July 2016

Four New Laws Affecting California Physicians

Four California laws creating new obligations for physicians have recently gone into effect: 1. SB 277, the Vaccine Mandate; 2. AB 679, the CURES registration requirement; 3. AB X2-15, the End-of-Life Option Act and; 4. SB 137, the physician directory reporting requirement.  In this article, I discuss the key requirements of each of these laws and the potential legal consequences of failing to meet those requirements.  
 

1.    Vaccine Mandate: Senate Bill 277 (Effective July 1, 2016) 

SB 277 eliminates the personal belief exemption from grade school vaccination requirements, and only permits exemptions for medical reasons.  Students must now have the required vaccinations or medical exemption statement prior to enrolling in grade schools and child care centers.  The law does not apply to children in home-based private schools.   

Generally, SB 277 requires students to be vaccinated for 1. diphtheria, 2. Haemophilus influenzae type B, 3. measles, 4. mumps, 5. pertussis (whooping cough), 6. poliomyelitis, 7. rubella, 8. tetanus, 9. hepatitis B and 10. varicella (chicken pox).  Vaccinations for measles, mumps, rubella or varicella are not required if the patient has proof of immunity for those diseases, however.  

Otherwise, only a written statement by a licensed physician will medically exempt a student from the required vaccination.  The physician’s written statement should state the child’s medical condition for which the immunization would not be considered safe, the specific nature and probable duration of the relevant medical condition and the vaccines from which the child is exempted.  In determining whether a child qualifies for a medical exemption, the physician is permitted but not required to consider the child’s family history.  As always, physicians must exercise professional judgment in deciding whether to provide a medical exemption. 
 

2.    CURES Registration: Assembly Bill 679 (Effective July 1, 2016)

The Controlled Substance Utilization Review and Evaluation System (CURES) is a database of all Schedule II, III and IV controlled substance prescriptions dispensed in California.  Physicians registered for CURES may use the database to guide patient treatment and help prevent abuse of controlled substances.  

AB 679 requires all California licensed prescribers authorized to prescribe scheduled drugs to register for CURES either by July 1, 2016 or upon receipt of a Drug Enforcement Administration Controlled Substance Registration Certificate, whichever occurs later.  Failure to meet the appropriate deadline may result in a citation containing an order of abatement or in administrative fines not to exceed $2,500.  
 

3.    End-of-Life Option Act: Assembly Bill X2-15 (Effective June 9, 2016)

AB X2-15, also known as the End-of-Life Option Act, allows a physician to prescribe an aid-in-dying drug, which a terminally ill patient may voluntarily self-administer to end his or her life.  Under the Act, only terminally ill California residents over eighteen years of age with the capacity to make medical decisions are eligible for an aid-in-dying drug.  To request such a prescription, the patient must submit to the attending physician two oral requests made at least fifteen days apart, and one written request.  The attending physician must directly receive the three requests and document them in the patient’s medical record. 

A physician does not need to participate in activities authorized under the Act. If an attending physician chooses to participate, however, the physician must first verify the patient’s decisional capacity and terminal diagnosis.1  A second consulting physician must also confirm the patient’s decisional capacity and diagnosis.   Moreover, the attending physician must ensure the patient is making an informed decision2  and alert the patient that he or she may rescind the drug request at any time and need not ingest it if it is prescribed.  Finally, if all other requirements are met,3  the attending physician must give the patient a final attestation form,4  which the patient must fill out within 48 hours prior to self-administering the aid-in-dying drug.  

Failure to comply with the requirements of the Act could have serious ramifications, including possible criminal liability. Refer to CAFP’s End-of-Life Option Act monograph for a more detailed checklist of requirements. It is imperative to ensure full compliance with the law before prescribing an aid-in-dying drug.
 

4.    Physician Directory Reporting: Senate Bill 137 (Effective July 1, 2016)

SB 137 requires health plans and health insurers (collectively referred to as “payers” in this article) to publish provider directories to provide patients with more accurate information on contracting providers.  Under SB 137, providers have two main obligations to help payers update their directories.  

First, contracts between payers and providers must include a requirement that the provider inform the payer within five business days when the provider is not accepting new patients, or, if the provider had previously not accepted new patients, if the provider is now accepting new patients.  Also, if a provider who is not accepting new patients is contacted by a new patient, the provider must direct the individual to both the plan for assistance in finding a provider and to the Department of Managed Health Care to report any directory inaccuracy.  
    
Second, providers must respond to payer notifications regarding the accuracy of their provider directory information, either by verifying that the information is correct or by updating the information accordingly.  Failure to respond may result in deferred payment and exclusion from the provider directory.  Payers may also terminate contracts with providers for repeated failure to update their directory information. CAFP’s January 2016 Practice Management Newsletter, SB 137 to Impose New Responsibilities on Family Physicians in 2016,  gives a detailed account of new requirements of which to be aware. 
 

Conclusion
Health care is one of the most regulated industries in the United States, and it is important for physicians to stay informed about their duties under the ever changing law.  This article highlights the basic requirements of four new laws affecting California physicians.  As always, this article does not provide a comprehensive list of legal issues that may arise, nor does it constitute legal advice.  If you have questions about compliance with the laws, we recommend that you consult an attorney. 
 

Scott Kessenick practices in all areas at Kessenick Gamma & Free, LLP, a San Francisco firm providing legal representation to physicians, physician groups, and other health care professionals. He may be reached at skessenick@kgf-lawfirm.com.

 

 

[1] The consulting physician must submit compliance form to attending physician that indicates consulting physician’s diagnosis and assessment of patient’s mental status. Cal. Health & Safety Code § 443.6(f).   

[2] To ensure the patient is making an informed decision, the attending physician must discuss the medical prognosis, potential risks of ingesting the aid-in-dying drug, the probable result of ingesting the drug, the possibility of obtaining the drug without ingesting it, and alternative treatment options.  Cal. Health & Safety Code § 443.1(i).  

[3] Attending physician must complete a compliance form, then submit this form and the consulting physician’s compliance form to the California Department of Public Health. Cal. Health & Safety Code § 443.5(a)(11).

[4] Final attestation form must comport with the details specified in the Act.  Cal. Health & Safety Code § 443.11(c).
 


DISCLAIMER
The articles provided in Practice Management News are general. They do not constitute legal, practice management or coding advice in any particular factual situation or create at attorney-client relationship. Consult your attorney or other professional for advice in your particular situation.