CMA Legislative Wrap Up

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol 2022 Legislative Wrap-Up(THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role. Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather By Janice Rocco, CMA Chief of Staff than on an assessment of levels of neglect by mandatory

Ireporters.n 2021, with emergency use authorization for COVID-19 vaccines, the hope was that the pandemic would end and life could go back to normal. Instead, it wasn’t until 2022 that the state legislature began moving back to something AB 2274 (B. RUBIO): MANDATED resembling business as usual. REPORTERS – STATUTE OF LIMITATIONS would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current The state declaration of the COVID-19 State of Emergency remains in effect. The State Capitol is again open to the public, Status: Signed by Governor (Chapter 587, Statutes but even that has changed in ways that provide less access to legislators and their staff than was the case prior to the of 2022). pandemic. The Capitol building is undergoing construction and legislators have moved their offices outside the Capitol. Assembly Bill 2274 would have made it a continuing crime Committee hearings are being conducted in person again, though often with a hybrid phone-in option. Separate from the if mandated reporters, which includes physicians, did not legislature, public meetings held by state departments and commissions have begun shifting back to a hybrid approach, so report child abuse regardless of whether or not the failure that we can be back in person again. These changes mean that we have adjusted and found new ways that we, as advocates, to report was intentional. CMA secured amendments to communicate with legislators and their staff. instead extend the statute of limitations for a person to In California, we had five legislative seats become vacant during the year, which meant five special elections to fill them. By bring a lawsuit against a mandated reporter who did not the time each of these races had concluded, a total of five new Democrats had been sworn into office. With these additions, report to five years from the date of the occurrence of the Democrats continue to have a supermajority in both the Assembly and the Senate. offense. The closing of the 2021–2022 legislative session also brought with it the end of an era for a well-respected member of the legislature. Senator Richard Pan, M.D., spent 12 years serving California in the legislature by focusing on improving the state’s health care system, fighting for patients and the practice of medicine. Though Dr. Pan has many legislative accomplishments, we are particularly grateful for his leadership during the COVID-19 pandemic, where his expertise was critical to our state on a daily basis. AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES Status: Signed by Governor (Chapter 264, Statutes of 2022). Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

HEALTH CARE REFORM AB 1954 (QUIRK): PHYSICIANS AND

As the legislative year began, AB 1400, the single payer health care coverage bill, was before the State Assembly for a vote. That bill died in the Assembly at the end of January, which then shifted the discussion to other health care SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS Status: Signed by Governor (Chapter 232, Statutes of 2022). reform measures. The Governor’s Office of Health Care Assembly Bill 1954 originally would have prohibited Affordability proposal from 2021 was back for discussion physicians from denying treatment to a patient solely and debate, with the California Medical Association (CMA) based on a positive drug test for tetrahydrocannabinol fighting to prevent this broad measure from becoming an (THC). CMA successfully negotiated amendments stating administrative burden for physician practices. that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a Ultimately, we were successful in getting physician positive drug screen for THC. This amendment restored practices with fewer than 25 physicians exempted from a physician’s discretion for medical decision-making. The both the data submission requirements and the cost amendments ensure that physicians are protected from targets that the state will develop. Similarly, we fought liability risk and continue to have the ability to make to prevent independent practice associations (IPAs) from medical decisions for their patients. being included as a way to impose cost targets and data submission requirements on smaller physician groups, AB 2085 (HOLDEN): CRIMES – MANDATED ultimately seeing them removed from the bill. We were REPORTERS also able to get the Newsom Administration to commit Status: Signed by Governor (Chapter 770, Statutes to include $200 million in the state budget for grants to of 2022). assist physician practices with implementation of some Assembly Bill 2085 originally required mandatory reporters, of the provisions in Office of Health Care Affordability including physicians, to make a determination between legislation, such as a shift to alternative payment models. “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought STATE BUDGET amendments to clarify that health professionals must have Another victory in the health care reform space was achieved via the 2022–23 state budget. Continuing California’s commitment to achieving universal health clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role. care access, the $308-billion budget includes a phasedAmendments were taken to the bill focusing the measure in system to provide full scope Medi-Cal coverage to on the definition of “general neglect” in the law rather all income-eligible Californians regardless of age or than on an assessment of levels of neglect by mandatory documentation status by January 1, 2024. This makes reporters. California the first state in the nation to expand its Medicaid program to provide full benefits to all eligible individuals—a critical step in our shared goal of ensuring that every Californian has access to quality health care. AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS Status: Signed by Governor (Chapter 587, Statutes of 2022). Many other CMA priorities and supported issues were Assembly Bill 2274 would have made it a continuing crime addressed in the 2022–23 budget, including: a permanent if mandated reporters, which includes physicians, did not extension of key Medi-Cal telehealth flexibilities report child abuse regardless of whether or not the failure implemented during the pandemic; full funding for the to report was intentional. CMA secured amendments to Prop. 56 Medi-Cal supplemental payments and graduate instead extend the statute of limitations for a person to medical education funding programs; major investments bring a lawsuit against a mandated reporter who did not in health care workforce development; $1.3 billion for report to five years from the date of the occurrence of the health care worker retention pay; $700 million in equity offense. and practice transformation payments; and $200 million for reproductive health and reproductive justice issues. AB 2338 (GIPSON): HEALTH CARE DECISIONS (For more details on the state budget, see cmadocs.org/ – DECISION MAKERS AND SURROGATES budget-22-23.) Status: Signed by Governor (Chapter 264, Statutes

of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become MICRA designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or When the year began, the expectation was that CMA’s otherwise unable to personally designate a surrogate. CMA focus in 2022 would be working to defeat the sosecured amendments that made the hierarchy suggestive called “Fairness for Injured Patients Act” (FIPA) ballot and not mandatory, thereby addressing the liability concerns initiative that had qualified for the November 2022 that initially existed with the bill. ballot. The ballot initiative, if it had passed, would have eviscerated the protections of California’s Medical Injury SB 923 (WIENER): GENDER-AFFIRMING CARE Compensation Reform Act (MICRA). After Californians Status: Signed by Governor (Chapter 822, Statutes Allied for Patient Protection (CAPP), led by CMA CEO of 2022). Dustin Corcoran, negotiated a legislative deal with Senate Bill 923 initially would have required physicians FIPA proponents, Assemblymember Eloise Gómez and their staff to complete a one-time cultural humility Reyes put that legislative deal into AB 35, the MICRA course for the transgender, gender nonconforming and Modernization Act. Just 16 days later, Governor Newsom intersex (TGI) communities before they would be able to signed the bill into law and FIPA proponents removed contract with a health plan to provide care. The provider their initiative from the ballot. This historic agreement or staff would be required to take the course again if a prevented a costly ballot fight and ushered in a new and complaint was filed against the provider or their staff. sustained era of stability around malpractice liability. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical MEDICAL BOARD education cultural competency requirements and removed the contracting prohibitions in the bill.

CMA aggressively fought AB 2060 (Quirk), which would have created a public member majority on the Medical SB 964 (WIENER): BEHAVIORAL HEALTH Board of California. We were able to kill this bill in its Status: Vetoed by Governor. first house. Senate Bill 964 would have required the Board of At the same time, CMA sponsored legislation—AB 1636 Behavioral Sciences to analyze current law and provide by Assemblymember Akilah Weber, M.D.—to recommendations to the legislature about actions it preserve the integrity of the medical profession by can take to increase the supply of behavioral health ensuring physicians convicted of sexual assault with professionals and increase access to behavioral health a patient lose their license with no ability for it to services. The board would have to evaluate current be reinstated. This bill removes the medical board’s scope of practice laws, licensing and clinical training discretion to give or reinstate the license of a physician or requirements, and requirements for the renewal surgeon who lost their license due to sexual misconduct requirements for expired licenses. The bill ultimately with a patient. This bill would also deny a physician’s would have required a report of the current behavioral and surgeon’s license to an applicant who has been or is health workforce and the state’s behavioral workforce required to register as a sex offender. needs. CMA successfully removed the review of current scope of practice laws.

HEALTH IT AB 1375 (ATKINS): NURSING: NURSE

CMA had three significant victories addressing health PRACTITIONERS AND NURSE-MIDWIVES – information technology issues. The passage of AB 852 ABORTION AND PRACTICE STANDARDS (Wood) eliminates administrative burdens associated Status: Signed by Governor (Chapter 631, Statutes with complying with California’s electronic prescribing of 2022). mandate. AB 32 (Aguiar-Curry) permanently ensures Senate Bill 1375 is intended to increase access to abortion parity in reimbursement for telehealth services provided services by trained nurse practitioners. However, as through Medi-Cal managed care plans, so that this introduced, it would also have eliminated the transition reimbursement reform lasts beyond the public health to practice for Section 103 and Section 104 nurse emergency. Finally, SB 1419 (Becker) helps physicians practitioners, which is much broader and unrelated to comply with the new federal information blocking rule and abortion care. At CMA’s request, a number of amendments protects patients’ sensitive medical information. were adopted that removed our opposition. The bill was amended to include additional training safeguards for REPRODUCTIVE RIGHTS nurse practitioners performing aspiration abortions and to In June, the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health caused shockwaves on a national remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

scale, as access to reproductive health care services was AB 1954 (QUIRK): PHYSICIANS AND stripped away from millions of Americans overnight. SURGEONS – TREATMENT AND MEDICATION CMA and other organizations had begun planning for this OF PATIENTS USING CANNABIS reality in late 2021 by forming the Future of Abortion Status: Signed by Governor (Chapter 232, Statutes Council to develop legislative and budget proposals to of 2022). ensure that access to abortion care would not be denied in Assembly Bill 1954 originally would have prohibited California once the court overturned Roe v. Wade. physicians from denying treatment to a patient solely This year, 15 reproductive health care bills were signed based on a positive drug test for tetrahydrocannabinol into law by Governor Newsom, including bills meant to (THC). CMA successfully negotiated amendments stating strengthen protections for physicians and other health that a physician shall not automatically deny treatment care providers from civil or criminal actions that could or medication to a qualified patient based solely on a arise in other states if providers treat patients from outside positive drug screen for THC. This amendment restored California. Additionally, $200 million was included in the a physician’s discretion for medical decision-making. The 2022–23 state budget to expand access to reproductive amendments ensure that physicians are protected from health care, including abortion. liability risk and continue to have the ability to make medical decisions for their patients.

ADMINISTRATIVE BURDENS AB 2085 (HOLDEN): CRIMES – MANDATED

CMA sponsored REPORTERS SB 250 (Pan) to reduce administrative burdens from health plans’ prior authorization Status: Signed by Governor (Chapter 770, Statutes requirements and ensure that patients get the care they of 2022). need, when they need it. This bill was strongly opposed by Assembly Bill 2085 originally required mandatory reporters, the health plans and although it passed the Senate, it fell including physicians, to make a determination between short in the Assembly Appropriations Committee. “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought SCOPE OF PRACTICE amendments to clarify that health professionals must have Another big fight this year was CMA’s work with the clear standards about mandatory reporting and that making California Academy of Eye Physicians and Surgeons an assessment between “general” and “severe” neglect to oppose AB 2236 (Low), which would have allowed should not be a part of their role. optometrists to perform certain surgical procedures Amendments were taken to the bill focusing the measure without the same training as ophthalmologists. This bill on the definition of “general neglect” in the law rather was hard-fought in the legislature and was the last bill than on an assessment of levels of neglect by mandatory to pass the Assembly before midnight on the final night reporters. of the legislation session, when it eventually received the 41st vote it needed for passage. Even though this bill narrowly made it out of the legislature, Governor Newsom heard from hundreds of physicians and vetoed it to protect patients, issuing a strong statement about the inadequacy AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS Status: Signed by Governor (Chapter 587, Statutes of 2022). of its training requirements. Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not LOOKING BACK AT A BUSY SESSION report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to By the time the Governor’s bill final signing period for the instead extend the statute of limitations for a person to 2021–22 legislative session ended, Governor Newsom had bring a lawsuit against a mandated reporter who did not signed 997 bills into law and vetoed 169 bills. report to five years from the date of the occurrence of the On the following pages, you will find summaries of many offense. of the key bills that CMA was involved with in 2022. AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes

For more details on the major bills that CMA followed this of 2022). year, visit cmadocs.org/legwrap2022. Subscribe to CMA’s Assembly Bill 2338 would have adopted a rigid, default free biweekly Newswire and stay informed on CMA’s hierarchy surrogate consent law in which family members legislative efforts and other issues critical to the practice and the people closest to a patient by kinship become of medicine at cmadocs.org/subscribe.

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE

Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill. The California Medical Association (CMA), working to empower physicians to lead and transform the health care SB 964 (WIENER): BEHAVIORAL HEALTH system, recently welcomed Stuart Thompson, J.D., as its new Status: Vetoed by Governor. Senior Vice President. In that role, he will lead the association’s Senate Bill 964 would have required the Board of government relations and political operations efforts. Behavioral Sciences to analyze current law and provide “Stuart’s impressive record of success inside the halls of government and across California’s political landscape will be a great asset as we navigate rapid changes in our health care delivery system and look for opportunities to improve the health of all Californians by helping people get timely, high-quality care,” said CMA CEO Dustin Corcoran. recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately “We have a big year ahead of us and Stuart’s deep would have required a report of the current behavioral understanding of health care policy, and the legislative and health workforce and the state’s behavioral workforce regulatory agencies in California, will position CMA as an needs. CMA successfully removed the review of current even greater force in the health care advocacy space.” scope of practice laws. Thompson has over 15 years of legislative, government and legal experience in California, most recently serving as the Chief Deputy Legislative Secretary in Governor Gavin Newsom’s administration. Having already served as Associate Director of Government Relations at CMA for five years prior to joining the Newsom administration, Thompson’s wealth of experience advocating on behalf of physicians and the patients they serve makes him uniquely suited for the role. “This is a pivotal time for health care in our state and

I am thrilled to join CMA’s lobbying team to advance meaningful, measurable improvements in California’s health care delivery system,” said Thompson. “By bridging the gap between policymakers and medical professionals, we can achieve a health care system that delivers for all Californians.”

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

SPONSORED BILLS AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION AB 32 (AGUIAR-CURRY): TELEHEALTH Status: Signed by Governor (Chapter 515, Statutes of 2022). OF PATIENTS USING CANNABIS Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 32 ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, adds flexibility for providers to enroll patients in certain Medi-Cal programs remotely, and requires the Department of Health Care Services to complete an evaluation to assess the benefits of telehealth in Medi-Cal by July 2025. Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The AB 1636 (WEBER): PHYSICIAN LICENSURE amendments ensure that physicians are protected from OR REVOCATION – SEXUAL MISCONDUCT liability risk and continue to have the ability to make Status: Signed by Governor (Chapter 453, Statutes medical decisions for their patients. of 2022). Assembly Bill 1636, by Assemblymember Akilah Weber, M.D., protects patients and maintains confidence in the medical profession by ensuring physicians convicted of AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS Status: Signed by Governor (Chapter 770, Statutes of 2022).sexual misconduct have their license revoked and cannot acquire or have a license reinstated. This bill removes the Medical Board of California’s ability to give a license to or reinstate a physician who lost their license due to sexual misconduct with a patient. Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have AB 2055 (LOW): CONTROLLED SUBSTANCES clear standards about mandatory reporting and that making – CURES DATABASE an assessment between “general” and “severe” neglect Status: Held in Assembly Appropriations should not be a part of their role. Suspense Committee. Amendments were taken to the bill focusing the measure Assembly Bill 2055 would have rehoused the state’s on the definition of “general neglect” in the law rather prescription drug monitoring program – the Controlled than on an assessment of levels of neglect by mandatory Substance Utilization Review and Evaluation System reporters. (CURES) database – from the Department of Justice to the California State Board of Pharmacy. CURES should be AB 2274 (B. RUBIO): MANDATED managed with the primary goals of improving patient care REPORTERS – STATUTE OF LIMITATIONS and public health, and as such it should be administered by Status: Signed by Governor (Chapter 587, Statutes an entity whose mission and policies focus on the use of of 2022). the database by health care providers and research experts. Assembly Bill 2274 would have made it a continuing crime AB 2098 (LOW): PHYSICIANS AND if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure SURGEONS – UNPROFESSIONAL CONDUCT to report was intentional. CMA secured amendments to Status: Signed by Governor (Chapter 938, Statutes of 2022). instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not Assembly Bill 2098 provides that the dissemination of report to five years from the date of the occurrence of the misinformation or disinformation related to COVID-19 offense. by a physician to their patient constitutes unprofessional conduct. The bill clarifies that the medical board may AB 2338 (GIPSON): HEALTH CARE DECISIONS take action if a licensee provides misinformation that – DECISION MAKERS AND SURROGATES departs from the applicable standard of care or did so with Status: Signed by Governor (Chapter 264, Statutes malicious intent or the intent to mislead.of 2022). The governor issued a statement in conjunction with his signature on the bill, which read in part: “I am signing this Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become bill because it is narrowly tailored to apply only to those designated surrogate decision-makers for the patient’s health egregious instances in which a licensee is acting with care decisions, including when the patient is incapacitated or malicious intent or clearly deviating from the required otherwise unable to personally designate a surrogate. CMA standard of care while interacting directly with a patient secured amendments that made the hierarchy suggestive under their care. To be clear, this bill does not apply to any and not mandatory, thereby addressing the liability concerns speech outside of discussions directly related to COVID-19 that initially existed with the bill. treatment within a direct physician patient relationship.” SB 923 (WIENER): GENDER-AFFIRMING CARE

AB 2132 (VILLAPUDUA): TUITION FOR Status: Signed by Governor (Chapter 822, Statutes MEDICAL SERVICE PILOT PROGRAMof 2022).

Status: Held in Assembly Higher Education Senate Bill 923 initially would have required physicians Committee. and their staff to complete a one-time cultural humility Assembly Bill 2132 would have created a pilot course for the transgender, gender nonconforming and program, administered by the California Student Aid intersex (TGI) communities before they would be able to Commission, to identify and select individuals from contract with a health plan to provide care. The provider diverse, underrepresented communities to fund their or staff would be required to take the course again if a education from community college/undergraduate school complaint was filed against the provider or their staff. through completion of their medical residency program. CMA secured amendments to the bill that incorporated the The individual would have been required to commit to TGI community into current physician continuing medical practicing in medically underserved areas after completing education cultural competency requirements and removed their residency program. the contracting prohibitions in the bill.

AB 2522 (GRAY): PUBLIC HEALTH SB 964 (WIENER): BEHAVIORAL HEALTH WORKFORCE LOAN REPAYMENT PROGRAM Status: Vetoed by Governor.

Status: Held in Senate Appropriations Committee. Senate Bill 964 would have required the Board of Assembly Bill 2522 sought to create a dedicated loan Behavioral Sciences to analyze current law and provide repayment program for the state’s public health workforce. recommendations to the legislature about actions it There are currently no existing retention or recruitment can take to increase the supply of behavioral health loan repayment programs for non-licensed public health professionals and increase access to behavioral health personnel. services. The board would have to evaluate current SB 250 (PAN): HEALTH CARE COVERAGE Status: Passed Senate. Held in Assembly Appropriations Committee. scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral Senate Bill 250 would have comprehensively reformed the health workforce and the state’s behavioral workforce prior authorization process by requiring that physicians needs. CMA successfully removed the review of current be included in the development and updating of plan scope of practice laws. utilization management criteria; requiring plans to create a prior authorization exemption program that allows AB 1375 (ATKINS): NURSING: NURSE physicians who are practicing within the plan’s criteria PRACTITIONERS AND NURSE-MIDWIVES – 90% of the time to get a blanket exemption for one year ABORTION AND PRACTICE STANDARDS from the plan’s prior authorization requirements; and Status: Signed by Governor (Chapter 631, Statutes giving a treating physician who does not have a prior of 2022). authorization exemption the right to have an appeal of a Senate Bill 1375 is intended to increase access to abortion denial be conducted by a physician in the same or similar services by trained nurse practitioners. However, as specialty. introduced, it would also have eliminated the transition SB 1419 (BECKER): HEALTH INFORMATION Status: Signed by Governor (Chapter 888, Statutes of 2022). to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments Senate Bill 1419 helps California physicians comply with the federal information blocking rule. In spring 2021, the federal 21st Century Cures Act final rule took effect. That rule has had unintended consequences for patients and physicians regarding sensitive medical information. were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

SB 1419 improves quality of care by guaranteeing that AB 1954 (QUIRK): PHYSICIANS AND physicians and patients have all the information needed for SURGEONS – TREATMENT AND MEDICATION integrated health care. OF PATIENTS USING CANNABIS This bill provides patients with the right to receive Status: Signed by Governor (Chapter 232, Statutes results of their imaging scans in written or oral form, of 2022). the same protection currently provided to lab results. It Assembly Bill 1954 originally would have prohibited also provides enhanced protection for sensitive medical physicians from denying treatment to a patient solely information, as defined by the Confidentiality of Medical based on a positive drug test for tetrahydrocannabinol Information Act. (THC). CMA successfully negotiated amendments stating Additionally, this bill provides a framework for application programming interfaces by incorporating the requirements of the Interoperability and Patient Access final rule for state-regulated health plans and insurers. that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from CO-SPONSORED BILLS liability risk and continue to have the ability to make medical decisions for their patients.

AB 1608 (GIPSON): COUNTY OFFICERS – CONSOLIDATION OF OFFICES Status: Passed Assembly. Held on Senate Floor. AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 1608 would have eliminated the ability Assembly Bill 2085 originally required mandatory reporters, of a county board of supervisors to consolidate the including physicians, to make a determination between offices of the sheriff and the coroner. The bill would “severe neglect” and “general neglect,” and required that have also required counties that currently consolidate they only report neglect deemed “severe.” CMA sought those offices to separate the roles. The intent behind amendments to clarify that health professionals must have the bill was to retain physician autonomy and prevent clear standards about mandatory reporting and that making forensic pathologists from being pressured to change an assessment between “general” and “severe” neglect their cause of death determinations due to pressure from should not be a part of their role. a sheriff/coroner in order to reduce any indications of law enforcement misconduct. Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather PRIORITY SUPPORT BILLS than on an assessment of levels of neglect by mandatory reporters.

AB 35 (REYES): CIVIL DAMAGES – MEDICAL MALPRACTICE Status: Signed by Governor (Chapter 17, Statutes of 2022). AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS Status: Signed by Governor (Chapter 587, Statutes of 2022). Assembly Bill 35, the MICRA Modernization Act, Assembly Bill 2274 would have made it a continuing crime implements the compromise that was negotiated between if mandated reporters, which includes physicians, did not CAPP and the proponents of the “Fairness for Injured report child abuse regardless of whether or not the failure Patients Act” ballot proposition. The bill extends the longto report was intentional. CMA secured amendments to term predictability and sustainability of the state’s medical malpractice laws and settles a decades-long divide on the issue. After the bill was signed, FIPA proponents withdrew their ballot measure, avoiding a million-dollar fight. instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become AB 852 (WOOD): ELECTRONIC PRESCRIBING designated surrogate decision-makers for the patient’s health Status: Signed by Governor (Chapter 518, Statutes care decisions, including when the patient is incapacitated or of 2022). otherwise unable to personally designate a surrogate. CMA Assembly Bill 852 gives physicians more flexibility secured amendments that made the hierarchy suggestive in complying with California’s electronic prescribing and not mandatory, thereby addressing the liability concerns mandate. This bill exempts low-volume prescribers (many that initially existed with the bill. of them retired or semi-retired physicians who maintain SB 923 (WIENER): GENDER-AFFIRMING CARE a license), prescribers in areas of natural disasters, Status: Signed by Governor (Chapter 822, Statutes and prescribers who are granted a waiver based on of 2022). extraordinary circumstances. These new exceptions also Senate Bill 923 initially would have required physicians track with exceptions in the Medicare program. and their staff to complete a one-time cultural humility AB 1242 (BAUER-KAHAN, BONTA AND course for the transgender, gender nonconforming and GARCIA): REPRODUCTIVE RIGHTS – PROTECTIONS FOR PATIENTS AND PROVIDERS Status: Signed by Governor (Chapter 627, Statutes of 2022). intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical Assembly Bill 1242 protects those performing, aiding in education cultural competency requirements and removed the performance of or obtaining an abortion from arrest the contracting prohibitions in the bill. and prohibits law enforcement from cooperating with or providing information to those outside of California SB 964 (WIENER): BEHAVIORAL HEALTH regarding lawful abortion. This bill went into effect Status: Vetoed by Governor. immediately when it was signed into law on September Senate Bill 964 would have required the Board of 27, 2022. Behavioral Sciences to analyze current law and provide AB 1666 (BAUER-KAHAN): ABORTION – CIVIL recommendations to the legislature about actions it ACTIONS Status: Signed by Governor (Chapter 42, Statutes of 2022). can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current Assembly Bill 1666 enacts legal protections from civil and criminal liability for clinicians that provide abortions to patients who reside in other states with hostile abortion laws. These protections include precluding liability for any of the following “crimes” in other states: aiding or abetting in the inducing of an abortion; receiving or seeking an abortion; and performing and inducing an abortion. This scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws. bill went into effect immediately when it was signed into AB 1375 (ATKINS): NURSING: NURSE law on June 24, 2022. PRACTITIONERS AND NURSE-MIDWIVES –

AB 1797 (WEBER): IMMUNIZATION REGISTRY Status: Signed by Governor (Chapter 582, Statutes of 2022). ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

Assembly Bill 1797 requires health care providers and other agencies, including but not limited to, schools, childcare facilities, Women, Infants, and Children service providers, health care plans, foster care agencies, and county human services agencies to disclose immunization information to local health departments and the California Department of Public Health (CDPH). The data includes disclosure of a new data point related to a patient’s or client’s race and ethnicity. This bill was part of the legislature’s broader “vaccine work group” legislative package. Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

AB 2223 (WICKS): REPRODUCTIVE HEALTH AB 1954 (QUIRK): PHYSICIANS AND Status: Signed by Governor (Chapter 629, Statutes SURGEONS – TREATMENT AND MEDICATION of 2022). OF PATIENTS USING CANNABIS

Assembly Bill 2223 clarifies the law to prevent anyone Status: Signed by Governor (Chapter 232, Statutes in California from being investigated, prosecuted, or of 2022). incarcerated for ending a pregnancy or experiencing Assembly Bill 1954 originally would have prohibited pregnancy loss. physicians from denying treatment to a patient solely AB 2626 (CALDERON): MEDICAL BOARD based on a positive drug test for tetrahydrocannabinol OF CALIFORNIA – LICENSEE DISCIPLINE – ABORTION Status: Signed by Governor (Chapter 565, Statutes of 2022). Assembly Bill 2626 prevents state licensing boards from suspending or revoking the license of someone who (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make performs an abortion in accordance with California law. medical decisions for their patients.

Additionally, the bill prohibits the boards from taking an adverse action against an applicant or licensee that was AB 2085 (HOLDEN): CRIMES – MANDATED disciplined in another state for performing an abortion if REPORTERS the abortion met the applicable standard of care for the Status: Signed by Governor (Chapter 770, Statutes procedure in California. of 2022). SB 866 (WIENER): MINORS – VACCINE CONSENT Status: Passed Senate, but not taken up on Assembly Floor. Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have Senate Bill 866 would have allowed minors 15 years of age clear standards about mandatory reporting and that making or older to consent to vaccines that the United States Food an assessment between “general” and “severe” neglect and Drug Administration and Advisory Committee on should not be a part of their role.

Immunization Practices have approved. Existing law allows minors 12 years of age or older to make certain medical Amendments were taken to the bill focusing the measure decisions without parental consent, most notably as it relates on the definition of “general neglect” in the law rather to consenting to general medical care if the minor lives than on an assessment of levels of neglect by mandatory separately from their parents or legal guardians. Due to reporters. timing and vocal opposition, this legislation was not taken AB 2274 (B. RUBIO): MANDATED up for a vote on the Assembly floor. REPORTERS – STATUTE OF LIMITATIONS

SB 871 (PAN): PUBLIC HEALTH – IMMUNIZATIONS Status: Signed by Governor (Chapter 587, Statutes of 2022).

Status: Held in Senate Health Committee. Assembly Bill 2274 would have made it a continuing crime Senate Bill 871 would have added the COVID-19 vaccine if mandated reporters, which includes physicians, did not to the list of required vaccinations before a pupil can be report child abuse regardless of whether or not the failure admitted into any private or public elementary or secondary to report was intentional. CMA secured amendments to school, childcare center, day nursery, nursery, family day care instead extend the statute of limitations for a person to home or development center. The bill also would also have bring a lawsuit against a mandated reporter who did not removed the personal belief exemption for the COVID-19 report to five years from the date of the occurrence of the vaccination. This bill was part of the legislature’s broader offense. “vaccine work group” package of legislation. AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become SB 883 (ROTH): UMBILICAL CORD BLOOD designated surrogate decision-makers for the patient’s health COLLECTION PROGRAM care decisions, including when the patient is incapacitated or Status: Signed by Governor (Chapter 604, Statutes otherwise unable to personally designate a surrogate. CMA of 2022). secured amendments that made the hierarchy suggestive Senate Bill 883 extends the University of California’s and not mandatory, thereby addressing the liability concerns Umbilical Cord Blood Collection Program through that initially existed with the bill. January 1, 2026. Stored umbilical cord blood is a lifeSB 923 (WIENER): GENDER-AFFIRMING CARE saving resource that is used to treat more than 80 diseases Status: Signed by Governor (Chapter 822, Statutes such as leukemia, lymphoma and immune deficiency.of 2022). SB 1473 (PAN): HEALTH CARE COVERAGE Senate Bill 923 initially would have required physicians Status: Signed by Governor (Chapter 545, Statutes and their staff to complete a one-time cultural humility of 2022). course for the transgender, gender nonconforming and Senate Bill 1473 requires health plans to cover COVID-19 intersex (TGI) communities before they would be able to therapeutics consistent with current law related to contract with a health plan to provide care. The provider coverage of COVID-19 testing and vaccinations, which or staff would be required to take the course again if a was signed into law in 2021 through CMA-sponsored SB complaint was filed against the provider or their staff. 510 (Pan). Additional provisions of the bill extend coverage CMA secured amendments to the bill that incorporated the for out-of-network cost-sharing for COVID-19 testing and TGI community into current physician continuing medical vaccination to six months after the federal public health education cultural competency requirements and removed emergency expires. the contracting prohibitions in the bill.

SCA 10 (ATKINS): REPRODUCTIVE FREEDOM SB 964 (WIENER): BEHAVIORAL HEALTH

Status: Signed by Governor (Chapter 97, Statutes Status: Vetoed by Governor.

of 2022). Senate Bill 964 would have required the Board of Senate Constitutional Amendment 10 creates a pathway Behavioral Sciences to analyze current law and provide for California to constitutionally protect an individual’s recommendations to the legislature about actions it right to reproductive freedom and to obtain health services, can take to increase the supply of behavioral health including abortion and contraception. Approved with a professionals and increase access to behavioral health two-thirds vote of the legislature, the provisions of this bill services. The board would have to evaluate current became Proposition 1 on the November 2022 ballot, which scope of practice laws, licensing and clinical training passed with an overwhelming margin of support. requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately PRIORITY OPPOSE BILLS would have required a report of the current behavioral health workforce and the state’s behavioral workforce AB 1278 (NAZARIAN): PHYSICIANS AND needs. CMA successfully removed the review of current scope of practice laws.

SURGEONS – PAYMENTS: DISCLOSURE: NOTICE AB 1375 (ATKINS): NURSING: NURSE Status: Signed by Governor (Chapter 750, Statutes PRACTITIONERS AND NURSE-MIDWIVES – of 2022). ABORTION AND PRACTICE STANDARDS

Assembly Bill 1278 requires physicians to provide each Status: Signed by Governor (Chapter 631, Statutes patient with a written or electronic notice about the federal of 2022). Open Payments database at their initial office visit, and obtain Senate Bill 1375 is intended to increase access to abortion a signature from the patient or a patient representative. services by trained nurse practitioners. However, as This bill was introduced in 2021 and originally would have required physicians to provide each patient with detailed information about the physician’s personal receipt of gifts or funds from pharmaceutical companies, device manufacturers, etc., as reported by those entities in the federal Open Payments database on an annual basis. CMA sought amendments, and the bill was narrowed to a onetime, general notice to patients about the existence of the Open Payments database. introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

AB 1328 (IRWIN): CLINICAL LABORATORY AB 1954 (QUIRK): PHYSICIANS AND TECHNOLOGY AND PHARMACISTS SURGEONS – TREATMENT AND MEDICATION Status: Held on Senate Floor. OF PATIENTS USING CANNABIS

Assembly Bill 1328 would have created a scope infringement allowing pharmacists to order and perform Status: Signed by Governor (Chapter 232, Statutes of 2022). over 1,400 Clinic Laboratory Improvement AmendmentsAssembly Bill 1954 originally would have prohibited approved tests, not limited to temperature, pulse and physicians from denying treatment to a patient solely respiration. This bill would also have authorized a based on a positive drug test for tetrahydrocannabinol pharmacist to order and interpret any test results they (THC). CMA successfully negotiated amendments stating ordered to “promote patient health.” CMA worked hard that a physician shall not automatically deny treatment to seek amendments and ultimately stop the bill on the or medication to a qualified patient based solely on a Senate Floor. positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The AB 1400 (KALRA): GUARANTEED HEALTH amendments ensure that physicians are protected from CARE FOR ALL liability risk and continue to have the ability to make Status: Held on Assembly Floor. medical decisions for their patients. Assembly Bill 1400, the California Guaranteed Health AB 2085 (HOLDEN): CRIMES – MANDATED Care for All Act, would have created the CalCare program to administer and provide universal single payer health REPORTERS Status: Signed by Governor (Chapter 770, Statutes care coverage and a health care cost control system in the of 2022). state. The bill contained minimal details regarding the administration of such a program. Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between AB 1785 (DAVIES): CALIFORNIA PARENTS’ “severe neglect” and “general neglect,” and required that BILL OF RIGHTS ACT they only report neglect deemed “severe.” CMA sought Status: Held in Assembly Education Committee. amendments to clarify that health professionals must have Assembly Bill 1785 attempted to create a “California Parents’ Bill of Rights” by making numerous technical and substantive amendments to various code sections. This clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role. bill would have undermined existing protections for health Amendments were taken to the bill focusing the measure care decisions, and the resulting records, that a minor has on the definition of “general neglect” in the law rather a statutory right to make. In addition, the bill attempted than on an assessment of levels of neglect by mandatory to erode the ability of a school district to require certain reporters. immunizations. AB 2274 (B. RUBIO): MANDATED

AB 2060 (QUIRK): MEDICAL BOARD OF REPORTERS – STATUTE OF LIMITATIONS CALIFORNIA Status: Signed by Governor (Chapter 587, Statutes Status: Killed on Assembly Floor. of 2022).

Assembly Bill 2060 sought to change the composition Assembly Bill 2274 would have made it a continuing crime of the Medical Board of California to a public member if mandated reporters, which includes physicians, did not majority and eliminate the licensee majority of the board’s report child abuse regardless of whether or not the failure disciplinary panels. This was the second consecutive to report was intentional. CMA secured amendments to legislative session that the Legislature sought this change instead extend the statute of limitations for a person to to the board’s composition. bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become AB 2080 (WOOD): HEALTH CARE designated surrogate decision-makers for the patient’s health CONSOLIDATION AND CONTRACTING care decisions, including when the patient is incapacitated or FAIRNESS ACT OF 2022 otherwise unable to personally designate a surrogate. CMA Status: Held in Senate Health Committee. secured amendments that made the hierarchy suggestive Assembly Bill 2080 would have required any medical group, hospital, hospital system, health care service plan and not mandatory, thereby addressing the liability concerns that initially existed with the bill. or pharmacy benefit manager to provide written notice SB 923 (WIENER): GENDER-AFFIRMING CARE to the Attorney General (AG) at least 90 days before Status: Signed by Governor (Chapter 822, Statutes agreeing to a merger, acquisition or change in control with of 2022). another health care entity if the transaction had a value Senate Bill 923 initially would have required physicians of $15 million or more. The bill would authorize the AG and their staff to complete a one-time cultural humility to consent to, give conditional consent to, or not consent course for the transgender, gender nonconforming and to the agreement, and if the AG did not consent to the intersex (TGI) communities before they would be able to agreement, the transaction would be stopped. contract with a health plan to provide care. The provider AB 2236 (LOW) OPTOMETRY: CERTIFICATION TO PERFORM ADVANCED PROCEDURES Status: Vetoed by Governor. or staff would be required to take the course again if a complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed Assembly Bill 2236 would have authorized optometrists to the contracting prohibitions in the bill. perform laser and surgical procedures on a patient’s eye if they met minimal education and training requirements, SB 964 (WIENER): BEHAVIORAL HEALTH including performing 43 procedures on live patients. The Status: Vetoed by Governor. bill failed to adequately educate optometrists to develop Senate Bill 964 would have required the Board of clinical competency and judgment to identify, manage Behavioral Sciences to analyze current law and provide and mitigate complications during surgery to prevent recommendations to the legislature about actions it permanent damage to patients’ eyes and eyesight. can take to increase the supply of behavioral health Echoing CMA’s concerns, Governor Newsom vetoed the professionals and increase access to behavioral health bill with a statement indicating: “I am not convinced that services. The board would have to evaluate current the education and training required is sufficient to prepare scope of practice laws, licensing and clinical training optometrists to perform the surgical procedures identified. requirements, and requirements for the renewal This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program.” requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

SB 920 (HURTADO): MEDICAL BOARD OF CALIFORNIA: INVESTIGATIONS: RECORD REQUESTS Status: Held in Senate Business, Professions, and Economic Development Committee. AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 920 sought to erode privacy protections for both patients and physicians by allowing Medical Board of California investigators to inspect records prior to requesting a subpoena for the records in order to establish good cause for further investigation. This was the second consecutive legislative session that the Legislature sought this change. Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

SB 1023 (HURTADO): HEALTH PROFESSIONS AB 1954 (QUIRK): PHYSICIANS AND – TRAINING AND EDUCATION: BLUE RIBBON SURGEONS – TREATMENT AND MEDICATION COMMISSION OF PATIENTS USING CANNABIS

Status: Held in Assembly Health Committee. Status: Signed by Governor (Chapter 232, Statutes

Senate Bill 1023 sought to create a Blue-Ribbon of 2022). Commission on Strengthening our Health System Assembly Bill 1954 originally would have prohibited by Transforming Medical Training and Education to physicians from denying treatment to a patient solely Improve Patient Protection. The bill was a misguided based on a positive drug test for tetrahydrocannabinol effort to address broader concerns about the regulation (THC). CMA successfully negotiated amendments stating of physicians and surgeons by the medical board. In that a physician shall not automatically deny treatment particular, the bill sought to reconsider the evidentiary standard used in disciplinary cases. CMA was able to negotiate amendments with the author to refocus the bill on seeking information and reporting on methods to increase the number of diverse physicians entering the workforce, particularly in low-income and rural communities. or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

SB 1467 (KAMLAGER): MATERNAL MENTAL AB 2085 (HOLDEN): CRIMES – MANDATED HEALTH REPORTERS

Status: Held in Senate Health Committee. Status: Signed by Governor (Chapter 770, Statutes

Senate Bill 1467 sought to ensure that all biological of 2022). mothers are offered maternal mental health care services Assembly Bill 2085 originally required mandatory reporters, or are screened appropriately for maternal mental health including physicians, to make a determination between conditions. CMA expressed concern that the term “severe neglect” and “general neglect,” and required that biological mother may exclude a population of people that they only report neglect deemed “severe.” CMA sought may be pregnant or become pregnant. amendments to clarify that health professionals must have CMA’s Council on Legislation took an oppose unless amended position and sought an amendment to change the term biological mother to birthing person. Instead, the bill clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role. failed to garner a hearing in its first committee. Amendments were taken to the bill focusing the measure ACA 11 (KALRA): TAXES TO FUND HEALTH CARE COVERAGE AND COST CONTROL Status: Held in Assembly Rules Committee. on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters. Assembly Constitutional Amendment 11 was the AB 2274 (B. RUBIO): MANDATED companion funding mechanism for the single-payer health REPORTERS – STATUTE OF LIMITATIONS care system proposed under AB 1400 (Kalra, 2021), which Status: Signed by Governor (Chapter 587, Statutes the association took an oppose unless amended position of 2022). on. ACA 11 would have raised the gross receipts tax, Assembly Bill 2274 would have made it a continuing crime increased the employer and employee shares of the payroll if mandated reporters, which includes physicians, did not tax, and increased the personal income tax on high earners. report child abuse regardless of whether or not the failure This bill was never referred out of the Assembly Rules Committee. to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become SUCCESSFULLY NEGOTIATED BILLS designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or AB 1704 (CHEN): LIMITED PODIATRIC RADIOGRAPHY PERMITS Status: Signed by Governor (Chapter 580, Statutes otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns of 2022). that initially existed with the bill. Assembly Bill 1704 adds health care professionals SB 923 (WIENER): GENDER-AFFIRMING CARE operating leg-only podiatric radiography equipment Status: Signed by Governor (Chapter 822, Statutes under the supervision of a licensed podiatrist to the list of of 2022). individuals exempted from the existing requirements of state law regarding who is permitted to operate radiological equipment in California. It also tried to remove the CDPH Radiologic Health Branch’s authority to determine certification and move it to the Podiatric Medical Board of California. CMA was able to retain the certification authority within CDPH and provide more specificity related Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a to the requirements to receive this permit. complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the AB 1809 (AGUIAR-CURRY): NURSING TGI community into current physician continuing medical FACILITY RESIDENT INFORMED CONSENT education cultural competency requirements and removed PROTECTION ACT OF 2022 the contracting prohibitions in the bill.

Status: Vetoed by Governor. SB 964 (WIENER): BEHAVIORAL HEALTH

Assembly Bill 1809 would have required informed consent be given by a skilled nursing facility resident before Status: Vetoed by Governor. being prescribed and administered any psychotherapeutic Senate Bill 964 would have required the Board of medication. Additionally, the prescribing physician could Behavioral Sciences to analyze current law and provide be charged with criminal battery for not obtaining the recommendations to the legislature about actions it consent from the resident. CMA secured amendments to can take to increase the supply of behavioral health narrow the drugs affected by the bill, remove the charge professionals and increase access to behavioral health of criminal battery from the bill and to require only the services. The board would have to evaluate current relevant information about the prescribed medication be scope of practice laws, licensing and clinical training given to the resident for consent purposes. requirements, and requirements for the renewal AB 1896 (QUIRK): GAMETE BANKS Status: Vetoed by Governor. Assembly Bill 1896 would have added notification requirements to gamete banks. Specifically, this bill attempted to require gamete banks to notify clients of requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws. the risk of inbreeding and steps to mitigate that risk. AB 1375 (ATKINS): NURSING: NURSE In addition, the banks would have been required to PRACTITIONERS AND NURSE-MIDWIVES – implement a secure process for tracking future sperm donations and sharing that information with other gamete banks. CMA staff successfully negotiated amendments ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022). that minimized this bill to being education-based only, while reducing the administrative burdens and liability Senate Bill 1375 is intended to increase access to abortion risk that were originally part of the bill. services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role. Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE

Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff. CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH

Status: Vetoed by Governor.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES – ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.