Despite numerous vetoes from the governor, 2009 produced significant, if incremental, changes to laws affecting the practice of medicine in California. With the health system reform debate now centered in Congress, state policy makers directed much of their attention to discrete issues impacting patient access to health care, the role of allied health professionals, medical records and privacy, physician licensing and discipline, patient safety and professional liability.

Below is a summary of some of the most significant new statutes enacted in California, along with references to the most relevant ON-CALL document that discusses the topic more fully. For a more detailed summary of the new laws discussed below and for a summary of other new laws impacting the practice of medicine, see http://www.cmanet.org/newlaws.

The law requiring health plans and insurers to cover “off-label” medications was expanded to require coverage where the drug has been recognized for treatment of the condition by one of the listed compendia, if recognized by the federal Centers for Medicare and Medicaid Services as part of an anticancer chemotherapeutic regimen. For more information, see CMA ON-CALL #0507, "Drug Formularies, Prescription Drug Benefit Plans, and Pharmacy Benefit Managers," and #1071, "Coverage Requirements/Pre-Existing Condition Exclusions." (AB 830)

This new law prohibits a health care service plan or health insurer from rescinding an individual health care service plan contract or individual health insurance policy for any reason, or from canceling, limiting, or raising the premiums of the plan contract or policy due to any omission, misrepresentation, or inaccuracy in the application form, after 24 months following the issuance of the plan contract or policy. For more information, see CMA ON-CALL #1025, "Denials of Necessary Medical Services,” and #0145, “Payment Denial After Treatment Authorization or Verification of Eligibility.” (AB 108)

The new law imposes various obligations on hospitals, physicians and other providers with respect to verifying a patient’s Medi-Cal eligibility, billing Medi-Cal beneficiaries, and the reporting of Medi-Cal beneficiaries to consumer credit reporting agencies. (AB 1142)

A new law that applies to the Worker’s Compensation system provides that, regardless whether an employer has established a medical provider network or entered into a contract with a health care organization, an employer that authorizes medical treatment shall not rescind or modify the authorization, for any reason, after that treatment has been provided. For more information, see CMA ON-CALL #1929, “Treating Physicians: Payment for Treatment (OMFS).” (AB 361)

 

A new law requires osteopathic physicians (like those licensed by the Medical Board) to report to the Osteopathic Medical Board of California ("Board") at the time of initial licensure any specialty board certification and their practice status. The new law also allows the Board to collect information regarding osteopathic physicians’ backgrounds and foreign language proficiencies. For more information, see CMA ON-CALL #0220, "Disclosure Requirements - State and Federal."(SB 620)

Clarifying that licensing boards for non-physicians have no jurisdiction to investigate or discipline physicians. For more information, see CMA ON-CALL #1605, "Medical Assistants," and #0708, "MBC Enforcement Authority." (AB 1535)

 

Existing law establishes a licensee’s obligations to comply with requests or subpoenas for medical records from the Medical Board. That law was amended to apply to “certified medical records,” which are defined as a copy of the patient’s medical records authenticated by the licensee or health care facility. The amended law also allows for penalties of up to $10,000 for failure to comply with a request for a patient’s certified medical records, when accompanied by that patient’s written authorization for release of records to the board, or for failure to comply with a court order mandating the release of records to the Board. For more information, see CMA ON-CALL #1420 "Administrator and Board Access to Peer Review Files." (AB 1070)

 

The Legislature clarified the scope of practice of a nurse practitioner (NP) to provide that standardized procedures may also be implemented that authorize a nurse practitioner to (1) order durable medical equipment, as specified; (2) certify disability after performance of a physical examination by the NP and in collaboration with a physician; and (3) approve, sign, or otherwise modify a plan treatment for individuals receiving home health services or personal care services, after consultation with the treating physician. For more information, see CMA ON-CALL #1615, "Nurses." (SB 819)

The law provides under which conditions a physician may delegate to a licensed physician assistant (PA) procedures using fluoroscopy and specifies the requirements a physician must meet to supervise a PA in performing the functions authorized by the Radiologic Technology Act. For more information on physician assistants, see CMA ON-CALL #1620, "Physician Assistants." For more information on x-rays, see CMA ON-CALL #1335, "Mammography Facilities and X-rays." (AB 356)

A physician may not perform elective cosmetic surgery procedure on a patient unless the patient has received, within 30 days prior to the procedure, and confirmed as up-to-date on the day of the procedure, a physical examination by, and written clearance for the procedure from, any of the practitioners listed in the statute. For more information, see CMA ON-CALL #0790, "Grounds for Medical Board Discipline," and #0202, "Surgicenters and Other Outpatient Facilities." (AB 1116)

The new law extends physician’s immunity from civil and criminal liability to cover the detention of any person who meets specified criteria, whether or not they qualify for a 72 hour evaluation, and for the actions after release of a person who was detained up to 24 hours and who meets specified criteria. For more information, see "Mental Health: §5150 Holds/72-Hour Detention." (SB 743)

 

The 2009 amendments to existing law require, after July 1, 2010, that hospitals conduct a security and safety assessment annually and that the security plan be updated annually based on the assessment.  In developing this plan, the hospital must consult with members of the medical staff, as specified. (AB 1083)

 

The law was clarified to require licensed clinics, among other licensed institutions (and now also home health agencies) to report instances of unlawful or unauthorized access to a patient’s medical information to the Department of Public Health and to the affected patient within 5 business days of detecting it. For more information, see CMA ON-CALL #1144, "Security Breach of Health Information." (SB 337)

 

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The California Medical Association’s Information-on-Demand Service (available online at www. CMAnet.org)
 
CMA ON-CALL is the most comprehensive health law and medical practice resource for California physicians. It is an online library that includes most of the Center for Legal Affairs’ California Physician Legal Handbook (CPLH), as well as more specialized information on peer review and other topics, including information from the CMA’s Center for Medical Policy and Economics. These documents are available free to members at the members-only website, www.cmanet.org/member or by calling the member help center at 800.786.4262. Nonmembers can purchase CMA ON-CALL documents for $2 per page in the CMA Bookstore, www.cmanet.org/bookstore.