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AB-1622 Family physicians.(2019-2020)

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Date Published: 10/09/2019 09:00 PM
AB1622:v92#DOCUMENT

Assembly Bill No. 1622
CHAPTER 632

An act to amend Sections 1682 and 2746.2 of the Business and Professions Code, to amend Section 6254.18 of the Government Code, to amend Sections 1339.7, 1367.695, 101560, 123515, 127900, 128205, and 151001 of the Health and Safety Code, to amend Section 10123.84 of the Insurance Code, to amend Section 1308.8 of the Labor Code, to amend Section 13776 of the Penal Code, and to amend Sections 14088 and 14134.5 of the Welfare and Institutions Code, relating to family physicians.

[ Approved by Governor  October 08, 2019. Filed with Secretary of State  October 08, 2019. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 1622, Carrillo. Family physicians.
(1) Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California. Existing law makes it unprofessional conduct for a dentist to fail to obtain the written informed consent of a patient before administering general anesthesia and, until January 1, 2022, conscious sedation, and, for a minor, requires the written informed consent to include a statement that encourages the patient to explore all options available for the child’s anesthesia for their dental treatment and consult with the child’s dentist or pediatrician as needed.
This bill would revise the content of the informed consent statement to specify that the patient is encouraged to consult with the child’s dentist, pediatrician, or family physician as needed.
(2) Existing law, the Nursing Practice Act, provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and authorizes the board to issue a certificate to practice nurse-midwifery to a person who meets educational standards established by the board or the equivalent of those educational standards. Existing law authorizes the board to appoint a committee of qualified physicians and nurses, including obstetricians and nurse-midwives, to develop the necessary standards relating to educational requirements, ratios of nurse-midwives to supervising physicians, and associated matters.
This bill would additionally authorize the committee to include family physicians.
(3) Existing law, the Sexual Health Education Accountability Act, requires a sexual health education program to meet specified requirements, including that information be medically accurate, current, and objective. For purposes of this act, “medically accurate” means, in part, verified or supported by research conducted in compliance with scientific methods and published in peer review journals, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, including the federal Centers for Disease Control and Prevention.
This bill would modify the term “medically accurate” to additionally reference the American Academy of Family Physicians as a professional organization with the requisite experience.
(4) Existing law precludes an infant under one month of age to be employed on a motion picture set or location unless a physician and surgeon who is certified in pediatrics by a specialty board provides written certification concerning the infant, including that the infant was carried to full term.
This bill would additionally authorize the prescribed certification to be made by a physician and surgeon who is certified in family medicine by a specialty board.
(5) Existing law, the Reproductive Rights Law Enforcement Act, requires the Attorney General to carry out certain functions relating to anti-reproductive-rights crimes in consultation with, among others, subject matter experts, and to convene an advisory committee that consists of members of the organizations identified as subject matter experts.
This bill would include the American Academy of Family Physicians as subject matter experts for purposes of the act.
(6) Existing law, the Song-Brown Health Care Workforce Training Act, defines a “family physician” as a primary care physician who renders continued comprehensive and preventative health care services to families and who has received specialized training in an approved family medicine residency for 3 years after graduation from an accredited medical school. Existing law generally refers to a physician and surgeon who specializes in family medicine as a family practice physician and surgeon.
This bill would expand the definition of “family physician” for purposes of the act to mean a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received the specialized training described above. The bill would apply the “family physician” definition to various provisions of law. The bill would refer to an individual who practices family medicine as a family physician and surgeon, and would make technical, conforming, and nonsubstantive changes.
(7) This bill would incorporate additional changes to Section 1308.8 of the Labor Code proposed by AB 267 to be operative only if this bill and AB 267 are enacted and this bill is enacted last.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature hereby finds and declares all of the following:
(a) Family physicians are primary care specialists, and they receive specialized training and education in primary care, including extensive training in pediatrics, obstetrics, adult medicine, and behavioral health.
(b) Family medicine is the only physician specialty that addresses the entire spectrum of patient needs, providing clinical and supportive services that include acute, chronic, and preventive care, behavioral and mental health, oral health, health promotion, and other services for all ages and genders regardless of disease or organ system.
(c) Family physicians throughout the state are finding their hospital privileges constrained, particularly as they relate to prenatal, delivery-related, and postpartum health care.
(d) Some health systems and payers have restricted the full spectrum practice of family medicine, thereby reducing access to care, increasing health system costs, and restricting patient choice.
(e) Family medicine is a broad spectrum primary care specialty, and family physicians uniquely serve patients from birth to death.

SEC. 2.

 Section 1682 of the Business and Professions Code, as amended by Section 10 of Chapter 929 of the Statutes of 2018, is amended to read:

1682.
 In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a) Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b) Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c) Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d) Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e) (1) Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the child’s parent or guardian.
(2) The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
“The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment, and consult with your dentist, family physician, or pediatrician as needed.”
(3) Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
(f) This section shall remain in effect only until January 1, 2022, and as of that date is repealed.

SEC. 3.

 Section 1682 of the Business and Professions Code, as added by Section 11 of Chapter 929 of the Statutes of 2018, is amended to read:

1682.
 In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a) Any dentist performing dental procedures to have more than one patient undergoing moderate sedation, deep sedation, or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer moderate sedation, deep sedation, or general anesthesia.
(b) Any dentist with patients recovering from moderate sedation, deep sedation, or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from moderate sedation, deep sedation, or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c) Any dentist with patients who are undergoing deep sedation, general anesthesia, or moderate sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment and ventilation continuously monitored using at least two of the three following methods:
(1) Auscultation of breath sounds using a precordial stethoscope.
(2) Monitoring for the presence of exhaled carbon dioxide with capnography.
(3) Verbal communication with a patient under moderate sedation. This method shall not be used for a patient under deep sedation or general anesthesia.
(d) Any dentist with patients who are undergoing moderate sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e) (1) Any dentist to fail to obtain the written informed consent of a patient prior to administering moderate sedation, deep sedation, or general anesthesia. In the case of a minor, the consent shall be obtained from the child’s parent or guardian.
(2) The written informed consent for general anesthesia, in the case of a minor, shall include, but not be limited to, the following information:
“The administration and monitoring of deep sedation or general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment, and consult with your dentist, family physician, or pediatrician as needed.”
(3) Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral moderate sedation, moderate sedation, deep sedation, or general anesthesia.
(f) This section shall become operative on January 1, 2022.

SEC. 4.

 Section 2746.2 of the Business and Professions Code is amended to read:

2746.2.
 Each applicant shall show by evidence satisfactory to the board that they have met the educational standards established by the board or have at least the equivalent thereof. The board may appoint a committee of qualified physicians and nurses, including, but not limited to, obstetricians and nurse-midwives, to develop the necessary standards relating to educational requirements, ratios of nurse-midwives to supervising physicians, and associated matters. The committee may also include family physicians.

SEC. 5.

 Section 6254.18 of the Government Code is amended to read:

6254.18.
 (a) This chapter does not require disclosure of any personal information received, collected, or compiled by a public agency regarding the employees, volunteers, board members, owners, partners, officers, or contractors of a reproductive health services facility who have notified the public agency pursuant to subdivision (d) if the personal information is contained in a document that relates to the facility.
(b) For purposes of this section, the following terms have the following meanings:
(1) “Contractor” means an individual or entity that contracts with a reproductive health services facility for services related to patient care.
(2) “Personal information” means the following information related to an individual that is maintained by a public agency: social security number, physical description, home address, home telephone number, statements of personal worth or personal financial data filed pursuant to subdivision (n) of Section 6254, personal medical history, employment history, electronic mail address, and information that reveals any electronic network location or identity.
(3) “Public agency” means all of the following:
(A) The State Department of Health Care Services.
(B) The Department of Consumer Affairs.
(C) The Department of Managed Health Care.
(D) The State Department of Public Health.
(4) “Reproductive health services facility” means the office of a licensed physician and surgeon whose specialty is family medicine, obstetrics, or gynecology, or a licensed clinic, where at least 50 percent of the patients of the physician or the clinic are provided with family planning or abortion services.
(c) Any person may institute proceedings for injunctive or declarative relief or writ of mandate in any court of competent jurisdiction to obtain access to employment history information pursuant to Sections 6258 and 6259. If the court finds, based on the facts of a particular case, that the public interest served by disclosure of employment history information clearly outweighs the public interest served by not disclosing the information, the court shall order the officer or person charged with withholding the information to disclose employment history information or show cause why they should not disclose pursuant to Section 6259.
(d) In order for this section to apply to an individual who is an employee, volunteer, board member, officer, or contractor of a reproductive health services facility, the individual shall notify the public agency to which their personal information is being submitted or has been submitted that they fall within the application of this section. The reproductive health services facility shall retain a copy of all notifications submitted pursuant to this section. This notification shall be valid if it complies with all of the following:
(1) Is on the official letterhead of the facility.
(2) Is clearly separate from any other language present on the same page and is executed by a signature that serves no other purpose than to execute the notification.
(3) Is signed and dated by both of the following:
(A) The individual whose information is being submitted.
(B) The executive officer or their designee of the reproductive health services facility.
(e) The privacy protections for personal information authorized pursuant to this section shall be effective from the time of notification pursuant to subdivision (d) until either one of the following occurs:
(1) Six months after the date of separation from a reproductive health services facility for an individual who has served for not more than one year as an employee, contractor, volunteer, board member, or officer of the reproductive health services facility.
(2) One year after the date of separation from a reproductive health services facility for an individual who has served for more than one year as an employee, contractor, volunteer, board member, or officer of the reproductive health services facility.
(f) Within 90 days of separation of an employee, contractor, volunteer, board member, or officer of the reproductive health services facility who has provided notice to a public agency pursuant to subdivision (c), the facility shall provide notice of the separation to the relevant agency or agencies.
(g) This section does not prevent the disclosure by a government agency of data regarding age, race, ethnicity, national origin, or gender of individuals whose personal information is protected pursuant to this section if the data does not contain individually identifiable information.

SEC. 6.

 Section 1339.7 of the Health and Safety Code is amended to read:

1339.7.
 The state department shall administer the program authorized in this article. In administering the program, the state department shall do all of the following:
(a)  Verify hospital eligibility, pursuant to Section 1339.9, and designate those hospitals as primary health service hospitals.
(b)  Establish criteria for the health service plans pursuant to Section 1339.15.
(c)  Review a general acute care hospital’s health service plan based upon recommendations of the local health systems agency, input from local public meetings, recommendations of the medical advisory panel, as appropriate, and the adequacy of the plan in meeting the criteria established pursuant to this section. The state department shall approve, deny, or defer the plan in whole or in part, and shall notify the hospital of its findings, in writing, within 120 days after receipt of the plan. The plan shall be deemed approved if the hospital has not received notification from the state department within the 120-day period.
(d)  Negotiate and grant exceptions to the licensure requirements for general acute care hospitals that are necessary to serve the purposes of this article when the granting of those exceptions do not jeopardize the health and welfare of the patients. Exceptions that are granted shall be consistent with the primary health service hospital’s plan and any amendments thereto.
(e)  Convene an advisory panel to review the medical-surgical and obstetrical services proposed as part of the primary hospital service plan and make recommendations to the state department on the medical appropriateness of those services according to the primary health service hospital’s proposed plan. The panel shall include, but not be limited to, a rural hospital administrator, a rural family physician and surgeon, a rural hospital nurse administrator, an internist, a primary care mid-level practitioner, and a physician and surgeon from a hospital which serves as a referral center for rural hospitals.
(f)  Issue evidence of primary health service hospital designation and evidence of the number of acute care beds approved as swing beds pursuant to paragraph (4) of subdivision (b) of Section 1339.15.
(g)  Monitor the performance of the primary health service hospital to assure compliance with the hospital’s plan and licensure requirements from which those hospitals are not exempt.
(h)  Immediately upon the denial of a primary health service hospital’s health service plan, or a portion thereof, notify the hospital in writing. Within 20 days after the state department mails the notice, the hospital may present a written petition for a hearing to the state department. Upon receipt by the state department of the petition in proper form, the petition shall be set for hearing. The proceedings shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the state department shall have all the powers granted therein.
(i)  Compile and make available to health systems agencies and primary health service hospitals, information regarding state and federal funding programs for which the primary health service hospital may be eligible, the procedures necessary to apply for funding, and a description of how such requests may be incorporated into a primary health service hospital’s plan and opportunities for diversification of services, the requirements and feasibility, and the procedures for development of those services.
(j)  On behalf of primary health service hospitals, seek appropriate federal waivers consistent with the intent of this act.
(k)  Contract with one or more health systems agencies to perform the functions specified in subdivision (c) of Section 1339.11.
(l)  Develop or assist hospitals submitting a primary health service plan pursuant to Section 1339.15 to develop the following:
(1)  Alternative methods of filing claims which reduce administrative costs.
(2)  Alternative methods of Medi-Cal payment to hospitals.
(3)  Other methods of filing claims which reduce administrative costs.
(4)  Simplified and abbreviated procedures required by the department of Medi-Cal costs reports.
(5)  An abbreviated medical and social review process and other control processes.
(m)  Provide technical assistance to primary health service hospitals in development of their health service plan.

SEC. 7.

 Section 1367.695 of the Health and Safety Code is amended to read:

1367.695.
 (a)  The Legislature finds and declares that the unique, private, and personal relationship between women patients and their obstetricians and gynecologists warrants direct access to obstetrical and gynecological physician services.
(b)  Each health care service plan contract issued, amended, renewed, or delivered in this state, except a specialized health care service plan, shall allow an enrollee the option to seek obstetrical and gynecological physician services directly from a participating obstetrician and gynecologist or directly from a participating family physician and surgeon designated by the plan as providing obstetrical and gynecological services.
(c)  In implementing this section, a health care service plan may establish reasonable requirements governing utilization protocols and the use of obstetricians and gynecologists, or family physicians and surgeons, as provided for in subdivision (b), participating in the plan network, medical group, or independent practice association, if those requirements are consistent with the intent of this section, are customarily applied to other physicians and surgeons, such as primary care physicians and surgeons, to whom the enrollee has direct access, and are no more restrictive for the provision of obstetrical and gynecological physician services. An enrollee shall not be required to obtain prior approval from another physician, another provider, or the health care service plan prior to obtaining direct access to obstetrical and gynecological physician services, but the plan may establish reasonable requirements for the participating obstetrician and gynecologist or family physician and surgeon, as provided for in subdivision (b), to communicate with the enrollee’s primary care physician and surgeon regarding the enrollee’s condition, treatment, and any need for followup care.
(d)  This section does not diminish the requirements of Section 1367.69.

SEC. 8.

 Section 101560 of the Health and Safety Code is amended to read:

101560.
 Unless the context otherwise requires, this article governs the construction of this chapter. As used in this chapter:
(a)  “Authority” means the Monterey County Special Health Care Authority.
(b)  “Board” means the Monterey County Special Health Care Authority Board.
(c)  “County” means the County of Monterey.
(d)  “Health care system” means any system established to arrange for the provision of medical services.
(e)  “Public agency” means the United States, the State of California, any political subdivision, county, municipality, district, or agency of the State of California or of the United States and any department, bureau, or commission of the State of California or of the United States.
(f)  “Person” means any individual, firm, partnership, association, corporation, limited liability company, trust, business trust, or the receiver or trustee or conservator for any of the above, but does not include a public agency.
(g)  “The professional advisory board” means that advisory board to the authority’s board composed of nine health and medical care professionals appointed by the Monterey County Board of Supervisors, five of whom shall be nominated by the Monterey County Medical Society, with at least one to be a member of the Monterey County Chapter of the American Academy of Family Physicians, one of whom shall be nominated by Natividad Medical Center, one of whom shall be nominated by the Monterey County Hospital Administrators’ Association, and two of whom shall be nominated by other organizations in the County of Monterey representing other professional health care providers.
(h)  “The community advisory board” means that advisory board to the authority’s board appointed by the Monterey County Board of Supervisors which is comprised of 15 persons who represent community and consumer interests and who do not directly earn their income from the provision of medical or health services.
(i)  For the purposes of this part, the term “medical services or medical benefits” does not include dental care or dental benefits.
(j)  For the purposes of this part, the term “health care” does not include dental care.

SEC. 9.

 Section 123515 of the Health and Safety Code is amended to read:

123515.
 In processing and awarding contracts, grants, or agreements pursuant to this article, the department shall evaluate the ability of applicants to meet, to the maximum extent possible, the following criteria:
(a)  The applicant’s prior experience in providing community-based, comprehensive perinatal care and services to low-income women and infants.
(b)  The applicant’s ability to provide comprehensive perinatal care, either directly or through subcontract. Those services comprising comprehensive perinatal care include, but are not limited to, the following:
(1)  Initial and ongoing physical assessment.
(2)  Psychosocial assessments and counseling, and referral when appropriate.
(3)  Nutrition assessments, counseling and referral to counseling on food supplement programs, vitamins, and breastfeeding.
(4)  Health educational assessments, and intervention and referral, including childbirth preparation and parenting.
(5)  Outreach and community education.
(6)  Laboratory, radiology, and other specialized services as indicated.
(7)  Delivery, postpartum followup, and pediatric care through the first year of life.
(c)  The quality of care that is being, or has been provided to low-income women and infants by health care providers.
(d)  Whether the area that is, or that will be, serviced by the applicant is medically underserved or has otherwise demonstrated the need for comprehensive, community-based perinatal services.
(e)  The applicant’s ability to use an appropriate multidisciplinary staff working as a team, in consultation with obstetricians, pediatricians, and family practitioners when appropriate, to provide a full range of comprehensive perinatal care services. Staffing patterns shall reflect, to the maximum extent feasible, at all levels, the cultural, linguistic, ethnic, and other social characteristics of the community served. This staff shall include at least one of those persons described in paragraphs (1) to (3), inclusive, of this subdivision, as follows, and may include, but not be limited to, a combination of those persons described in paragraphs (4) to (10), inclusive, of this subdivision, as follows:
(1)  An obstetrician.
(2)  A pediatrician.
(3)  (A) A family physician.
(B) For purposes of this paragraph, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(4)  Certified nurse-midwives, public health nurses, nurse practitioners, or physician assistants.
(5)  Nutritionists.
(6)  Social workers.
(7)  Health and childbirth educators.
(8)  A family planning counselor.
(9)  Community outreach peer workers.
(10)  A translator.

SEC. 10.

 Section 127900 of the Health and Safety Code is amended to read:

127900.
 (a)  The Legislature finds and declares that evidence exists to support the development of health promotion and health-risk reduction programs as an effective method of constraining the annual inflation rate for expenditures in the health industry. It is, therefore, the intent of the Legislature that a health manpower education program be developed to demonstrate the health promotion and health-risk reduction concept at educational institutions, with special emphasis on health manpower development in urban areas having a disproportionate share of disadvantaged and indigent persons.
(b)  The office shall establish a contract program for funding allied health manpower training projects related to health promotion and health-risk reduction. The contract program shall provide funds to eligible institutions, as determined by the office, for all of the following purposes:
(1)  Teaching existing and future primary care providers about health-risk reduction through the institutions’ basic curricula.
(2)  Recruiting, remediating, and retaining minority allied health professionals, including, but not limited to, physician assistants, nurse practitioners, nurse-midwives, public health nurses, health educators, dieticians, and nutritionists, especially those who provide in-home patient care.
(3)  Increasing the supply of medical care in underserved urban areas and demonstrating methods which reduce cost through the use of allied health personnel.
(c)  (1) These funds shall be available to institutions which currently operate programs for training family physicians, other primary care physicians, and those health professionals identified in paragraph (2) of subdivision (b).
(2) For purposes of this subdivision, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(d)  The recipients of the funds shall provide, but shall not be limited to providing, orientation and training of primary care providers in teaching methods related to patient health education and health promotion, such as educating allied health professionals in the principles of self-care management as it relates to specific health problems in medically underserved communities.
(e)  The office shall consult with organizations and experts in the field regarding the establishment of this program, and beginning with the 1986–87 fiscal year, this program shall be implemented to the extent funds are provided in the Budget Act. This program shall be designed to accommodate an appropriation request in the range of forty thousand dollars ($40,000) to eighty thousand dollars ($80,000) per year.
(f)  The director of the office may waive any of the requirements of subdivisions (b) and (c) if a potential contractor demonstrates an ability to meet the goals and objectives of the program.

SEC. 11.

 Section 128205 of the Health and Safety Code is amended to read:

128205.
 As used in this article, and Article 2 (commencing with Section 128250), the following terms have the following meanings:
(a) “Family physician” means a primary care physician and surgeon who is prepared to and renders continued comprehensive and preventative health care services to individuals and families and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(b) “Primary care physician” means a physician who is prepared to and renders continued comprehensive and preventative health care services, and has received specialized training in the areas of internal medicine, obstetrics and gynecology, or pediatrics.
(c) “Associated” and “affiliated” mean that relationship that exists by virtue of a formal written agreement between a hospital or other health care delivery system and an approved medical school that pertains to the primary care or family medicine training program for which state contract funds are sought.
(d) “Commission” means the California Healthcare Workforce Policy Commission.
(e) “Programs that train primary care physician’s assistants” means a program that has been approved for the training of primary care physician assistants pursuant to Section 3513 of the Business and Professions Code.
(f) “Programs that train primary care nurse practitioners” means a program that is operated by a California school of medicine or nursing, or that is authorized by the Regents of the University of California or by the Trustees of the California State University, or that is approved by the Board of Registered Nursing.
(g) “Programs that train registered nurses” means a program that is operated by a California school of nursing and approved by the Board of Registered Nursing, or that is authorized by the Regents of the University of California, the Trustees of the California State University, or the Board of Governors of the California Community Colleges, and that is approved by the Board of Registered Nursing.
(h) “Teaching health center” means a community-based ambulatory patient care center that operates a primary care residency program. Community-based ambulatory patient care settings include, but are not limited to, federally qualified health centers, community mental health centers, rural health clinics, health centers operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, and entities receiving funds under Title X of the federal Public Health Service Act (Public Law 91-572).

SEC. 12.

 Section 151001 of the Health and Safety Code is amended to read:

151001.
 For purposes of this division, the following definitions shall apply:
(a) “Age appropriate” means topics, messages, and teaching methods suitable to particular ages or age groups of children and adolescents, based on developing cognitive, emotional, and behavioral capacity typical for the age or age group.
(b) A “sexual health education program” means a program that provides instruction or information to prevent adolescent pregnancy, unintended pregnancy, or sexually transmitted diseases, including HIV, that is conducted, operated, or administered by any state agency, is funded directly or indirectly by the state, or receives any financial assistance from state funds or funds administered by a state agency, but does not include any program offered by a school district, a county superintendent of schools, or a community college district.
(c) “Medically accurate” means verified or supported by research conducted in compliance with scientific methods and published in peer review journals, when appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, including, but not limited to, the federal Centers for Disease Control and Prevention, the American Public Health Association, the Society for Adolescent Health and Medicine, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.

SEC. 13.

 Section 10123.84 of the Insurance Code is amended to read:

10123.84.
 (a) The Legislature finds and declares that the unique, private, and personal relationship between women patients and their obstetricians and gynecologists warrants direct access to obstetrical and gynecological physician services.
(b) Each policy of disability insurance that covers hospital, medical, or surgical expenses, and that is issued, amended, delivered, or renewed in this state, shall allow a policyholder the option to seek obstetrical and gynecological physician services directly from an obstetrician and gynecologist or directly from a participating family physician and surgeon designated by the plan as providing obstetrical and gynecological services.
(c) In implementing this section, a disability insurer may establish reasonable requirements governing utilization protocols and the use of obstetricians and gynecologists or family physicians and surgeons, as provided for in subdivision (b), if those requirements are consistent with the intent of this section, are customarily applied to other physicians and surgeons, including primary care physicians and surgeons, to whom the policyholder has direct access, and are no more restrictive for the provision of obstetrical and gynecological physician services. A policyholder shall not be required to obtain prior approval from another physician, another provider, or the insurer prior to obtaining direct access to obstetrical and gynecological physician services, but the insurer may establish reasonable requirements for the participating obstetrician and gynecologist or the family physician and surgeon, as provided in subdivision (b), to communicate with the policyholder’s primary care physician regarding the policyholder’s condition, treatment, and any need for followup care.
(d) This section does not diminish the requirements of Section 10123.83.

SEC. 14.

 Section 1308.8 of the Labor Code is amended to read:

1308.8.
 (a) No infant under the age of one month may be employed on any motion picture set or location unless a licensed physician and surgeon who is board certified in either pediatrics or family medicine provides written certification that the infant is at least 15 days old and, in their medical opinion, the infant was carried to full term, was of normal birth weight, is physically capable of handling the stress of filmmaking, and the infant’s lungs, eyes, heart, and immune system are sufficiently developed to withstand the potential risks.
(b) Any parent, guardian, or employer of a minor, and any officer or agent of an employer of a minor, who directly or indirectly violates subdivision (a), or who causes or suffers a violation of subdivision (a), with respect to that minor, is guilty of a misdemeanor punishable by a fine of not less than two thousand five hundred dollars ($2,500) nor more than five thousand dollars ($5,000), by imprisonment in the county jail for not more than 60 days, or by both that fine and imprisonment.

SEC. 14.5.

 Section 1308.8 of the Labor Code is amended to read:

1308.8.
 (a) No infant under the age of one month may be employed in the entertainment industry unless a licensed physician and surgeon who is board certified in either pediatrics or family medicine provides written certification that the infant is at least 15 days old and, in their medical opinion, the infant was carried to full term, was of normal birth weight, is physically capable of handling the stress of working in the entertainment industry, and the infant’s lungs, eyes, heart, and immune system are sufficiently developed to withstand the potential risks.
(b) Any parent, guardian, or employer of a minor, and any officer or agent of an employer of a minor, who directly or indirectly violates subdivision (a), or who causes or suffers a violation of subdivision (a), with respect to that minor, is guilty of a misdemeanor punishable by a fine of not less than two thousand five hundred dollars ($2,500) nor more than five thousand dollars ($5,000), by imprisonment in the county jail for not more than 60 days, or by both that fine and imprisonment.

SEC. 15.

 Section 13776 of the Penal Code is amended to read:

13776.
 The following definitions apply for the purposes of this title:
(a) “Anti-reproductive-rights crime” means a crime committed partly or wholly because the victim is a reproductive health services client, provider, or assistant, or a crime that is partly or wholly intended to intimidate the victim, any other person or entity, or any class of persons or entities from becoming or remaining a reproductive health services client, provider, or assistant. “Anti-reproductive-rights crime” includes, but is not limited to, a violation of subdivision (a) or (c) of Section 423.2.
(b) “Subject matter experts” includes, but is not limited to, the Commission on the Status of Women and Girls, law enforcement agencies experienced with anti-reproductive-rights crimes, including the Attorney General and the Department of Justice, and organizations such as the American Civil Liberties Union, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the California Council of Churches, the California Medical Association, the Feminist Majority Foundation, NARAL Pro-Choice California, the National Abortion Federation, the California National Organization for Women, the Planned Parenthood Federation of America, Planned Parenthood Affiliates of California, and the Women’s Health Specialists clinic that represent reproductive health services clients, providers, and assistants.
(c) “Crime of violence,” “nonviolent,” “reproductive health services;” “reproductive health services client, provider, or assistant;” and “reproductive health services facility” each has the same meaning as set forth in Section 423.1.

SEC. 16.

 Section 14088 of the Welfare and Institutions Code is amended to read:

14088.
 (a) The purpose of this article is to ensure that the Medi-Cal program shall be operated in the most cost-effective and efficient manner possible with the optimum number of Medi-Cal providers, and shall ensure quality of care and known access to services.
(b) For the purposes of this article, the following definitions shall apply:
(1) “Primary care provider” means either of the following:
(A) (i) Any internist, general practitioner, obstetrician-gynecologist, pediatrician, family physician and surgeon, nonphysician medical practitioner, or any primary care clinic, rural health clinic, community clinic or hospital outpatient clinic currently enrolled in the Medi-Cal program, which agrees to provide case management to Medi-Cal beneficiaries.
(ii) For purposes of this subparagraph, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.
(B) A county or other political subdivision that employs, operates, or contracts with, any of the primary care providers listed in subparagraph (A), and that agrees to use that primary care provider for the purposes of contracting under this article.
(2) “Primary care case management” means responsibility for the provision of referral, consultation, ordering of therapy, admission to hospitals, followup care, and prepayment approval of referred services.
(3) “Designation form” or “form” means a form supplied by the department to be executed by a Medi-Cal beneficiary and a primary care provider or other entity eligible pursuant to this article who has entered into a contract with the department pursuant to this article, setting forth the beneficiary’s choice of contractor and an agreement to be limited by the case management decisions of that contractor and the contractor’s agreement to be responsible for that beneficiary’s case management and medical care, as specified in this article.
(4) “Emergency services” means health care services rendered by an eligible Medi-Cal provider to a Medi-Cal beneficiary for those health services required for alleviation of severe pain or immediate diagnosis and treatment of unforeseen medical conditions which if not immediately diagnosed and treated could lead to disability or death.
(5) “Modified primary care case management” means primary care case management wherein capitated services are limited to primary care practitioner office visits only.
(6) “Service area” means an area designated by either a single federal Postal ZIP Code or by two or more Postal ZIP Codes that are contiguous.
(c) For purposes of Medi-Cal managed care plans, as defined in subdivision (m) of Section 14016.5, “nonphysician medical practitioner” means a physician assistant performing services under physician and surgeon supervision in compliance with Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code, a certified nurse-midwife performing services under physician and surgeon supervision in compliance with Article 2.5 (commencing with Section 2746) of Chapter 6 of Division 2 of the Business and Professions Code, or a nurse practitioner performing services in collaboration with a physician and surgeon pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of the Business and Professions Code.

SEC. 17.

 Section 14134.5 of the Welfare and Institutions Code is amended to read:

14134.5.
 All of the following requirements apply to the provision of services pursuant to subdivision (u) of Section 14132:
(a) “Comprehensive perinatal provider” means any general practice physician, family physician and surgeon, obstetrician-gynecologist, pediatrician, certified nurse-midwife, a group, any of whose members is one of the above-named providers, or any preferred provider organization or clinic enrolled in the Medi-Cal program and certified pursuant to the standards of this section.
(b) “Perinatal” means the period from the establishment of pregnancy to one month following delivery.
(c) “Comprehensive perinatal services” shall include, but not be limited to, the provision of the combination of services developed through the former Department of Health Services Obstetrical Access Pilot Program provided or coordinated by a comprehensive perinatal provider.
(d) The comprehensive perinatal provider shall schedule visits with appropriate providers and track the patient to verify whether services have been received. As part of the reimbursement for coordinating these services, the comprehensive perinatal provider shall ensure the provision of the following services either through the provider’s own service or through subcontracts or referrals to other providers:
(1) A psychosocial assessment and when appropriate referrals to counseling.
(2) Nutrition assessments and when appropriate referral to counseling on food supplement programs, vitamins, and breastfeeding.
(3) Health, childbirth, and parenting education.
(e) (1) Except where existing law prohibits the employment of physicians, a health care provider may employ or contract with all of the following medical and other practitioners for the purpose of providing the comprehensive services delineated in this section:
(A) Physicians, including a general practitioner, a family physician and surgeon, a pediatrician, or an obstetrician-gynecologist.
(B) Certified nurse-midwives.
(C) Licensed midwives.
(D) Nurses.
(E) Nurse practitioners.
(F) Physician assistants.
(G) Social workers.
(H) Health and childbirth educators.
(I) Registered dietitians.
(2) The department shall adopt regulations that define the qualifications of any of these practitioners who are not currently included under the regulations adopted pursuant to this chapter. Providers shall, as feasible, utilize staffing patterns that reflect the linguistic and cultural features of the populations they serve.
(f) The California Medical Assistance Program and the Maternal and Child Health Branch of the State Department of Public Health, in consultation with the California Conference of Local Health Officers, shall establish standards for health care providers and services rendered pursuant to this subdivision.
(g) The department shall assist local health departments to establish a community perinatal program whose responsibilities may include certifying and monitoring providers of comprehensive perinatal services. The department shall provide the local health departments with technical assistance for the purpose of implementing the community perinatal program. The department shall utilize, to the extent feasible, and to the extent funding for administrative costs is available, local health departments in the administration of the perinatal program. If these funds are unavailable, the department shall use alternative means to implement the community perinatal program.
(h) (1) It is the intent of the Legislature that the department shall establish a method for reimbursement of comprehensive perinatal providers that shall include a fee for coordinating services and shall be sufficient to cover reasonable costs for the provision of comprehensive perinatal services. The department may utilize fees for service, capitated fees, or global fees to reimburse providers. However, if capitated or global fees are established, the department shall set minimum standards for the provision of services including, but not limited to, the number of prenatal visits, and the amount and type of psychosocial, nutritional, and educational services that patients receive.
(2) Notwithstanding the type of reimbursement system, the comprehensive perinatal provider shall not be financially at risk for the provision of inpatient services. The provision of inpatient services that are not related to perinatal care shall not be subject to the requirements of this section. Inpatient services related to services pursuant to this subdivision shall be reimbursed, in accordance with Section 14081, 14086, 14087, or 14087.2, whichever is applicable.
(i) The department shall develop systems for the monitoring and oversight of the comprehensive perinatal services provided in this section. The monitoring shall include, but shall not be limited to, the collection of information using the perinatal data form.
(j) Participation for services provided pursuant to this section shall be voluntary. The department shall adopt patient rights safeguards for recipients of the comprehensive perinatal services.
(k) The amendments made to this section by the act that added this subdivision do not revise or expand the scope of practice of licensed midwives, as defined in Article 24 (commencing with Section 2505) of Chapter 5 of Division 2 of the Business and Professions Code.
(l) Notwithstanding subdivision (a), on the effective date of the regulations adopted by the Medical Board of California pursuant to Section 2507 of the Business and Professions Code, a licensed midwife shall be eligible to serve as a comprehensive perinatal provider.
(m) For purposes of this section, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.

SEC. 18.

 Section 14.5 of this bill incorporates amendments to Section 1308.8 of the Labor Code proposed by both this bill and Assembly Bill 267. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2020, (2) each bill amends Section 1308.8 of the Labor Code, and (3) this bill is enacted after Assembly Bill 267, in which case Section 14 of this bill shall not become operative.