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SB-885 Sexually transmitted diseases.(2019-2020)

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Date Published: 02/25/2020 09:00 PM
SB885:v98#DOCUMENT

Amended  IN  Senate  February 25, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 885


Introduced by Senator Pan
(Coauthor: Senator Leyva)
(Coauthor: Assembly Member Aguiar-Curry)

January 23, 2020


An act to amend Section 4076 of the Business and Professions Code, to amend Section 120582 of the Health and Safety Code, and to amend Sections 14105.181 and 14132.07 of the Welfare and Institutions Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 885, as amended, Pan. Sexually transmitted diseases.
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law prohibits a Medi-Cal managed care plan from restricting a beneficiary’s choice of a qualified provider from whom the beneficiary may receive covered family planning services.
Under existing law, the Medi-Cal program, pursuant to a federal waiver, program administers the Family Planning, Access, Care, and Treatment (Family PACT) Program within the department to provide comprehensive clinical family planning services to a person with a family income at or below 200% of the federal poverty level. Existing law requires reimbursement rates for office visits billed as comprehensive clinical family planning services by Family PACT waiver providers or Medi-Cal providers to receive a rate augmentation equal to the weighted average of at least 80 percent of the amount that the federal Medicare program reimburses for the same or similar office visits.
This bill would specify that family planning services for which a Medi-Cal managed care plan may not restrict a beneficiary’s choice of a qualified provider include sexually transmitted disease (STD) testing and treatment. The bill would, subject to an appropriation by the Legislature, Legislature and any potential draw down of federal matching funds, authorize an office visit to a Family PACT waiver provider or Medi-Cal provider for specified STD-related services for uninsured, income-eligible patients, or patients with health care coverage who have confidentiality concerns and concerns, who are not at risk for experiencing or causing an unintended pregnancy, and who are not in need of contraceptive services, to be reimbursed at the same rate as comprehensive clinical family planing services.
Existing law authorizes a specified health care provider who diagnoses an STD, as specified, to prescribe, dispense, furnish, or otherwise provide prescription antibiotic drugs to that patient’s sexual partner or partners without examination of that patient’s partner or partners. The Pharmacy Law provides for the licensure and regulation of pharmacists by the California State Board of Pharmacy. The Pharmacy Law requires a pharmacist to dispense a prescription in a container that, among other things, is correctly labeled with the name of the patient or patients.
This bill would name the above practice “patient-delivered “expedited partner therapy.” The bill would require a health care provider to include “patient-delivered “expedited partner therapy” or “PDPT” “EPT” on a prescription if the practitioner is unable to obtain the name of a patient’s sexual partner, and would authorize a pharmacist to dispense a patient-delivered an expedited partner therapy prescription and label the drug without an individual’s name if the prescription includes “patient-delivered “expedited partner therapy” or “PDPT.” “EPT.” The bill would specify that a physician, surgeon, or nurse practitioner health care provider is not liable for in a medical malpractice action or professional disciplinary action if the use of patient-delivered expedited partner therapy is in compliance with the law, unless the malpractice rises to the level except in cases of intentional misconduct, gross negligence, or wanton or reckless activity.
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 finds and declares the following:
(a) Rates of sexually transmitted diseases (STDs) are at an alarming and historic high in California and across the country.
(b) Although our STD public health crisis is being felt in communities across the state, California youth, people of color, and men who have sex with men (MSM) bisexual and transgender women, and bisexual and gay men are disproportionately impacted.
(c) Studies conducted by the federal Centers for Disease Control and Prevention (CDC) suggest a range of factors may contribute to rising STD rates, including lack of access to care, poverty, stigma, discrimination, and drug use.
(d) The CDC estimates that there are approximately 19,000,000 new STD infections each year. Nearly 500,000 Californians were infected with syphilis, chlamydia, or gonorrhea in 2017, an increase of 40 percent since 2013.
(e) In 2016 alone, gonorrhea rates increased by double digits in the following counties: Los Angeles by 27 percent, San Diego by 35.5 percent, Orange by 32 percent, San Francisco by 18 percent, Kings by 41 percent, and Fresno by 13 percent. The Counties of Mendocino and Sacramento led the increase at 81 percent and 50 percent, respectively. These rates continued to increase in 2017 and 2018.
(f) Statewide data indicate that over one-half of all STDs in the state are experienced by California youth 15 to 24 years of age, inclusive.
(g) California has the second highest syphilis rates in the nation. While 90 percent of all male syphilis cases in 2013 were among MSM populations, bisexual and gay men, the epidemic has spread among women. Between 2008 and 2018, the syphilis rate among women of reproductive age increased by 743 percent.
(h) California ranks fifth among states in congenital syphilis rates. In 2018, more than 329 babies were born with congenital syphilis and there were 20 stillbirths associated with the disease.
(i) Approximately $1 billion is spent annually statewide on health costs associated with STDs.
(j) The cost of STDs to the United States health care system is estimated to be as much as $15.9 billion annually.
(k) Untreated STDs can lead to serious long-term health consequences. The CDC estimates that untreated STDs cause at least 24,000 women in the United States each year to become infertile.
(l) STDs increase both the transmission and acquisition of human immunodeficiency virus (HIV), particularly among MSM populations. bisexual and gay men.
(m) The human papilloma virus (HPV) can lead to increased risk of developing cancer. The number of HPV-related cancers in men dramatically increased in 2016.
(n) Untreated syphilis can also result in devastating and negative maternal child health outcomes, including infant death. The CDC estimates that of the pregnant women who acquire syphilis up to four years before delivery, 80 percent will transmit the infection to the fetus and 40 percent may result in stillbirth or death.
(o) With California facing an unprecedented STD public health crisis, the state must enact a robust and comprehensive response to curb escalating STD rates.
(p) The scope of the STD epidemic requires a bold response. California must take a comprehensive and robust approach to expanding access to STD care and coverage for low-income Californians who are uninsured, enrolled in Medi-Cal, or unable or unwilling to obtain services directly at a health center.

SEC. 2.

 Section 4076 of the Business and Professions Code is amended to read:

4076.
 (a) A pharmacist shall not dispense any prescription except in a container that meets the requirements of state and federal law and is correctly labeled with all of the following:
(1) Except when the prescriber or the certified nurse-midwife who functions pursuant to a standardized procedure or protocol described in Section 2746.51, the nurse practitioner who functions pursuant to a standardized procedure described in Section 2836.1 or protocol, the physician assistant who functions pursuant to Section 3502.1, the naturopathic doctor who functions pursuant to a standardized procedure or protocol described in Section 3640.5, or the pharmacist who functions pursuant to a policy, procedure, or protocol pursuant to Section 4052.1, 4052.2, or 4052.6 orders otherwise, either the manufacturer’s trade name of the drug or the generic name and the name of the manufacturer. Commonly used abbreviations may be used. Preparations containing two or more active ingredients may be identified by the manufacturer’s trade name or the commonly used name or the principal active ingredients.
(2) The directions for the use of the drug.
(3) The name of the patient or patients.
(4) The name of the prescriber or, if applicable, the name of the certified nurse-midwife who functions pursuant to a standardized procedure or protocol described in Section 2746.51, the nurse practitioner who functions pursuant to a standardized procedure described in Section 2836.1 or protocol, the physician assistant who functions pursuant to Section 3502.1, the naturopathic doctor who functions pursuant to a standardized procedure or protocol described in Section 3640.5, or the pharmacist who functions pursuant to a policy, procedure, or protocol pursuant to Section 4052.1, 4052.2, or 4052.6.
(5) The date of issue.
(6) The name and address of the pharmacy, and prescription number or other means of identifying the prescription.
(7) The strength of the drug or drugs dispensed.
(8) The quantity of the drug or drugs dispensed.
(9) The expiration date of the effectiveness of the drug dispensed.
(10) The condition or purpose for which the drug was prescribed if the condition or purpose is indicated on the prescription.
(11) (A) Commencing January 1, 2006, the physical description of the dispensed medication, including its color, shape, and any identification code that appears on the tablets or capsules, except as follows:
(i) Prescriptions dispensed by a veterinarian.
(ii) An exemption from the requirements of this paragraph shall be granted to a new drug for the first 120 days that the drug is on the market and for the 90 days during which the national reference file has no description on file.
(iii) Dispensed medications for which no physical description exists in any commercially available database.
(B) This paragraph applies to outpatient pharmacies only.
(C) The information required by this paragraph may be printed on an auxiliary label that is affixed to the prescription container.
(D) This paragraph shall not become operative if the board, prior to January 1, 2006, adopts regulations that mandate the same labeling requirements set forth in this paragraph.
(b) If a pharmacist dispenses a prescribed drug by means of a unit dose medication system, as defined by administrative regulation, for a patient in a skilled nursing, intermediate care, or other health care facility, the requirements of this section will be satisfied if the unit dose medication system contains the aforementioned information or the information is otherwise readily available at the time of drug administration.
(c) If a pharmacist dispenses a dangerous drug or device in a facility licensed pursuant to Section 1250 of the Health and Safety Code, it is not necessary to include on individual unit dose containers for a specific patient, the name of the certified nurse-midwife who functions pursuant to a standardized procedure or protocol described in Section 2746.51, the nurse practitioner who functions pursuant to a standardized procedure described in Section 2836.1 or protocol, the physician assistant who functions pursuant to Section 3502.1, the naturopathic doctor who functions pursuant to a standardized procedure or protocol described in Section 3640.5, or the pharmacist who functions pursuant to a policy, procedure, or protocol pursuant to Section 4052.1, 4052.2, or 4052.6.
(d) If a pharmacist dispenses a prescription drug for use in a facility licensed pursuant to Section 1250 of the Health and Safety Code, it is not necessary to include the information required in paragraph (11) of subdivision (a) when the prescription drug is administered to a patient by a person licensed under the Medical Practice Act (Chapter 5 (commencing with Section 2000)), the Nursing Practice Act (Chapter 6 (commencing with Section 2700)), or the Vocational Nursing Practice Act (Chapter 6.5 (commencing with Section 2840)), who is acting within their scope of practice.
(e) A pharmacist shall use professional judgment to provide a patient with directions for use that enhance the patient’s understanding of those directions, consistent with the prescriber’s instructions.
(f) Notwithstanding subdivision (a) or any other law, a pharmacist may dispense a drug prescribed pursuant to Section 120582 of the Health and Safety Code and label the drug without the name of an individual for whom the drug is intended if the prescription includes the words “patient-delivered “expedited partner therapy” or the letters “PDPT.” “EPT.”

SEC. 3.

 Section 120582 of the Health and Safety Code is amended to read:

120582.
 (a) Notwithstanding any other law, a physician and surgeon who diagnoses a sexually transmitted chlamydia, gonorrhea, or other sexually transmitted infection, as determined by the department, in an individual patient may prescribe, dispense, furnish, or otherwise provide prescription antibiotic drugs to that patient’s sexual partner or partners without examination of that patient’s partner or partners. This practice shall be known as patient-delivered expedited partner therapy (PDPT). (EPT). The department may adopt regulations to implement this section.
(b) Notwithstanding any other law, a nurse practitioner pursuant to Section 2836.1 of the Business and Professions Code, a certified nurse-midwife pursuant to Section 2746.51 of the Business and Professions Code, and a physician assistant pursuant to Section 3502.1 of the Business and Professions Code may dispense, furnish, or otherwise provide include EPT in their practice by dispensing, furnishing, or otherwise providing prescription antibiotic drugs to the sexual partner or partners of a patient with a diagnosed sexually transmitted chlamydia, gonorrhea, or other sexually transmitted infection, as determined by the department, without examination of the patient’s sexual partner or partners.
(c) If a health care provider is unable to obtain the name of a patient’s sexual partner for a drug prescribed pursuant to subdivision (a) or (b), the prescription shall include the words “patient-delivered “expedited partner therapy” or the letters “PDPT.” “EPT.”
(d) A health care provider shall not be liable in a medical malpractice action or professional disciplinary action if the use of PDPT EPT is in compliance with this section, except in cases of intentional misconduct, gross negligence, or wanton or reckless activity.

SEC. 4.

 Section 14105.181 of the Welfare and Institutions Code is amended to read:

14105.181.
 (a) For purposes of this section, the following definitions shall apply:
(1) “The Family Planning, Access, Care, and Treatment (Family PACT) waiver” PACT)” or “Family PACT waiver” PACT” means the program described in subdivision (aa) of Section 14132, as approved by a federal demonstration waiver. 14132.
(2) “Comprehensive clinical family planning services” means those services described in paragraph (8) of subdivision (aa) of Section 14132.
(3) “Office visits” means those procedures billed under Common Procedure Terminology codes 99201, 99202, 99203, 99204, 99211, 99212, 99213, and 99214.
(b) Reimbursement rates for office visits billed as comprehensive clinical family planning services by Family PACT waiver providers and for office visits billed as family planning services by Medi-Cal providers shall receive a rate augmentation equal to the weighted average of at least 80 percent of the amount that the federal Medicare program reimburses for these same or similar office visits. The rate augmentation shall be based upon Medicare rates in effect on December 31, 2007.
(c) Subject to an appropriation by the Legislature, Legislature and any potential draw down of federal matching funds, reimbursement may be provided for sexually transmitted disease-related services billed for outlined as reimbursable in the Family PACT Policies, Procedures, and Billing Instructions manual, in accordance with the “Treatment and Dispensing Guidelines for Clinicians” heading in the Benefits Grid section of that manual, to uninsured, income-eligible patients or patients with health care coverage who have confidentiality concerns and concerns, who are not at risk for pregnancy. experiencing or causing an unintended pregnancy, and who are not in need of contraceptive services. These office visits shall be reimbursed at the same rate as those office visits specified in subdivision (b).
(d) The augmentation of reimbursement rates described in subdivision (b) shall be made for office visits rendered on or after January 1, 2008.
(e) (1) The director may adopt regulations as necessary to implement this section. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. For purposes of this section, the adoption of the regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or the general welfare.
(2) As an alternative to paragraph (1), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may administer this section, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action.

SEC. 5.

 Section 14132.07 of the Welfare and Institutions Code is amended to read:

14132.07.
 (a) A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services, including sexually transmitted disease testing and treatment, covered by the Medi-Cal program pursuant to subdivision (n) of Section 14132.
(b) The following definitions shall apply for purposes of this section:
(1) “Medi-Cal managed care plan” means an applicable organization or entity that contracts with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A) Article 2.7 (commencing with Section 14087.3).
(B) Article 2.8 (commencing with Section 14087.5).
(C) Article 2.81 (commencing with Section 14087.96).
(D) Article 2.82 (commencing with Section 14087.98).
(E) Article 2.91 (commencing with Section 14089).
(F) Chapter 8 (commencing with Section 14200).
(2) “Qualified provider” means a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c) A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
(d) If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.