Bill Text: CA SB359 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Hospital billing: emergency services and care.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2012-09-30 - In Senate. Consideration of Governor's veto pending. [SB359 Detail]

Download: California-2011-SB359-Amended.html

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BILL NUMBER: SB 359	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JANUARY 4, 2012

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 15, 2011

    An act to add Article 5.7 (commencing with Section 14186)
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal.   An act to amend Sections
113953.3 and 113973 of, and to add Section 113975 to, the Health and
Safety Code, relating to food facilities. 


	LEGISLATIVE COUNSEL'S DIGEST


   SB 359, as amended, Hernandez.  Medi-Cal: ground ambulance
rates.   Food facilities: hand washing.  
   Existing law, the California Retail Food Code, establishes uniform
health and sanitation standards for retail food facilities, as
defined. The law requires the State Department of Public Health to
adopt regulations to implement and administer those provisions, and
delegates primary enforcement duties to local health agencies. A
violation of any of these provisions is punishable as a misdemeanor.
 
   The code requires food employees to report to the person in charge
of a food facility when a food employee has a lesion or wound that
is open or draining unless specified conditions to cover or protect
the lesion are met. The code requires all employees to wash their
hands in specified instances, including before donning gloves for
working with food.  
   The code also requires gloves to be worn when contacting food and
food-contact surfaces under specified conditions, including when the
employee has any cuts, sores, or rashes. Gloves are required to be
changed, replaced, or washed as often as hand washing is required.
 
   This bill would require hands to be washed before initially
donning gloves and before donning gloves after specified instances
where gloves were required to be changed or replaced. The bill would
prohibit single-use gloves from being washed. The bill would also
prohibit an employee who has a lesion or wound that is open or
draining from handling food and would require a food employee who has
any cuts, sores, rashes, lesions, or wounds to cover or protect the
lesion, as specified. By imposing new duties upon local agencies and
expanding the definition of a crime, this bill would impose a
state-mandated local program.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that with regard to certain mandates no
reimbursement is required by this act for a specified reason. 

   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above. 

   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which health care services, including medical transportation
services, are provided to qualified low-income persons. The Medi-Cal
program is partially governed and funded under federal Medicaid
provisions. Existing law and regulations prescribe various
requirements governing payment policies and reimbursement rates for
these services.  
   This bill would require the department, by July 1, 2012, to adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services using one of 2 specified methodologies. 

   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program:  no   yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 113953.3 of the  
Health and Safety Code   is amended to read: 
   113953.3.  (a) Except as specified in subdivision (b), all
employees shall thoroughly wash their hands and that portion, if any,
of their arms exposed to direct food contact with cleanser and warm
water by vigorously rubbing together the surfaces of their lathered
hands and arms for at least 10 to 15 seconds and thoroughly rinsing
with clean running water followed by drying of cleaned hands and that
portion, if any, of their arms exposed. Employees shall pay
particular attention to the areas underneath the fingernails and
between the fingers. Employees shall wash their hands in all of the
following instances:
   (1) Immediately before engaging in food preparation, including
working with nonprepackaged food, clean equipment and utensils, and
unwrapped single-use food containers and utensils.
   (2) After touching bare human body parts other than clean hands
and clean, exposed portions of arms.
   (3) After using the toilet room.
   (4) After caring for or handling any animal allowed in a food
facility pursuant to this part.
   (5) After coughing, sneezing, using a handkerchief or disposable
tissue, using tobacco, eating, or drinking.
   (6) After handling soiled equipment or utensils.
   (7) During food preparation, as often as necessary to remove soil
and contamination and to prevent cross-contamination when changing
tasks.
   (8) When switching between working with raw food and working with
ready-to-eat food. 
   (9) Before donning gloves for working with food. 

   (10) 
    (9)  Before dispensing or serving food or handling clean
tableware and serving utensils in the food service area. 
   (11) 
    (10)  After engaging in other activities that
contaminate the hands. 
   (11) Before initially donning gloves for working with food and
before donning gloves to replace gloves that were changed or replaced
due to the circumstances described in paragraphs (2) to (10),
inclusive. 
   (b) If approved and capable of removing the types of soils
encountered in the food operations involved, an automatic handwashing
facility may be used by food employees to clean their hands.
   SEC. 2.    Section 113973 of the   Health
and Safety Code   is amended to read: 
   113973.  (a) Gloves shall be worn when contacting food and
food-contact surfaces if the employee has any cuts, sores, rashes,
artificial nails, nail polish, rings (other than a plain ring, such
as a wedding band), uncleanable orthopedic support devices, or
fingernails that are not clean, smooth, or neatly trimmed.
   (b) Whenever gloves  , except single-use gloves,  are
worn, they shall be changed, replaced, or washed as often as
handwashing is required by this part.
   (c) If  single-use   gloves are  used,
single-use gloves shall be used for only one task, such as working
with ready-to-eat food or with raw food of animal origin, used for no
other purpose, and shall be discarded when damaged or soiled, or
when interruptions in the food handling occur.  Single-use gloves
shall not be washed. 
   (d) Except as specified in subdivision (e), slash-resistant gloves
that are used to protect the hands during operations requiring
cutting shall be used only with food that is subsequently cooked as
specified in Section 114004, such as frozen food or a primal cut of
meat.
   (e) Slash-resistant gloves may be used with ready-to-eat food that
will not be subsequently cooked if the slash-resistant gloves have a
smooth, durable, and nonabsorbent outer surface or if the
slash-resistant gloves are covered with a smooth, durable,
nonabsorbent glove, or a single-use glove.
   (f) Cloth gloves may not be used in direct contact with food
unless the food is subsequently cooked.
   SEC. 3.    Section 113975 is added to the 
Health and Safety Code   , to read:  
   113975.  (a) Except as provided in subdivision (b), an employee
who has a lesion or wound that is open or draining shall not handle
food.
   (b) In addition to wearing gloves when contacting food and
food-contact surfaces, a food employee who has a cut, sore, rash,
lesion, or wound shall do all of the following:
   (1) If the lesion is located on the hand or wrist, an impermeable
cover, such as a finger cot or stall shall protect the lesion. A
single-use glove shall be worn over the impermeable cover.
   (2) If the lesion is located on exposed portions of the arms, an
impermeable cover shall protect the lesion.
   (3) If the lesion is located on other parts of the body, a dry,
durable, tight-fitting bandage shall cover the lesion. 
   SEC. 4.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution for certain costs that may be incurred by a local agency
or school district because, in that regard, this act creates a new
crime or infraction, eliminates a crime or infraction, or changes the
penalty for a crime or infraction, within the meaning of Section
17556 of the Government Code, or changes the definition of a crime
within the meaning of Section 6 of Article XIII B of the California
Constitution.  
   However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.  
  SECTION 1.   The Legislature finds and declares
all of the following:
   (a) The State Department of Health Care Services is required to
adhere to the current regulations establishing Medi-Cal payment rates
for ground ambulance services and the department is currently not in
compliance with those regulations.
   (b) Regarding Medi-Cal payment rates for ground ambulance
services, the State Plan under Title XIX of the federal Social
Security Act for the State of California requires that reimbursement
for each of the other types of care or service listed in Section
1396d of Title 42 of the United States Code that are included in the
program under the plan will be at the lesser of usual charges or the
limits specified in Article 7 (commencing with Section 51501) of
Chapter 3 of Division 3 of Title 22 of the California Code of
Regulations.
   (c) In establishing the evidentiary base, the Ninth Circuit Court
of Appeals has ordered the department to consider the costs of
providing the service.
   (d) Current law requires ground ambulance services provided to
state prison inmates to be reimbursed at the maximum rate of 120
percent of the Medicare Ambulance Fee Schedule (Sec. 5023.5, Pen.
C.).
   (e) Current law requires ground ambulance services provided under
the state workers compensation program to be reimbursed at the
maximum rate of 120 percent of the Medicare Ambulance Fee Schedule (8
Cal. Code Regs. 9789.70).
   (f) Emergency medical services systems are a critical safety net
service relied upon by the entire California population.
   (g) Ninety percent of Medi-Cal ground ambulance transports are
emergencies. Ground ambulance safety net providers cannot legally or
morally refuse to respond to emergency medical requests for service
and cannot refuse medically necessary emergency medical treatment and
transport.
   (h) Independent government cost studies indicate current Medi-Cal
payment rates cover just one quarter of the average cost of ground
ambulance service. Severe below-cost Medi-Cal payment rates threaten
to collapse the entire 911 emergency medical system safety net in
California.  
  SEC. 2.    Article 5.7 (commencing with Section
14186) is added to Chapter 7 of Part 3 of Division 9 of the Welfare
and Institutions Code, to read:

      Article 5.7.  Ground Ambulance Services


   14186.  (a) No later than July 1, 2012, the department shall adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services, based upon existing statutes, regulations, and
case law.
   (b) In establishing the rates as required in subdivision (a), the
department shall use one of the following methodologies:
   (1) Establish payment rates through regulation based on the
methodology required by the courts including doing all of the
following:
   (A) Develop a rate study or establish a cost-based evidentiary
base that results in proposed rates.
   (B) Present the proposed rates at a public hearing.
   (C) Combine public input and the evidentiary base for a final
adopted regulation.
   (2) Establish payment rates for ground ambulance services at 120
percent of the current Medicare Ambulance Fee Schedule and designate
the ambulance cost study conducted by the federal Government
Accountability Office (GAO-07-383) as the evidentiary base.