Bill Text: CA AB824 | 2011-2012 | Regular Session | Amended
Bill Title: Rural hospitals: physician services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-02-01 - Died pursuant to Art. IV, Sec. 10(c) of the Constitution. From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB824 Detail]
Download: California-2011-AB824-Amended.html
BILL NUMBER: AB 824 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 31, 2011
INTRODUCED BY Assembly Member Chesbro
FEBRUARY 17, 2011
An act to amend Section 1179 of the Health and Safety
Code, relating An act to add and repeal Chapter 6.5
(commencing with Section 124871) of Part 4 of Division 106 of the
Health and Safety Code, relating to public health.
LEGISLATIVE COUNSEL'S DIGEST
AB 824, as amended, Chesbro. Rural health.
Rural hospitals: physician services.
Existing law requires the Secretary of the California Health and
Welfare Agency to establish an Office of Rural Health within the
agency and sets forth its powers and duties relating to promoting a
strong working relationship between state government, prescribed
entities, and rural consumers and relating to developing health
initiatives and maximizing existing resources without duplication.
Existing law makes related findings and declarations,
including, but not limited to, recognizing the need to take a
comprehensive approach to strengthen and coordinate rural health
programs and health care delivery systems.
This bill would revise those findings and declarations to,
instead, recognize the need to take a comprehensive approach, which
includes federal health care reform, to strengthen and coordinate
rural health programs and health care delivery systems.
Existing law generally provides for the licensure of health
facilities, including rural general acute care hospitals, by the
State Department of Public Health.
Existing law requires the department to provide expert technical
assistance to strategically located, high-risk rural hospitals, as
defined, to assist the hospitals in carrying out an assessment of
potential business and diversification of service opportunities.
Existing law also requires the department to continue to provide
regulatory relief when appropriate through program flexibility for
such items as staffing, space, and physical plant requirements.
This bill would, until January 1, 2022, establish a demonstration
project authorizing a rural hospital, as defined, that meets
specified conditions, to employ up to 10 physicians and surgeons at
one time, except as provided, to provide medical services at the
rural hospital or other health facility that the rural hospital owns
or operates, and to retain all or part of the income generated by the
physicians and surgeons for medical services billed and collected by
the rural hospital if the physician and surgeon in whose name the
charges are made approves the charges. The bill would require a rural
hospital that employs a physician and surgeon pursuant to those
provisions to develop and implement a policy regarding the
independent medical judgment of the physician and surgeon. The bill
would require these physicians and surgeons to biennially sign a
specified statement.
The bill would impose various duties on the department and the
Medical Board of California including a requirement that the board
deliver a report to the Legislature regarding the demonstration
project by January 1, 2019.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: yes
no .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all
of the following:
(a) Many hospitals in the state are having great difficulty
recruiting and retaining physicians.
(b) There is a shortage of physicians in communities across
California, particularly in rural areas, and this shortage limits
access to health care for Californians in these communities.
(c) The average age of physicians in rural and underserved urban
communities is approaching 60 years of age, with many of these
physicians planning to retire within the next two years.
(d) Allowing rural hospitals to directly employ physicians will
allow rural hospitals to provide economic security adequate for a
physician to relocate and reside in the communities served by the
rural hospitals and will help rural hospitals recruit physicians to
provide medically necessary services in these communities and further
enhance technological developments such as the adoption of
electronic medical records.
(e) Allowing rural hospitals to directly employ physicians will
provide physicians with the opportunity to focus on the delivery of
health services to patients without the burden of administrative,
financial, and operational concerns associated with the establishment
and maintenance of a medical office, thereby giving the physicians a
reasonable professional and personal lifestyle.
(f) Direct employment of physicians by the University of
California hospitals, county hospitals, and community clinics has
proved to be a successful recruitment tool for those entities and
provided physicians with much sought after economic and professional
security.
(g) It is the intent of the Legislature by enacting this act to
establish a demonstration project authorizing a rural hospital that
meets the conditions set forth in Chapter 6.5 (commencing with
Section 124871) of Part 4 of Division 106 of the Health and Safety
Code to employ physicians directly and to charge for their
professional services.
(h) It is the intent of the Legislature to prevent a rural
hospital that employs a physician from interfering with, controlling,
or otherwise directing the physician's medical judgment or medical
treatment of patients.
(i) It is the further intent of the Legislature to increase the
number of physicians in rural communities to address the
unprecedented physician shortage and not to redistribute the current
physicians, by allowing rural hospitals to directly hire physicians
currently working in health clinics in these communities.
SEC. 2. Chapter 6.5 (commencing with Section
124871) is added to Part 4 of Division 106 of the Health
and Safety Code , to read:
CHAPTER 6.5. RURAL HOSPITAL PHYSICIAN AND SURGEON SERVICES
DEMONSTRATION PROJECT
124871. For purposes of this chapter, "rural hospital" means all
of the following:
(a) A general acute care hospital located in an area designated as
nonurban by the United States Census Bureau.
(b) A general acute care hospital located in a rural-urban
commuting area code of 4 or greater as designated by the United
States Department of Agriculture.
(c) A rural general acute care hospital, as defined in subdivision
(a) of Section 1250.
124872. (a) Notwithstanding Article 18 (commencing with Section
2400) of Chapter 5 of Division 2 of the Business and Professions Code
and in addition to other applicable laws, a rural hospital whose
service area includes a medically underserved area, a medically
underserved population, or that has been federally designated as a
health professional shortage area may employ one or more physicians
and surgeons, not to exceed 10 physicians and surgeons at one time,
except as provided in subdivision (c), to provide medical services at
the rural hospital or other health facility, as defined in Section
1250, that the rural hospital owns or operates. The rural hospital
may retain all or part of the income generated by the physician and
surgeon for medical services billed and collected by the rural
hospital, if the physician and surgeon in whose name the charges are
made approves the charges.
(b) A rural hospital may participate in the program if both of the
following conditions are met:
(1) The rural hospital documents that it has been unsuccessful in
recruiting one or more primary care or speciality physicians for at
least 12 continuous months beginning July 1, 2010. An exception shall
be provided to the 12 month recruiting process when there is an
unexpected or sudden vacancy that needs to be filled immediately.
(2) The chief executive officer of the rural hospital certifies to
the Medical Board of California that the inability to recruit
primary care or speciality physicians has negatively impacted patient
care in the community and that there is a critical unmet need in the
community, based on a number of factors, including, but not limited
to, the number of patients referred for care outside the community,
the number of patients who experienced delays in treatment, and the
length of the treatment delays.
(c) The total number of licensees employed by the rural hospital
at one time shall not exceed 10, unless the employment of additional
physicians and surgeons is deemed appropriate by the Medical Board of
California on a case-by-case basis. In making this determination,
the board shall take into consideration whether access to care is
improved for the community served by the hospital by increasing the
number of physicians and surgeons employed.
124873. (a) A rural hospital that employs a physician and surgeon
pursuant to Section 124872 shall develop and implement a written
policy to ensure that each employed physician and surgeon exercises
his or her independent medical judgment in providing care to
patients.
(b) Each physician and surgeon employed by a rural hospital
pursuant to Section 124872 shall sign a statement biennially
indicating that the physician and surgeon:
(1) Voluntarily desires to be employed by the hospital.
(2) Will exercise independent medical judgment in all matters
relating to the provision of medical care to his or her patients.
(3) Will report immediately to the Medical Board of California any
action or event that the physician and surgeon reasonably and in
good faith believes constitutes a compromise of his or her
independent medical judgment in providing care to patients in a rural
hospital or other health care facility owned or operated by the
rural hospital.
(c) The signed statement required by subdivision (b) shall be
retained by the rural hospital for a period of at least three years.
A copy of the signed statement shall be submitted by the rural
hospital to the Medical Board of California within 10 working days
after the statement is signed by the physician and surgeon.
(d) A rural hospital shall not interfere with, control, or direct
a physician and surgeon's exercise of his or her independent medical
judgment in providing medical care to patients. If, pursuant to a
report to the Medical Board of California required by paragraph (3)
of subdivision (a), the Medical Board of California believes that a
rural hospital has violated this prohibition, the Medical Board of
California shall refer the matter to the State Department of Public
Health, which shall investigate the matter. If the department
concludes that the rural hospital has violated the prohibition, it
shall notify the rural hospital. The rural hospital shall have 20
working days to respond in writing to the department's notification,
following which the department shall make a final determination. If
the department finds that the rural hospital violated the
prohibition, it shall assess a civil penalty of five thousand dollars
($5,000) for the first violation and twenty-five thousand dollars
($25,000) for any subsequent violation that occurs within three years
of the first violation. If no subsequent violation occurs within
three years of the most recent violation, the next civil penalty, if
any, shall be assessed at the five thousand dollar ($5,000) level. If
the rural hospital disputes a determination by the department
regarding a violation of the prohibition, the rural hospital may
request a hearing pursuant to Section 131071. Penalties, if any,
shall be paid when all appeals have been exhausted and the department'
s position has been upheld.
(e) Nothing in this chapter shall exempt a rural hospital from a
reporting requirement or affect the authority of the board to take
action against a physician and surgeon's license.
124874. (a) Not later than January 1, 2019, the Medical Board of
California shall deliver a report to the Legislature regarding the
demonstration project established pursuant to this chapter. The
report shall include an evaluation of the effectiveness of the
demonstration project in improving access to health care in rural and
medically underserved areas and the demonstration project's impact
on consumer protection as it relates to intrusions into the practice
of medicine.
(b) This chapter shall remain in effect only until January 1,
2022, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2022, deletes or extends
that date.
SECTION 1. Section 1179 of the Health and
Safety Code is amended to read:
1179. The Legislature finds and declares all of the following:
(a) Outside of California's four major metropolitan areas, the
majority of the state is rural. In general, the rural population is
older, sicker, poorer, and more likely to be unemployed, uninsured,
or underinsured. The lack of primary care, specialty providers and
transportation continue to be significant barriers to access to
health services in rural areas.
(b) There is no coordinated or comprehensive plan of action for
rural health care in California to ensure the health of California's
rural residents. Most of the interventions that have taken place on
behalf of rural communities have been limited in scope and purpose
and were not conceived or implemented with any comprehensive or
systematic approach in mind. Because health planning tends to focus
on approaches for population centers, the unique needs of rural
communities may not be addressed. A comprehensive plan and approach
is necessary to obtain federal support and relief, as well as to
realistically institute state and industry interventions.
(c) Rural communities lack the resources to make the transition
from present practices to managed care, and to make other changes
that may be necessary as the result of health care reform efforts.
With numerous health care reform proposals being debated and with the
extensive changes in the current health care delivery system, a
comprehensive and coordinated analysis must take place regarding the
impact of these proposals on rural areas.
(d) Rural areas lack the technical expertise and resources to
improve and coordinate their local data collection activities, which
are necessary for well-targeted health planning, program development,
and resource development. Data must be available to local
communities to enable them to plan effectively.
(e) The Legislature recognizes the need to take a comprehensive
approach, which includes federal health care reform, to strengthen
and coordinate rural health programs and health care delivery systems
in order to:
(1) Facilitate access to high quality health care for California's
rural communities.
(2) Promote coordinated planning and policy development among
state departments and between the State and local public and private
providers.
