Bill Text: CA SB994 | 2015-2016 | Regular Session | Amended

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Bill Title: Health care districts: design-build.

Spectrum: Slight Partisan Bill (Democrat 3-1)

Status: (Failed) 2016-11-30 - From Assembly without further action. [SB994 Detail]

Download: California-2015-SB994-Amended.html

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BILL NUMBER: SB 994	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 14, 2016
	AMENDED IN SENATE  APRIL 14, 2016
	AMENDED IN SENATE  MARCH 28, 2016

INTRODUCED BY    Senator   Hill 
 Senators   Hill   and Allen 
    (   Principal   coauthors:  
Assembly Members   Hadley   and Mullin   )


                        FEBRUARY 10, 2016

   An act to  amend the heading of Article 2.6 (commencing
with Section 1645) of Chapter 4 of Division 2 of, to amend the
heading of Article 10 (commencing with Section 2190) of Chapter 5 of
Division 2 of, and to add Sections 1645.5, 2197, 2454.6, and 2496.5
to, the Business and Professions Code, and to add Article 2.7
(commencing with Section 1223) of Chapter 1 of Division 2 to the
Health and Safety Code, relating to antimicrobial stewardship.
  add and repeal Sections 32132.9 and 32132.95 of the
Health and Safety Code, relating to health care districts, and
declaring the urgency thereof, to take effect immediately. 


	LEGISLATIVE COUNSEL'S DIGEST


   SB 994, as amended, Hill.  Antimicrobial stewardship
policies.   Health care districts: design-build. 

   Existing law authorizes certain health care districts to use the
design-build process when contracting for the construction of a
building or improvements directly related to construction of a
hospital or health facility building in those districts, as
specified. Existing law sets forth the procurement process for
design-build projects, as specified, and requires specified
information submitted by design-build entities to be certified under
penalty of perjury.  
   This bill would authorize, until January 1, 2022, the Beach Cities
Health District and the Peninsula Health Care District to use the
design-build process for the construction of facilities or other
buildings in those districts, as specified. Because the bill would
expand the application of the procurement process to additional
design-build entities, the bill would expand the crime of perjury,
thereby imposing a state-mandated local program.  
   This bill would make legislative findings and declarations as to
the necessity of a special statute for the Beach Cities Health
District and the Peninsula Health Care District.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   This bill would declare that it is to take effect immediately as
an urgency statute.  
   (1) Under the existing Dental Practice Act, the Dental Board of
California licenses and regulates the practice of dentistry. The act
provides that an applicant may obtain an initial 2-year license to
practice dentistry and a 2-year renewal license. The act also makes
certain conduct unprofessional conduct and authorizes the board to
revoke or suspend a license or reprimand or place on probation a
dentist for that unprofessional conduct.  
   Under the existing Medical Practice Act, the Medical Board of
California, the Osteopathic Medical Board of California, and the
California Board of Podiatric Medicine establish requirements
pursuant to which an applicant may obtain an initial 2-year license
or subsequent 2-year renewal license to practice medicine as a
podiatrist, as a physician and surgeon, osteopathic medicine as an
osteopathic physician and surgeon, or podiatric medicine as a
podiatrist, respectively. Under existing law, the Medical Board of
California is required to adopt and administer standards for the
continuing education of physicians and surgeons and each year audits
a random sample of physicians and surgeons who have reported
compliance with those requirements and requires a noncompliant
licensee to make up the deficiency during the next renewal period.
Under existing law, a licensee who fails to so comply is ineligible
for a subsequent renewal license until he or she documents compliance
to the board. Existing law provides for similar continuing education
requirements as a condition of obtaining a renewal license to
practice osteopathic medicine and podiatric medicine. The act
authorizes these boards to discipline a licensee for specified
unprofessional conduct.  
   This bill would require a "covered licensee," defined as a
dentist, physician and surgeon, osteopathic physician and surgeon, or
person licensed to practice podiatric medicine, who practices in a
setting other than a clinic, general acute care hospital, or skilled
nursing facility, to adopt and implement an antimicrobial stewardship
policy consistent with specified guidelines or methods of
intervention, as defined, before applying for a renewal license and,
upon applying for a renewal license, to certify in writing, on a form
prescribed by the respective licensing board, that he or she has
both adopted an antimicrobial stewardship policy and is in compliance
with that policy. The bill would require those licensing boards to
audit, during each year, a random sample of covered licensees who
have certified compliance with these requirements and would limit the
audit of an individual covered licensee to once every 4 years. The
bill would require a covered licensee who is selected for audit to
submit to the board, on a form prescribed by the board, a copy of his
or her antimicrobial stewardship policy. The bill would require the
respective licensing board, that determines that its audited covered
licensee has failed to comply with these requirements, to require
that covered licensee to comply with these requirements during the
following renewal period. The bill would provide that the failure of
a covered licensee to comply with those requirements during the
renewal period constitutes unprofessional conduct.  

   (2) Under existing law, health facilities, including, among
others, general acute care hospitals, skilled nursing facilities,
primary care clinics, and specialty clinics, are licensed and
regulated by the State Department of Public Health, and a violation
of those provisions is a crime. Existing law requires that each
general acute care hospital, on or before July 1, 2015, adopt and
implement an antimicrobial stewardship policy in accordance with
guidelines established by the federal government and professional
organizations that includes a process to evaluate the judicious use
of antibiotics, as specified. Existing law requires each skilled
nursing facility, on or before January 1, 2017, to adopt and
implement an antimicrobial stewardship policy consistent with
guidelines developed by the federal Centers for Disease Control and
Prevention and other specified entities.  
   This bill would, beginning January 1, 2018, require a clinic to
adopt and implement an antimicrobial stewardship policy consistent
with specified guidelines or methods of intervention, as defined.
Because this bill would create new crimes, the bill would impose a
state-mandated local program.  
   (3) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason. 
   Vote:  majority   2/3  . Appropriation:
no. Fiscal committee: yes. State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 32132.9 is added to the 
 Health and Safety Code   , to read:  
   32132.9.  (a) Notwithstanding Section 32132 or any other law, upon
approval by the board of directors of the Beach Cities Health
District, the design-build process described in Chapter 4 (commencing
with Section 22160) of Part 3 of Division 2 of the Public Contract
Code may be used to assign contracts for the construction of
facilities or other buildings in that district.
   (b) For purposes of this section, all references in Chapter 4
(commencing with Section 22160) of Part 3 of Division 2 of the Public
Contract Code to "local agency" shall mean the Beach Cities Health
District and its board of directors.
   (c) To the extent that any project utilizing the design-build
process authorized by subdivision (a) is otherwise required to comply
with the standards and requirements of the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing
with Section 129675) of Part 7 of Division 107), this section shall
not be construed as an exemption from that act.
   (d) This section 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. 
   SEC. 2.    Section 32132.95 is added to the 
 Health and Safety Code   , to read:  
   32132.95.  (a) Notwithstanding Section 32132 or any other law,
upon approval by the board of directors of the Peninsula Health Care
District, the design-build process described in Chapter 4 (commencing
with Section 22160) of Part 3 of Division 2 of the Public Contract
Code may be used to assign contracts for the construction of
facilities or other buildings in that district.
   (b) For purposes of this section, all references in Chapter 4
(commencing with Section 22160) of Part 3 of Division 2 of the Public
Contract Code to "local agency" shall mean the Peninsula Health Care
District and its board of directors.
   (c) To the extent that any project utilizing the design-build
process authorized by subdivision (a) is otherwise required to comply
with the standards and requirements of the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing
with Section 129675) of Part 7 of Division 107), this section shall
not be construed as an exemption from that act.
   (d) This section 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. 
   SEC. 3.    The Legislature finds and declares that a
special law is necessary and that a general law cannot be made
applicable within the meaning of Section 16 of Article IV of the
California Constitution because of the unique circumstances relating
to the Beach Cities Health District and the Peninsula Health Care
District. 
   SEC. 4.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution. 
   SEC. 5.    This act is an urgency statute necessary
for the immediate preservation of the public peace, health, or safety
within the meaning of Article IV of the Constitution and shall go
into immediate effect. The facts constituting the necessity are:
 
   In order for the Beach Cities Health District and the Peninsula
Health Care District to facilitate construction of facilities or
other buildings in those districts at the earliest possible time
pursuant to design-build authority, and to ensure the expedient
provision of health care services in those districts at the earliest
possible time, it is necessary that this act take immediate effect.
 
  SECTION 1.    The Legislature finds and declares
all of the following:
   (a) The overuse and misuse of antibiotics can lead to the
development of antibiotic-resistant infections, a major public health
threat.
   (b) The federal Centers for Disease Control and Prevention (CDC)
estimates that at least 2,000,000 Americans are infected with, and at
least 23,000 Americans die as a result of, antibiotic-resistant
infections every year, resulting in at least $20 billion in direct
health care costs and at least $35 billion in lost productivity in
the United States.
   (c) Antibiotic resistance is a growing threat. A recent study
commissioned by the United Kingdom determined that by 2050,
worldwide, more people will die from antibiotic-resistant infections
than from cancer.
   (d) The overuse and misuse of antibiotics in human medicine is a
significant factor driving the development of antibiotic resistance,
and a majority of antibiotics are prescribed in outpatient settings,
including primary care physician offices, outpatient settings where
physician assistants and nurse practitioners work, dentist offices,
and other specialty health care providers.
   (e) According to the CDC, in one year, 262.5 million courses of
antibiotics are written in outpatient settings. This equates to more
than five prescriptions written each year for every six people in the
United States. The CDC estimates that over one-half of the
antibiotics prescribed in outpatient settings are unnecessary.
   (f) More than 10 million courses of antibiotics are prescribed
each year for viral conditions that do not benefit from antibiotics.
   (g) Antibiotic stewardship programs, which are already required in
general acute care hospitals and skilled nursing facilities in the
state, but not in outpatient settings, are an effective way to reduce
inappropriate antibiotic use and the prevalence of
antibiotic-resistant infections.
   (h) The President's National Action Plan for Combating
Antibiotic-Resistant Bacteria calls for the establishment of
antibiotic stewardship activities in all health care delivery
settings, including outpatient settings, by 2020.  
  SEC. 2.    The heading of Article 2.6 (commencing
with Section 1645) of Chapter 4 of Division 2 of the Business and
Professions Code is amended to read:

      Article 2.6.  Continuing Education and Antimicrobial
Stewardship

 
  SEC. 3.    Section 1645.5 is added to the Business
and Professions Code, to read:
   1645.5.  (a) For purposes of this section the following
definitions apply:
   (1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing the
development of antimicrobial resistant infections, that is consistent
with one of the following parameters:
   (A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
   (B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
   (2) A "covered licensee" means a dentist who practices dentistry
in a setting other than a clinic licensed pursuant to Section 1204 of
the Health and Safety Code, a general acute care hospital as defined
in subdivision (a) of Section 1250 of the Health and Safety Code, or
a skilled nursing facility as defined in subdivision (c) of Section
1250 of the Health and Safety Code.
   (3) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
   (b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
   (c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
   (d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
   (2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
   (e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
renewal period,that failure constitutes unprofessional conduct
subject to discipline pursuant to Section 1670.  
  SEC. 4.    The heading of Article 10 (commencing
with Section 2190) of Chapter 5 of Division 2 of the Business and
Professions Code is amended to read:

      Article 10.  Continuing Medical Education and Antimicrobial
Stewardship

 
  SEC. 5.    Section 2197 is added to the Business
and Professions Code, to read:
   2197.  (a) For purposes of this section the following definitions
apply:
   (1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing the
development of antimicrobial resistant infections, that is consistent
with one of the following parameters:
   (A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
   (B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
   (2) A "covered licensee" means a physician and surgeon who
practices medicine in a setting other than a clinic licensed pursuant
to Section 1204 of the Health and Safety Code, a general acute care
hospital as defined in subdivision (a) of Section 1250 of the Health
and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.
   (3) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
   (b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
   (c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
   (d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
   (2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
   (e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
renewal period, that failure constitutes unprofessional conduct
subject to discipline pursuant to Section 2234.  
  SEC. 6.    Section 2454.6 is added to the Business
and Professions Code, to read:
   2454.6.  (a) For purposes of this section the following
definitions apply:
   (1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing the
development of antimicrobial resistant infections, that is consistent
with one of the following parameters:
   (A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
   (B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
   (2) A "covered licensee" means an osteopathic physician and
surgeon who practices osteopathic medicine in a setting other than a
clinic licensed pursuant to Section 1204 of the Health and Safety
Code, a general acute care hospital as defined in subdivision (a) of
Section 1250 of the Health and Safety Code, or a skilled nursing
facility as defined in subdivision (c) of Section 1250 of the Health
and Safety Code.
   (3) "Evidence-based methods" has the same meaning as in paragraph
(3) of subdivision (a) of Section 2197.
   (b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
   (c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
   (d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
   (2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
   (e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following renewal
period. If the covered licensee fails to comply within that renewal
period, that failure constitutes unprofessional conduct subject to
discipline pursuant to Section 2234.  
  SEC. 7.    Section 2496.5 is added to the Business
and Professions Code, to read:
   2496.5.  (a) For purposes of this section the following
definitions apply:
   (1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing the
development of antimicrobial resistant infections, that is consistent
with one of the following parameters:
   (A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
   (B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
   (2) A "covered licensee" means a podiatrist who practices
podiatric medicine in a setting other than a clinic licensed pursuant
to Section 1204 of the Health and Safety Code, a general acute care
hospital as defined in subdivision (a) of Section 1250 of the Health
and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.
   (3) "Evidence-based methods" has the same meaning as in paragraph
(3) of subdivision (a) of Section 2197.
   (b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
   (c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
   (d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
   (2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
   (e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following renewal
period. If the covered licensee fails to comply within that renewal
period, that failure constitutes unprofessional conduct subject to
discipline pursuant to Section 2234.  
  SEC. 8.    Article 2.7 (commencing with Section
1223) is added to Chapter 1 of Division 2 of the Health and Safety
Code, to read:

      Article 2.7.  Antimicrobial Stewardship Guidelines


   1223.  (a) For purposes of this article the following definitions
apply.
   (1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate prescribing of antimicrobials for patients, with the
goal of reducing antimicrobial overuse and misuse and minimizing the
development of antimicrobial resistant infections.
   (2) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
   (b) On or before January 1, 2018, a primary care clinic or
specialty clinic, licensed pursuant to Section 1204, shall adopt and
implement an antimicrobial stewardship policy that is consistent with
one of the following parameters:
   (1) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
   (2) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
 
  SEC. 9.    No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.