September 30th marked the deadline for the Governor to sign or veto bills for the 2018 state legislative session. CAPH monitored the health-care related bills very closely, and engaged in a number of bills that would have impacted public health care systems. Below is a summary of key health care-related legislation relevant to public health care systems.
SB 1152 (Hernandez) – Homeless Discharge – SIGNED
This bill requires health facilities to include, within the hospital discharge policy, a written homeless patient discharge planning policy and process. CAPH provided a number of amendments that were included in the final version of the bill. SB 1152 was signed into law by the Governor.
SB 1288 (Leyva) – Nurse Staffing Ratios – VETOED
This bill would have required state periodic inspections of health facilities to include reviews of compliance with the nurse-to-patient ratios and staff assignment regulations. It also would have required the Department of Public Health to ensure that these inspections are not announced in advance of the date of inspections. As well as increased penalties for violations, currently there are only mandatory penalties for violations that cause immediate jeopardy, but this would have added mandatory penalties in other cases. CAPH worked closely with our members that had concerns with this bill and monitored it closely, as CHA led the industry opposition to the legislation. SB 1288 was vetoed by the Governor.
AB 3115 (Gipson) – Community Paramedicine – VETOED
This bill would have authorized local Emergency Medical Service (EMS) agencies to develop community paramedicine programs and alternate destination programs in California. An alternate destination would have been considered a mental health facility (such as a crisis stabilization unit) or authorized sobering center. The community paramedicine program would have been able to assist with post discharge follow up, tuberculosis therapy, and case management services for frequent ER patients. The bill would have also made permanent changes to the EMS Commission. \AB 3115 was vetoed by the Governor.
SB 1125 (Atkins) FQHC Reimbursement – VETOED
This bill would have authorized reimbursement for a maximum of two visits, under the Medi-Cal program, taking place on the same day at a single location, if after the first visit the patient suffers illness or injury requiring additional diagnosis or treatment, or if the patient has a medical visit and another health visit, as defined. The bill’s implementation was contingent on a budget appropriation, which was not included in the final FY18-19 State Budget. CAPH submitted a letter in support of this bill. SB 1125 was vetoed by the Governor.
SB 1447 (Hernandez) – Automated Drug Delivery Systems -SIGNED
This bill was sponsored by the Board of Pharmacy and imposes new licensure requirements on Automated Drug Delivery Systems, which the bill establishes as an umbrella term, and includes both Automated Unit Dose Systems (AUDS- also known as Pyxis or Omnicell) and Automated Patient Dispensing Systems (APDS). AUDS are used by providers in the health facility setting to store and administer medications. Whereas, APDS essentially are prescription drug vending machines and are directly accessed by patients to fill prescriptions. The bill exempts AUDS operating under the acute hospital consolidated license but requires any other machines to each have their own license, and imposes new requirements in order to obtain licensure. CAPH submitted a letter of concerns surrounding AUDS licensure, noting particular challenges for clinics and other facilities run by public health care systems that are not operating under the hospital license. The bill was signed by the Governor and the requirements take effect on July 1, 2019.
AB 2037 (Bonta) – Automated Drug Delivery Systems – SIGNED
This bill is sponsored by IMGRX/MedifriendRx, which manufacturers Automated Patient Dispensing Systems (APDS) and are drug vending machines for patients to fill take home prescriptions (as described above in the SB 1447 section). This bill expands the types of health facilities that APDS can be used at to include all settings that are eligible as covered entities for the 340B Drug Pricing Program, upon obtaining a license and fulfilling certain requirements. The bill previously applied to Automated Drug Delivery Systems, which would have included Automated Unit Dose Systems, such as Pyxis or Omnicell units, as described above in the SB 1447 section. CAPH worked with that author and the sponsors to limit the language to APDS’ only. AB 2037 was signed by the Governor.
SB 1108 (Hernandez) – Medicaid Waiver/Work Requirements – SIGNED
An earlier version of this bill would have prohibited the Department from seeking or obtaining a Medicaid waiver to require work or community engagement activities as a condition of Medi-Cal eligibility or coverage. However, SB 1108 was amended in August to affirmatively state that the purpose of the Medi-Cal program is to provide comprehensive health care to low-income Californians, and allows waivers that promote the broader goals of coverage and improvements in care. On the earlier version of the bill, CAPH submitted a letter of concern, and provided input on the proposed changes. SB 1108 was signed into law by the Governor.
SB 906 (Beall) – Medi-Cal: Mental Health Services: Family Support- VETOED
SB 906 would have established a statewide peer, parent, transition-age, and family support specialist certification program, as part of the state’s comprehensive mental health and substance use disorder delivery system and the Medi-Cal program. CAPH submitted a support letter on SB 906. SB 906 was vetoed by the Governor.
AB 2083 (Cooley) – Continuum of Care Reform – SIGNED
AB 2083 states the intent of the Legislature to enact legislation that would build upon the current Continuum of Care Reform (CCR) implementation effort by developing a coordinated and trauma-informed system-of-care approach to better provide care for foster youth, require specified agencies to develop and implement local memoranda of understanding to provide care management coordination for child welfare-involved children, youth, and families, and establish a joint state interagency resolution team. AB 2083 was signed into law by the Governor.