In 2023, Governor Newsom signed 890 bills into law and vetoed 156.
Sourcing from bill summaries produced by the California Medical Association (CMA) and CAP’s team of policy experts at Capitol Advocacy, here are some of the more significant healthcare laws affecting physicians:
AB 118 (Committee on Budget) Budget Act of 2023: Health.
SUMMARY: For dates of service no sooner than January 1, 2024, or on the effective date of any necessary federal approvals, whichever is later, requires the reimbursement rates for primary care services, obstetric care services, doula services, and certain outpatient mental health services to be the greater of 87.5% of the lowest maximum allowance established by the federal Medicare Program for the same or similar services or the level of reimbursement. Requires the Department of Managed Health Care to annually review and revise the reimbursement rates, and to develop and implement a methodology for establishing rates or payments for the services. Payments would be supported by the managed care organization provider tax revenue or other state funds appropriated to the department as the state share for this purpose, including, but not limited to, funds transferred to the Medi-Cal Provider Payment Reserve Fund, and to the Healthcare Treatment Fund under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016. Requires each Medi-Cal managed care plan to reimburse a network provider furnishing those services at least the amount the network provider would be paid for those services in the Medi-Cal fee- for-service delivery system.
AB 119 (Committee on Budget) Medi-Cal: Managed Care Organization (MCO) Provider Tax.
SUMMARY: Medi-Cal services are provided pursuant to contracts with various types of managed care plans. The bill would restructure the MCO provider tax, with certain modifications to the above-described provisions, including changes to the taxing tiers and tax amounts, for purposes of the tax periods of April 1, 2023, through December 31, 2023, and the 2024, 2025, and 2026 calendar years. The bill would create the Managed Care Enrollment Fund to replace the Health Care Services Special Fund. Under the bill, moneys deposited into the fund would, upon appropriation, be available to the department for the purpose of funding the following subcomponents to support the Medi-Cal program: (1) the nonfederal share of increased capitation payments to Medi-Cal managed care plans; (2) the nonfederal share of Medi-Cal managed care rates for health care services; and (3) transfers to the Medi-Cal Provider Payment Reserve Fund, as established pursuant to specified provisions.
AB 470 (Valencia D) Continuing Medical Education: Physicians and Surgeons.
SUMMARY: Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of physicians and surgeons. Existing law requires the board to adopt and administer standards for the continuing education of physicians and surgeons.
This bill would specify that these educational activities may also include activities that are designed to improve the quality of physician patient communication.
AB 571 (Petrie-Norris D) Medical Malpractice Insurance.
SUMMARY: Existing law defines “liability insurance” to include, among other things, insurance coverage against the legal liability of the insured, and against loss, damage, or expense incident to a claim arising out of the death or injury of any person as the result of negligence or malpractice in rendering professional services by any person who holds a certificate or license issued pursuant to the Medical Practice Act or the Osteopathic Initiative Act, or a license as a community clinic or health facility, as specified. This bill would prohibit an insurer from refusing to issue or renew or terminating professional liability insurance for health care providers, as specified, and from imposing a surcharge or increasing the premium or deductible solely based on any prohibited bases for discrimination, including a health care provider offering or performing abortion, contraception, gender-affirming health care, or care related to those health care services that are lawful in this state but unlawful in another state.
AB 816 (Haney D) Minors: Consent to Medical Care.
SUMMARY: Existing law authorizes a minor who is 12 years of age or older to consent to medical care and counseling relating to the diagnosis and treatment of a drug- or alcohol-related problem. Existing law exempts replacement narcotic abuse treatment, as specified, from these provisions.
This bill would authorize a minor who is 16 years of age or older to consent to replacement narcotic abuse treatment that uses buprenorphine at a physician’s office, clinic, or health facility, by a licensed physician and surgeon or other health care provider, as specified, whether or not the minor also has the consent of their parent or guardian. The bill would authorize a minor 16 years of age or older to consent to any other medications for opioid use disorder from a licensed narcotic treatment program as replacement narcotic therapy without the consent of the minor’s parent or guardian only if, and to the extent, expressly permitted by federal law.
AB 1070 (Low D) Physician Assistants: Physician Supervision: Exceptions.
SUMMARY: Existing law, the Physician Assistant Practice Act, establishes the Physician Assistant Board within the jurisdiction of the Medical Board of California for the licensure and regulation of physician assistants. The act authorizes physician assistants to perform medical services as set forth by regulations and the act when those services are rendered pursuant to a practice agreement and under the supervision of a licensed physician and surgeon. Existing law prohibits a physician and surgeon from supervising more than 4 physician assistants at any one time.
This bill would also authorize a physician and surgeon to supervise up to 8 physician assistants at one time if all of the physician assistants are focused solely on performing in-home health evaluations to gather patient information and perform annual wellness visits or health evaluations that do not involve direct patient treatment or prescribing medication.
AB 1286 (Haney D) Pharmacy.
SUMMARY: Existing law authorizes the California State Board of Pharmacy to appoint an executive officer to exercise the powers and perform the duties delegated by the board. A violation of the Pharmacy Law is a crime. This bill would authorize a pharmacist-in-charge to make staffing decisions to ensure sufficient personnel are present in the pharmacy to prevent fatigue, distraction, or other conditions that may interfere with a pharmacist’s ability to practice competently and safely. The bill would authorize a pharmacist on duty, if the pharmacist-in-charge is not available, to adjust staffing according to workload if needed. The bill would require a pharmacist-in-charge or pharmacist on duty to immediately notify store management of any conditions that present an immediate risk of death, illness, or irreparable harm to patients, personnel, or pharmacy staff. The bill would require store management to take immediate and reasonable steps to address and resolve those conditions, and, if those conditions are not resolved within 24 hours, would require the pharmacist-in-charge or pharmacist on duty to ensure the board is notified. The bill would require the executive officer, upon a reasonable belief that conditions within a pharmacy exist that present an immediate risk of death, illness, or irreparable harm to patients, personnel, or pharmacy staff, to issue a cease-and-desist order, as specified. The bill would make a failure to comply with the cease-and-desist order unprofessional conduct for a pharmacy corporation.
AB 1557 (Flora R) Pharmacy: Electronic Prescriptions.
SUMMARY: Existing law establishes in the Department of Consumer Affairs the California State Board of Pharmacy to license and regulate the practice of pharmacy. The Pharmacy Law authorizes a prescriber or a prescriber’s authorized agent to electronically enter a prescription into a pharmacy’s or hospital’s computer from a location outside of the pharmacy or hospital. The Pharmacy Law makes those provisions inapplicable to prescriptions for controlled substances classified in Schedule II, III, IV, or V, except as permitted pursuant to specified provisions. That law generally punishes a knowing violation of its provisions as a misdemeanor. This bill would delete the provision, making the authorization to electronically enter a prescription inapplicable to controlled substances. The bill would also authorize a pharmacist located and licensed in the state to, on behalf of a licensed health care facility, from a location outside of the facility, verify medication chart orders for appropriateness before administration consistent with federal requirements, as established in the health care facility’s policies and procedures. The bill would require a health care facility to maintain a record of a pharmacist’s verification of a medication chart order pursuant to that provision, as specified. By expanding the scope of the crime of violating the Pharmacy Law, this bill would impose a state-mandated local program.
SB 525 (Durazo D) Minimum Wages: Health Care Workers.
SUMMARY: Establishes minimum wage schedules for covered health care employees, as defined, depending on the nature of the employer. Physician groups with fewer than 25 physicians are excluded. For any covered health care facility employer, as defined, with 10,000 or more full-time equivalent employees (FTEE), as defined, any covered health care facility employer that is a part of an integrated health care delivery system or a health care system with 10,000 or more FTEEs, a covered health care facility employer that is a dialysis clinic or is a person that owns, controls, or operates a dialysis clinic, or a covered health facility owned, affiliated, or operated by a county with a population of more than 5,000,000 as of January 1, 2023, require the minimum wage for covered health care employees to be $23 per hour from June 1, 2024, to May 31, 2025, inclusive, $24 per hour from June 1, 2025, to May 31, 2026, inclusive, and $25 per hour from June 1, 2026, and until as adjusted as specified.
SB 345 (Skinner D) Healthcare Services: Legally Protected Healthcare Activities.
SUMMARY: Existing law makes specified actions by licensed health care providers’ unprofessional conduct and, in certain cases, a criminal offense. This bill would prohibit a healing arts board, as defined, from denying an application for a license or imposing discipline upon a licensee or health care practitioner on the basis of a civil judgment, criminal conviction, or disciplinary action in another state if that judgment, conviction, or disciplinary action is based solely on the application of another state’s law that interferes with a person’s right to receive sensitive services, as defined, that would be lawful if provided in this state, regardless of the patient’s location. The bill would further provide that the performance, recommendation, or provision of a legally protected health care activity by a licensee or health care practitioner acting within their scope of practice for a patient who resides in a state in which the performance, recommendation, or provision of that legally protected health care activity is illegal, does not, by itself, constitute professional misconduct, upon which discipline or other penalty may be taken.
SB 385 (Atkins D) Physician Assistant Practice Act: Abortion by Aspiration: Training.
SUMMARY: The Physician Assistant Practice Act establishes the Physician Assistant Board to license and regulate physician assistants. Existing law makes it a crime to perform an abortion without holding a license to practice as a physician and surgeon, or without holding a specified license or certificate under the Physician Assistant Practice Act that authorizes the holder to perform specified functions necessary for an abortion in the first trimester of pregnancy. The act requires a physician assistant to complete training and comply with certain protocols, as specified, to receive authority from the physician assistant’s supervising physician and surgeon to perform an abortion by aspiration techniques.
This bill would revise the training requirements to instead require a physician assistant to achieve clinical competency by successfully completing requisite training, as described, in performing an abortion by aspiration techniques. The bill would set forth what types of training qualify. The bill would remove the requirement that a physician assistant follow certain protocols to receive authority from the physician assistant’s supervising physician and surgeon to perform an abortion by aspiration techniques.
SB 667 (Dodd D) Healing Arts: Pregnancy and Childbirth.
SUMMARY: Existing law authorizes a certified nurse-midwife to practice with a physician and surgeon under mutually agreed-upon policies and protocols, as specified, to provide a patient with care outside of that scope of services or to provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium. This bill would revise and recast those provisions to, among other things, authorize a certified nurse-midwife, pursuant to policies and protocols that are mutually agreed upon with a physician and surgeon, as specified, to provide a patient with care outside of that scope of services, to provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium, or to furnish or order a Schedule II or III controlled substance, as specified. The bill would include care for common gynecologic conditions, as specified, in the scope of services a certified nurse-midwife is authorized to perform without policies and protocols that are mutually agreed upon with a physician and surgeon. The bill would additionally authorize a general acute care hospital, as defined, or a special hospital specified as a maternity hospital, as defined, to grant privileges to a certified nurse-midwife, allowing them to admit and discharge patients upon their own authority if in accordance with organized medical staff bylaws of that facility and within the nurse-midwife’s scope of practice.
For more information:
CMA Summary: Click to View
Capitol Advocacy Summary: www.CAPphysicians.com/AdvocacySummary
Gabriela Villanueva is CAP’s Government and External Affairs Analyst. Questions or comments related to this article should be directed to GVillanueva@CAPphysicians.com.