SFMMS BOARD SETS 2023 LEGISLATIVE PRIORITIES

Every year, state legislators introduce thousands of bills addressing all topics of law. Several hundred pieces of legislation relate to health care. The California Medical Association (CMA) and your SFMMS staff review each bill to analyze how it might affect your patients and practice. The SFMMS Board met recently to decide which state legislation to act on, and of those bills, which would be a focal point of SFMMS advocacy. Below is a list of state bills SFMMS will support, the first three of which have been identified as top SFMMS priorities.

In the following bill descriptions, you will find quotes from SFMMS physician leaders about why the three bills SFMMS has prioritized for action are important to their practices.

AB 816 (Haney) Minors: consent to medical care

This bill allows a minor who is 16 years of age or older to consent to replacement narcotic abuse treatment that uses buprenorphine, while maintaining the requirement that the professional person providing the treatment shall include the parent in the treatment plan, unless the professional determines it would be inappropriate.

AB 816 (Haney) – Jayme Congdon, MD, MS, FAAP, General Pediatrician and Health

Services Researcher, San Francisco, CA

As a pediatrician, I consistently make every effort to engage families in the care of my patients. This is especially true with substance use disorders, for which parental involvement in recovery has been shown to improve treatment outcomes. However, for patients without an available or supportive caregiver (e.g., unhoused youth), or for those unwilling to disclose their substance use to caregivers, parental consent should not be a barrier to safe and effective care. Just one example is CB, a 17-year-old daily fentanyl user. She came in for treatment with her mother, a single parent who was already in treatment for opioid use disorder. Before CB’s outpatient appointment, her mother relapsed and left their home, and CB was left to care for herself and her younger siblings. CB could not receive ongoing treatment without parental consent, per California law. Without access to treatment, CB ultimately relapsed as well. AB 816 will ensure this unnecessary outcome does not occur again.

AB 1644 (Bonta) Medi-Cal: medically supportive food and nutrition services.

Makes medically supportive food and nutrition intervention plans, as defined, a covered benefit under the Medi-Cal program.

Adam Francis, CAE

AB 1644 (Bonta) – Melanie Thompson, DO – Chief Medical Officer, Marin Community Clinics

Too often, as a primary care physician I see the fallout when patients are discharged from the hospital with a scary, new diagnosis or are grappling with a chronic disease, in which diet plays a key role. Early on in my practice, I had a very young patient diagnosed with kidney failure who ended up requiring dialysis. I remember trying to explain how the eventual outcome would likely be a kidney transplant and provided a list of very common foods to avoid or the patient could become terribly sick and possibly die. My patient eventually quit school because she was so overwhelmed, and her parents struggled to understand and care for her. When I think of that family, I can’t help but wonder if her difficulties would have been lessened if AB 1644 had already been in place. One of my patients with diabetes never knew what cottage cheese was until he attended our diabetes group! Imagine how others must feel when we print out a list and make assumptions that a trip to the grocery store might be so simple. It is past time that we recognize food as medicine and like any medicine that is critical for the management of a disease, it should be a covered benefit for our most vulnerable. AB 1644 is an innovative way to provide some of those key supports.

SB 70 (Wiener) Prescription drug coverage. Ensures insurance coverage for a prescription drug that is prescribed appropriately for off-label use.

SB 70 (Wiener) – Haining Yu, MD, MPH –Child & Adolescent Psychiatry, San Francisco, CA

As we continue to face a youth mental health crisis, it’s clear that mental health treatments, including medications, are lifesaving and lifechanging, particularly for children and adolescents facing anxiety and depression. However, of the seven SSRIs that are approved for use in the U.S., only two (Fluoxetine for 8 and up, Escitalopram for 12 and up) are approved by the FDA to treat depression for patients under 18 years of age. Of the 10 other common non-SSRI antidepressants (often used for patients who do not respond to or cannot tolerate a first line SSRI), none are approved for use to treat depression in patients under 18 years of age. SB 70 helps address this by lowering common hurdles that I face in my practice as a child and adolescent psychiatrist. This legislation helps ensure that insurances are not limiting which formulation of a medication is covered for patients. My patient Katie has significant anxiety and OCD which makes it difficult for her to swallow pills. The process of getting approved for liquid fluox- etine led to unnecessary interruptions in getting the medication that she needed in a formulation that she could actually use. My patient Dan experienced significant side effects on both fluoxetine and escitalopram, and had to deal with insurance push back when we wanted to try another commonly used antidepressant. SB 70 ensures these patients and many more in my practice do not face bureaucratic barriers to life-saving medications.

AB 470 (Valencia) Continuing medical education: physicians and surgeons.

This CMA-sponsored bill allows continuing medical education (CME) requirements to include courses that are designed to improve the quality of physician-patient communication through culturally and linguistically competent education.

AB 571 (Petrie-Norris) Medical malpractice insurance.

This CMA-sponsored bill ensures licensed medical providers have access to professional liability insurance coverage without discrimination for providing abortion care, contraception and gender affirming care.

AB 620 (Connolly) Health care coverage for metabolic disorders.

Extends health plan coverage for medical nutrition therapies that benefit pediatric patients (children) who may not be able to use, or are sensitive to, certain medications.

AB 765 (Wood) Truth in Advertising: medical specialty titles.

This CMA-sponsored bill ensures health care consumers are not mislead or deceived into believing their health care provider is a physician or surgeon by preventing non-physician health care providers from using terms like “-ologist" or "surgeon" or “medical doctor” or other similar combination of “physicianequivalent” titles.

AB 815 (Wood) Health care coverage: provider credentials.

This CMA-sponsored bill requires the California Health and Human Services Agency to create and maintain a provider credentialing board, with specified membership, to certify private and public entities for purposes of credentialing physicians and surgeons and other health care providers in lieu of a health care service plan’s or health insurer’s credentialing process. A health care service plan or health insurer, or its delegated entity, would be required to accept a valid credential from a board-certified entity without imposing additional criteria requirements and to pay a fee to a board-certified entity based on the number of contracted providers credentialed through the board-certified entity.

AB 864 (Haney) Substance use disorder: telephone system.

This bill would create a 3-digit phone number to a statemanaged crisis center that gives public health information on the prevention of drug overdoses, advice for family members and people experiencing drug addiction, and referrals to substance use disorder treatment.

AB 935 (Connolly) Tobacco sales: flavored tobacco ban.

Existing law makes selling flavored tobacco punishable as an infraction. This bill makes it punishable by civil penalties in the same manner as the STAKE Act.

SB 90 (Wiener) Health care coverage: insulin affordability.

Prohibits a deductible for insulin or imposing a copayment of more than $35 for a 30-day supply for a high deductible health plan.

SB 487 (Atkins) Abortion: provider protections.

This CMA-sponsored bill protects California health care providers from automatic suspension from the Medi-Cal program if they are suspended from a Medicaid program in another state as a result of providing health care services that are legal in California. It will also prohibit health insurers from discriminating against or refusing to contract with a health care provider who may have been sanctioned in another state as a result of providing health care services that are prohibited or restricted in that state, but are legal in California. SB 487 also strengthens civil protections and provides additional safeguards for California abortion providers and other entities and individuals that serve and support abortion patients that reside in states with hostile abortion laws.

SB 582 (Becker) Health records: EHR vendors.

This CMA-sponsored bill requires the state entity regulating physician compliance with data exchange regulations 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. These changes will allow regulators to crack down on exorbitant pricing schemes and guarantee that physicians are not hampered in complying by vendor practices.

SB 598 (Skinner) Health care coverage: prior authorization.

This CMA-sponsored bill requires health plans to create exemption programs that allow physicians who are practicing within the plan's criteria 90% of the time to receive a one-year exemption from the plan's prior authorization requirements. Additionally, the legislation will give a treating physician the right to have an appeal of a prior authorization denial conducted by a physician peer of the same or similar specialty. (Delegated physician groups would be exempt from these requirements, meaning the legislation will only apply to health plans.)

SB 634 (Becker) Low Barrier Navigation Center: opportunity housing

Streamlines the process to create an "opportunity housing project," which is a project that provides non-congregate housing which is relocatable, and reserved for one or more target populations (i.e., tiny houses for underserved homeless populations).