Telehealth, Hospital Operations, Advance Health Care Directives, Multi-Discipline Professional Partnerships, Practice Expansion Issues, and Transgender Changes Impacting Licenses

This newsletter includes a much wider array of topics than the prior one, from telehealth, to emergency times and cannabis in hospitals, to changes to partnerships with podiatrists, transgender licensing issues, and dentists from Mexico—there’s something here for everyone, enjoy!

Telehealth

AB 1369, the David Hall Act, expands out-of-state providers’ ability to provide telehealth care. The provider and the patient must, however, be eligible.

The patient must:

1) have a life-threatening condition;

2) give written, informed consent for both the use of the out-of-state provider using telehealth and the release of records from the out-of-state physician to the patient’s primary-care physician;

3) and have not been accepted into a clinical trial for the condition.

The out-of-state provider must:

1) be in good standing in their state;

2) not have prior discipline;

3) and be an expert in the patient’s condition.

Hospital Operations

There are a few new laws impacting hospital operations. One dealing with procurement and another cannabis use.

AB 1392 alters the existing law requiring hospitals with operating expenses of $50,000,000 or more, and hospitals in a health system with operating expenses of $25,000,000 or more, to annually report on minority, women, LGBT, and disabled-veteran business procurement efforts. The new law requires a plan, submitted each July 1, beginning in 2025, to increase procurement from such businesses. The plan must show goals, but not quotas, and what the hospital is doing to make it easier to hire those businesses. The law also encourages smaller hospitals to do the same. California’s Department of Health Care Access and Information will create guidelines for “voluntary use” and will be reviewing the plans to make sure they are complete.

That Department already has a “Hospital Supplier Diversity Commission” made up of stakeholders in public health, diversity, and procurement with representatives from minority, women, LGBT, and disabled veteran business groups. This law adds a commissioner requirement of “a practitioner or expert in the field of supplier diversity” and now allows the commissioners to be paid. And the Department can make a database of verified minority, women, LGBT, and disabled veteran businesses enterprises that are prime suppliers to hospitals. As for cannabis in hospitals, SB 302 expands the “Ryan’s Law” requirements for allowing terminally ill patients to use cannabis in certain situations within a health care facility. It allows for cannabis use for patients over 65 with a chronic disease and now covers home health agencies. If a facility denies a patient admission, it must certify the denial is not based on cannabis use. Facilities do not have to comply if the US Department of Justice or CMS inquire about the facility. Hospitals’ transfer times are also impacted this year. Under AB 40, California’s Emergency Medical Services Authority, who coordinates the state’s emergency medical services, must, on or before December 31, 2024, implement an electronic signature program for use between the emergency department medical personnel at a receiving hospital and the transporting emergency medical personnel. The e-signature will show 1) when the ambulance arrived at the hospital’s ED and 2) when care was transferred. By July 1, local EMS agencies must develop a standard transfer time of at most 30 minutes, 90% of the time, for ambulance-patient offloads.

By September 1, hospitals must work with their ED staff and employee representatives to create a protocol for ambulance-patient-offload-time reductions that deals with specific factors. The hospital must file it with EMS and report any revisions to it annually. Starting by December 31, EMS will monitor every hospital’s monthly offload-time data. If the hospital’s times are above EMS standards it will be reported to various agencies.

Advance Health Care Directives

AB 1029 impacts what a patient’s representative can consent to using an Advance Health Care Directive form. Previously, the representative could make a list of decisions, such as selection of providers, tests, surgeries, medication, and withholding nutrition. AB 1029 clarifies that the representative, however, cannot make a decision for the patient as to:

· convulsive treatment,

· psychosurgery,

· sterilization,

· or abortion.

The patient can still use a separate psychiatric advance directive for mental-health care issues. The new law changes the existing directive form to clarify these changes.

Multi-Discipline Professional Partnerships

AB 834 altered the Medical Practice Act to now allow the formation of a professional partnership or group that includes both physicians/surgeons and doctors of podiatric medicine. The majority of the partners and partnership interests in the professional partnership must be physicians and surgeons or doctors of podiatric medicine. Partners cannot practice in, or vote on, areas beyond their scope. They can, however, vote on all general business matters.

Practice Expansion Issues

AB 936 expanded the ability for dental students, who have begun clinical training, to practice in certain settings, without pay, and under supervision. And AB 1395 requires the Medical Board to issue a 3-year license to certain applicants from Mexico participating in the “Licensed Physicians and Dentists from Mexico Pilot Program.”

AB 1646 modified the ability of physicians, unlicensed in California, to practice in an ACGME-approved programs.

AB 470 impacted the already-existing physician “cultural and linguistic competency” requirements for CME. This law requires updated “threshold language requirements” for such classes.

Transgender Changes Impacting Licenses

SB 372 requires state licensing boards, upon notice of a change from the licensee, to update the license to reflect a new name or gender. For the various online license-verification sites, the boards must remove references to the former name or gender for all public information on the internet. The boards thereafter cannot publish the licensee’s former name or gender online. The board must then post a statement telling the public to contact the board for more information. For specified licensees, the board cannot even post enforcement records online; they will just note the licensee was previously subject to an enforcement action and direct the public to contact the board.

Questions or Deeper Analyses?

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As always, we appreciate the trust you put in us to provide you with a proactive and customized legal strategy to keep your reputation intact in the areas of employment law and healthcare law.

Best,

Keith W. Carlson and Nima A. Jalali