It Was the Best of Times, It Was the Worst of Times: CMA’s 2007–2008 Legislative Wrap-up
There are moments in political life that should be preserved in a time capsule to warn future generations from repeating the mistakes of their predecessors. This legislative session could certainly qualify as one of those moments. At the beginning of 2007, the governor embarked on a massive media blitz to pass universal health reform. But by the end of 2008, the state passed a budget that eliminates healthcare coverage for 250,000 Californians.
What happened?
Sacramento was buzzing in January of 2007 with the possibility that universal healthcare would finally be achieved. Governor Schwarzenegger had proposed a comprehensive proposal that garnered national attention. Both Democratic leaders also had proposed their own plans and the state seemingly was set for a banner year. That year-long effort famously flamed out when the State Senate defeated the governor’s proposal on January 28, 2008, largely due to concerns over the growing budgetary problems facing the state.
As much as 2007 was dominated by hope, 2008 was dominated by anger, animosity, and a broken state budget. The governor invested mightily in his healthcare reform effort, and its defeat left a bad taste in everyone’s mouth. There was enough finger-pointing to satisfy even the most cynical of political observers. The governor and Assembly Speaker Fabian Nuñez blamed Senate President Pro Tem Don Perata. Don Perata blamed the governor and Fabian Nuñez. And while the blame game was in full force, everyone suddenly realized we had a massive budget problem with no real way out of it.
By February of 2008 the governor was forced to exercise his mid-year cut authority to close a $15 billion budget deficit. The Legislature became immediately embroiled in a fight over whether to adopt or reject the proposed cuts. All of the Legislature’s energy was lost to the reality that the state was, and remains, broke.
As part of the mid-year cuts, the governor and Legislature slashed Medi-Cal reimbursement rates by 10 percent, forcing CMA to go to court to block the state from implementing the cuts. It is a sad commentary on political reality when politicians are cutting already dismally low reimbursements and judges are the only ones standing in their way. At least our justice system works on occasion.
The structural deficit remained pegged at over $15 billion dollars even after $7 billion in mid-year cuts. That massive deficit, combined with a partisan standoff, led to a historic budget delay. The new budget was not enacted until September 23, 2008. The governor now holds a dubious record: signing the latest budget in the history of California. And what did Californians get a result of the historic delay? A gimmicky budget that is already out of balance. Such is life in Sacramento.
The next two years are likely to be dominated by a perfect financial storm: a Legislature unable or unwilling to make difficult decisions to increase revenue or massively cut services, a governor who has become completely isolated from both Republicans and Democrats in the Legislature, and a weakening economy that will lead to diminishing tax revenues for the state.
Is there a chance that the animosity that has defined the last two years will disappear or at least diminish in the governor’s final two years? Perhaps. Both the Assembly and Senate have elected leaders, Karen Bass and Darrell Steinberg respectively, who are known to be driven primarily by policy and a desire to do what is best for the state. Whether they can contain the hostility and bitterness of past battles and find some way to coax Republicans to the negotiating table remains a very open question. Governor Schwarzenegger vetoed a record number and percentage of bills in 2008, making even more difficult legislative leadership’s efforts to overcome their colleagues’ animosity and frustration and move forward with a positive agenda.
Their success or failure will probably be the best barometer for the state’s ability to dig itself out of a massive structural budget deficit. If they fail, the governor’s final two years will likely be incredibly disappointing.
Given all of that uplifting news, there were still many legislative proposals significant to patients and physicians; and, considering the insanity of the 2007–2008 legislative session, CMA was incredibly successful!
Among the bills signed into law was legislation to provide physicians whistleblower protections and a prohibition on insurance companies from rescinding treatment authorizations after the service has been provided in good faith. Perhaps most importantly, an egregious HMO loophole was closed. HMO fines will no longer be used to offset the fees they pay to the Department of Managed Health Care (DMHC). Instead, that money will be used to finance the Steve Thompson Loan Repayment Program (STLRP) and the Major Risk Medical Insurance Program (MRMIP). The STLRP provides loan forgiveness to medical school graduates who agree to practice in underserved areas. MRMIP provides insurance to those with pre-existing medical conditions that cannot obtain coverage in the open market.
CMA also defeated a bevy of scope bills and an attempt to obliterate the corporate bar on the practice of medicine. Additionally, CMA defeated an incredibly onerous bill that would have created a commission of political hacks to rank physicians. This legislation also would have allowed the commission to demand any and all records from physicians and medical groups and levy any tax they saw fit on physicians and medical groups.
All in all, it was a successful legislative session for CMA despite the major disappointment of not achieving universal healthcare. The following pages provide a more detailed breakdown of the major issues impacting patients and physicians in California.
BUDGET
California faced an unprecedented fiscal shortfall in the 2008–2009 fiscal year. In order to resolve the shortfall, Governor Schwarzenegger’s January budget included some deep programmatic cuts, including a 10 percent cut to Medi-Cal provider rates. In a special session to take action on the fiscal crisis, Legislators rejected a number of the eligibility and benefits cuts to Medi-Cal and other health programs, but did adopt a 10 percent reduction to Medi-Cal reimbursement and an accounting trick that delayed payment for Medi-Cal providers. After months of CMA’s legislative, grassroots, and media advocacy, the Budget Conference Committee voted to restore most of the 10 percent provider rate cut.
After the longest delay in the state’s history, Governor Schwarzenegger finally signed the $145 billion state budget on Tuesday, September 23, 2008.
While hospitals, clinics, nursing homes, and other institutional providers will finally receive long overdue Medi-Cal payments, the budget did not achieve any meaningful structural budget reform. The budget also cuts education, healthcare, social services, and transportation, although program cuts are much more modest than those in the governor’s January budget proposal. Instead of long-term solutions, the spending plan is held together by temporary revenue gimmicks and questionable fiscal assumptions that will exacerbate problems in future years. Unfortunately, the state’s revenue picture is unlikely to improve in the next fiscal year. As a result, the newly passed 2008–2009 budget would leave the state in a financial hole before the 2009–2010 fiscal year has even begun.
CMA and other provider groups successfully petitioned the courts for a preliminary injunction to stop the Medi-Cal reimbursement rate cuts. As a result, the courts ordered that Medi-Cal rates be fully restored as of August 18, 2008. Because of our legal efforts, any attempt by the Department of Health Care Services to implement the cut would be in contempt of court.
CMA-SPONSORED BILLS
AB 214 (Fuentes) PHYSICIAN HEALTH PROGRAM
This bill would have instituted the Public Protection and Physician Health Program within the Department of Public Health. The bill would have established a committee within the department comprised of experts in addiction and mental health and public members appointed by the governor, department, and Legislature. The committee would have been tasked with developing regulations and best practices for referral to treatment and monitoring of impaired physicians. Licensed physicians would have been allowed to volunteer to enter a program that would have agreed to abide by the regulations established and accepted by the committee. The bill would have allowed for multiple not-for-profit entities to be accepted into the program. Physician licensing fees of up to 2.5 percent of each fee (approximately $11 per licensee per year) would have been used to fund the work of the committee and the department. The physician participant would have been charged with the costs of individual treatment and monitoring.
— Vetoed by Governor on September 30, 2008
AB 632 (Salas) WHISTLEBLOWER PROTECTION
This bill clarifies that a physician and surgeon is protected as a whistleblower when information is given to a healthcare facility, government accreditation committee, or peer review body. A 1999 bill (SB 97, Burton) granted whistleblower protection to employees and patients of healthcare facilities by adding Health and Safety Code §1278.5 Senate Bill 97 was authored to prohibit a health facility from discriminating against a patient or employee who presents a grievance or cooperates in any investigation against that facility. This bill clearly extends that protection to physicians.
— Signed by Governor, Effective January 1, 2008
AB 682 (Berg, Garcia, Huffman) ROUTINE HIV SCREENING
This bill facilitates routine screening for HIV in all healthcare settings, as recommended by the federal Centers for Disease Control and Prevention (CDC). Tens of thousands of Californians do not know they are infected with HIV and are unknowingly infecting others. The law required written informed consent before a patient can be tested for HIV. This had proven to be a barrier to routine screening for HIV in populations that are not at obvious risk but may still be infected. In order to achieve routine screening in California, AB 682 has established a simpler standard of consent for the general population, as well as for pregnant women, which will incentivize healthcare providers to comply with CDC guidelines and make HIV screening a routine part of their healthcare delivery. At the same time, AB 682 still ensures that patients are aware of the test and know they may opt out of screening.
— Signed by Governor, Effective January 1, 2008
AB 1155 (Huffman) DMHC ENFORCEMENT
This bill would have required that enforcement actions by the Department of Managed Health Care (DMHC) make physicians whole. Where the DMHC finds that an HMO has underpaid a physician (pursuant to the law created by AB 1455), the bill would have required the penalty amount to, at a minimum, equal the amount of the underpayment plus interest. Additionally, the HMO would have been fined an amount equal to the underpayment, removing DHMC’s discretion to levy fines.
— Vetoed by Governor on 8/1/08
AB 1226 (Hayashi) MEDI-CAL PHYSICIAN ENROLLMENT
This bill helps facilitate physician enrollment in the Medi-Cal program by shortening the time the Department of Health Services (DHS) has to process physician applications. It has created a more efficient provider enrollment process by allowing physicians already approved as Medicare providers and hospital-based physicians to enroll using an alternative, simplified application. The bill also allows a physician to submit a shortened application for a change of address, rather than have to submit a new application.
— Signed by Governor, Effective January 1, 2008
AB 1324 (De La Torre) RETROACTIVE POLICY CANCELLATION
This bill protects patients and physicians by prohibiting HMOs and insurance companies from retroactively rescinding or modifying treatment authorizations after the treatment has been provided by the physician in good faith. The bill reaffirms that “authorization” includes confirming eligibility; thereby ensuring that once treatment is authorized by the HMO, it has no incentive to “save” money by canceling or rescinding coverage.
— Signed by Governor, Effective January 1, 2008
AB 1945 (De La Torre) HEALTHCARE COVERAGE
This bill would have protected innocent patients from unlawful rescission or cancellation of their health coverage. The bill would have improved the questions on the application, required the application to be approved by the regulator before its use, required complete medical underwriting prior to issuing a policy, included notice and disclosure of rights and responsibilities to enrollees, and established an enrollee’s right to an automatic, independent, external review process to approve an insurers request to cancel or rescind an individual’s healthcare coverage using a clear, “intentional” standard as the basis for any rescission. This bill was a comprehensive measure that would have removed the ability of health plans and insurers to act as “judge and jury” when they wished to rescind coverage in the individual market.
— Vetoed by Governor on September 30, 2008
AB 1962 (De La Torre) MATERNITY COVERAGE
This bill would have ensured fair, affordable access to maternity coverage in healthcare benefits, regardless of the type of plan offered. This bill would have closed a loophole exploited by health insurance companies in order to sell cheap, “subprime” non-comprehensive coverage. This bill brought two bodies of law into conformity by requiring all individual and group health insurance policies regulated under the Department of Insurance to cover maternity services, while HMOs regulated by the Department of Managed Health Care (DMHC) are already required to meet these standards.
— Vetoed by Governor on September 30, 2008
AB 2440 (Laird) MEDI-CAL PROCEDURE CODING
This bill would have required the Department of Health Care Services (DHCS) to update specific diagnostic (ICD) codes by October 1 of the year in which the codes were published. It also required DHCS to publish the updated codes in the Medi-Cal provider bulletin within the same period of time.
— Vetoed by Governor on September 27, 2008
AB 2805 (Ma) ASSIGNMENT OF BENEFITS
This bill would have added individual healthcare service plans to Knox-Keene requirements to permit assignment of benefits allowing the physician to be paid directly by a health plan. Under current practice some health plans are providing service reimbursement directly to the patient and requiring the physician to bill the patient even when the patient specifies that they would like the provider to be paid directly.
— Failed on the Assembly Floor
AB 2839 (Huffman) CONFIDENTIALITY CLAUSES
This bill would have prohibited a healthcare service plan from requiring a healthcare provider to execute an unfair and unreasonable agreement as a condition of entering into contract negotiations with the plan or insurer. This bill would have authorized the Department of Managed Health Care (DMHC) or the Insurance Commissioner to suspend or revoke the license of a healthcare service plan or the certificate of authority of a health insurer or assess administrative penalties if the director or commissioner determines that the plan or insurer had violated those provisions.
— Held on the Assembly Appropriations Committee Suspense File
AB 2847 (Krekorian) HEALTHCARE SERVICE PLANS: LIABILITY
This bill would have shifted the burden of proof to health insurance companies that denied medical treatment, requiring them to show why a particular medical service was not medically necessary. This legislation would seek to protect consumers and the doctor-patient relationship by creating a presumption that a physician’s diagnosis and treatment is medically necessary. This bill would have also amended the independent medical review law in order to authorize physicians to appeal denials of healthcare treatment by insurance companies.
— Held on the Assembly Appropriations Committee Suspense File
SB 527 (Steinberg) AUTISM SPECTRUM DISORDERS: SCREENING PILOT PROJECT
This bill would have established a privately funded, voluntary pilot program that would establish best practices to improve early screening, diagnosis, referral, and treatment for children with an autism spectrum disorder (ASD). The American Academy of Pediatrics California was a co-sponsor of this measure. This bill was part of a package of bills carried by the legislative leadership to address gaps in services for families of children with ASD.
— Vetoed by Governor on September 30, 2008
SB 1379 (Ducheny) STEVEN M. THOMPSON LOAN REPAYMENT PROGRAM
This bill will close a loophole that allows health plans to benefit from violating the law by using penalties assessed on individual health plans to collectively reduce the fee health plans pay to support DMHC. Instead, the first $1 million of the penalty money will be used to fund the Steven M. Thompson Physician Loan Repayment Program. Any remaining penalty money will be used to support the state’s high-risk insurance pool, for Californians that are otherwise unable to get health coverage due to a pre-existing condition.
— Signed by Governor, Effective January 1, 2009
CMA-OPPOSED LEGISLATION
AB 374 (Berg) CALIFORNIA COMPASSIONATE CHOICES ACT
This bill would have allowed physicians in California to prescribe lethal doses of pharmaceutical drugs to people who have been diagnosed with a terminal illness and are in intractable pain. The bill was modeled after the Oregon law allowing physicians and surgeons to help a person end their life.
— Died on the Assembly Floor
AB 425 (Adams) VEHICLES: MOTORCYCLES: SAFETY HELMETS: EXCEPTIONS
This bill would have exempted from the motorcycle helmet law a driver who is 18 years of age or older who has either completed a motorcycle rider training program, or has been issued a class M1 license or endorsement or a comparable license or endorsement from another jurisdiction.
— Failed in Assembly Transportation Committee
AB 636 (Levine) ACUPUNCTURE
This bill would have added the use of “low-level laser stimulation” to the modalities that may be performed under an acupuncturist’s license. This therapy would have been performed with a bio-stimulation laser device designated as a class IIIb laser by the Federal Food and Drug Administration.
— Failed in Assembly Business and Professions Committee
AB 1276 (Karnette) PRESCRIPTION LABELS
This bill would have made it unprofessional conduct for each instance that a physician and surgeon writes a prescription without specifically asking the patient if they would like the intended purpose of the drug to be written on the prescription label.
— Failed in Assembly Business and Professions Committee
AB 1444 (Emmerson) PHYSICAL THERAPISTS
This bill would have allowed physical therapists to be able to treat patients without referral from a physician.
— Failed in Assembly Business and Professions Committee
AB 1436 (Hernandez) NURSE PRACTITIONER
This bill would have significantly expanded the scope of practice of a nurse practitioner. The bill attempted to recognize nurses as independent practitioners and would authorize them to provide comprehensive healthcare including making diagnoses and initiating emergency procedures. Though this proposal constituted the practice of medicine for NPs, AB 1436 gave the board of registered nursing the sole authority to interpret the practice of nurse practitioners and divested the Medical Board from the authority of any oversight.
— Failed in Senate Business and Professions Committee
AB 1643 (Niello) NURSE PRACTITIONERS
Current law requires nurse practitioners to practice under the supervision of a physician and restricts physicians from supervising more than four nurse practitioners. This bill would have eliminated that restriction and allowed an unlimited number of nurse practitioners to operate under any type of clinic with one physician acting as a medical director. This bill was drafted to aid in the proliferation of retail health clinics.
— Failed in Assembly Business and Professions Committee
AB 1944 (Swanson) HEALING ARTS
This bill would have eliminated the corporate bar on the practice of medicine by allowing healthcare districts to hire and charge for physician services. The bill would have eliminated a pilot project that contained a limited exemption to the bar by allowing healthcare districts in medically underserved areas with financial problems to hire physicians.
— Failed in Senate Health Committee
AB 2146 (Feuer) HEALTHCARE PROVIDERS: BILLING
This bill would have required the state to develop and implement policies on non-payment of healthcare providers in the Healthy Families and Medi-Cal programs for hospital-acquired conditions and adverse events. AB 2146 would have given broad policy-making authority to the Department of Health Care Services and the Managed Risk Medical Insurance Board with minimal legislative oversight, allowing these entities to establish non-payment policies governing non-payment for hospital-acquired conditions using rules from the Centers for Medicare and Medicaid Services (CMS) as a guideline. AB 2146 would not have established an independent, fair process to determine who was responsible for the error that led to the hospital-acquired condition nor did it include a risk-adjustment mechanism. This bill would have conflicted with new federal rules, which apply only to hospitals, and allowed the state to go beyond the CMS regulations, without the same detailed financial, clinical and scientific considerations.
— Held on Senate Appropriations Suspense File
AB 2516 (Mendoza) PRESCRIPTIONS: ELECTRONIC TRANSMISSION
This bill would have required all prescriptions (except in emergencies, direct administration in a hospital, or as prohibited by federal law) to be electronically transmitted to the patient’s pharmacy of choice by January 1, 2010.
— Failed in Assembly Business and Professions Committee
AB 2967 (Lieber) HEALTHCARE OUTCOMES REPORTING REQUIREMENTS
This bill would have established a new provider outcome reporting program that would have required the state to collect and publicly report on a host of measures related to healthcare cost and outcomes measures. Given the tremendous burden and cost the new requirements it would have put on physicians, the bill was amended to exclude physicians and physician groups from both the reporting requirements and the mandatory fee to fund the new program.
— Died on Senate Inactive File
SB 389 (Yee) BILLING FOR SERVICES RENDERED
This bill would have prohibited out-of-network hospital-based physicians working at hospitals that have contracts with HMOs from billing enrollees of HMOs and, effectively, allow HMOs to unilaterally set rates for out-of-network emergency care. This bill would have also required the Department of Managed Health Care and the Department of Insurance to implement an independent provider dispute resolution system in consultation with representatives of health plans or insurers, providers, and consumer representatives.
— Failed in Senate Judiciary Committee
SB 993 (Calderon, Aanestad) PSYCHOLOGISTS: PRESCRIBING DRUGS
This bill would have allowed psychologists, after training and receiving certification adopted by the Board of Psychology, to prescribe psychotropic drugs. This bill would have given the Board of Psychology the ability to administer a licensing program for prescribing psychologists.
— Failed in Senate Business and Professions Committee
SB 840 (Kuehl) SINGLE-PAYER HEALTH COVERAGE
This bill was a reintroduction of Senator Kuehl’s legislation to create a single-payer system of healthcare in California. Specifically, SB 840 would have created a single-payer purchasing pool and would prohibit most private health insurance from being sold. The new system would have been funded by employer fees, individual contributions, and consolidating state and federal funding. An individual could have selected a primary care provider or enroll in an HMO. The new office of the Health Care Commissioner (HCC) would have determined premium costs, provider rates, and program costs, drug pricing and financing mechanism. All Californians residents would have been eligible.
— Vetoed by Governor on September 30, 2008
SB 981 (Perata) HEALTHCARE COVERAGE
This bill prohibited non-contracted emergency room physicians from seeking the balance of payment due from health plan enrollees, a term known as “balance billing.” The bill provided an interim payment mechanism of 250 percent of Medicare rates with an annual inflator. The bill also would have required the Department of Managed Health Care (DMHC) to establish an Independent Dispute Resolution Program to be administered by an organization chosen by DMHC. It would have established DMHC’s jurisdiction on non-contracting emergency physicians (e.g., imposition of civil penalties on non-contracting emergency physicians for violating the law). Though SB 981 was specific to emergency room physicians, it had the potential for setting up the framework for future legislation that could have been harmful for other providers treating patients in an emergency setting.
— Vetoed by Governor on September 30, 2008
SB 1014 (Kuehl) SINGLE-PAYER HEALTHCARE COVERAGE TAX
This bill would have imposed various new taxes to fund SB 840 (Kuehl). The bill would have imposed a new tax on taxable income above $200,000, non-wage income, self-employment income, and payroll.
— Failed in Senate Revenue and Tax Committee
SB 1179 (Aanestad) IMMUNIZATIONS
This bill would have deleted the authority of the Department of Public Health to add or remove from the list of vaccines that are required for school entry. Currently, the department can “deem appropriate” any vaccination recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices, although they have never used this authority. The author believed that some vaccine decisions have a social and moral component and therefore every new mandatory vaccine should obtain legislative approval.
— Failed in Senate Health Committee
SB 1300 (Corbett) HEALTHCARE COVERAGE: PROVIDER CONTRACTS
This bill would have allowed healthcare service plans and insurers to divulge cost and quality information as they deem appropriate. The bill would have prohibited confidentiality clauses from being inserted into contracts between healthcare providers and payers.
— Failed on Senate Floor — Concurrence
SB 1427 (Calderon) PSYCHOLOGISTS: SCOPE OF PRACTICE
This bill would have allowed psychologists to prescribe drugs for the treatment of specified disorders if certain requirements were met. This bill would have allowed the certification and licensure process for a prescribing psychologists and all oversight to be under the Board of Psychology. The bill would have required collaboration with a licensed physician and surgeon, but the language allowed for many of the requirements to be waived in emergent situations or demonstration of facilities with a shortage of available psychiatrists.
— Failed in Senate Business and Professions Committee
SB 1640 (Ashburn) MEDICAL CORPORATIONS
This bill would have eliminated the corporate bar on the practice of medicine by affirmatively stating that corporations may have the professional rights, privileges, and powers of physicians. The provision of law, which this bill was seeking to upend, is often cited as the primary code which prevents the corporate practice of law.
— Failed in Senate Business and Professions Committee
SB 1669 (McClintock) HEALTHCARE COVERAGE: WAIVERED CONDITIONS
This bill would have authorized a plan contract or insurance policy to include a provision that excludes coverage for any length of time for a “waivered condition” for which medical advice, diagnosis, care, or treatment was recommended or received from a licensed health practitioner during the ten years immediately preceding the coverage. The bill appeared to allow health plans to exclude coverage from someone with an existing condition that dates back ten years for “any length of time,” rather than the current 12-month period.
— Failed in Senate Health Committee
BILLS OF INTEREST
AB 8 (Nuñez) HEALTHCARE COVERAGE
This bill would have made a number of substantial changes to the healthcare system. The bill would have expanded the state’s Medi-Cal and Healthy Families Programs to children and their parents up to 300 percent of the federal poverty level, and to certain uninsured adults. The plan would have created a health insurance purchasing pool and implement insurance market reforms. The plan would have been financed by redirecting existing resources and requiring an employer and employee contribution.
— Vetoed by Governor on October 12, 2007
AB 1900 (Nava) SANTA BARBARA TRAUMA CENTER
This bill, supported by CMA, allows Santa Barbra County to continue to collect $5 per every $10 in fines and penalties generated within the county on DUI related offenses for the local Maddy Fund. This bill was necessary to maintain a portion of funding for a local trauma center from a special exception that was created for Santa Barbra County due to the Board of Supervisors electing to fund courthouse renovation instead of emergency care.
— Signed by Governor on September 26, 2008
SB 761 (Ridley-Thomas) MEDICAL BOARD OF CALIFORNIA
This bill would have formed a Clinical Advisory Council for the diversion program maintained by the Medical Board of California (MBC). The council would have ensured the diversion program maintains a high level of quality care for impaired physicians. The bill would have continued the pilot program on vertical integration between medical board investigators and Deputy Attorney Generals. Early results had shown a decrease in the length of investigations by the MBC.
— Failed in Assembly Appropriations
SB 1294 (Ducheny) HEALING ARTS
This bill, as amended on July 1, 2008, would have continued a pilot project that allowed qualified district hospitals to directly hire and charge for physician services. There were significant protections contained within the bill. A qualified district hospital must serve a medically underserved population, medically underserved area, or a health professions shortage area as defined by the federal government, or be a rural hospital as defined by California law. The facility must have had a net loss from operations, and patient days must exceed 50 percent Medicare, Medi-Cal, or uninsured. The medical staff must have approved with an affirmative vote that the employment is in the best interest of the community. The pilot required a written employment contract to be entered into within three years and was limited to four years once signed. The pilot was limited to 20 physicians statewide however there was a provision that the Medical Board may increase this number, which, according to the Medical Board, would have required regulations. The pilot was limited to no more than two participants at any one facility but again, the board may have allowed additional contracts if it is deemed appropriate on a case-by-case basis. The bill stated that a district hospital shall not interfere with, control, or otherwise direct a physician and surgeon’s professional judgment. Continuation of the pilot program was in lieu of an outright elimination of the bar against the corporate practice of medicine at healthcare district hospitals.
— Failed in Assembly Appropriations Committee
SB 1406 (Correa) OPTOMETRY
In its original form, this bill would have significantly expanded the scope of practice of optometrists by allowing them to diagnose and treat any part of the visual system for any conditions he or she is trained to do including minor surgeries. After extensive negotiations, SB 1406 has been significantly amended and no longer contained scope expansion specific to surgery or any procedures involving a scalpel or injections. New language included a committee made up of three physicians and three optometrists that will develop the appropriate certification requirements for optometrists seeking to treat glaucoma. The amendments also incorporate appropriate referral requirements and retained many patient safeguards.
— Signed by Governor on September 26, 2008