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Legislative
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California ACEP’s advocates work tirelessly each day to ensure that the interests of emergency physicians and their patients are protected and promoted in the Legislature. Over its nearly forty-year advocacy history, California ACEP has sponsored numerous pieces of legislation which have protected patients and directed millions of needed dollars into California’s emergency care safety net. On issues ranging from Injury and Illness Prevention to Emergency Medical Services to Reimbursement and more, California ACEP’s impressive legislative record is among the most successful in the house of medicine.

 

 
2018 Legislative Accomplishments
 
Sponsored
  • Budget Request: State-Funded Certified Drug and Alcohol Counselors in EDs
    California ACEP requested the State to provide $20 million for a grant program to place alcohol and drug counselors in emergency departments (ED) throughout the state. Unfortunately, our precise proposal was left out of the final budget deal made with the Governor. However, sometimes ideas floated in the public policy arena take shape in different ways. We are pleased to report this is the case with our alcohol and drug counselor proposal. The State recognizes the important role emergency medicine can play in getting patients the treatment they need and has allocated $15 million in funding for use in up to 30 emergency departments. The funding will be administered through the Public Health Institute’s California Bridge Program to increase access to evidence-based treatment for substance use disorders.
  • Budget Request: Ensure Emergency Medicine Receives Prop 56 GME Funding
    California ACEP ensured the $40 million in Proposition 56 funds for GME for emergency physicians and primary care physicians was properly allocated. You may recall, last year the money was not used to augment GME programs. This year we were successful in having the funds allocated correctly to GME programs. This is a great victory for emergency medicine residency programs, enabling them to expand the number of residency slots in California. The $40 million in Prop. 56 funding will be administered by Physicians for a Healthy California (PHC) through a new grant program, CalMedForce, which will award funding to primary care and emergency medicine residency programs in California.  $7.6 million is dedicated to emergency medicine.
  • AB 2983 (Arambula) – Voluntary psychiatric care
    AB 2983 was signed into law and will take effect January 1, 2019.  Hospitals can no longer require patients voluntarily seeking mental health services in the ED to be placed on a 5150 for purposes of transferring them to another facility.  You will need to document written consent by the patient for treatment and transfer, but a patient who is voluntarily seeking treatment, and is not a danger to themselves or others or gravely disabled as a result of a mental health disorder, should no longer be placed on a 5150 in order to be transferred.
  • AB 2099 (Gloria) – Mental health: 5150 Forms
    AB 2099 was signed into law and will take effect January 1, 2019.  In some counties, patients have been denied care because their accompanying 5150 form was not an original. The law is silent on whether this is required which has led to inconsistent interpretations among counties. This is a dated practice in an age where electronic signatures are widely accepted as binding and secure for various legal documents and medical purposes including prescribing. Original signature requirements add additional time and bureaucracy into the process of helping someone receive urgently needed mental health care. AB 2099 clarifies that a copy of a 5150 form is valid.
Priority Bills Opposed
  • AB 3087 (Kalra) – Price Caps on Healthcare Services
    AB 3087 sought to create inflexible, government-managed price caps on commercial insurance payments. Despite capping payments to providers and hospitals, this bill did nothing to ensure that patient out-of-pocket costs would be decreased. This simplistic approach to health care cost-containment dramatically threatens access to care for patients and disproportionately impacts emergency medicine. Emergency physicians rely on the payments from the roughly one-third of patients they treat who are commercially insured to make up for the loss in payments from the rest of the patients they care for. Unlike other physicians who can adjust their payer mix to ensure financial viability, emergency physicians must treat every patient. The payment caps AB 3087 sought to impose on emergency physicians cannot be absorbed elsewhere or passed on in costs to others, and therefore directly impact our ability to adequately staff EDs. This bill did not pass the legislature.

  • SB 1152 (Hernandez) – Hospital Discharge of Homeless Patients 
    In an effort to address some high-profile cases of homeless patients being discharged in hospital gowns and transferred to shelters in distant cities which were unable to accept the patients, SB 1152 sought to dramatically restrict the ability of hospitals to discharge homeless patients.  When introduced, this bill would have made it nearly impossible to discharge a homeless patient from your emergency department. For example, one of the many requirements was that a homeless patient be “permitted to remain in the facility for the time necessary to ensure that he or she is released during daytime hours where the receiving social services or other agency is open and available to receive the patient.” The bill originally also impacted your ability to discharge homeless patients based on your clinical determination. Neither of those requirements remain. We worked extensively with the author’s office and sponsors to amend the bill and California ACEP was able to obtain a number of amendments to limit the number of requirements on treating physicians, as well as soften the impact on your ED. The bill was signed into law and most provisions become effective January 1, 2019.

 

Other Bills of Interest
  • Community Paramedicine Scope of Practice Expansion
    California ACEP has been heavily involved in an effort by hospitals and EMS providers dating back to 2014 which seeks to expand paramedic scope practice.  This effort began with a pilot of 17 different projects ranging from transporting 911 callers to alternate destinations, to allowing paramedics to make home visits to provide care such as directly observed TB therapy and hospice care.  Two pieces of legislation were introduced in 2018 to permanently allow this scope expansion. Ensuring patient safety continues to be a priority for California ACEP.  We opposed AB 1795 (Gipson) because, among other things, it would have allowed patients to be transported to unlicensed sobering centers and did not contain EMTALA protections.  On the other hand, SB 944 (Hertzberg) contains those and other necessary patient safety protections, and California ACEP supported this measure.  The same was true for a later amended AB 3115 (Gipson).  Both AB 1795 and SB 944 did not pass the Legislature.  AB 3115 passed the Legislature but was vetoed by the Governor.
  • Legislating the Practice of Medicine
    There were numerous bills introduced in 2018 which sought to substitute the opinion of the legislature for that of practicing physicians. Most of the efforts in 2018 related to restricting the judgment of physicians around opioid prescribing. Another group of bills sought to mandate specific CME courses. California ACEP is opposed to all such legislation.
Historical Successes
Featured Members
Chi L. PerlrothMeet California ACEP's President Dr. Chi Perlroth!
Lori D. WinstonMeet California ACEP's Secretary Dr. Lori Winston!

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