CMA's Regulations Quick List (April 13, 2010)

CMA's Regulations Quick List provides a summary and current status of significant regulations followed by CMA's Center for Medical and Regulatory Policy. The Quick List is circulated regularly on a monthly basis or more frequently, as needed. For more information on a specific regulatory package, please contact the appropriate CMA staff member identified at the end of each regulation summary by email or by calling (916) 444-5532.

SCOPE OF PRACTICE IN LICENSED HEALTH FACILITIES
Proposed by the California Department of Public Health (CDPH)
This regulatory package proposes to dramatically increase the scope of practice for a variety of licensed healthcare providers in hospital settings. These regulations would allow nonphysician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers. In an earlier iteration, these regulations also contained provisions that would have defeated the right of medical staff self-governance, but which were removed after strong opposition from CMA. On October 14, 2009, OAL disapproved the regulations, thus beginning the 120-day period for CDPH to submit a revised package. CMA remains strongly opposed to these regulations.

• Status as of 04/13/10: Noticed: 07/11/08. Disapproved by OAL: 10/09/09. Second 15-day Comment Period: 11/20/09–12/07/09. CMA Comments Submitted: 12/07/09. Revisions Sent to OAL: 02/11/10. Approved by OAL: 03/03/10. Effective: 04/02/10.
• CMA Staff: Veronica Ramirez

MANIPULATION UNDER ANESTHESIA
Proposed by the Board of Chiropractic Examiners
These regulations propose to allow chiropractors to perform manipulation on a patient who is under anesthesia administered by a physician, surgeon, or other authorized healthcare provider. CMA repeatedly urged the board to withdraw this regulatory proposal and remains concerned that manipulation under anesthesia is outside the lawful scope of chiropractic practice.

• Status as of 04/13/10: Noticed: 01/12/09. Fourth 15-day Comment Period: 10/28/09–11/12/09. CMA Comments Submitted: 11/12/09. Approved by OAL: 02/16/10. Effective: 03/18/10.
• CMA Staff: Veronica Ramirez

PHYSICIAN OFFICE SIGNAGE
Proposed by the Medical Board of California (MBC)
These regulations would require physicians to post a “Notice to Consumers” that the MBC regulates physicians and to provide the phone number and website for the MBC. CMA is concerned that this requirement will be an unnecessary administrative burden on physicians who are already required to post their medical license or wear a nametag indicating their licensing status. CMA’s amendment requests were rejected by the MBC.

• Status as of 04/13/10: Noticed: 06/05/09. CMA Comments Submitted: 07/15/09. Final Statement of Reasons Issued: 07/24/09. Sent to OAL: 02/17/10. Approved by OAL: 04/01/10. Effective: 06/27/10.
• CMA Staff: Yvonne Choong

RESCISSION AND UNDERWRITING
Proposed by the Department of Insurance (DOI)
These regulations would provide regulatory protections for consumers in the event a health insurer attempts to rescind their individual health coverage. It would specifically require health insurers to prove that the consumer “knowingly” misrepresented facts. CMA is working with DOI to address the issue of having an independent third party review all proposed rescission before it gets finalized.

• Status as of 04/13/10: Noticed: 06/05/09. CMA Comments Submitted: 07/14/09. Expected Decision: 06/05/10.
• CMA Staff: Armand Feliciano

CHANGES TO CME REQUIREMENTS
Proposed by the Physician Assistant Committee
CMA took no issue with the intent of this regulatory package; however, in the original language, physician assistants were referred to as possessing a “license to practice medicine,” which CMA opposed through written comments. The Physician Assistant Committee has since removed language referring to such a license.

• Status as of 04/13/10: Noticed: 06/26/09. CMA Comments Submitted: 08/13/09. Awaiting Committee Revision. Expected Decision: 06/26/10.
• CMA Staff: Veronica Ramirez

DISCIPLINARY GUIDELINES
Proposed by the Medical Board of California (MBC)
These regulations were issued to amend the Manual of Model Disciplinary Orders and Disciplinary Guidelines to reflect changes in law, clarify existing language, and make technical changes to reflect the current probationary environment. CMA submitted comments offering amendments to sections related to the use of alcohol and controlled substances because the original language would have allowed for the MBC to order a cessation of medical practice should a licensee have a positive biological fluid test for certain substances or fail to cooperate in a random biological fluid testing program. CMA’s amendment requests have been rejected by the MBC, but a final decision by the OAL is still pending.

• Status as of 04/13/10: Noticed: 09/11/09. CMA Comments Submitted: 10/23/09. Board Has Completed Final Revisions of the Regulation. Expected Decision: 09/11/10.
• CMA Staff: Yvonne Choong

TIMELY ACCESS REGULATION
Proposed by the Department of Managed Health Care
These regulations would require health plans and physicians to abide by specific time standards when setting up appointment for patients (e.g., urgent care appointments within 48 hours of the requested appointment). CMA submitted comments to give physicians more flexibility in abiding by the specific time standards, and to prohibit health plans from passing on administrative costs to physicians associated with the implementation of the regulation.

• Status as of 04/13/10: Noticed: 09/25/09. CMA Comments Submitted: 10/07/09. Approved by OAL: 12/21/09. Effective: 01/17/10. HMOs Must Demonstrate Compliance Plans to DMHC: 10/17/10. Full Implementation by HMOs Required: 01/17/11.
• CMA Staff: Armand Feliciano

GLAUCOMA CERTIFICATION REQUIREMENTS
Proposed by the Board of Optometry
These regulations were issued as a result of SB 1406 (Correa), which was chaptered in 2008. These regulations would establish requirements that optometrists must meet in order to be issued a certificate to treat glaucoma. In its current form, the regulations would allow optometrists to treat glaucoma without requiring any hands-on training, to which CMA has testified in opposition.

• Status as of 04/13/10: Noticed: 11/12/09. CMA Comments Submitted: 12/21/09. First 15-day Comment Period: 03/24/10–04/08/10. CMA Comments Submitted: 04/07/10. Expected Decision: 11/12/10.
• CMA Staff: Veronica Ramirez

HEALTHY FAMILIES PROGRAM: LEGAL IMMIGRANTS
Proposed by the Managed Risk Medical Insurance Board
These emergency regulations would allow the state to access federal funding to cover legal immigrants who have been in the country less than five years. The state of California has previously covered this population using state funds but, due to changes passed to the CHIP program earlier this year, the federal government will now cover this population. CMA supports these regulations, as they would provide healthcare to all children regardless of immigration status.

• Status as of 04/13/10: Noticed: 11/12/09. CMA Comments Submitted: 01/04/10. Effective: 01/21/10.
• CMA Staff: David Ford

PATIENT-CENTERED PRESCRIPTION LABELS
Proposed by the Board of Pharmacy
This regulatory package would specify how prescription drug information is to be displayed on a prescription drug container label. It would require pharmacists, when applicable, to use standardized words and phrases on these labels to describe directions for use of the drug. These regulations would also clarify what language interpretive services are required to be provided by pharmacies and would require the Board of Pharmacy to publish language translations of certain directions of use on its website by October 2011. CMA generally supports these regulations, with the exception of a physician liability concern that has since been corrected by the board.

• Status as of 04/13/10: Noticed: 11/12/09. CMA Comments Submitted: 01/04/10. First 15-day Comment Period: 02/22/10–03/10/10. CMA Comments Submitted: 03/10/10. Expected Decision: 11/12/10.
• CMA Staff: Veronica Ramirez

DISCOUNT HEALTH PLANS
Proposed by the Department of Managed Health Care
The DMHC is currently considering regulations that would allow them to regulate “discount health plans.” The discount health plan business model generally market discount health services to employers and individual consumers. Services can include dental, chiropractic, pharmacy, acupuncture, physician, hospital, or basic medical care. The programs typically charge a monthly or annual fee in exchange for a list of participating providers whose services will be provided at a “discount.” Marketing of these programs has increased through the use of the Internet and fax machines. CMA submitted written and oral comments in opposition to the regulations.

• Status as of 04/13/10: Noticed: 01/08/10. CMA Comments Submitted: 02/22/10. Awaiting Department Revision. Expected Decision: 01/08/11.
• CMA Staff: Armand Feliciano

ELECTRONIC AND STANDARDIZED MEDICAL TREATMENT BILLING
Proposed by the Division of Workers’ Compensation
These regulations would encourage both workers’ compensation insurers and providers to transition to electronic billing. They would implement standard claims forms to be used in workers’ compensation cases, clarify that workers’ compensation insurers are subject to HIPAA rules, and increase penalties on insurers that fail to pay physicians in a timely manner. In addition, these regulations would clarify rules and procedures to be used in electronic billing. CMA policy generally supports an expansion of electronic billing, as it is a more efficient means of submitting claims to payers.

• Status as of 04/13/10: Noticed: 03/05/10. Public Hearings: 04/23/10 and 04/26/10. Forty-five-day Comment Period: 03/05/10–04/26/10.
• CMA Staff: David Ford

RBRVS FEE SCHEDULE
Proposed by the Division of Workers’ Compensation
This proposed regulation would transition physician payment in workers’ compensation from the current Official Medical Fee Schedule (OMFS) to an RBRVS system. CMA has long opposed using RBRVS for workers’ compensation, as we believe it does not adequately reimburse physicians for the extra time and administrative burdens involved in treating workers’ compensation patients. The formal regulation process will begin sometime later this year.

• Status as of 04/13/10: Noticed: 03/22/10. Informal Comment Period: 03/22/10–04/05/10. CMA Comments Submitted: 04/05/10.
• CMA Staff: David Ford

MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS
Proposed by the Center for Medicare and Medicaid Services
Under the American Recovery and Reinvestment Act (also known as the “Stimulus Bill”), Medicare provider physicians are eligible to receive up to $44,000 for demonstrating “meaningful use” of an electronic health record system. This federal rulemaking will institute the first stage of the definition of meaningful use. As the incentive program continues, there will be two more stages. CMA believes that the current definition of meaningful use is unreasonable and will be extremely difficult to attain.

• Status as of 04/13/10: Language Released: 12/30/09. Sixty-day Comment Period: 01/13/10–03/15/10. CMA Comments Submitted: 03/12/10.
• CMA Staff: David Ford

CERTIFICATION OF ELECTRONIC HEALTH RECORDS
Proposed by the Center for Medicare and Medicaid Services
In order to qualify for federal electronic health record (EHR) provider incentives, physicians must use a certified EHR system. These regulations would lay out two processes through which systems would be certified. The first process would begin in early summer but would only be temporary. The second process would take longer to begin, but would be permanent. CMA submitted comments urging this process to be as inclusive and straightforward as possible, grandfathering in legacy systems.

• Status as of 04/13/10: Noticed in Federal Register: 03/10/10. Thirty-day Comment Period on Temporary Program: 03/10/10–04/09/10. CMA Comments Submitted: 04/05/10.
• CMA Staff: David Ford

ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES
Proposed by the Department of Justice
This interim final rule would, for the first time, allow physicians to transmit prescriptions for controlled substances electronically. The regulations will also allow pharmacies to receive, dispense, and archive these prescriptions. Recent CMA policy supports the establishment of requirements enabling the use of eprescribing for controlled substances.

• Status as of 04/13/10: Noticed in Federal Register: 03/31/10. Comment Period: 03/31/10–06/01/10.
• CMA Staff: David Ford