California New Law Alert 2020

Published on: July 11, 2020

All laws effective January 1, 2020 unless otherwise noted.

AB 779 (Low)- Effective January 1, 2021
Acupuncture wall and pocket licenses

Licensed acupuncturists must apply to the Acupuncture Board to obtain a wall license for each place of practice and to renew each wall license biennially. They must also carry a pocket license during treatments made outside of the licensee’s place of practice.

SB 697 (Caballero)
Changes to physician supervisory requirements of Physician Assistants

This law makes several changes to The Physician Assistant Practice Act, including:

• Replaces “delegation of services agreement” with “practice agreement” (delegation of service agreements in effect prior to January 1, 2020 meet the requirements of the new “practice agreement”)
• Provides that a supervising physician must be available by telephone or other electronic communication method at the time the PA examines the patient, but does not need to be physically available on the premises.
• Removes requirements for medical chart review by physicians
• Removes the requirement that the medical record identify the responsible supervising physician
• Authorizes a PA under physician supervision to administer medications and transmit drug orders under certain circumstances, in accordance with a practice agreement and consistent with the PA’s education and clinical competency

For a summary of the bill, specifics of the “practice agreement” and an FAQ addressed by The Physician Assistant Board, please see: https://pab.ca.gov/forms_pubs/sb697faqs.pdf

This new law is also addressed in MIEC’s publication The Use of Advanced Practice Providers in a Medical Practice: Update 2020.

AB 528 (Low)- Effective July 1, 2021

Access to CURES database expanded

Several changes will go into effect next year, including:

• Pharmacies and other dispensers will be required to report information to CURES no more than one working day after a controlled substance is dispensed.
• Schedule V controlled substances will be reported to CURES
• Licensed physicians who do not hold a DEA registration will be permitted to apply for access to the CURES database.Prescribers will be required to check CURES at least every six months for ongoing controlled substance prescriptions, rather than every four months as previously required.
• Expanded delegate access to CURES: Currently, licensed delegates may apply for access to CURES through the DOJ and are authorized to make patient activity report (PAR) requests on behalf of prescribers. However, those delegates are not authorized to view the information on the report, and are therefore not allowed to actually retrieve, open, and print the report for inclusion in a patient’s chart, requiring each prescriber to log into CURES and retrieve the report themselves. The new law will provide delegates with fuller access to PARs, within existing medical privacy requirements, for purposes of assisting prescribers who are required to consult those reports

AB 714 (Wood)- Effective September 5, 2019

Clarification of 2018 Naloxone law

Existing law requires a prescriber to offer a prescription for naloxone hydrochloride, or another drug approved by the FDA for the reversal of opioid depression, and to provide education on overdose prevention and the use of naloxone to certain high-risk patients. The new law provides clarifications in response to concerns raised by the medical community.

For specifics, please see the Medical Board of California’s notice at: https://www.mbc.ca.gov/Download/Documents/AB714Notice.pdf

AB 1264 (Petrie-Norris)- Effective October 11, 2019

Telehealth Prescribing

This law specifies that an “appropriate prior examination” for purposes of prescribing, dispensing, or furnishing prescription drugs does not require a synchronous interaction between the patient and the prescriber and can be achieved through the use of telehealth, including a self-screening tool or questionnaire, provided that the provider complies with the appropriate standard of care. Per the bill’s author, one intent of the law was to increase access to contraceptive pills, such as through Planned Parenthood’s smartphone application (PPDirect). Specifically, this definition of “appropriate prior examination applies if any of the following scenarios:

• The prescriber is serving in the absence of the patient’s regular physician and the drugs are prescribed only as necessary to maintain the patient until the return of the patient’s practitioner and for no longer than 72 hours.
• The prescriber transmitted the order to an RN or LVN at an inpatient facility, the nurse has reviewed the patient’s medical records, and the prescriber is designated to serve in the absence of the patient’s regular practitioner.
• The prescriber is a designated practitioner serving in the absence of the patient’s physician, has reviewed the patient’s records and ordered the renewal of a medically indicated prescription for an amount not exceeding the original prescription in strength or amount or for more than one refill.
• Antibiotic prescriptions to patients and partners pursuant to diagnosis of a sexually transmitted infection.

This bill does not apply to controlled substances. Except under limited circumstances, physicians must perform a physical examination prior to prescribing a controlled substance.

SB 276 & 714 (Pan)

Effective January 1, 2021

Immunizations: medical exemptions

By 2021 the State Department of Public Health must develop an electronic, standardized, statewide medical exemption request form that would be transmitted using the California Immunization Registry (CAIR). Physicians must use the standardized form, must conduct a physical examination of the child, and provide a basis for the medical exemption.

AB 5 (Gonzalez)

Worker status: employees and independent contractors

This law replaces the criteria by which workers are classified as employees versus independent contractors with a more narrowly defined “ABC test” to determine classification. The aim is to protect workers from being inappropriately classified as independent contractors and denied the benefits and protections enjoyed by employees.

Under the new law, a worker is to be considered an employee unless the hiring entity demonstrates that all of the following conditions are satisfied:

1. The person is free from the control and direction of the hiring entity in connection with the performance of the work, both under the contract for the performance of the work and in fact.
2. The person performs work that is outside the usual course of the hiring entity’s business.
3. The person is customarily engaged in an independently established trade, occupation, or business of the same nature as that involved in the work performed.

Specified professions are exempt from the new criteria under AB 5, and can continue to be classified as independent contractors even if they do not meet the “ABC” test.

The list of exempt professions within the realm of health care includes:

• physicians and surgeons
• dentists
• podiatrists
• psychologists
• veterinarians

Other professions within health care are NOT exempt from AB 5 and therefore must meet the law’s stated criteria in order to be appropriately classified as independent contractors, such as:

• nurse practitioners
• physician assistants
• acupuncturists
• medical assistants, technicians, therapists, medical office staff

MIEC recommends:

Physicians and acupuncturists who contract with independent contractors in professions that are NOT exempt from the new requirements should consult with their business attorneys to determine whether the worker meets the three conditions listed above, and, if not, appropriate action to take.