- Requires the following services to be Medi-Cal reimbursable when provided by an enrolled community clinic during a state of emergency:
- Telehealth services;
- Telephonic services; and,
- All Medi-Cal covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
- Authorizes DHCS to apply provision 4) above to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.
State of Emergency Provisions
- Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, DHCS, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Permits any agency directed by the Governor to perform activities pursuant to 6) above to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
Pharmacy Law
- Permits a licensed nonprofit community clinic, a free clinic, a county-owned or operated primary care clinic, a clinic operated by a federally recognized Indian tribe or tribal organization, an intermittent clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic and that is open no more than 20 hours per week, and a student health center clinic operated by a public institution of higher education, and a nonprofit multispecialty clinic to:
- In good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public.
- Furnish, during a state of emergency, dangerous drugs to any of the following:
- Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. Permits a clinic furnishing dangerous drugs under this provision to only furnish a quantity sufficient to alleviate the temporary shortage;
- A patient pursuant to a prescription or as otherwise authorized by law;
- A health care provider that is not a clinic but that is authorized to purchase dangerous drugs; and,
- To another clinic under common control, including a mobile clinic during a declared federal, state or local emergency.
- States that, during a proclaimed state of emergency, nothing in the Pharmacy Law prohibits a pharmacist, a licensed clinic licensed, or a specified mobile pharmacy or clinic from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
- Expands the existing requirement that the Board, during a declared federal, state, or local emergency, allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care to also allow for the employment of a mobile clinic, if specified conditions currently applicable to mobile pharmacies are met.
- Permits the Board to elect to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the declared emergency if, in the Board’s opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
Comments
- Author’s statement. According to the author, the 2017 wildfire season was one of the worst in California’s history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients’ care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims. AB 2576 is critical to ensure that communities continue to receive timely access to health care during an emergency situation. This bill will ease and standardize the process for clinics and their providers to deliver health care when the physical clinic may not be accessible. By clearly authorizing expedited temporary pharmacy licenses, telephone appointments, home care visits, and health services in shelters during declared emergencies, AB 2576 will remove barriers to continuity of care when disaster strikes.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee, staff notes the estimate includes a degree of uncertainty, as an event’s magnitude and duration are unknowable. Initial administrative workload is needed to engage with federal partners to gain federal financial participation to implement the bill’s provisions, and to receive necessary state plan amendment or waiver approvals.
- Potentially significant costs (likely, low millions General Fund/federal fund) related to clinics and Medi-Cal reimbursement rates for telehealth, telephone, and all other covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility, that were provided at a temporary shelter, a patient’s home, or any other location, if the services were provided within the boundaries of the emergency proclamation.
- One-time costs of $7,500 (Pharmacy Board Contingent Fund) for enforcement workload.
CaliforniaHealth+ Advocates (co-source)
Redwood Community Health Coalition (co-source)
Alameda Health Consortium
Asian Health Services
Borrego Community Health Foundation
Borrego Health
California Pharmacists Association
California School-Based Health Alliance
California State Board of Pharmacy
Capitol Health Network
Clinicas de Salud del Pueblo
Coalition of Orange Community Health Centers
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Improvement Partners
Community Health Systems, Inc.
County Health Executives Association of California
East Valley Community Health Center
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Indian Health Council, Inc.
La Maestra Health Centers
Lifelong Medical Care
Marin Community Clinics
Mendocino Coast Clinics
Mountain Health and Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
OCHIN
OLE Health
Operation Samahan
Planned Parenthood Affiliates of California
Planned Parenthood of the Pacific Southwest
San Diego American Indian Health Council
San Diego Family Care
San Francisco Community Clinic Consortium
San Ysidro Health
San Ysidro Health Center
Santa Rosa Community Health
Shasta Community Health Center
Sonoma Valley Community Health Center
Southern Indian Health Council
Sycuan Medical Dental Center
Vista Community Clinic
West County Health Centers, Inc.
Westside Family Health Center
OPPOSITION: (Verified 8/15/18)
Department of Finance
ARGUMENTS IN SUPPORT: This bill is jointly sponsored by CaliforniaHealth+ Advocates (CH+A) and Redwood Community Health Coalition, which argue the 2017 fire season was one of the worst in history and took a devastating toll on impacted communities, including community health centers.
CH+A writes that this bill is critical to ensure that communities continue to receive timely access to care when disaster strikes by clarifying state law to ensure that providers can have telephonic appointments (“visits”) with patients. During an emergency, this is the most efficient way to provide care, to provide services outside the FQHC (such as in shelters and home visits), and to establish a Board of Pharmacy temporary permitting process when a health center that has been destroyed or impacted cannot operate their pharmacy and dispense medication to patients.
ARGUMENTS IN OPPOSITION: The Department of Finance (DOF) writes in opposition that codifying the provisions of this bill likely creates new state-only General Fund costs because it is unclear whether it would require DHCS to provide
expanded benefits during states of emergency, regardless of federal approval. DOF states DHCS will be required to seek approvals from the Centers for Medicare & Medicaid Services for the reimbursement of telephonic services and Medi-Cal services provided in locations other than at a clinic’s premises and at a fee-for-service provider’s premises, as these services are currently not covered by Medi-Cal. DOF also states that existing federal law authorizes the Secretary of the Health and Human Services Agency to temporarily waive or modify application of specified requirements related to the provision of health care items and services to meet the needs of Medi-Cal beneficiaries during an emergency, and existing state law also allows the Board broad authority to waive provisions of the Pharmacy Act.
ASSEMBLY FLOOR: 70-0, 5/25/18
AYES: Acosta, Aguiar-Curry, Baker, Berman, Bigelow, Bloom, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Mark Stone, Thurmond, Ting, Voepel, Weber, Wood, Rendon
NO VOTE RECORDED: Travis Allen, Arambula, Bonta, Brough, Levine, Mullin, Steinorth, Waldron
8/19/18 13:34:17
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2017 - 2018 Regular Session
AB 2576 (Aguiar-Curry) - Emergencies: health care
Version: June 27, 2018 | Policy Vote: HEALTH 9 - 0, B., P. & E.D. 9 - 0 |
Urgency: No | Mandate: No |
Hearing Date: August 16, 2018 | Consultant: Samantha Lui |
Bill Summary:
Allows certain services to be provided during, and 90 calendar days after the conclusion of, a state of emergency, including furnishing medication without a prescription and telehealth provided by a community clinic to a Medi-Cal beneficiary. Requires specified services, including telephone services, to be Medi-Cal reimbursable during a state of emergency. Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 16, 2018
Fiscal Impact:
Staff notes the estimate includes a degree of uncertainty, as an event’s magnitude and duration are unknowable. Initial administrative workload is needed to engage with federal partners to gain federal financial participation to implement the bill’s provisions, and to receive necessary state plan amendment or waiver approvals.
- Potentially significant costs (likely, low millions General Fund/federal fund) related to clinics and Medi-Cal reimbursement rates for telehealth, telephone, and all other covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility, that were provided at a temporary shelter, a patient’s home, or any other location, if the services were provided within the boundaries of the emergency proclamation.
- One-time costs of $7,500 (Pharmacy Board Contingent Fund) for enforcement workload.
Author Amendments:
- Clarifies that licensed clinics (a nonprofit community clinic or free clinic, a primary care clinic owned or operated by a county, a clinic operated by a federally recognized Indian tribe or tribal organization, a clinic operated by a primary care clinic or free clinic, a student health clinic operated by a public institution of higher education, or a nonprofit multispecialty clinic) are authorized to furnish dangerous drugs to specified entities during a proclaimed state of emergency.
-- END --
SENATE COMMITTEE ON
Senator Anthony Portantino, Chair
2017 - 2018 Regular Session
AB 2576 (Aguiar-Curry) - Emergencies: health care
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
Allows certain services to be provided during, and 90 calendar days after the conclusion of, a state of emergency, including furnishing medication without a prescription and telehealth provided by a community clinic to a Medi-Cal beneficiary. Requires specified services, including telephone services, to be Medi-Cal reimbursable during a state of emergency. Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency.
Fiscal Impact:
Staff notes the following fiscal estimate includes a degree of uncertainty, as an event’s magnitude and duration are unknowable. Initial administrative workload is needed to engage with federal partners to gain federal financial participation to implement the bill’s provisions, and to receive necessary state plan amendment or waiver approvals. The ongoing fiscal impact is anticipated due to the increasing frequency of state-declared disasters and emergencies.
- Ongoing administrative workload costs (mid-hundreds of thousands, General Fund/federal fund) for the Department of Health Care Services staffing, who would be dedicated to working on state plan amendments, waivers, and to process claims submitted by clinics.
- Potentially significant costs (likely, tens of millions General Fund/federal fund) related to clinics and Medi-Cal reimbursement rates for telehealth, telephone, and all other covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility, that were provided at a temporary shelter, a patient’s home, or any other location, if the services were provided within the boundaries of the emergency proclamation.
- Minor and absorbable workload, according to the Board of Pharmacy.
Background:
Many boards within the DCA with practice acts outlined in the BPC are authorized to suspend compliance or waive the applicability of those acts for services provided by licensees during a state of emergency. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, and public health. Technologies include video-conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Current law authorizes all licensed healthcare providers to offer services via telehealth and sets forth for consumer protections, such as proper notification and adherence to privacy laws.
Medi-Cal does not currently reimburse for telephone visits. Medi-Cal policy requires the originating site for a telehealth visit to be a health care provider’s office. Federally qualified health centers (FQHCs) can bill for telehealth under current law, subject to specified conditions. Allowing a clinic to bill for services provided somewhere other than on the clinic’s premises has previously been referred to as allowing billing outside the “four walls” of the clinic.
Federal Medicaid law prohibits a state from preventing an FQHC from entering into contractual relationships with private practice dental providers in the provision of federally-qualified health center services. DHCS has not issued regulations on billing outside the four walls. For FQHCs and rural health clinics (RHCs), state Medi-Cal statute and the DHCS Provider Manual for RHC and FQHCs lists the provider types who FQHCs and RHCs can bill for, and defines a “visit” as a face-to-face encounter between an RHC or FQHC recipient and a specified health care providers but is silent on whether this encounter has to occur within the four walls of the licensed FQHC or RHC.
In October 2017, in response to the 18 fires in California, DHCS wrote to CMS requesting a waiver of billing requirements for FQHCs, such as allowing telephonic services to meet billable visit criteria for services provided by FQHC providers to affected beneficiaries, and allowing a FQHC to bill for its prospective payment rates when providing services in a mobile clinic or temporary location in the event the clinic facility was damaged. In December 2017, the state submitted a State Plan Amendment (SPA) requesting it be allowed to waive the monthly premiums associated with Medi-Cal coverage under the Other Targeted Low Income Program (OTLICP, which refers to the prior Healthy Families program) on a case-by-case basis if payment would create undue hardship for the individual. This SPA would also allow DHCS to waive these contributions for the months of October through December 2017 for children living in the federally recognized disaster areas in Butte, Lake, Mendocino, Napa, Nevada, Orange, Sonoma, and Yuba counties. California also asked that it be allowed to waive monthly premiums during future declared disasters on a case-by-case basis if payment would create undue hardship for the individual. SPA approval was received from CMS on February 27, 2018 and was retroactive to October 1, 2017, allowing premium payment to be waived by the state on a case-by case basis, if payment would create an undue hardship for the individual.
Proposed Law:
Assembly Bill 2576 includes the following provisions, among others:
- Authorizes the Governor to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits.
- To expedite application processing timelines.
- To direct, to the extent necessary, the State Department of Health Care Services, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Authorizes any agency directed by the Governor to perform emergency activities to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
- Provides that face-to-face nor a patient’s physical presence is required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, to the extent that federal financial participation is available.
- Requires the following services to be reimbursable when provided by an enrolled community clinic or enrolled fee-for-service Medi-Cal provider, clinic, or facility, during or immediately following a state of emergency:
- Telehealth services.
- Telephonic services.
- All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
- Requires the department to seek federal approval of any necessary state plan amendments or waivers to implement this section.
Related Legislation:
- SB 1125 (Atkins) would require Medi-Cal reimbursement to FQHCs and RHCs for two visits taking place on the same day at a single location when the patient suffers illness or injury requiring additional diagnosis or treatment after the first visit, or when the patient has a medical visit and another health visit with a mental health or dental provider. SB 1125 is pending consideration in the Assembly Appropriations Committee.
- SB 960 (Hernandez, 2016) would require reproductive health care services provided through telehealth to be covered by the Medi-Cal program. The bill would require telephonic and electronic patient management services to be covered by the Medi-Cal program. The bill was held under submission on the Senate Appropriations Committee Suspense File.
- SB 289 (Mitchell, 2015) would have mandated that health insurers and health plans provide coverage for telephonic and electronic patient management services provided by a contracted physician or non-physician health care provider.
- SB 1427 (Chesbro of 2008) would have allowed an FQHC to bill the Medi-Cal program for FQHC services delivered in locations other than the FQHC’s site or sites by a provider who is an employee or a contracted member of the staff of the FQHC if specified requirements were met, including that the FQHC services are provided in the offsite location, rather than at the FQHC’s site or sites, for health or medical reasons. SB 1427 was vetoed by then-Governor Arnold Schwarzenegger.
-- END --
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2017 - 2018 Regular
Bill No: Hearing Date: June 25, 2018
Author: | |||
Version: | April 26, 2018 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Mason | ||
Subject:
SUMMARY: Allows certain services to be provided during and following a state of emergency, including furnishing medication without a prescription and telehealth provided by a community clinic to a Medi-Cal beneficiary and requires specified services to be Medi-Cal reimbursable during a state of emergency, including telephone services. Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency.
NOTE: This bill was heard in the Senate Committee on Health on June 20, 2018 and passed with a vote of 9-0.
Existing law:
- Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals. (Business and Professions Code (BPC) §§ 500 et seq.)
- Defines “dangerous drug” or “dangerous device” as any drug or device unsafe for self-use in humans or animals, including any drug that bears the legend: “Caution: federal law prohibits dispensing without prescription, “ and “Rx only,” and including any device that bears the statement: “Caution: federal law restricts this device to sale by or on the order of a ____,” “Rx only,” or words of similar import, the blank to be filled in with the designation of the practitioner licensed to use or order use of the device and including any other drug or device that by federal or state law can be lawfully dispensed only on prescription or furnished pursuant to Board of Pharmacy (Board) regulations. (BPC § 4022)
- Defines “dispense” as the furnishing of drugs or devices upon a prescription from a physician, dentist, optometrist, podiatrist, veterinarian, or ND or upon an order to furnish drugs or transmit a prescription from a CNM, NP, PA, ND, or pharmacist acting within the scope of his or her practice. Dispense also means and refers to the furnishing of drugs or devices directly to a patient by a physician, dentist, optometrist, podiatrist, or veterinarian, or by a CNM, NP, ND, PA or pharmacist acting within the scope of his or her practice. (BPC § 4024)
- Specifies certain requirements regarding the dispensing and furnishing of dangerous drugs and devices, and prohibits a person from furnishing any dangerous drug or device except upon the prescription of a physician, dentist, podiatrist, optometrist, veterinarian or ND. (BPC § 4059)
- Authorizes a pharmacist to furnish a dangerous drug or dangerous devices in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. Authorizes the Board, during a declared federal, state, or local emergency, to waive provisions of the Pharmacy Law if, in the board’s opinion, the waiver will aid in the protection of public health or the provision of patient care. Authorizes the Board, during a declared federal, state, or local emergency, to allow a mobile pharmacy to be used in impacted areas according to certain requirements. (BPC § 4062)
- Allows a prescription for a dangerous drug or dangerous device to be refilled without the prescriber’s authorization if, in the pharmacist’s professional judgment, failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on the patient’s well-being. (BPC § 4064)
- Defines “telehealth” to mean the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient's health care service while the patient is at the originating site and the health care provider is at a distant site; telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (BPC § 2290.5(a)(6))
- Requires a licensed health care practitioner providing services via telehealth to be subject to the requirements and definitions set forth in existing law, as specified, to the practice act relating to his or her licensed profession, and to the regulations adopted by a board pursuant to that practice act. (BPC § 686)
- Defines “health care provider” for purposes of telehealth to mean a person who is licensed under BPC. (BPC § 2290.5 (a)(3))
This bill:
- States findings and declarations about authority of the Governor to direct state agencies to take various actions in natural disasters and other declared emergencies; about the necessity of healthcare providers providing care to patients both during and immediately following a declared emergency; about healthcare delivery through or extraordinary means, including providing care telephonically or in temporary shelters in emergency situations; and about the importance of community clinics and health centers in providing patients with necessary resources and information in natural disasters.
- Authorizes a clinic to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency.
- Authorizes a clinic to furnish dangerous drugs to another clinic or wholesaler to alleviate a temporary shortage in a quantity sufficient to alleviate the temporary shortage; to a patient pursuant to a prescription or as otherwise authorized by law; to a health care provider that is not a clinic but that is authorized to purchase dangerous drugs; and to another clinic under common control, including a mobile clinic during a declared federal, state or local emergency.
- Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency.
- Authorizes services to be provided to a Medi-Cal beneficiary during or immediately following a state of emergency by an enrolled community clinic (defined as a community clinic licensed by the Department of Public Health, a federally qualified health center, a rural health center, an intermittent clinic exempt from licensure; a tribal clinic exempt from licensure; and an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinic’s provider master file. and only to the extent that federal financial participation is available) without face-to-face contact or a patient’s physical presence on the premises.
- Establishes that the following services are reimbursable when provided by an enrolled community clinic during a state of emergency:
- Telehealth services.
- Telephonic services.
- All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
FISCAL EFFECT:
This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated May 16, 2018, this bill will result in minor and absorbable costs to the Board the Department of Health Care Services to comply with its requirements and information technology costs to the Board not likely to exceed $10,000.
COMMENTS:
- Purpose. The Author is the sponsor of this bill. According to the Author, “AB 2576 addresses a variety of challenges identified during the disaster response to the wildfires of 2017. These changes will improve the ability of community health clinics and their health care providers to deliver timely access to services after a disaster occurs.”
The Author states that “This bill is needed to help community health clinics, who serve large local populations and often many low-income patients, feel confident during emergencies that they can continue to provide patients with health care and pharmacy services and they will be reimbursed. Disasters present unique challenges to providing care. While the health providers and clinics did incredible work to bring essential health services to the victims of the wildfires, there were challenges that we can learn from to improve outcomes and response efforts that will ensure that California’s 1,300 CHCs are even better prepared to deliver health care during and after a declared emergency. Many of the lessons learned come from the critical engagement and coordination between local health centers and the California Department of Health Care Services (DHCS) and California Department of Public Health (DPH). These Departments responded to the urgent needs of the impacted communities, providing invaluable flexibility in getting health centers the resources and assurances they needed to resume and continue seeing patients throughout the affected area. Though things went well, there is no question that during a disaster when a clinic is unavailable and patients cannot access their provider as usual, there needs to be a clear, efficient, and meaningful set of rules that allows for continuity of care. By increasing flexibility in licensing, permitting, and reimbursing temporary clinic sites and health services during emergency, victims will have one less thing to worry about.”
- Background.
Services During a Natural Disaster or State of Emergency. Many boards within the DCA with practice acts outlined in the BPC are authorized to suspend compliance or waive the applicability of those acts for services provided by licensees during a state of emergency. The Board advises that it “encourages its licensees to assist, and follow directions from, local, state, and national health officials. The Board expects licensees to apply their judgment and training to providing medication to patients in the best interests of the patients, with circumstances on the ground dictating the extent to which regulatory requirements can be met in affected areas. The Board further expects that during such emergency, the highest standard of care possible will be provided, and that once the emergency has dissipated, its licensees will return to practices conforming to state and federal requirements.”
Telehealth. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, and public health. Technologies include video-conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Current law authorizes all licensed healthcare providers to offer services via telehealth and sets forth for consumer protections, such as proper notification and adherence to privacy laws. Telephone visits are not currently covered by Medi-Cal, but telehealth services are.
- Arguments in Support. Supporters state that the 2017 fire season was one of the worst in history and took a devastating toll on impacted communities, including community health centers. Supporters write that over a three month period in late 2017, over two dozen health center corporations, serving a 10-county region, were impacted by fires and during that time, providers and staff provided services without the assurance they would be able to seek reimbursement. According to supporters, building on lessons learned from 2017 and to make sure health centers are better prepared to continuing delivering care during and after a declared emergency, this bill is critical to ensure that communities continue to receive timely access to care when disaster strikes.
- Author’s Amendments Agreed to in Senate Health. The Author agreed to amend the bill to allow the Department of Health Care Services (DHCS), through Medi-Cal, to reimburse additional providers, clinics and facilities in a declared emergency and immediately following, as well as require DHCS to ensure its telehealth reimbursement policies permit reimbursement for telehealth services appropriately provided by a community clinic during an emergency.
SUPPORT AND OPPOSITION:
Support:
CaliforniaHealth+Advocates (co-sponsor)
Redwood Community Health Coalition (co-sponsor)
Alameda Health Consortium
Asian Health Services
Borrego Community Health Foundation
Borrego Health
California Pharmacists Association
California School-Based Health Alliance
California State Board of Pharmacy
Capitol Health Network
Clinicas de Salud del Pueblo
Coalition of Orange Community Health Centers
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Improvement Partners
Community Health Systems, Inc.
County Health Executives Association of California
East Valley Community Health Center
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Indian Health Council, Inc.
La Maestra Health Centers
Lifelong Medical Care
Marin Community Clinics
Mendocino Coast Clinics
Mountain Health and Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
North East Medical Services
Northeast Valley Health Corporation
OCHIN
OLE Health
Operation Samahan
Planned Parenthood Affiliates of California
Planned Parenthood of the Pacific Southwest
San Diego American Indian Health Council
San Diego Family Care
San Francisco Community Clinic Consortium
San Ysidro Health
San Ysidro Health Center
Santa Rosa Community Health
Shasta Community Health Center
Sonoma Valley Community Health Center
Southern Indian Health Council
Sycuan Medical Dental Center
Vista Community Clinic
West County Health Centers, Inc.
Westside Family Health Center
Opposition:
None on file as of June 20, 20018.
-- END –
AB 2576 (Aguiar-Curry) Mock Up Pursuant to Agreement in Senate Health
Welfare and Institutions Code Section 14132.723
WIC 14132.723.
(a) (1) Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patient’s physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(2) Notwithstanding any other law, and only to the extent that federal financial participation is available, the department may apply paragraph (1) to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.
(b) For purposes of this section, the following terms shall have the following meanings:
(1) “Enrolled community clinic” shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinic’s provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2) “Immediately following” shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, or the destruction of a Medi-Cal provider site, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a), the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3) “Premises” shall mean either of the following, as applicable:
(A) A site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(B) A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, at the address listed on its license or listed in the provider master file.
(4) “Telehealth” shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c) The following services shall be reimbursable when provided by an enrolled community clinic during or immediately following a state of emergency:
(1) Telehealth services.
(2) Telephonic services.
(3) All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d) For an enrolled fee-for-service Medi-Cal provider, clinic, or facility that has been approved by the department pursuant to paragraph (2) of subdivision (a), the following services shall be reimbursable when provided by that provider, clinic, or facility during or immediately following a state of emergency:
(1) Telehealth services.
(2) Telephonic services.
(3) All covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility but that are provided somewhere other than on the provider’s, clinic’s, or facility’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(e) For purposes of paragraph (1) of subdivision (c) and paragraph (1) of subdivision (d), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to permit reimbursement for all telehealth services appropriately provided by an enrolled community clinic, or, if approved by the department pursuant to paragraph (2) of subdivision (a), by an enrolled fee-for-service Medi-Cal provider, clinic, or facility, respectively, during or immediately following a state of emergency. Nothing in this subdivision is intended to limit reimbursement for, or coverage of, or to reduce access to, services provided through telehealth on or before the enactment of this section.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, provider bulletins, or similar instructions.
(g) The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.
SENATE COMMITTEE ON HEALTH
Senator Dr. Richard Pan, Chair
BILL NO: AB 2576
AUTHOR: | Aguiar-Curry | ||
VERSION: | April 26, 2018 | ||
HEARING DATE: | June 20, 2018 | ||
CONSULTANT: | Scott Bain | ||
SUBJECT: Emergencies: health care.
SUMMARY:
Prohibits face-to-face contact or a patient’s physical presence on the premises from being required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during a state of emergency, or for 90 calendar days after the conclusion of the state of emergency, unless extended by the Governor. Requires specified services to be Medi-Cal reimbursable during a state of emergency, including telephone services. Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency.
Existing law:
- Authorizes the Governor, under the California Emergency Services Act, to proclaim a state of emergency when specified conditions of disaster or extreme peril to the safety of persons and property exist. [GC §8625]
- Defines a “state of emergency” as the duly proclaimed existence of conditions of disaster or of extreme peril to the safety of persons and property within the state caused by such conditions as air pollution, fire, flood, storm, epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestation or disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake, or other conditions, other than conditions resulting from a labor controversy or conditions causing a “state of war emergency,” which, by reason of their magnitude, are or are likely to be beyond the control of the services, personnel, equipment, and facilities of any single county, city and county, or city and require the combined forces of a mutual aid region or regions to combat, or with respect to regulated energy utilities, a sudden and severe energy shortage requires extraordinary measures beyond the authority vested in the California Public Utilities Commission. [GC §8558]
- Authorizes the Governor to make, amend, and rescind orders and regulations necessary to carry out the provisions of the California Emergency Services Act, requires the orders and regulations to have the force and effect of law, and requires orders and regulations, or amendments or rescissions to orders and regulations, issued during a state of war emergency or state of emergency to be in writing and to take effect immediately upon their issuance.
[GC §8567] - Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize and employ state personnel, equipment, and facilities to perform activities that are designed to prevent or alleviate actual and threatened damage due to that emergency. Authorizes a state agency so directed to expend any of the moneys that have been appropriated to it in order to perform that activity. [GC §8628]
- Permits the Governor, during a state of emergency, to make, amend, or rescind orders and regulations that temporarily suspend any state, county, city, or special district statute, ordinance, regulation, or rule imposing non-safety related restrictions on the delivery of food products, pharmaceuticals, and other emergency necessities distributed through retail or institutional channels, including, but not limited to, hospitals, jails, restaurants, and schools. [GC §8627.5]
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services (DHCS), which provides comprehensive health care coverage for low-income individuals. Outpatient clinic, Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services are covered benefits under the Medi-Cal program. [WIC §14000, et seq. §14132]
- Requires FQHCs and RHCs to be reimbursed on a per-visit basis. Defines a “visit” as a face-to-face encounter between an FQHC or RHC patient and specified health care providers. [WIC §14132.100]
- Permits an FQHC or RHC to request a supplemental payment if extraordinary circumstances beyond the control of the FQHC or RHC, and PPS payments are insufficient due to these extraordinary circumstances. Makes supplemental payments arising from extraordinary circumstances under this subdivision solely and exclusively within the discretion of DHCS. [WIC §14132.100]
- Makes specified types of clinics (primary care clinics, specialty clinics [as defined], and psychology clinics) eligible for Department of Public Health (DPH) licensure. [HSC §1204, 1204.1]
- Defines a “community clinic” as a primary care clinic operated by a tax-exempt nonprofit corporation that is supported and maintained in whole or in part by donations, bequests, gifts, grants, government funds or contributions, that may be in the form of money, goods, or services. Requires any charges to the patient made by a community clinic to be based on the patient’s ability to pay, utilizing a sliding fee scale. Prohibits a natural person or persons from operating a community clinic. [HSC §1204]
- Exempts specified clinics from being eligible for DPH licensure-related provisions, including any clinic conducted, maintained, or operated by a federally recognized Indian tribe or tribal organization, that is located on land recognized as tribal land by the federal government, or that is under a contract with the United States regardless of the location of the clinic, clinics conducted, operated, or maintained as outpatient departments of hospitals, a clinic that is operated by a primary care community or free clinic and that is operated on separate premises from the licensed clinic and is only open for limited services of no more than 30 hours a week (an “intermittent clinic”). [HSC §1206]
- Permits a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. [BP §4062]
- Permits the Board of Pharmacy (Board), during a declared federal, state, or local emergency, to waive application of any provisions of the Pharmacy Law or the regulations adopted pursuant to it if, in the Board’s opinion, the waiver will aid in the protection of public health or the provision of patient care. [BP §4062]
- Requires the Board to allow, during a declared federal, state, or local emergency, for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- A mobile pharmacy shares common ownership with at least one currently licensed pharmacy in good standing;
- The mobile pharmacy retains records of dispensing;
- A licensed pharmacist is on the premises and the mobile pharmacy is under the control and management of a pharmacist, while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy is located within the declared emergency area or affected areas; and,
- The mobile pharmacy ceases the provision of services within 48 hours following the termination of the declared emergency. [BP §4062]
- Permits a prescription for a dangerous drug or dangerous device to be refilled without the prescriber’s authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacist’s professional judgment, failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on the patient’s well-being. [BP §4064]
This bill:
Medi-Cal Provisions
- Prohibits face-to-face contact or a patient’s physical presence on the premises from being required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during a state of emergency, or for 90 calendar days after the conclusion of the state of emergency, to the extent federal financial participation is available.
- Defines an “enrolled community clinic” to mean
- A community clinic licensed by the DPH;
- An FQHC;
- An RHC;
- An intermittent clinic exempt from licensure;
- A tribal clinic exempt from licensure; and,
- An outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinic’s provider master file.
- Permits the Governor or DHCS, under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, to extend the state of emergency beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
- Requires the following services to be Medi-Cal reimbursable when provided by an enrolled community clinic during a state of emergency:
- Telehealth services;
- Telephonic services; and,
- All Medi-Cal covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
- Permits DHCS to implement, interpret, and make specific the community-clinic Medi-Cal provisions by means of all-county letters, provider bulletins, or similar instructions.
- Requires DHCS to seek federal approval of any necessary state plan amendments or waivers to implement this bill.
State of Emergency Provisions
- Permits the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, DHCS, or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Permits any agency directed by the Governor to perform activities pursuant to 7) above to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
Pharmacy Law
- Permits a licensed nonprofit community clinic, a free clinic, a county-owned or operated primary care clinic, a clinic operated by a federally recognized Indian tribe or tribal organization, an intermittent clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic and that is open no more than 20 hours per week, and a student health center clinic operated by a public institution of higher education, and a nonprofit multispecialty clinic to:
- In good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public.
- Furnish dangerous drugs to any of the following:
- Another clinic or wholesaler to alleviate a temporary shortage of a dangerous drug that could result in the denial of health care. Permits a clinic furnishing dangerous drugs under this provision to only furnish a quantity sufficient to alleviate the temporary shortage;
- A patient pursuant to a prescription or as otherwise authorized by law;
- A health care provider that is not a clinic but that is authorized to purchase dangerous drugs; and,
- To another clinic under common control, including a mobile clinic during a declared federal, state or local emergency.
- States that, during a proclaimed state of emergency, nothing in the Pharmacy Law prohibits a pharmacist, a licensed clinic licensed, or a specified mobile pharmacy or clinic from refilling a prescription if the prescriber is unavailable, or if after a reasonable effort has been made, the pharmacist, clinic, or mobile pharmacy is unable to contact the prescriber.
- Expands the existing requirement that the Board, during a declared federal, state, or local emergency, allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care to also allow for the employment of a mobile clinic, if specified conditions currently applicable to mobile pharmacies are met.
- Permits the Board to elect to continue to waive application of any provision of the Pharmacy Law for up to 90 days following the termination of the declared emergency if, in the Board’s opinion, the continued waiver will aid in the protection of the public health or in the provision of patient care.
Legislative Findings
- Makes legislative findings and declarations regarding the authority of the Governor in a declared emergency; the need to ensure health care providers can continue to provide care to patients both during and immediately following a declared emergency is essential for protecting the public health and safety; that health care is often provided through innovative or extraordinary means, including providing care telephonically or in temporary shelters; that community clinics and health centers are crucial to emergency response and recovery efforts; and the purpose of this legislation is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of health care services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
FISCAL EFFECT:
According to the Assembly Appropriations Committee:
- Minor and absorbable costs to the Board (Pharmacy Board Contingent Fund) and DHCS (GF/federal) to comply with the bill's requirements.
- Information technology costs to the Board not likely to exceed $10,000 to add new enforcement codes (Pharmacy Board Contingent Fund).
PRIOR VOTES:
Assembly Floor: | 70 - 0 |
Assembly Appropriations Committee: | 17 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, the 2017 wildfire season was one of the worst in California’s history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients’ care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims. AB 2576 is critical to ensure that communities continue to receive timely access to health care during an emergency situation. This bill will ease and standardize the process for clinics and their providers to deliver health care when the physical clinic may not be accessible. By clearly authorizing expedited temporary pharmacy licenses, telephone appointments, home care visits, and health services in shelters during declared emergencies, AB 2576 will remove barriers to continuity of care when disaster strikes.
- Medi-Cal reimbursement for FQHCs and RHCs and clinics. Medi-Cal does not currently reimburse for telephone visits. Medi-Cal policy requires the originating site for a telehealth visit to be a health care provider’s office. FQHCs can bill for telehealth under current law, subject to specified conditions.
Allowing a clinic to bill for services provided somewhere other than on the clinic’s premises has previously been referred to as allowing billing outside the “four walls” of the clinic. Federal Medicaid law prohibits a state from preventing an FQHC from entering into contractual relationships with private practice dental providers in the provision of federally-qualified health center services. DHCS have not issued regulations on billing outside the four walls. For FQHCs and RHCs, state Medi-Cal statute and the DHCS Provider Manual for RHC and FQHCs lists the provider types who FQHCs and RHCs can bill for, and defines a “visit” as a face-to-face encounter between an RHC or FQHC recipient and a specified health care providers but is silent on whether this encounter has to occur within the four walls of the licensed FQHC or RHC.
SB 1427 (Chesbro of 2008) would have allowed an FQHC to bill the Medi-Cal program for FQHC services delivered in locations other than the FQHC’s site or sites by a provider who is an employee or a contracted member of the staff of the FQHC if specified requirements were met, including that the FQHC services are provided in the offsite location, rather than at the FQHC’s site or sites, for health or medical reasons. SB 1427 was vetoed by then-Governor Arnold Schwarzenegger.
In October 2017, in response to the 18 fires in California, DHCS wrote to CMS requesting a waiver of billing requirements for FQHCs, such as allowing telephonic services to meet billable visit criteria for services provided by FQHC providers to affected beneficiaries, and allowing a FQHC to bill for its prospective payment rates when providing services in a mobile clinic or temporary location in the event the clinic facility was damaged. - State Plan Amendment related to fires. In December 2017, the state submitted a State Plan Amendment (SPA) requesting it be allowed to waive the monthly premiums associated with Medi-Cal coverage under the Other Targeted Low Income Program (OTLICP, which refers to the prior Healthy Families program) on a case-by-case basis if payment would create undue hardship for the individual. This SPA would also allow DHCS to waive these contributions for the months of October through December 2017 for children living in the federally recognized disaster areas in Butte, Lake, Mendocino, Napa, Nevada, Orange, Sonoma, and Yuba counties. California also asked that it be allowed to waive monthly premiums during future declared disasters on a case-by-case basis if payment would create undue hardship for the individual.
SPA approval was received from CMS on February 27, 2018 and was retroactive to October 1, 2017 allowing premium payment to be waived by the state on a case-by case basis, if payment would create an undue hardship for the individual. - Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Committee on Business, Professions and Economic Development.
- Related legislation. SB 1125 (Atkins) would require Medi-Cal reimbursement to FQHCs and RHCs for two visits taking place on the same day at a single location when the patient suffers illness or injury requiring additional diagnosis or treatment after the first visit, or when the patient has a medical visit and another health visit with a mental health or dental provider. SB 1125 is awaiting hearing in the Assembly Health Committee.
AB 2333 (Wood) requires OES to establish a behavioral health deputy director to ensure individuals have access to necessary mental and behavioral health services and supports in the aftermath of a natural disaster or declaration of a state of emergency. Requires the DHCS director, in coordination with OES, to immediately request necessary federal and state waivers to ensure the provision of health care services to individuals in an impacted area during a natural disaster or declared state of emergency. AB 2333 is scheduled for hearing on June 27, 2018 in the Senate Health Committee. - Prior legislation. SB 960 (Hernandez of 2016) would have required telephonic and electronic patient management services provided by a physician or a nonphysician health care provider acting within his or her scope of licensure to be a benefit under the Medi-Cal program in both fee-for-service and managed care, to the extent that federal financial participation is available and any necessary federal approvals have been obtained. SB 960 was held on the Senate Appropriations Committee suspense file.
AB 2507 (Gordon of 2016) would have expended the definition of telehealth to also include telephone, email and synchronous text, and chat conferencing as billable telehealth modalities and requires health plans and insurers to reimburse telehealth services to the same extent as services provided through in person. AB 2507 was held on the Senate Appropriations Committee suspense file.
SB 1427 (Chesbro of 2008) would have allowed an FQHC to bill the Medi-Cal program for FQHC services delivered in locations other than the FQHC’s site or sites by a provider who is an employee or a contracted member of the staff of the FQHC if specified requirements were met, including that the FQHC services are provided in the offsite location, rather than at the FQHC’s site or sites, for health or medical reasons.
This bill was vetoed by the Governor. In his veto message, the Governor stated this bill would unintentionally create a loophole that may compromise program integrity and expose the State to more than a billion dollars in costs. He directed DHCS to work with stakeholders and the Legislature on statutory changes to provide FQHCs flexibility to bill for services provided outside the site, while maintaining appropriate controls to protect program integrity, and ensuring health centers will continue operating within licensing laws and regulations.
- Support. This bill is jointly sponsored by CaliforniaHealth+Advocates (CH+A) and Redwood Community Health Coalition, which argue the 2017 fire season was one of the worst in history and took a devastating toll on impacted communities, including community health centers. Over a three-month period in late 2017, nearly two dozen health center corporations, serving a 10 county region, were impacted by fires. In addition to first responders and government officials who have worked together to coordinate relief efforts for fire-affected areas, community health centers have been on the front line, treating non-emergency patients, providing resources to victims of the fires, and serving communities as they rebuild.
CH+A writes that, building on lessons learned from 2017 to make sure health centers are better prepared to continue delivering care during and after a declared emergency, this bill is critical to ensure that communities continue to receive timely access to care when disaster strikes by clarifying state law to ensure that providers can have telephonic appointments (“visits”) with patients. During an emergency, this is the most efficient way to provide care, to provide services outside the FQHC (such as in shelters and home visits), and to establish a Board of Pharmacy temporary permitting process when a health center that has been destroyed or impacted cannot operate their pharmacy and dispense medication to patients. CH+A states the 2017 fires showed the need to make sure health centers are better prepared to continue delivering care during and after a declared emergency. CH+A states that, where and when it was safe to operate, health center staff rushed to provide primary care anyway they could in shelters and on the phone, without the assurance that they would be able to seek reimbursement for these services. When their physical facilities were destroyed, they needed to quickly relocate their pharmacy resources, but were met with a permit process that took too long. CH+A concludes that this bill provides much needed clarity in the law to guarantee that future leaders know exactly what to do to mitigate the unique care challenges a disaster may present.
- Policy issues.
- Issue with telehealth. This bill permits FQHCs and RHCs, and community clinics to bill via telephone and via telehealth in a declared state of emergency. Telephone visits are not currently covered by Medi-Cal, but telehealth services are. It is unclear what statutory or DHCS policy is preventing these entities from using telehealth during a state of emergency.
- Should this bill apply more broadly? This bill permits clinic providers to bill outside normal payment parameters in Medi-Cal, including licensed clinics and some unlicensed clinics (intermittent and tribal clinics) but not others unlicensed clinics (such as a student health center, a community mental health center, or a hospital outpatient departments). Should this bill apply to other providers who would potentially be able to use the billing flexibility in this bill in the event of a declared emergency?
SUPPORT AND OPPOSITION:
Support: CaliforniaHealth+Advocates (co-sponsor)
Redwood Community Health Coalition (co-sponsor)
Alameda Health Consortium
Asian Health Services
Borrego Community Health Foundation
Borrego Health
California Pharmacists Association
California School-Based Health Alliance
California State Board of Pharmacy
Capitol Health Network
Clinicas de Salud del Pueblo
Coalition of Orange Community Health Centers
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Improvement Partners
Community Health Systems, Inc.
County Health Executives Association of California
East Valley Community Health Center
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Indian Health Council, Inc.
La Maestra Health Centers
Lifelong Medical Care
Marin Community Clinics
Mendocino Coast Clinics
Mountain Health and Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
OLE Health
OCHIN
Operation Samahan
Planned Parenthood Affiliates of California
Planned Parenthood of the Pacific Southwest
San Diego American Indian Health Council
San Diego Family Care
San Francisco Community Clinic Consortium
San Ysidro Health
San Ysidro Health Center
Santa Rosa Community Health
Shasta Community Health Center
Sonoma Valley Community Health Center
Southern Indian Health Council
Sycuan Medical Dental Center
Vista Community Clinic
West County Health Centers, Inc.
Westside Family Health Center
Oppose: None received
-- END --
Date of Hearing: May 16, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 2576
Author:(Aguiar-Curry) – As Amended Ver:April 26, 2018
Policy Committee: | Health | Vote: | 15 - 0 |
Business and Professions | 16 - 0 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill provides flexibility with respect to provision of and reimbursement for clinic and pharmacy services during a declared state of emergency. Specifically, this bill:
- Allows clinics to furnish drugs and devices without a prescription during a federal, state, or local emergency.
- Allows the Board of Pharmacy to continue to waive application of laws governing pharmacies and drug dispensing for up to 90 days following the termination of a declared emergency.
- Allows for the filling of prescriptions without contact with the prescriber during a state of emergency if the prescriber is unable to be contacted.
- Specifies to whom clinics can dispense drugs.
- Authorizes the governor to direct all state agencies to take actions designed to allow community clinics and health centers to provide services and receive reimbursement during or immediately following the emergency.
- Provides that a patient need not be physically present on the premises of a community clinic to be reimbursed for the services by the Medi-Cal program, and requires reimbursement for services provided through telehealth or over the telephone.
FISCAL EFFECT:
- Minor and absorbable costs to the Board of Pharmacy (Pharmacy Board Contingent Fund) and the Department of Health Care Services (DHCS) (GF/federal) to comply with the bill's requirements.
- Information technology costs to the Board of Pharmacy not likely to exceed $10,000 to add new enforcement codes (Pharmacy Board Contingent Fund).
COMMENTS:
- Purpose. This bill is intended to remove barriers to continuity of care critical during and in the aftermath of a disaster and ensure clinics can claim reimbursement for care delivered during a state of emergency in ways that may otherwise not be eligible for reimbursement. According to the author, the devastating fires last year in Northern California illustrate the need for this bill. On October 9, 2017, Santa Rosa Community Health’s largest health center, the Vista Campus (Vista), was destroyed by extensive fire, smoke, heat, and water damage from the wildfires in the North Bay. In response, the health center took quick action to ensure the best continuity of care for patients. This bill is sponsored by CaliforniaHealth+ Advocates and the Redwood Community Health Coalition and has no opposition.
- Clinic pharmacies. Under current law, clinics are primarily regulated by the Department of Public Health. However, in order to dispense drugs at the clinic site, a clinic must also have a license from the Board of Pharmacy. Current law provides the Board of Pharmacy with expansive powers to respond to emergencies, including the power to waiver law and to adopt regulations permitting drug dispensing in emergency situations. This bill specifies needed legal authorization for clinic drug dispensing in such situations.
- Medi-Cal clinic reimbursement. Community clinics are paid by Medi-Cal on a per-visit basis in an amount equal to the clinic's cost of delivering services. Because the per-visit rate is calculated based on the overall cost divided by number of visits, the law restricts visits eligible for reimbursement to the specific type of visit used in the calculation (generally a face-to-face visit with a particular type of provider). This bill would make the reimbursement rules more flexible during a state of emergency to accommodate modes of care delivery appropriate to the situation.
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 2576
Author:(Aguiar-Curry) – As Introduced Ver:February 15, 2018
NOTE: This bill is double-referred, having previously been heard in the Assembly Health Committee on April 17th and approved on a 15-0 vote.
SUBJECT: Emergencies: healthcare.
SUMMARY: AB 2576 would require the Board of Pharmacy to issue a temporary pharmacy or clinic permit to a requesting pharmacy or clinic during a proclaimed state of emergency. The bill would authorize the Governor to direct all state agencies to take actions designed to allow community clinics and health centers to provide services and receive reimbursement during or immediately following the emergency. The bill would provide that a patient need not be physically present on the premises of a community clinic in order for the Medi-Cal program to provide reimbursement for services provided to the patient.
EXISTING LAW:
- Licenses and regulates various clinics, including community and primary care clinics under the Department of Public Health. (Health and Safety Code Section 1200 et seq.)
- Establishes the Medi-Cal program as California’s Medicaid program, administered by the Department of Health Care Services. (Welfare and Institutions Code Section 14000 et seq.)
- Requires federally qualified health centers and rural health clinics to be reimbursed on a per-visit basis. Defines a “visit” as a face-to-face encounter between a federally qualified health center or rural health clinic patient and specified health care providers. States that the Medi-Cal reimbursement to federally qualified health centers and rural health clinics on a per-visit rate is known as the Prospective Payment System. (Welfare and Institutions Code Section 14132.100)
- Defines telehealth as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. (Business and Professions Code Section 2290.5)
- Defines “state of emergency” to be the duly proclaimed existence of conditions of disaster or of extreme peril to the safety of persons and property within the state caused by such conditions as air pollution, fire, flood, storm, epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestation or disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake, or other conditions, other than conditions resulting from a labor controversy or conditions causing a “state of war emergency,” which, by reason of their magnitude, are or are likely to be beyond the control of the services, personnel, equipment, and facilities of any single county, city and county, or city and require the combined forces of a mutual aid region or regions to combat, or with respect to regulated energy utilities, a sudden and severe energy shortage requires extraordinary measures beyond the authority vested in the California Public Utilities Commission. (Government Code Section 8558)
- Provides that the Governor may proclaim a state of emergency in an area affected or likely to be affected, as defined in existing law; and either:
- The Governor is requested to do so in the case of a city by the mayor or chief executive, or in the case of a county by the chairman of the board of supervisors or the county administrative officer; or,
- The Governor finds that local authority is inadequate to cope with the emergency. (Government Code Section 8625)
- Establishes the Board of Pharmacy to regulate the practice of pharmacy. (Business and Professions Code Section 4000 et seq.)
- Authorizes the Board of Pharmacy, notwithstanding any provision of the Pharmacy Law, to adopt regulations permitting the dispensing of dangerous drugs or devices in emergency situations, and permitting dispensing of drugs or devices pursuant to a prescription of a person licensed to prescribe in a state other than California, where the person would under California law be permitted to prescribe drugs or devices and where the pharmacist has first interviewed the patient to determine the authenticity of the prescription. (Business and Professions Code Section 4005)
- Authorizes a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. Requires a record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained. (Business and Professions Code Section 4062 (a))
- Allows the Board of Pharmacy to waive application of any provision of the Pharmacy Law or related regulations during a declared federal, state, or local emergency, if, in its opinion, the waiver will aid in the protection of public health or the provision of patient care. (Business and Professions Code Section 4062(b))
- Requires, during a federal, state or local emergency, the Board of Pharmacy to allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- The mobile pharmacy shares common ownership with at least one currently licensed pharmacy in good standing;
- The mobile pharmacy retains records of dispensing, as specified;
- A licensed pharmacist is on the premises and the mobile pharmacy is under the control and management of a pharmacist while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy is located within the declared emergency area or affected areas; and,
- The mobile pharmacy ceases the provision of services within 48 hours following the termination of the declared emergency. (Business and Professions Code Section 4062 (c))
THIS BILL:
- Would Authorize the following pharmacies or clinics, during or immediately following a proclaimed state of emergency, to request the Board of Pharmacy to issue a temporary pharmacy or clinic permit to further the health and safety of the public within 30 calendar days after the conclusion of the proclaimed state of emergency:
- A licensed nonprofit community clinic or free clinic;
- A primary care clinic owned or operated by a county;
- A clinic operated by a federally recognized Indian tribe or tribal organization;
- A clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic, that is open no more than 20 hours per week;
- A student health center clinic operated by a public institution or higher education; and,
- A nonprofit multispecialty clinic, as specified.
- Would require the pharmacy or clinic specified in 1) above to use best efforts to keep a record containing the date, name, and address of each person to whom a drug or device is furnished during a proclaimed state of emergency. Requires a pharmacy or clinic issued a temporary permit under this bill to maintain the name, strength, and quantity of any drug or device furnished during the emergency.
- Would require a temporary pharmacy or clinic permit to be valid until 90 calendar days after the termination of the proclaimed state of emergency. Provides that in cases of extraordinary circumstances, such as the destruction of a permitted pharmacy or clinic, and at the discretion of the Board of Pharmacy or by the direction of the Governor, a temporary pharmacy or clinic permit shall be valid for a period of time longer than 90 calendar days and as long as is necessary for the health and safety of the public.
- Would require the Board of Pharmacy, during a proclaimed state of emergency, to allow for the employment of a mobile pharmacy or mobile clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing;
- The mobile pharmacy or clinic retains records of dispensing, as required above;
- A licensed pharmacist or professional director is on the premises and the mobile pharmacy or clinic is under the control and management of a pharmacist or professional director while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy or clinic is located within the declared emergency area or affected areas;
- The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
- Requires the Board of Pharmacy, during a proclaimed state of emergency, to waive any application fees for a temporary or mobile pharmacy or clinic permit that may apply.
- Requires the Board of Pharmacy to waive any other provisions of the Pharmacy Law or the regulations adopted pursuant to it if, in the Board of Pharmacy’s opinion, or at the Governor’s direction, the waiver will aid in the protection of public health or the provision of patient care.
- Authorizes the Governor to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, the Department of Health Care Services or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- Authorizes any agency directed by the Governor to perform activities pursuant to 7) above to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
- Provides, to the extent federal financial participation is available, neither face-to-face contact nor a patient’s physical presence on the premises be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or within 90 calendar days after the conclusions of the proclaimed state of emergency.
- Authorizes the Department of Health Care Services, under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, to determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
- Requires the following services to be reimbursable when provided by an enrolled community clinic during a state of emergency:
- Telehealth services;
- Telephonic services;
- All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
- Authorizes the Department of Health Care Services to implement, interpret, and make specific provisions above by means of all-county letters, provider bulletins, or similar instructions.
- Requires the Department of Health Care Services to seek federal approval of any necessary state plan amendments or waivers to implement the bill.
- Specifies the purpose of this bill is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by CaliforniaHealth+ Advocates and Redwood Community Health Coalition.
According to the author, “The 2017 wildfire season was one of the worst in California’s history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients’ care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims. AB 2576 is critical to ensure that communities continue to receive timely access to health care during an emergency situation. This bill will ease and standardize the process for clinics and their providers to deliver health care when the physical clinic may not be accessible. By clearly authorizing expedited temporary pharmacy licenses, telephone appointments, home care visits, and health services in shelters during declared emergencies, AB 2576 will remove barriers to continuity of care when disaster strikes.”
Background.
Federally qualified health centers and rural health clinics. These clinics serve a significant portion of the uninsured and underinsured in California. They are open-door providers that treat patients on a sliding scale fee structure and make their services available regardless of a patient's ability to pay. There are approximately 600 federally qualified health centers and 350 rural health clinics in California. All federally qualified health centers and a majority of the rural health clinics are either non-profit community clinics or government entities. Because these clinics are safety net providers, their continued survival depends heavily on the stability and adequacy of revenues from the Medi-Cal program.
These clinics are paid by Medi-Cal on a "per visit" basis in an amount equal to the clinic's cost of delivering services. Essentially, the Department of Health Care Services calculates the annual cost of care provided by each clinic and divides the total by the number of visits to determine a per visit rate. A “visit” requires a face-to-face encounter between a patient and specified health care providers. Reimbursement is governed by both state and federal law. For Medi-Cal managed care plan patients, the Department reimburses these clinics for the difference between its per-visit rate and the payment made by the plan. This payment is known as a “wrap around” payment.
Telehealth and Medi-Cal reimbursement. Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for in-person services. Currently, Medi-Cal pays for evaluation and management services, psychiatric diagnostic examinations and therapeutic service, dermatology, ophthalmology, and dentistry provided by telehealth, as well as certain administrative costs.
As mentioned above, federally qualified health centers and rural health clinics are paid on a “per visit” basis and a visit requires a face-to-face encounter between a patient and specified health care providers. According to the Department’s website, allowable costs associated with telehealth services may be included in the per-visit rate; however, these sites may not bill for originating site or transmission fees.
Under this bill, if federal approval is obtained, neither face-to-face contact nor a patient’s physical presence on the premises of an enrolled community clinic is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency. Additionally, this bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by an enrolled community clinic during a state of emergency.
Board of Pharmacy licensing of clinics for pharmacy services. Under current law, clinics are primarily regulated by the Department of Public Health. However, in order to dispense drugs at the clinic site, a clinic must also have a license from the Board of Pharmacy. In instances where a clinic is displaced, the Board of Pharmacy cannot license clinic’s new site to dispense drugs until the Department of Public Health has authorized the clinic to operate at that site.
Board of Pharmacy emergency powers. Current law provides the Board of Pharmacy with expansive powers to respond to emergencies. Business and Professions Code Section 4005 authorizes the Board, notwithstanding any provision of the Pharmacy Law, to adopt regulations permitting the dispensing of drugs or devices in emergency situations. Business and Professions Code Section 4062 authorizes a pharmacist to furnish a dangerous drug or device in reasonable quantities without a prescription during a declared emergency. Business and Professions Code Section 4062 authorizes the Board, during a declared emergency, to waive application of any provision of the Pharmacy Law or implementing regulations if the Board finds that the waiver will aid in the protection of public health or the provision of patient care. Finally, Business and Professions Code Section 4062 requires the Board to allow for the employment of a mobile pharmacy during an emergency, if specified conditions are met.
October 2017 Northern California Fires. According to the author, the devastating fires last year in Northern California illustrates the need for this bill. On October 9, 2017, Santa Rosa Community Health’s largest health center, the Vista Campus (Vista), was destroyed due to extensive fire, smoke, heat, and water damage from the wildfires in the North Bay. In a few short hours, 24,000 of the 50,000 patients at Vista lost their medical home where they receive comprehensive primary care and mental health services. Without the ability to provide services, the health center and the community’s health and well-being are at risk.
In response, the health center took quick action to ensure the best continuity of care. This included opening temporary exam rooms at neighboring health centers (shipping containers modified for use and mobile units), as well as taking advantage of telephonic visits to the extent viable.
Current Related Legislation.
AB 2102 (Rodriguez) would require the Emergency Medical Services Authority to establish training standards and licensing reciprocity procedures for out-of-state fire and paramedic personnel who render aid in this state on a temporary basis during a declared state of emergency. Status: AB 2102 is pending in Assembly Health Committee.
AB 2333 (Wood) would establish a behavioral health deputy director within the Office of Emergency Services to ensure individuals have access to necessary mental and behavioral health services and supports in the aftermath of a natural disaster or declaration of a state of emergency and requires the deputy director to collaborate with DHCS to coordinate the delivery of trauma-related support to individuals affected by a natural disaster or state of emergency. Status: AB 2333 is pending in Assembly Health Committee.
AB 2941 (Berman) would require a health plan or health insurer to ensure its enrollees or insureds who have been displaced by a state of emergency have continued access to medically necessary health care services. Status: AB 2941 is pending in Assembly Appropriations Committee.
ARGUMENTS IN SUPPORT:
CaliforniaHealth+ Advocates writes in support, “AB 2576 is critical to ensure that communities continue to receive timely access to care when disaster strikes…A health center that has been destroyed or impacted cannot operate their pharmacy and dispense medication to patients. An accelerated Board of Pharmacy permitting process is needed for temporary pharmacy permits”.
ARGUMENTS IN OPPOSITION:
None on file.
POLICY ISSUE(S) FOR CONSIDERATION:
As noted above, current law provides fairly broad power for pharmacists to dispense dangerous drugs without a prescription during a declared emergency and for the Board of Pharmacy to waive any provision of the Pharmacy Law in order to protect public health.
Rather than creating a new body of law authorizing temporary pharmacy licenses for clinics or authorizing mobile pharmacies, it would be more efficient to specify that the existing powers of the Board can be applied to clinics licensed by the Board.
AMENDMENTS:
- Delete Section 2 of the bill (new Business and Professions Code Section 4062.5).
- Amend Business and Professions Code Section 4062 to also authorize clinics licensed by the Board of Pharmacy to dispense dangerous drugs during an emergency without a prescription, authorize the employment of a mobile clinic, and authorize the Board of Pharmacy to continue to waive provisions of the Pharmacy Law for up to 90 days following the termination of a state of emergency.
- Amend Business and Professions Code Section 4064 to authorize a pharmacist, clinic, or mobile pharmacy to refill a prescription if the prescriber is unavailable, during a proclaimed state of emergency.
- Amend Business and Professions Code Section 4126.5 to authorize a pharmacy to furnish dangerous drugs to a mobile pharmacy during a declared state of emergency and authorize a clinic, during a declared state of emergency to furnish dangerous drugs to another clinic or wholesaler, a patient pursuant to a prescription, a health care provider that is authorized to purchase dangerous drugs, or to another clinic under common control including a mobile clinic.
REGISTERED SUPPORT:
CaliforniaHealth+ Advocates (cosponsor)
Redwood Community Health Coalition (cosponsor)
Alameda Health Consortium
California School-Based Health Alliance
Capitol Health Network
Clinicas de Salud del Pueblo
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
County Health Executives Association of California
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Lifelong Medical Care
Marin Community Clinics
Neighborhood Healthcare
North Coast Clinics Network
Northeast Valley Health Corporation
Planned Parenthood Affiliates of California
San Francisco Community Clinic Consortium
San Ysidro Health
Santa Rosa Community Health
Sonoma Valley Community Health Center
West County Health Centers, Inc.
Westside Family Health Center
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Brendan McCarthy / B. & P. / (916) 319-3301
Date of Hearing: April 10, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2576
Author:(Aguiar-Curry) – As Introduced Ver:February 15, 2018
SUBJECT: Emergencies: healthcare.
SUMMARY: Expands the types of services that are reimbursable when provided by a community clinic during a state of emergency and federal approval is obtained. Requires the Board of Pharmacy (BOP) to immediately issue a temporary pharmacy or clinic permit to specified clinics during as state of emergency. Specifically, this bill:
- Provides, to the extent federal financial participation is available, neither face-to-face contact nor a patient’s physical presence on the premises be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or within 90 calendar days after the conclusions of the proclaimed state of emergency.
- Authorizes the Department of Health Care Services (DHCS), under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, to determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
- Applies the provisions of 1) above to the following enrolled community clinic:
- A community clinic;
- An intermittent clinic;
- A tribal clinic or an outpatient setting conducted, maintained, or operated by a federally recognized Indian tribe, Tribal Organization, or Urban Indian Organization, as defined; and,
- An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC), regardless of license type or license-exempt status.
- Defines premises for purposes of 1) above to mean a site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license, or listed in the provider master file.
- Requires the following services to be reimbursable when provided by an enrolled community clinic during a state of emergency:
- Telehealth services;
- Telephonic services;
- All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
- Authorizes DHCS to implement, interpret, and make specific provisions in 1) to 5) above by means of all-county letters, provider bulletins, or similar instructions.
- Requires DHCS to seek federal approval of any necessary state plan amendments or waivers to implement provisions in 1) to 5) above.
- Authorizes the Governor to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including all of the following:
- To issue permits;
- To expedite application processing timelines;
- To direct, to the extent necessary, DHCS or any other state agency, to seek all appropriate federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency; and,
- To provide guidance, supplemental services, or whatever resources may be necessary to political subdivisions to ensure the provision of services by community clinics and health centers that are necessary to provide for the health and safety of the citizens of the affected area.
- To issue permits;
- Authorizes any agency directed by the Governor to perform activities pursuant to 8) above to expend any of the moneys that have been appropriated to it in order to perform those activities, irrespective of the particular purpose for which the moneys were originally appropriated.
- Authorizes the following pharmacies or clinics, during or immediately following a proclaimed state of emergency, to request and BOP to issue a temporary or clinic permit to further the health and safety of the public within 30 calendar days after the conclusion of the proclaimed state of emergency:
- A licensed nonprofit community clinic or free clinic, as defined;
- A primary care clinic owned or operated by a county, as specified;
- A clinic operated by a federally recognized Indian tribe or tribal organization, as specified;
- A clinic operated by a primary care community or free clinic, operated on separate premises from a licensed clinic, that is open no more than 20 hours per week, as specified;
- A student health center clinic operated by a public institution or higher education, as specified; and,
- A nonprofit multispecialty clinic, as specified.
- Requires the pharmacy or clinic specified in 10) above to use best efforts to keep a record containing the date, name, and address of each person to whom a drug or device is furnished during a proclaimed state of emergency. Requires a pharmacy or clinic issued a temporary permit under this bill to maintain the name, strength, and quantity of any drug or device furnished during the emergency.
- Requires a temporary pharmacy or clinic permit issued to be valid until 90 calendar days after the termination of the proclaimed state of emergency. Provides that in cases of extraordinary circumstances, such as the destruction of a permitted pharmacy or clinic, and at the discretion of the BOP or by the direction of the Governor, a temporary pharmacy or clinic permit to be valid for a period of time longer than 90 calendar days and as long as is necessary for the health and safety of the public.
- Requires the BOP, during a proclaimed state of emergency, to allow for the employment of a mobile pharmacy or mobile clinic in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- The mobile pharmacy or clinic shares common ownership with at least one currently licensed pharmacy or clinic in good standing;
- The mobile pharmacy or clinic retains records of dispensing, as required by 11) above;
- A licensed pharmacist or professional director is on the premises and the mobile pharmacy or clinic is under the control and management of a pharmacist or professional director while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy or clinic is located within the declared emergency area or affected areas;
- The mobile pharmacy or clinic ceases the provision of services within 48 hours following the termination of the declared emergency.
- Requires the BOP, during a proclaimed state of emergency, to waive any application fees for a temporary or mobile pharmacy or clinic permit that may apply. Requires the BOP to waive any other provisions of this bill or the regulations adopted pursuant to it if, in the BOP opinion, or at the Governor’s direction, the waiver will aid in the protection of public health or the provision of patient care.
- Specifies the purpose of this bill is to clarify what state and local agencies can currently do under existing law to ensure continuity of care and access to the broadest array of healthcare services possible during and immediately following a state of emergency, and to require state agencies to seek any necessary federal approvals that may be required in order to provide care to as many people impacted by the emergency as possible.
EXISTING LAW:
- Licenses and regulates various clinics, including community and primary clinics under the Department of Public Health.
- Establishes the Medi-Cal program as California’s Medicaid program, administered by DHCS. Covers under Medi-Cal comprehensive health care benefits, including those offered to beneficiaries at FQHCs and RHCs.
- Requires FQHCs and RHCs to be reimbursed on a per-visit basis. Defines a “visit” as a face-to-face encounter between a FQHC or RHC patient and specified health care providers. States that the Medi-Cal reimbursement to FQHCs and RHCs on a per-visit rate is known as the Prospective Payment System (PPS).
- Permits a FQHC or RHC to elect to have pharmacy or dental services reimbursed on a fee-for-service basis, utilizing the current fee schedules established for those services. Requires these costs to be adjusted out of the FQHC’s or RHC’s clinic base rate as scope-of-service change.
- Defines telehealth as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
- Provides that the Governor may proclaim a state of emergency in an area affected or likely to be affected, as defined in existing law; and either:
- The Governor is requested to do so in the case of a city by the mayor or chief executive, or in the case of a county by the chairman of the board of supervisors or the county administrative officer; or,
- The Governor finds that local authority is inadequate to cope with the emergency.
- Establishes the BOP to regulate the practice of pharmacy.
- Authorizes a pharmacist, in good faith, to furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, state, or local emergency, to further the health and safety of the public. Requires a record containing the date, name, and address of the person to whom the drug or device is furnished, and the name, strength, and quantity of the drug or device furnished shall be maintained.
- Allows BOP to waive any application fee during a declared federal, state, or local emergency, if, in its opinion, the waiver will aid in the protection of public health or the provision of patient care.
- Requires, during a federal, state or local emergency, the BOP to allow for the employment of a mobile pharmacy in impacted areas in order to ensure the continuity of patient care, if all of the following conditions are met:
- The mobile pharmacy shares common ownership with at least one currently licensed pharmacy in good standing;
- The mobile pharmacy retains records of dispensing, as specified;
- A licensed pharmacist is on the premises and the mobile pharmacy is under the control and management of a pharmacist while the drugs are being dispensed;
- Reasonable security measures are taken to safeguard the drug supply maintained in the mobile pharmacy;
- The mobile pharmacy is located within the declared emergency area or affected areas; and,
- The mobile pharmacy ceases the provision of services within 48 hours following the termination of the declared emergency.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, the 2017 wildfire season was one of the worst in California’s history. Nearly two dozen community health centers were impacted by the fires, putting thousands of patients’ care in jeopardy. In addition to firefighters, police officers, and government officials who worked together to coordinate relief in the affected areas, community health center providers were on the front lines, treating non-emergency patients and providing resources to victims.
This bill is critical to ensure that communities continue to receive timely access to health care during an emergency situation. This bill will ease and standardize the process for clinics and their providers to deliver health care when the physical clinic may not be accessible. By clearly authorizing expedited temporary pharmacy licenses, telephone appointments, home care visits, and health services in shelters during declared emergencies, this bill will remove barriers to continuity of care when disaster strikes - BACKGROUND.
- FQHCs and RHCS. FQHCs and RHCs serve a significant portion of the uninsured and underinsured in California. They are open-door providers that treat patients on a sliding scale fee structure and make their services available regardless of a patient's ability to pay. There are approximately 600 FQHCs and 350 RHCs in California. All FQHCs, and a majority of the RHCs, are either non-profit community clinics or government entities. Because these clinics are safety net providers, their continued survival depends heavily on the stability and adequacy of revenues from the Medi-Cal program.
FQHCs and RHCs are paid by Medi-Cal on a "per visit" basis in an amount equal to the clinic's cost of delivering services. Essentially, DHCS calculates the annual cost of care provided by each clinic and divides the total by the number of visits to determine a per visit rate. A “visit” requires a face-to-face encounter between a FQHC or RHC patient and specified health care providers. Reimbursement to FQHCs and RHCs is governed by both state and federal law. For Medi-Cal managed care plan patients, DHCS reimburses FQHCs and RHCs for the difference between its per-visit PPS rate and the payment made by the plan. This payment is known as a “wrap around” payment. - Telehealth Advancement Act of 2011. AB 415 (Logue), Chapter 547, Statutes of 2011, enacted the Telehealth Advancement Act of 2011 (Act). Among other provisions, the Act updated legal definitions of telehealth, streamlined medical approval processes for telehealth-delivered services, and broadened the types of allowed telehealth-delivered services. The Act also removed limits on the location where telehealth services may take place; eliminated the ban on email or telephone-delivered services; included all California-licensed health professionals as telehealth providers; and changed telehealth’s additional written patient consent requirement to verbal consent.
- Medi-Cal & Telehealth. California law defines telehealth as a mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and health care provider is at the distant site. Telehealth includes telemedicine, store and forward, remote patient monitoring devices, telephone calls, facsimile machines (faxes), tweets, and other electronic health care communication between providers and patients. According to DHCS, it considers telehealth a cost-effective alternative to health care provided in-person, particularly to underserved areas. Telehealth is not a distinct service, but a way that providers deliver health care to their patients that approximates in-person care. The standard of care is the same whether the patient is seen in-person or through telehealth. DHCS’s coverage and reimbursement policies for telehealth align with the California Telehealth Advancement Act of 2011 and federal regulations.
Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for in-person services. The following is a list of telehealth services that Medi-Cal currently pays:- Selected Evaluation and Management services for patient visit and consultation;
- Selected psychiatric diagnostic interview examination and selected psychiatric therapeutic services;
- Teledermatology by store and forward;
- Teleophthalmology by store and forward;
- Teledentistry;
- Transmission costs (up to 90 minutes per patient, per day, per provider).
- Originating site facility fee; and,
- Interpretation and report of X-rays and electrocardiograms performed via telehealth.
- FQHCs/RHCs & Telehealth. As mentioned above, FQHCs and RHCs are paid on a “per visit” basis and a visit requires a face-to-face encounter between a FQHC or RHC patient and specified health care providers. According to DHCS’s Internet Website, allowable costs associated with telehealth services may be included in the FQHCs or RHCs PPS rate; however, these sites may not bill for originating site or transmission fees.
According to the CaliforniaHealth+Advocates, there are several telemedicine arrangements that determine appropriate billing for telemedicine services. The factors to consider are: i) where the patient is physically located; ii) what are, if any, the payment arrangements with the specialty provider site; iii) if it is medically necessary for the provider and specialist to be present with the patient, and; iv) the patient has a telemedicine interaction with a billable provider or off-site specialist.
Under this bill, if federal approval is obtained, neither face-to-face contact nor a patient’s physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency. Additionally, this bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by an enrolled community clinic during a state of emergency. - Example of a state of emergency. According to the author, the devastating fire last year in Northern California illustrates the need for this bill. On October 9, 2017, Santa Rosa Community Health’s largest health center, the Vista Campus (Vista), was destroyed due to extensive fire, smoke, heat, and water damage from the wildfires in the North Bay. In a few short hours, 24,000 of the 50,000 patients at Vista lost their medical home where they receive comprehensive primary care and mental health services. Without the ability to provide services, the health center and the community’s health and well-being is at risk.
In response, the health center took quick action to ensure the best continuity of care. This included opening temporary exam rooms at neighboring health centers (shipping containers modified for use and mobile units), as well as taking advantage of telephonic visits to the extent viable. - Governor’s Press Release. A recent press release by the Governor described a partnership with specified legislators on solutions this year that will make California more resilient against the impacts of natural disasters and climate change. The press release stated that the Administration will work closely with legislative leaders and the Joint Legislative Committee on Emergency Management, as well as the relevant standing policy committees, to craft solutions to:
- Modernize vegetation and forest management practices for fire prevention and carbon sequestration;
- Ensure utility and public infrastructure is designed, constructed and operated to maximize resiliency to extreme weather events and natural disasters;
- Enhance the emergency response system, including consideration of mutual aid resources, telecommunications, 911 systems, and community needs, particularly in low-income and vulnerable rural and urban communities;
- Examine the availability of insurance products in high wildfire areas in light of increased risks from climate change; and,
- Update liability rules and regulations for utility services in light of changing climate and the increased severity and frequency of weather events.
- FQHCs and RHCS. FQHCs and RHCs serve a significant portion of the uninsured and underinsured in California. They are open-door providers that treat patients on a sliding scale fee structure and make their services available regardless of a patient's ability to pay. There are approximately 600 FQHCs and 350 RHCs in California. All FQHCs, and a majority of the RHCs, are either non-profit community clinics or government entities. Because these clinics are safety net providers, their continued survival depends heavily on the stability and adequacy of revenues from the Medi-Cal program.
According to the press release, this work will give state and local governments effective tools to reduce risks and enhance the resiliency of communities and infrastructure. It builds on the ongoing work by the Legislature and administration – alongside the federal government, private sector, non-governmental organizations, community members, and other stakeholders – to improve fire threat evaluation, hazard mitigation, carbon storage capacity and tree mortality and forest management practices.
- SUPPORT. According to the CaliforniaHealth+Advocates and the Redwood Community Health Coalition, cosponsors of this bill, this bill is critical to ensure that communities continue to receive timely access to care when disaster strikes. Supporters state that this bill will clarify state law to ensure that providers can have telephonic appointments (visits) with patients because during a state of emergency, this is the most efficient way to provide care. Secondly, while many health centers already have cooperative agreements with their county and local partners to provide services in shelters, greater clarity is needed to guarantee health centers can bill for these services. Thirdly, those with access and functional needs are hit especially hard during disasters. While health centers may use telephonic visits to care for these patients, the ability to provide, and be reimbursed for, home visits would create the necessary flexibility to keep patients healthy at home and avoid unnecessary strain on emergency care. Lastly, a health center that has been destroyed or impacted cannot operate their pharmacy and dispense medication to patients. An accelerated BOP permitting process is needed for temporary pharmacy site permits.
- RELATED LEGISLATION.
- AB 2102 (Rodriguez) requires the Emergency Medical Services Authority to establish training standards and licensing reciprocity procedures for out-of-state fire and paramedic personnel who render aid in this state on a temporary basis during a declared state of emergency. AB 2102 is pending in Assembly Health Committee.
- AB 2333 (Wood) establishes a behavioral health deputy director within the
- AB 2428 (Gonzalez Fletcher) authorizes an FQHC or RHC that is adding or has added one or more physical plants that meet specified criteria to its primary care license to elect to have the physical plant or physical plants be billed by and reimbursed at the same rate as the FQHC or RHC, or an alternative reimbursement rate, as specified. AB 2428 also provides that a primary care clinic with additional locations added to its primary care clinic license need not separately enroll the additional locations as separate providers, as specified. AB 2428 is pending in Assembly Health Committee.
- AB 2861 (Salas) requires DHCS to allow a licensed practitioner of the healing arts or a certified substance use disorder counselor to receive Medi-Cal reimbursement for substance use disorder services provided through telehealth in accordance with the Medicaid state plan. AB 2361 is pending in Assembly Health Committee.
- AB 2941 (Berman) requires a health plan or health insurer to ensure its enrollees or insureds, who have been displaced by a state of emergency, as defined, have continued access to medically necessary health care services. AB 2941 is pending in Assembly Health Committee.
- PREVIOUS LEGISLATION.
- SB 323 (Mitchell), Chapter 540, Statutes of 2017, authorizes FQHCs and RHCs to receive reimbursement from county specialty mental health plans and through Drug Medi-Cal (DMC) outside of the regular Medi-Cal reimbursement structure that applies to FQHCs and RHCs.
- SB 456 (Pan) would have allowed FQHCs or RHCs to enter into an agreement with a public or private entity willing and qualified to provide services that follow the patient, as defined. SB 456 was held on the Assembly Appropriations Committee suspense file.
- SB 1335 (Mitchell) of 2016, would have authorized FQHCs and RHCs to provide DMC services and to be reimbursed for those services. SB 1335 died on the Assembly Inactive file.
- SB 147 (Hernandez), Chapter 760, Statutes of 2014, requires DHCS to authorize a three-year payment reform pilot project for FQHCs using an alternative payment methodology authorized under federal Medicaid law. SB 147 requires an FQHC participating in the pilot to receive a per member, per month payment for each of its APM enrollees from a Medi-Cal managed care health plan, instead of the wrap around payment FQHCs currently receive from DHCS.
- DOUBLE-REFERRAL. This bill has been double-referred; upon passage of this committee, it will be referred to the Assembly Business and Professions Committee.
- POLICY COMMENT. As described in existing law above, the BOP already has broad authority to waive the provisions of the Pharmacy Act during a declared federal, state or local emergency, including waiving the requirement to obtain various pharmacy or clinic permits such as those specified in this bill. With the exception of the timeframe and record keeping provisions, the BOP provisions in this bill seem redundant. As this bill moves forward, the author may wish to clarify the necessity of the BOP provisions.
REGISTERED SUPPORT / OPPOSITION:
Support
CaliforniaHealth+Advocates (cosponsor)
Redwood Community Health Coalition (cosponsor)
Alameda Health Consortium
Borrego Community Health Foundation
California School-Based Health Alliance
Capitol Health Network
Clinicas de Salud del Pueblo
Coastal Health Alliance
CommuniCare Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Systems, Inc.
Health Alliance of Northern California
Health Center Partners of Southern California
Imperial Beach Community Clinic
Indian Health Center of Santa Clara Valley
Indian Health Council, Inc.
La Maestra Health Centers
Lifelong Medical Care
Marin Community Clinics
Mountain Health and Community Services
Neighborhood Healthcare
North Coast Clinics Network
North County Health Services
Northeast Valley Health Corporation
Operation Samahan
Planned Parenthood of the Pacific Southwest
San Diego American Indian Health Council
San Diego Family Care
San Francisco Community Clinic Consortium
San Ysidro Health
San Ysidro Health Center
Santa Rosa Community Health
Sonoma Valley Community Health Center
Southern Indian Health Council
Sycuan Medical Dental Center
Vista Community Clinic
West County Health Centers, Inc.
Westside Family Health Center
Opposition
None on file.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097
Bill Author
