Bill Text: CA SB994 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care districts: design-build.
Spectrum: Slight Partisan Bill (Democrat 3-1)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB994 Detail]
Download: California-2015-SB994-Amended.html
Bill Title: Health care districts: design-build.
Spectrum: Slight Partisan Bill (Democrat 3-1)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB994 Detail]
Download: California-2015-SB994-Amended.html
BILL NUMBER: SB 994 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 28, 2016
INTRODUCED BY Senator Hill
FEBRUARY 10, 2016
An act relating to outpatient health facilities.
to amend the heading of Article 2.6 (commencing with
Section 1645) of Chapter 4 of Division 2 of, and to amend the heading
of Article 10 (commencing with Section 2190) of Chapter 5 of
Division 2 of, and to add Sections 1645.5, 2197, 2454.6, and 2496.5
to, the B usiness and Professions Code, and to add Article
2.7 (commencing with Section 1223) of Chapter 1 of Division 2 to the
Health and Safety Code, relating to antimicrobial stewardship.
LEGISLATIVE COUNSEL'S DIGEST
SB 994, as amended, Hill. Outpatient health facilities:
antimicrobial stewardship. Antimicrobial stewardship
policies.
(1) Under existing law, the Dental Board of California, among
other things, establishes requirements pursuant to which an applicant
may obtain an initial 2-year license to practice dentistry and a
2-year renewal license, including that the board may require
successful completion of continuing education as a condition to
license renewal.
Under existing law, the Medical Practice Act, the Medical Board of
California, the Osteopathic Medical Board of California, and the
California Board of Podiatric Medicine establish requirements
pursuant to which an applicant may obtain an initial 2-year license
or subsequent 2-year renewal license to practice medicine as a
podiatrist, as a physician and surgeon, osteopathic medicine as an
osteopathic physician and surgeon, or podiatric medicine as a
podiatrist, respectively. Under existing law, the Medical Board of
California is required to adopt and administer standards for the
continuing education of physicians and surgeons and each year audits
a random sample of physicians and surgeons who have reported
compliance with those requirements and requires a noncompliant
licensee to make up the deficiency during the next renewal period.
Under existing law, a licensee who fails to so comply is ineligible
for a subsequent renewal license until he or she documents compliance
to the board. Existing law provides for similar continuing education
requirements as a condition of obtaining a renewal license to
practice osteopathic medicine and podiatric medicine.
This bill would require a "covered licensee," defined as a
dentist, physician and surgeon, osteopathic physician and surgeon, or
person licensed to practice podiatric medicine, who practices in a
setting other than a clinic, general acute care hospital, or skilled
nursing facility, to adopt and implement an antimicrobial stewardship
policy consistent with specified guidelines or methods of
intervention, as defined, before applying for a renewal license and,
upon applying for a renewal license, to certify in writing, on a form
prescribed by the respective licensing board, that he or she has
both adopted an antimicrobial stewardship policy and is in compliance
with that policy. The bill would require those licensing boards to
audit, during each year, a random sample of covered licensees who
have certified compliance with these requirements and would limit the
audit of an individual covered licensee to once every 4 years. The
bill would require a covered licensee who is selected for audit to
submit to the board, on a form prescribed by the board, a copy of his
or her antimicrobial stewardship policy. The bill would require the
respective licensing board, that determines that its audited covered
licensee has failed to comply with these requirements, to require
that covered licensee to comply with these requirements during the
following renewal period. The bill would provide that a covered
licensee who fails to comply is ineligible for license renewal until
he or she has documented compliance.
Under
(2) Under existing law, health
facilities, including, among others, general acute care hospitals,
skilled nursing facilities, primary care clinics, and specialty
clinics, are licensed and regulated by the State Department of Public
Health, and a violation of those provisions is a crime. Existing law
requires that each general acute care hospital, on or before July 1,
2015, adopt and implement an antimicrobial stewardship policy in
accordance with guidelines established by the federal government and
professional organizations that includes a process to evaluate the
judicious use of antibiotics, as specified. Existing law requires
each skilled nursing facility, on or before January 1, 2017, to adopt
and implement an antimicrobial stewardship policy consistent with
guidelines developed by the federal Centers for Disease Control and
Prevention and other specified entities.
This bill would state the intent of the Legislature to
enact legislation that would promote the establishment of
antimicrobial stewardship programs or policies in outpatient health
facilities. The bill makes related findings and declarations.
would, beginning January 1, 2018, require a clinic to
adopt and implement an antimicrobial stewardship policy consistent
with specified guidelines or methods of intervention, as defined.
Because this bill would create new crimes, the bill would impose a
state-mandated local program.
(3) 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 no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature
to enact legislation that would promote the establishment of
antimicrobial stewardship programs or policies in outpatient health
facilities.
SEC. 2. SECTION 1. The Legislature
finds and declares all of the following:
(a) The overuse and misuse of antibiotics can lead to the
development of antibiotic-resistant infections, a major public health
threat.
(b) The federal Centers for Disease Control and Prevention (CDC)
estimates that at least 2,000,000 Americans are infected with, and at
least 23,000 Americans die as a result of, antibiotic-resistant
infections every year, resulting in at least $20 billion in direct
health care costs and at least $35 billion in lost productivity in
the United States.
(c) Antibiotic resistance is a growing threat. A recent study
commissioned by the United Kingdom determined that by 2050,
worldwide, more people will die from antibiotic-resistant infections
than from cancer.
(d) The overuse and misuse of antibiotics in human medicine is a
significant factor driving the development of antibiotic resistance,
and a majority of antibiotics are prescribed in outpatient settings,
including primary care physician offices, outpatient settings where
physician assistants and nurse practitioners work, dentist offices,
and other specialty health care providers.
(e) According to the CDC, in one year, 262.5 million courses of
antibiotics are written in outpatient settings. This equates to more
than five prescriptions written each year for every six people in the
United States. The CDC estimates that over one-half of the
antibiotics prescribed in outpatient settings are unnecessary.
(f) More than 10 million courses of antibiotics are prescribed
each year for viral conditions that do not benefit from antibiotics.
(g) Antibiotic stewardship programs, which are already required in
general acute care hospitals and skilled nursing facilities in the
state, but not in outpatient settings, are an effective way to reduce
inappropriate antibiotic use and the prevalence of
antibiotic-resistant infections.
(h) The President's National Action Plan for Combating
Antibiotic-Resistant Bacteria calls for the establishment of
antibiotic stewardship activities in all health care delivery
settings, including outpatient settings, by 2020.
SEC. 2. The heading of Article 2.6
(commencing with Section 1645) of Chapter 4 of Division 2 of the
Business and Professions Code is amended to
read:
Article 2.6. Continuing Education and Antimicrobial
Stewardship
SEC. 3. Section 1645.5 is added to the
Business and Professions Code , to read:
1645.5. (a) For purposes of this section the following
definitions apply:
(1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate and optimal selection, dosage, and duration of
antimicrobials for patients, with the goal of reducing antimicrobial
overuse and misuse and minimizing the development of antimicrobial
resistant infections, that is consistent with one of the following
parameters:
(A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
(2) A "covered licensee" means a dentist who practices dentistry
in a setting other than a clinic licensed pursuant to Section 1204 of
the Health and Safety Code, a general acute care hospital as defined
in subdivision (a) of Section 1250 of the Health and Safety Code, or
a skilled nursing facility as defined in subdivision (c) of Section
1250 of the Health and Safety Code.
(3) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
(b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
(d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
period, he or she is ineligible for a subsequent license renewal
until he or she has documented compliance.
SEC. 4. The heading of Article 10 (commencing with
Section 2190) of Chapter 5 of Division 2 of the Business
and Professions Code is amended to read:
Article 10. Continuing Medical Education and
Antimicrobial Stewardship
SEC. 5. Section 2197 is added to the
Business and Professions Code , to read:
2197. (a) For purposes of this section the following definitions
apply:
(1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate and optimal selection, dosage, and duration of
antimicrobials for patients, with the goal of reducing antimicrobial
overuse and misuse and minimizing the development of antimicrobial
resistant infections, that is consistent with one of the following
parameters:
(A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
(2) A "covered licensee" means a physician and surgeon who
practices medicine in a setting other than a clinic licensed pursuant
to Section 1204 of the Health and Safety Code, a general acute care
hospital as defined in subdivision (a) of Section 1250 of the Health
and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.
(3) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
(b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
(d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
covered licensee to comply with subdivision (b) during the following
renewal period. If the covered licensee fails to comply within that
period, he or she is ineligible for a subsequent license renewal
until he or she has documented compliance.
SEC. 6. Section 2454.6 is added to the
Business and Professions Code , to read:
2454.6. (a) For purposes of this section the following
definitions apply:
(1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate and optimal selection, dosage, and duration of
antimicrobials for patients, with the goal of reducing antimicrobial
overuse and misuse and minimizing the development of antimicrobial
resistant infections, that is consistent with one of the following
parameters:
(A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence based
methods should include more than one intervention or component.
(2) A "covered licensee" means an osteopathic physician and
surgeon who practices osteopathic medicine in a setting other than a
clinic licenced pursuant to Section 1204 of the Health and Safety
Code, a general acute care hospital as defined in subdivision (a) of
Section 1250 of the Health and Safety Code, or a skilled nursing
facility as defined in subdivision (c) of Section 1250 of the Health
and Safety Code.
(3) "Evidence-based methods" has the same meaning as in paragraph
(3) of subdivision (a) of Section 2197.
(b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
(d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following renewal
period. If the covered licensee fails to comply within that period,
he or she is ineligible for a subsequent license renewal until he or
she has documented compliance.
SEC. 7. Section 2496.5 is added to the
Business and Professions Code , to read:
2496.5. (a) For purposes of this section the following
definitions apply:
(1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate and optimal selection, dosage, and duration of
antimicrobials for patients, with the goal of reducing antimicrobial
overuse and misuse and minimizing the development of antimicrobial
resistant infections, that is consistent with one of the following
parameters:
(A) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
(B) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence based
methods should include more than one intervention or component.
(2) A "covered licensee" means a podiatrist who practices
podiatric medicine in a setting other than a clinic licenced pursuant
to Section 1204 of the Health and Safety Code, a general acute care
hospital as defined in subdivision (a) of Section 1250 of the Health
and Safety Code, or a skilled nursing facility as defined in
subdivision (c) of Section 1250 of the Health and Safety Code.
(3) "Evidence-based methods" has the same meaning as in paragraph
(3) of subdivision (a) of Section 2197.
(b) A covered licensee shall adopt and implement an antimicrobial
stewardship policy before applying for a renewal license.
(c) Upon filing an application with the board for a renewal
license, a covered licensee shall certify in writing, on a form
prescribed by the board, that he or she has both adopted an
antimicrobial stewardship policy pursuant to subdivision (b) and is
in compliance with that policy.
(d) (1) The board shall audit during each year a random sample of
covered licensees who have certified compliance pursuant to
subdivision (c). The board shall not audit an individual covered
licensee more than once every four years.
(2) A covered licensee who is selected for audit shall submit to
the board, on a form prescribed by the board, a copy of his or her
antimicrobial stewardship policy.
(e) If the board determines that an audited covered licensee has
failed to comply with subdivision (b), the board shall require that
licensee to comply with subdivision (b) during the following renewal
period. If the covered licensee fails to comply within that period,
he or she is ineligible for a subsequent license renewal until he or
she has documented compliance.
SEC. 8. Article 2.7 (commencing with Section 1223)
is added to Chapter 1 of Division 2 of the Health and
Safety Code , to read:
Article 2.7. Antimicrobial Stewardship Guidelines
1223. (a) For purposes of this article the following definitions
apply.
(1) "Antimicrobial stewardship policy" means efforts to promote
the appropriate and optimal selection, dosage, and duration of
antimicrobials for patients, with the goal of reducing antimicrobial
overuse and misuse and minimizing the development of antimicrobial
resistant infections.
(2) "Evidence-based methods" means antimicrobial prescribing
intervention methods that have been proven effective through outcome
evaluations or studies, including, but not limited to, audit and
feedback, academic detailing, clinical decision support, delayed
prescribing practices, poster-based interventions, accountable
justification, and peer comparison.
(b) On or before January 1, 2018, a primary care clinic or
specialty clinic shall adopt and implement an antimicrobial
stewardship policy that is consistent with one of the following
parameters:
(1) Antimicrobial stewardship guidelines published by the federal
Centers for Disease Control and Prevention, the federal Centers for
Medicare and Medicaid Services, the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America,
or similar recognized professional organizations.
(2) Evidence-based methods. To the extent practicable,
antimicrobial stewardship policies based on proven, evidence-based
methods should include more than one intervention or component.
SEC. 9. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because 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.
