CMA 2023 Legislative Wrap-Up

CMA’S 2023 Legislative Wrap-Up

By Stuart Thompson, CMA Senior Vice President of Government Relations

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efore launching into the recap of the 2023 legislative session, I want to take a moment to express my gratitude for being back at CMA and I am honored to be given the responsibility of representing the profession in front of the California Legislature. I spent five years at CMA as a staff lobbyist from 2014 to 2018 and then spent four years in the Governor’s Office as the Chief Deputy Legislative Secretary. But coming back to CMA felt like coming home.

The theme of 2023 in the California State Legislature was one of change at the top. Robert Rivas became the new Assembly Speaker in July after a year-long tussle with the previous Speaker, Anthony Rendon, who held the position for seven years.

Members loyal to Speaker Rivas will ascend to important chairmanships and key leadership positions over the coming months.

The California Senate also saw a change in leadership, albeit with much less drama, as Senate President pro Tempore Toni Atkins announced she will be transitioning power to Senator Mike McGuire sometime next year. Pro Tem Atkins’ term expires in 2024, and she is ineligible to run for the state Legislature again. This transition will be watched very closely to determine when a new pro tem might take over and whether Senator McGuire will change the current pro tem leadership team.

Senator Atkins was the first woman elected as Senate president pro tem when she took the position in 2018. She has fiercely advocated for women’s reproductive rights, LGBTQ+ rights and affordable housing in California. In 2022, in the shadow of the U.S. Supreme Court’s decision to overturn Roe v. Wade, Senator Atkins introduced a state constitutional amendment permanently protecting abortion care as a fundamental right in California. Our physicians are grateful for the work Senator Atkins has done to protect patient access to reproductive care for Californians and the nation.

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The changes in leadership in both houses were preceded by an election that saw an enormous influx of new members in both the Assembly and Senate. The Assembly saw 30 new members, including Jasmeet Bains, M.D. Dr. Bains is a boardcertified family physician providing care in the Central Valley and has been a member of CMA and its House of Delegates for several years. Her focus during her first year in office has been fighting the fentanyl crisis plaguing California.

The Senate also saw 10 new members, and we hope to see Assemblymember Akilah Weber, M.D., join their ranks in 2024! There is no advocacy that can rival having actual physicians on the floors of the state Legislature, and we are beyond thrilled to have these two physician champions in the state Legislature.

LEGISLATIVE MATTERS State Budget CMA was successful this year in advocating for the largest influx of new Medi-Cal dollars the state has ever invested into the program. That we were able to accomplish this in a budget environment where most programs were being cut is a testament to CMA’s advocacy. The funding is based on the renewal of the MANAGED CARE ORGANIZATION (MCO) TAX, which allows the state to tax managed care plans in an effort to draw down federal funding to support the Medi-Cal program. To secure this historic deal, CMA led a coalition effort that included the hospitals, clinics, Planned Parenthood, emergency transport providers, and health plans with the goal of ensuring Medi-Cal enrollees receive the same level of coverage as other members of their community.

The MCO Tax – which is broadly supported by our health plan partners – will raise a total of $19.4 billion, with much of it being spent on the state’s health care infrastructure.

Starting in 2024, Medi-Cal provider rates will be increased to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in 2025, the MCO Tax will also provide a new infusion of $6 billion for the Medi-Cal program and the health care workforce. Specifically, there will be an annual appropriation of $1.38 billion in primary care rate increases; $1.15 billion in specialty care rate increases; $700 million to increase emergency department access (including $200 million for emergency department physicians); at least $500 million for family planning and reproductive health care;

and $600 million for behavioral health facilities, including increasing inpatient psychiatric beds.

Prior Authorization CMA SPONSORED SB 598 (SKINNER) – a

reintroduction of last year’s SB 250 (Pan) – which would provide physicians with an exemption from prior authorization if they had a good history of prior authorization approvals. Additionally, the bill would have discontinued prior authorization for a service if the health plan approves it 95% or more of the time and required insurance reviewers for denials to have the same medical expertise as the treating provider.

Unfortunately, Assembly Appropriations Committee Chair Chris Holden held SB 598 in committee and prevented prior authorization reform legislation from advancing for the second straight year (he also held SB 250 last year).

This action would have required CMA to introduce a new bill next year and start the legislative process from the beginning for the third time. However, CMA was successful in lobbying the Speaker’s Office to allow us to gut and amend another bill currently in Assembly Appropriations Committee, SB 516, to include SB 598’s provisions.

Adopting this approach will give us the necessary time to negotiate with the Newsom Administration to address their implementation concerns with the reform package and allow us to pick up right where we left off with SB 598. This bill will remain a top priority for CMA in the coming year.

Heal th Care Worker Minimum Wage SB 525 (DURAZO), which will gradually raise wages

of health care workers to $25 an hour, has been signed by Governor Newsom.

CMA had an oppose unless amended position on SB 525 and was advocating in coalition with other stakeholder groups. When SB 525 was amended during the last week of the legislative session to reflect a deal negotiated between some health care industry stakeholders and labor, CMA engaged in kind to limit the impact to our members.

CMA negotiated exemptions for IPAs and small practices with 24 physicians or less, as well as a gradual implementation of the wage increase. The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525, including other legislation that will raise the minimum wage for fast food workers to $20 per hour starting in April

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2024. Under that bill, a council will have the authority to increase the fast food minimum wage annually.

All of this is against the backdrop that California now requires an annual assessment and adjustment of the minimum wage to reflect inflation. Such an adjustment will occur on January 1, 2024, bringing California’s minimum wage up to $16 per hour.

SB 525 will neutralize efforts to enact health care worker minimum wages via local ballot measures across the state. Those efforts – assuming they resemble previous ballot measures in the cities of Inglewood and Downey – would have involved an immediate increase. The following chart shows when SB 525 wage increases would go into effect: SECTOR

2024

Physician groups with 25 or more physicians

$21

Physician groups part of large health systems with more than 10,000 workers and dialysis clinics

$23

Community clinics

$21

Hospitals with high mix of Medi-Cal and Medicare patients and rural independent hospitals

$18

CMA’s advocacy ensured that physician practices would not face more drastic and immediate wage increases that would be more difficult to weather. CMA will be closely monitoring how the new law impacts physician practices and patient care, especially small rural practices, hospitals and clinics.

Administrative Burden AB 1751 (GIPSON) was introduced at the request of the

California Chiropractic Association. The bill would have required physicians prescribing opioids to obtain signed consent that they talked to patients about alternative treatments to pain – including but not limited to chiropractic, mental health and acupuncture services – regardless of whether those treatments would even be beneficial. The bill was essentially an attempt to require physicians to talk to their patients about chiropractic services every single time they prescribed an opioid. AB 1751 was set to be heard in the Assembly Health Committee on two separate occasions but was never heard because of CMA’s grassroots and lobbying efforts. The bill must be acted upon in January 2024, or the bill will be considered dead.

2025

2026

2027

$23 $24

2028

$25

$25 $22

$25

Increase 3.5% annually until it reaches $25 in 2033 against the bill and prevented it from being taken up in its first committee, forcing it to become a two-year bill. AB 1570 must be acted upon by the end of January 2024, or the bill will be considered dead. We anticipate the proponents advancing some type of proposal in January, and CMA will be closely following any developments.

SB 524 (CABALLERO) would have allowed pharmacists

at retail pharmacy chains to furnish medications to treat COVID-19, influenza, streptococcal pharyngitis, STIs and conjunctivitis as part of the large chains’ attempt to establish small clinics within pharmacies. Thanks to CMA’s advocacy, the bill was held in the Senate Appropriations Committee.

Reproductive Heal th

Scope of Practice

California has long been known for supporting reproductive rights and the right for women to have autonomy over their bodies. This year, the Legislature burnished California’s reputation for reproductive rights even further by helping to provide protections not just for patients, but also for providers. With 14 states having some form of a ban on abortion, patients are forced to seek reproductive care in other states, with California being a primary destination.

Last year, Assemblymember Evan Low introduced AB 2236, which would have allowed optometrists with minimal training to infringe on the scope of ophthalmologists, including widening their scope to allow them to perform surgery and use lasers. CMA worked hard to persuade Governor Newsom to veto the bill. This year, Assemblymember Low introduced AB 1570, which was identical to the bill that Governor Newsom had vetoed just a few months earlier. CMA lobbied

Senate Pro Tem Toni Atkins authored CMA-SPONSORED SB 487, which prevents providers from having their MediCal provider eligibility threatened by states with abortion bans. Previously, if a state were to take action against a provider’s license for performing reproductive services that are lawful in California, they would automatically become ineligible to be a Medi-Cal provider. SB 487 allows providers who fall into this category to avoid losing their Medi-Cal

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provider eligibility simply because a state they previously worked in passed laws to ban those services. Gov. Newsom signed this bill into law on September 27, 2023.

Additionally, physicians have informed us that their liability insurance has been denied, terminated, or seen drastically increased premiums for providing reproductive and genderaffirming care services. CMA and other organizations in the California Future of Abortion Council co-sponsored AB 571, authored by Assemblymember Cottie Petrie-Norris, to alter the insurance code to prevent insurance companies from unreasonably increasing liability premiums or denying coverage to providers based on the services they provide. Gov. Newsom signed this bill into law on September 27, 2023.

Language Concordance Patients who receive linguistically concordant care experience better health outcomes. However, due to California’s diverse and growing population, physicians often need translators to communicate with their patients. CMA set out to help physicians close that communication gap and strengthen the patient-physician relationship by sponsoring AB 470, authored by Assemblymember Avelino Valencia. AB 470 allows physicians to take specific language courses to fulfill some continuing education requirements. The bill made it through the Legislature without opposition and was signed into law by Gov. Newsom on October 7, 2023.

Medical Board SB 815 is the bill extending the administration’s authority

of the Medical Board of California. This bill amends various sections of the Medical Practice Act. CMA focused on six priority issues in the bill: license fee increase, public member majority, lowering the evidentiary standard to preponderance of evidence, license revocation related to felony convictions, postgraduate training licenses and the medical board’s financial reserves.

CMA successfully reduced the proposed $487 license fee increase (which would have been a nearly 60% increase) to a $288 increase (33% increase). Additionally, CMA successfully removed the provision to institute a public member majority on the board, as well as the sections of the bill related to a lowered evidentiary standard. CMA also ensured that the overly broad language in the bill relating to licensure revocation for felony convictions was explicitly clarified with specific serious crimes.

In addition, SB 815 expanded the timelines and flexibility for postgraduate training licensure. This bill also establishes

a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years, until January 1, 2028.

Heal th IT An egregious problem physicians face is price gouging from electronic health record (EHR) vendors. When the state mandates a new EHR feature, software update or other change, vendors are charging physicians upwards of $30,000 to make the required changes. California physicians are forced to dig deep and pay outrageous fees or face being out of compliance.

CMA investigated and found there were no regulations on how much EHR vendors can charge, nor was there a regulator to oversee vendor activities. To correct this oversight, CMA sponsored SB 582 by Senator Josh Becker to fold EHR vendors into the state’s Data Exchange Framework, placing them under an entity that can regulate and take enforcement actions against vendors in California. Unfortunately, this bill was vetoed by the governor for being “premature” since the Data Sharing Governing Board has not yet been established.

CMA will pursue this policy again next fall.

Financial Disclosures Assemblymember Freddie Rodriguez introduced AB 616, which would require audited financial reports and statements from medical groups to be released to the public on the Department of Health Care Access and Information (HCAI) website. The bill would reverse a previous agreement made last year during the establishment of California’s Office of Health Care Affordability. This information becoming public could create an escalation of consolidation in the health care industry by allowing private equity and corporate interests to use the financial data to make acquisitions that will lead to higher costs and negatively impact patient outcomes.

CMA led a coalition to oppose the bill in the Legislature.

Despite CMA’s efforts, the bill made it to the governor’s desk during the last week of the session by the slimmest of margins. Ultimately, however, CMA succeeded in advocating for a veto of the bill by the governor.

On the following pages, you will f ind summaries of many of the key bills that CMA was involved with in 2023.

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SPONSORED AB 470 (VALENCIA): CONTINUING MEDICAL EDUCATION: PHYSICIANS & SURGEONS

are patient safety and fraud and waste protections built into the bill that are consistent with current practice and law.

Additionally, SB 516 would require health plans to provide a true peer-to-peer, within the same or similar specialty, when a physician is appealing a prior authorization denial.

Status: Signed by Governor (Chapter 330, Statutes of 2023)

SB 582 (BECKER): HEALTH INFORMATION

AB 470 will affirm the importance of cultural competency and language fluency as a core tenet of continuing medical education. This legislation will help physicians better communicate with patients in diverse communities across the state. California is a melting pot of cultures and languages, making it a minority-majority state. These important adjustments in state law will improve the quality of care by helping physicians effectively communicate with patients in diverse communities where English is a second language.

AB 571 (PETRIE-NORRIS): MEDICAL MALPRACTICE INSURANCE

Status: Signed by Governor (Chapter 256, Statutes of 2023)

AB 571 will ensure California’s reproductive and gender-affirming health care providers are able to obtain professional liability insurance without the fear of discrimination based on the services they provide. AB 571 prohibits insurers from refusing to issue professional liability insurance to licensed health care practitioners solely because they offer abortion, contraception or genderaffirming services.

SB 487 (ATKINS): ABORTION – PROVIDER PROTECTIONS

Status: Signed by Governor (Chapter 261, Statutes of 2023)

SB 487 will strengthen the civil protections for California’s reproductive health care service providers. It will prohibit payors from discriminating or taking adverse actions against providers who are subjected to civil, criminal or professional license actions for providing reproductive health care services to patients that have traveled from out of state.

SB 516 (SKINNER): HEALTH CARE COVERAGE – PRIOR AUTHORIZATION

Status: Two-Year Bill – In Assembly Appropriations Committee

SB 516 (previously SB 598) will reform the prior authorization process to ensure timely access to treatments and care, improve patient health outcomes and increase the efficiency and effectiveness of physician practices. SB 516 is a balanced approach that ensures physicians who practice within a plan’s criteria are exempt from prior authorization, thereby allowing physicians to care for the needs of their patients without undue burdens from health plans. There

Status: Vetoed by Governor

SB 582 would have authorized the California Health and Human Services (CalHHS) Data Exchange Framework to create policies and procedures for including EHR vendors in the legal structure of the framework and incorporate federal standards for the reasonableness of vendor fees. The bill was vetoed due to it being premature, with the advisory groups still in their infancy.

SUPPORT AB 33 (BAINS): FENTANYL MISUSE & OVERDOSE PREVENTION TASK FORCE

Status: Signed by Governor (Chapter 887, Statutes of 2023)

AB 33 will establish the Fentanyl Misuse & Overdose Prevention Task Force to undertake various duties relating to fentanyl abuse, including collecting and organizing data on the nature and extent of fentanyl abuse in California and evaluating approaches to increase public awareness of fentanyl abuse.

AB 85 (WEBER): SOCIAL DETERMINANTS OF HEALTH – SCREENING AND OUTREACH

Status: Vetoed by Governor

AB 85 would have added social determinants of health screenings as a covered benefit under commercial coverage and Medi-Cal. Additionally, the bill would have required health plans to connect providers with community health workers to assist with patient care coordination. Finally, AB 85 would have required HCAI to convene a working group to develop a standardized model and procedures for providers to use to implement the requirements of the bill and identify gaps in research and data, which would help to improve state policies on social determinants of health.

AB 360 (GIPSON): EXCITED DELIRIUM

Status: Signed by Governor (Chapter 431, Statutes of 2023)

AB 360 eliminates “excited delirium” as a medical diagnosis and prohibits the term from being listed as a cause of death on a death certificate. Amid concerns that physicians would be limited when describing a patient’s behavior, CMA staff assisted in crafting language to clarify that only the term excited delirium is prohibited.

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AB 576 (WEBER): MEDI-CAL – REIMBURSEMENT FOR ABORTION

AB 907 (LOWENTHAL): COVERAGE FOR PANDAS & PANS

Status: Vetoed by Governor

AB 907 would have required health plans to cover treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) prescribed by a licensed physician. The bill would not allow copays, deductibles or any other form of cost-sharing to be imposed if it was more than what is applied to similar covered benefits. The Governor vetoed the bill due to cost concerns.

AB 576 would have required the Medi-Cal program to reimburse providers prescribing medication to fully terminate a pregnancy.

AB 765 (WOOD): PHYSICIANS & SURGEONS – MEDICAL SPECIALTY TITLES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 765, the “California Patient Protection, Safety, Disclosure and Transparency Act,” is aimed at strengthening protections for health care consumers by addressing gaps in our current prohibition on use of the term “physician” by non-physician providers. The bill does so by ensuring consumers are not misled or deceived into believing their health care provider is a physician or surgeon. The bill also ensures that non-physician health care providers with advanced degrees do not confuse the public with the use of “ologist” titles like anesthesiologist or dermatologist or other similar combination of “physician-equivalent” titles.

AB 815 (WOOD): HEALTH CARE COVERAGE – PROVIDER CREDENTIALS

Status: Two-Year Bill – in Senate Health Committee

AB 815 would streamline the physician credentialing process with health plans and take significant steps in removing administrative waste within the care delivery system. AB 815 would require CalHHS to create a stakeholder board to approve independent entities credentialing physicians for health plans. If an approved entity credentials a physician, health plans would be required to accept physicians’ credentials from that entity.

AB 874 (WEBER): HEALTH CARE COVERAGE – OUT-OF-POCKET EXPENSES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 874 would ban the use of copay accumulator programs and ensure that any offered copay assistance benefits patients. Copay accumulator programs prevent copay assistance given to patients from counting toward their deductible and other out-of-pocket spending, which leaves patients facing increased and unexpected costs once the copay card is maximized and their deductible is deemed to have not been met. The use of these programs means patients are often forced to leave the pharmacy without the medication they need due to an inability to pay.

Status: Vetoed by Governor

AB 977 (RODRIGUEZ): EMERGENCY DEPARTMENTS – ASSAULT & BATTERY

Status: Two-Year Bill – Held in Assembly Public Safety Committee

AB 977 makes an assault or battery committed against a physician, nurse or other health care worker of a hospital engaged in providing services within the emergency department punishable by imprisonment in a county jail not exceeding one year and by a fine not exceeding $2,000, making the crime a felony.

AB 1089 (GIPSON): FIREARMS

Status: Signed by Governor (Chapter 243, Statutes of 2023)

AB 1089 prohibits unlicensed individuals from using a computer numerical control (CNC) milling machine or a 3D printer for manufacturing a firearm and a “digital firearm manufacturing code” to be shared or distributed.

Additionally, AB 1089 sets criteria for how a person can lawfully relinquish possession of a CNC or 3D printer intended to manufacture firearms.

AB 1194 (CARRILLO, WENDY): CA PRIVACY RIGHTS ACT OF 2020: EXEMPTIONS – ABORTION SERVICES

Status: Signed by Governor (Chapter 567, Statutes of 2023)

AB 1194 expands the exemptions under the California Privacy Rights Act of 2020 regarding protecting an individual’s information related to accessing or searching for services such as reproductive health care services, including contraception and abortion.

AB 1203 (BAINS): SALES & USE TAXES: EXEMPTIONS – BREAST PUMPS & RELATED SUPPLIES

Status: Signed by Governor (Chapter 833, Statutes of 2023)

AB 1203 removes the sales tax on the sale of breast pumps and other related supplies, including breast milk storage bags, cleaning supplies, nursing bras, creams and ointments, etc.

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AB 1701 expands the scope of resources and interventions provided under the Black Infant Health Program.

meals meet nutritional standards recommended by leading health experts. Additionally, SB 348 will maximize the federal Summer Electronic Benefit Transfer Program for Children nutrition benefits and build upon the federal program to further prevent childhood hunger during the summer.

AB 1731 (SANTIAGO): CURES DATABASE – BUPRENORPHINE

SB 357 (PORTANTINO): VEHICLES – PHYSICIAN & SURGEON REPORTING

Status: Signed by Governor (Chapter 144, Statutes of 2023)

Status: Two-Year Bill

AB 1731 will exempt a physician from having to consult the CURES database when they prescribe or furnish buprenorphine in the emergency department of a hospital. The administration of buprenorphine in an emergency department must be done in the most efficient and timely manner to save a patient’s life. While the CURES database is an extremely valuable clinical tool to ensure the safe prescribing of opioids, consultation in an emergency department where a patient is experiencing an overdose can delay and inhibit a health care worker from administering life-saving treatment. This bill ensures that patients who need buprenorphine to save their lives can get the treatment as fast as possible.

SB 357 seeks to remove outdated language from the Vehicle Code that discriminates against specific conditions, including epilepsy, and to protect the patient-physician relationship by giving physicians greater discretion when reporting patients that experience lapses of consciousness to the Department of Motor Vehicles.

AB 1701 (WEBER): BLACK INFANT HEALTH – CALIFORNIA PERINATAL EQUITY INITIATIVE

Status: Signed by Governor (Chapter 154, Statutes of 2023)

SB 2 (PORTANTINO): FIREARMS

Status: Signed by Governor (Chapter 249, Statutes of 2023)

SB 2 will strengthen the state’s existing concealed carry laws by developing new requirements for gun licensure applicants and renewals. Most notably, the bill increases the minimum age for a licensee to 21 years of age and develops a training program applicants must complete before receiving a license.

SB 43 (EGGMAN): BEHAVIORAL HEALTH

Status: Signed by Governor (Chapter 637, Statutes of 2023)

SB 43 will update the definition of “gravely disabled” to include a new focus on preventing serious physical and mental harm stemming from a person’s inability to provide for their needs for nourishment, personal or medical care, or shelter, or to attend to self-protection or personal safety, due to their mental health condition or substance use disorder.

SB 119 (COMMITTEE ON BUDGET & FISCAL REVIEW): MEDI-CAL: MANAGED CARE ORGANIZATION TAX

Status: Two-Year Bill – Referred to Budget Committee

SB 119 was this year’s budget trailer bill that contained the MCO Tax proposal that was successfully negotiated by CMA. The proposal will provide over $2 billion annually for Medi-Cal rate increases and provide new residency slots.

OPPOSE AB 236 (HOLDEN): HEALTH CARE COVERAGE – PROVIDER DIRECTORIES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

This bill would have required health plans to annually audit and meet accuracy standards for the provider information on their network directories and would have required a health plan to remove a provider from the directory if the plan has not compensated the provider for at least five claims in a year. The measure did not minimize the compliance burden on physician practices by failing to clarify that the burden to maintain accurate provider directories is the sole responsibility of the health plan. CMA was successful in holding the bill this year and will work constructively with the author to address the issue of inaccurate provider directories.

AB 616 (RODRIGUEZ): MEDICAL GROUP FINANCIAL TRANSPARENCY ACT

Status: Vetoed by Governor

AB 616 would have required audited financial reports and financial statements from medical groups to be released to the public on the HCAI website. AB 616 would have erased critical antitrust and privacy laws that have protected patient access to high-quality, cost-efficient care and would have hindered the ability of physician groups to recruit providers and employees into rural and low-income communities.

SB 348 (SKINNER): PUPIL MEALS

AB 1036 (BRYAN): HEALTH CARE COVERAGE – EMERGENCY MEDICAL TRANSPORT

Status: Signed by Governor (Chapter 600, Statutes of 2023)

Status: Two-Year Bill

SB 348 will ensure children attending public or charter schools have access to free breakfast and lunch and that the

AB 1036 required a physician to certify in the treatment record whether an “emergency medical condition” existed

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for every single patient that was transported to the hospital by an ambulance. This bill would have created an enormous administrative burden on emergency room physicians and exposed them to unwarranted liability.

AB 1091 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2023

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1091 would prohibit health plans and insurers from steering patients to another provider or facility or require the plan or insurer to contract with other providers or facilities that are affiliated with the original provider/facility and would essentially codify the court case involving Sutter and exclusive contracting. The bill would require a medical group, hospital or hospital system, health care service plan, health insurer or pharmacy benefit manager (all defined very broadly) to provide written notice to the Attorney General (AG) before entering into an agreement to make a material change to the entity’s organizational structure/corporate structure with a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to or not consent to the agreement. If the AG does not consent to the agreement, the structural change/acquisition may not move forward.

AB 1094 (WICKS): DRUG & ALCOHOL TESTING – INFORMED CONSENT

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1094 would require health care providers to receive written and verbal consent from a pregnant or perinatal person or the person authorized to consent for a newborn before performing drug or alcohol tests.

AB 1180 (RODRIGUEZ): EMERGENCY MEDICAL SERVICES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 1180 would remove the existing requirement that the Emergency Medical Services Authority Director be a licensed physician or surgeon. The administration has claimed it has struggled to find qualified candidates under this requirement.

AB 1369 (BAUER-KAHAN): OUT-OF-STATE PHYSICIANS AND SURGEONS: TELEHEALTH – LICENSE EXEMPTION

Status: Signed by Governor (Chapter 837, Statutes of 2023)

AB 1369 allows for a physician or surgeon licensed in another state to provide care via telehealth, with the requirement that the patient has a life-threatening condition.

The author of this bill has a constituent who had trouble accessing a California physician for an undisclosed rare disease. They believe this bill will solve the issue by allowing access to out-of-state physicians through telehealth.

AB 1570 (LOW): OPTOMETRY – CERTIFICATION TO PERFORM ADVANCED PROCEDURES

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1570 would expand the scope of practice for optometrists to perform advanced surgical and laser procedures with minimal training. These procedures include corneal crosslinking and laser trabeculoplasty, among others. Under this bill, optometrists would qualify to perform these advanced procedures after completing only 43 various surgical eye procedures.

AB 1751 (GIPSON): OPIOID PRESCRIPTIONS – INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1751 would force physicians to inform patients about nonpharmacological treatments for pain, including chiropractic, acupuncture and mental health services.

Additionally, this bill would require physicians to provide redundant patient notifications and get patient signatures through a cumbersome informed consent process. Under this bill, the only exception to the above requirements would be a patient in hospice care. CMA was successful in ensuring this bill did not have the votes to be heard in its first policy committee.

SB 481 (NIELLO): PHYSICIANS & SURGEONS – SPECIALTY CERTIFICATIONS & PRACTICE

Status: Two-Year Bill – Referred to Senate B&P

SB 4841 would have required the Medical Board of California and the Osteopathic Medical Board of California to annually post a report regarding the number of physicians and their specialty statewide and by county.

CMA opposed this bill because this information is already publicly available and collected by other state departments.

Additionally, this bill would have created a new cost for both boards, directly resulting in a request for more funding.

CMA was successful in stopping this legislation.

SB 524 (CABALLERO): PHARMACISTS: FURNISHING PRESCRIPTION MEDICATIONS

Status: Two-Year Bill – Held in Senate Appropriations Committee

SB 524 would have authorized pharmacists to furnish and prescribe treatments for any positive test outlined in this bill.

This includes antibiotics for various illnesses, conditions, and diseases. Under this bill, physicians would have been removed from the patient care process if the patient chose to test and treat at a pharmacy. The California Retailers Association, including CVS, Walgreens and Rite Aid, were the sponsors of this bill. CMA was successful in stopping this legislation.

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SB 625 (NGUYEN): HEALING ARTS – PREGNANCY & CHILDBIRTH

Status: Two-Year Bill – Held in Senate Judiciary Committee

SB 625 would require the California Department of Public Health to get written consent from the parent of a minor if the minor’s blood sample is to be used for research purposes. This bill would also not allow a residual newborn screening specimen to be released for law enforcement or forensic database purposes. This bill would add unnecessary administrative burdens to physicians who frequently collect blood draws for the purposes of genetic disease detection, while also threatening the financial stability of the genetic screening program.

SB 779 (STERN): PRIMARY CARE CLINIC DATA MODERNIZATION ACT

Status: Signed by Governor (Chapter 505, Statutes of 2023)

SB 779 will require all clinics, including those exempt from licensing requirements, to report information to HCAI related to patient demographics; payor mix; assigned enrollees in the Medi-Cal program and the prospective payment system rate they receive; an expansive and detailed workforce report; all mergers and acquisitions the clinic/system took part in; a report of quality and equity measures per patient; and a report of the workforce development programs the clinic/ system participates in (such as residency programs, allied health care professions degree programs and behavioral health professional degree programs).

SB 784 (BECKER): HEALTH CARE DISTRICTS – EMPLOYMENT

Status: Two-Year Bill – Held in Senate Appropriations

SB 784 would create an exemption to the Ban on the Corporate Practice of Medicine (Corporate Bar) for health care districts and nonprofit corporations with a health care district as its sole corporate member that owns or controls a general acute care hospital. SB 784 does away with those patient protections and creates a permanent exemption to the Corporate Bar by allowing a health care district to employ physicians in their hospitals. The exemption contained in the bill would subject patient care decisions to the whims and pressures of financial or political interests.

SB 815 (ROTH): HEALING ARTS

Status: Signed by Governor (Chapter 294, Statutes of 2023)

SB 815 amends various sections of the Medical Practice Act; however, there were six priority issues CMA tackled: license fee increase, public member majority, lowered evidentiary standard, license revocation related to felony convictions, post-graduate training licenses and the Medical

Board of California’s financial reserves. CMA successfully reduced the proposed $487 fee increase (which would have been a nearly 60% increase) to $288 (a 33% increase).

Additionally, CMA successfully removed the public member majority board composition provision and the sections related to a lowered evidentiary standard. CMA ensured that the originally overly broad section related to licensure revocation for felony convictions was explicitly clarified with specific serious crimes.

SB 815 also expanded timelines and flexibility for postgraduate training licensure. This bill also establishes a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years until January 1, 2028.

NEUTRAL AB 242 (WOOD): CRITICAL ACCESS HOSPITALS – EMPLOYMENT

Status: Signed by Governor (Chapter 641, Statutes of 2023)

AB 242 removed the sunset date for a current pilot program allowing critical access hospitals to employ physicians directly, which was due to expire on January 1, 2024, thus making the program permanent. In 2016, AB 2024 (Wood) established the pilot program and required a report to be created by the Office of Statewide Health Planning and Development (now HCAI) to determine the usage and efficacy of the program and its impact on patient care.

AB 1005 (ALVAREZ): IN-HOME SUPPORTIVE SERVICES – TERMINAL ILLNESS DIAGNOSIS

Status: Two-Year Bill – Held in Senate Appropriations

AB 1005 would require a physician, upon diagnosing a patient with a terminal illness and before discharge, to disclose information about the In-Home Supportive Services program, including eligibility criteria and a physical application.

AB 1029 (PELLERIN): ADVANCED HEALTH CARE DIRECTIVE FORM

Status: Signed by Governor (Chapter 171, Statutes of 2023)

AB 1029 would have allowed an individual to declare a separate agent for mental health services on an Advanced Health Care Directive Form. Following conversations with CMA staff, the author substantially amended the bill to clarify the treatments a health care agent has the authority to consent to on behalf of the patient.

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AB 1070 (LOW): PHYSICIAN ASSISTANTS – PHYSICIAN SUPERVISION: EXCEPTIONS

Status: Signed by Governor (Chapter 827, Statutes of 2023)

AB 1070 originally would have removed any sort of cap on the number of physician assistants that a physician could manage as it relates to gathering patient information and performing health examinations for patients in the in-home health evaluation setting. CMA worked through a cumbersome negotiating process with the author and stakeholders on this legislation to ensure there is a cap of eight physician assistants to one supervising physician for the tasks outlined in the bill and that this bill is explicitly limited to in-home health evaluations.

AB 1286 (HANEY): PHARMACY

Status: Signed by Governor (Chapter 470, Statutes of 2023)

AB 1286 will give a pharmacist in charge the autonomy to make staffing decisions based on the pharmacy’s needs and the pharmacy staff’s condition, among other decisions unrelated to the practice of medicine. This bill originally allowed pharmacy technicians to perform Clinical Laboratory Improvement Amendments waived testing, administer vaccines and perform other duties if deemed qualified by the pharmacist in charge. However, CMA ensured that pharmacy technicians would have a severely limited ability to test or administer vaccines while also requiring them to be certified in basic life support.

AB 1341 (BERMAN): PUBLIC HEALTH – ORAL THERAPEUTICS

Status: Signed by Governor (Chapter 276, Statutes of 2023)

AB 1341 originally would have allowed for pharmacists to furnish U.S. Food and Drug Administration (FDA) authorized COVID-19 oral therapeutics after administering and confirming a positive test for COVID-19, with minimal parameters. CMA worked closely with the author throughout the legislative process to ensure a sunset date of January 1, 2025, was added for furnishing oral therapeutics and to require all pharmacists who are furnishing oral therapeutics for COVID-19 to follow FDA clinical guidelines.

SB 339 (WIENER): HIV PREEXPOSURE PROPHYLAXIS AND POSTEXPOSURE PROPHYLAXIS

Status: Two-Year Bill

SB 339 would allow pharmacists to indefinitely furnish a recurring 90-day supply of HIV preexposure prophylaxis without a prescription ever being issued. Existing law allows a pharmacist to furnish a 60-day supply of HIV preexposure prophylaxis every two years if certain criteria and documentation requirements are met. CMA ensured that a provision was added to explicitly clarify that this bill

cannot expand the scope of practice for a pharmacist related to furnishing PrEP and PEP. SB 525 (DURAZO): MINIMUM WAGES – HEALTH CARE WORKERS

Status: Signed by Governon (Chapter 890, Statutes of 2023)

This bill sets a $25 minimum wage for health care workers in virtually every health care setting and facility. Depending on the facility, location and practice size, the minimum wage will be increased incrementally to allow employers to adjust to the wage requirements. CMA negotiated exemptions for IPAs and small practices with 24 physicians or less as well as a gradual implementation of the increase.

The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525. Without a legislative deal, labor unions were planning on filing a statewide ballot initiative to require a $25 statewide minimum wage requirement starting in 2025 that would apply to all health care settings.

SB 667 (DODD): HEALING ARTS: PREGNANCY & CHILDBIRTH

Status: Signed by Governor (Chapter 497, Statutes of 2023)

SB 667 would have originally expanded the duties that a Certified Nurse Midwife (CNM) could perform, specifically allowing CNMs certain privileges related to furnishing and prescribing prescriptions; admitting and discharging patients on the CNM’s own authority; authorization to be a lab director of a birth center; and performing various minor surgical procedures, typically performed by physicians.

CMA successfully removed the ability for CNMs to prescribe Schedule II and III controlled substances unless there are mutually agreed upon policies and protocols with a physician.

SAVE THE DATE FOR CMA’S LEGISLATIVE ADVOCACY DAY! April 10, 2024 | Sacramento CMA will host its 50th annual Legislative Advocacy Day in Sacramento on Wednesday, April 10, 2024.

Attendees will have the opportunity to meet with legislators on priority health care issues. This unique event is free of charge to all CMA physician members, residents and medical students. Plan to join your colleagues as they prepare to lobby their legislative leaders and serve as champions for the house of medicine!

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