CMA Legislative Update as of September 6
By the California Medical Association (CMA)
SB 491 — Nurse Practitioners: CMA had a great victory with the desired outcome of having SB 491 held on suspense. Essentially, the bill failed in committee and is done for the year. Unlike the Senate, the Assembly Appropriations Committee estimated significant costs associated with SB 491. We expect that the author will re-introduce a scope bill next year. We are also being very vigilant about ensuring that there is no attempt to do a “gut and amend” at the end of this year’s session.
SB 492 — Optometrists: The optometrist scope expansion bill is now a two-year bill done for the year due to the fact that it did not have sufficient votes in the Assembly Committee on Business, Professions, and Consumer Protections.
SB 493 — Pharmacists: CMA has removed its opposition after the sponsor agreed to our suggested amendments to limit furnishing to only nicotine-based tobacco cessation prescription drugs, with the requirement that it be done under a protocol with a physician. After its agreement with CMA, the bill has been moving through the Legislature with bi-partisan support.
AB 154 — Abortions: This bill would allow nurse practitioners, certified nurse midwives, and physician assistants to perform first trimester aspiration abortions. While it allows nonphysicians to perform abortions, the bill requires them to be supervised by a physician. The author took all the amendments CMA offered. This bill is now headed to the governor.
AB 1308 — Midwifery: It is still unclear whether or not the author intends to move this bill this year. The bill is still not yet amended. We will track this bill to ensure that the liability protections for physicians will be part of the bill.
AB 1000: A compromise measure, this bill would allow patients to directly access physical therapy services for a limited time before being seen by a physician. The bill would also allow licensed healthcare professionals to be employed by healthcare-related corporations, a key goal for CMA. AB 1000 passed the Senate Appropriations Committee and is now eligible to be heard on the Senate floor.
There is still no bill introduced in the Capitol. In our discussions with legislators, even among those who are not with us on MICRA, there is an acknowledgment that the trial lawyers do not have the votes in the Capitol to make any changes to MICRA. The Legislative Analyst's Office (LAO), charged with providing the attorney general with a fiscal analysis of all initiatives, recently released their report. The LAO has indicated that they anticipate significant fiscal impacts, including costs associated with higher medical malpractice costs, likely at least in the low tens of millions of dollars annually, potentially ranging to over one hundred million dollars annually.
Opioids / Medical Board:
SB 809-CURES: The bill has been amended to incorporate essentially the complete CMA-proposed language. While some of the components are slightly different from our original proposal, all our issues were addressed. The bill in print is a result of the great work of the Opioids Rapid Response Team!
SB 62 — Coroners: CMA offered amendments that will limit these reports to those deaths that result from an overdose and keep these reports confidential. So far the author has committed to the majority of CMA-suggested language, including the very important provision that requires these reports to be confidential. After careful consideration, and after the inclusion of a four-year sunset, CMA has removed its opposition.
SB 670 — Prescribing Limitations: The bill would allow the Medical Board to limit a physician’s controlled substance prescribing authority if there was probable cause that the physician was inappropriately prescribing controlled substances and that there was an imminent threat to the public. CMA was able to secure amendments that would add important due-process protections, including limiting it to Schedule II, III, and IV drugs and a hearing before three Medical Board members to approve or deny the proposed limitations. The committee would be comprised of two physicians and one public member. While these amendments improve the bill, it still fails to increase the standard from its current “probable cause” to a “clear and convincing” standard.
Given the low standard and the severe penalty, we are focusing our efforts on defeating this bill on the Assembly floor and have outreached to key legislators seeking to ask them to join us in opposition. We have sent a key contact alert on SB 670 and have outreached to our specialty groups.
SB 304-Medical Board Sunset: The bill is the sunset extension bill for the Medical Board. Significant issues raised by CMA (expert witness, board composition, 820 evaluations) were addressed in CMA’s favor. While the proposed transfer to the Department of Justice was rejected, the bill does transfer investigations to the Division of Investigators at the Department of Consumer Affairs.
SB 21 / AB 27 — UC Riverside Medical School: Both bills request the UC Riverside School of Medicine to establish a program with its medical student graduates and residents to make them aware of and help them apply for the Steven Thompson Loan Repayment Program. SB 21 has been sent to the governor.
AB 565 — Steve Thompson Program: The bill strengthens the Steve Thompson Program by allowing solo and small practice safety net doctors to be eligible for a Steve Thompson placement. The bill is now on the Senate floor.
AB 1288 — Licensing: The bill requires the Medical Board and the Osteopathic Board to establish a process to prioritize the applications of individuals who state the intent to practice in a medically underserved area or population. The bill has received bipartisan support throughout the process and is now headed to the governor.
CMA Co-sponsored Bills:
SB 191: This bill is co-sponsored with the California American College of Emergency Physicians and would extend the sunset that raises approximately $50 million to augment local county emergency medical services funds in order to provide emergency services. The bill is now headed to the governor.
SB 615 — CHFFA: While the bill was moved out of the Assembly Appropriations Committee, the provisions of interest to CMA were removed. As a result, we are no longer co-sponsoring this legislation.
AB 1208: This bill is co-sponsored with the California Academy of Family Physicians and would establish the Patient-centered Medical Home Act of 2013. The bill is now on the Senate Floor.
One more week of session left!