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SB-43 County health systems: County of San Mateo: dental care services.(2017-2018)

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Date Published: 06/18/2018 09:00 PM
SB43:v95#DOCUMENT

Amended  IN  Assembly  June 18, 2018
Amended  IN  Senate  April 05, 2017
Amended  IN  Senate  January 31, 2017
Amended  IN  Senate  January 12, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 43


Introduced by Senator Hill
(Coauthors: Senators Allen, Dodd, and Skinner)(Coauthors: Assembly Members Cristina Garcia and Maienschein)(Principal coauthor: Assembly Member Mullin)

December 05, 2016


An act to add Part 5.5 (commencing with Section 121565) to Division 105 of the Health and Safety Code, relating to public health. amend Section 14087.51 of, and to add Section 14087.511 to, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 43, as amended, Hill. Antimicrobial-resistant infection: reporting. County health systems: County of San Mateo: dental care services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. Existing law authorizes the County of San Mateo, and other counties electing to do so, to, by ordinance, establish a commission to arrange for the provision of health care services provided pursuant to the Medi-Cal program, and to provide health care delivery systems to other specified persons.
This bill would additionally authorize the County of San Mateo to arrange for the provision of dental care services provided pursuant to the Medi-Cal program. The bill would authorize the county to establish a 5-year pilot project to take any or all of certain activities relating to dental services, including, but not limited to, partnering with dental providers to deliver an integrated care approach to enrolled members, and establishing objectives for improving access to oral health care, including access to dental prevention services and pediatric dentistry.
This bill would make legislative findings and declarations as to the necessity of a special statute for the County of San Mateo.

Existing law establishes the State Department of Public Health and sets forth the powers and duties of the department. Existing law requires the department and general acute care hospitals to implement various measures relating to the prevention of health care associated infection, and requires that each general acute care hospital 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 the department to establish a list of reportable communicable and noncommunicable diseases and conditions, including, but not limited to, diphtheria, listeria, salmonella, shigella, and streptococcal infection in food handlers or dairy workers, and typhoid. Existing law requires local health officers to report to the department any disease or condition on the list, as specified by the department.

This bill would require specified general acute care hospitals and clinical laboratories to submit a report to the department, commencing July 1, 2019, and each July 1 thereafter, containing an antibiogram of the facility for the previous year. The bill would require the Antimicrobial Stewardship and Resistance Subcommittee of the Healthcare Associated Infections Advisory Committee of the department, on or before January 1, 2019, to develop and recommend to the department, the acceptable electronic format for the report and a method for the department to accurately estimate the number of deaths that result from antimicrobial resistant infections for specified types of antimicrobial infections. The bill would require the department, commencing January 1, 2020, and each January 1 thereafter, to publish and post on its Internet Web site a report that would include designated information relating to the incidence, type, and distribution of antimicrobial-resistant infections and the estimated number of deaths that result from antimicrobial resistant infections. The bill would prohibit data collected pursuant to the bill from being disclosed to the public on a facility-specific basis, but would allow for the disclosure of case-specific information, under prescribed circumstances.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14087.51 of the Welfare and Institutions Code is amended to read:

14087.51.
 (a) It is necessary that a special commission be established in San Mateo County and in any other county designated by the California Medical Assistance Commission in order to meet the problems of the delivery of publicly assisted medical care in the counties and to demonstrate ways of promoting quality care and cost efficiency.
(b) The Board of Supervisors of San Mateo County and of the designated counties may, by ordinance, establish commissions to do any or all of the following:
(1) Negotiate the exclusive contracts specified in Section 14087.5 and to arrange for the provision of health care services provided pursuant to this chapter.
(2) Enter into contracts for the provision of health care services to subscribers in the Healthy Families Program.
(3) Enter into agreements under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code.
(4) With respect to the County of San Mateo only, arrange for the provision of dental care services provided pursuant to this chapter.
(c) In addition to the authority specified in subdivision (b), the Board of Supervisors of San Mateo County may, by ordinance, authorize the commission established pursuant to this section to provide health care delivery systems for any or all of the following persons:
(1) Persons who are eligible to receive medical benefits under this chapter in the county, including, but not limited to, persons who are eligible through federal waiver or a pilot project.
(2) Persons who are eligible to receive medical benefits under both Title 18 and Title 19 of the federal Social Security Act.
(3) Persons who are eligible to receive medical benefits under Title 18 of the federal Social Security Act.
(4) Persons who are eligible to receive medical benefits under publicly supported programs if the commission and participating providers acting pursuant to subcontracts with the commission agree to hold harmless the beneficiaries of the publicly supported programs if the contract between the sponsoring government agency and the commission does not ensure sufficient funding to cover program costs.
(5) Other individuals or groups in the service area, including, but not limited to, public agencies, private businesses, and uninsured or indigent persons. The commission shall not use any payment or reserve from the Medi-Cal program for purposes of this paragraph.
(d) Nothing in this section shall prohibit the commission established pursuant to this section from providing services pursuant to paragraph (5) of subdivision (c) in counties other than the commission’s county if the commission is approved by the Department of Managed Health Care to provide services in those counties. The commission shall not use any payment or reserve from the Medi-Cal program for purposes of this subdivision.
(e) If the board of supervisors elects to enact an ordinance pursuant to this section, all rights, powers, duties, privileges, and immunities vested in a county by an article shall be vested in the county commission. Any reference in this article to “county” shall mean a commission established pursuant to this section.
(f) The enabling ordinance shall specify the membership of the county commission, the qualifications for individual members, and any other matters as the board of supervisors deems necessary or convenient for the conduct of the county commission’s activities. A commission so established shall be considered a public entity for purposes of Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. All commissioners shall be appointed by majority vote of the board of supervisors and shall serve at the pleasure thereof. The board of supervisors may appoint no more than two of its own members to serve on the commission.
(g) As an alternative to establishing a separate commission, the enabling ordinance may designate the board of supervisors itself as the commission authorized by this article.
(h) Nothing in this section shall This section shall not be construed to supersede Section 14093.06 or 14094.3.

SEC. 2.

 Section 14087.511 is added to the Welfare and Institutions Code, immediately following Section 14087.51, to read:

14087.511.
 If the County of San Mateo elects to provide dental care services pursuant to this article, the county may establish a five-year pilot project to do any or all of the following:
(a) Partner with dental providers to deliver an integrated care approach to enrolled members.
(b) Establish objectives for improving dental utilization, as medically indicated.
(c) Establish objectives for improving access to oral health care, including access to dental prevention services and pediatric dentistry.
(d) Test innovative payment models to incentivize dental provider participation.
(e) Evaluate the medical cost impact of integrating dental care, such as reducing emergency room visits due to dental pain and performing dental procedures in a hospital setting.

SEC. 3.

 The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances applicable to publicly assisted medical care in the County of San Mateo.
SECTION 1.

The Legislature finds and declares all of the following:

(a)The epidemic of antibiotic resistance is a worldwide problem and is expected to grow. The federal Centers for Disease Control and Prevention (CDC) estimates that antibiotic-resistant infections kill at least 23,000 Americans each year and sicken two million. The Review on Antimicrobial Resistance, a study commissioned by the United Kingdom, estimates that by 2050, if nothing is done, 10 million people will die worldwide from antibiotic-resistant infections, surpassing the 8.5 million people who will die from cancer.

(b)Antibiotic-resistant infections threaten modern medicine as we know it. If this epidemic is not curtailed, routine surgeries and minor infections may once again become life-threatening, jeopardizing the hard-won gains made battling infectious disease.

(c)Many leading public health organizations and world leaders have sounded the alarm about antibiotic resistance. The World Health Organization (WHO) has labeled antibiotic resistance as one of the biggest threats to global health and the CDC identifies antibiotic resistance as one of our most serious health threats. In September 2016, the United Nations (UN) convened in New York and put forward a declaration to tackle antibiotic resistance. It was only the fourth time in history that the UN had met to tackle a global health problem, underscoring the significance of the problem.

(d)Monitoring and tracking antibiotic resistance is a core component to combating antibiotic resistance, as specified by the CDC. With appropriate surveillance of antibiotic-resistant infections, public health leaders can develop appropriate protocols for prevention, control, and treatment, can monitor disease trends, assess effectiveness of prevention and control measures, identify populations or geographic areas at high risk, and more.

(e)Despite the magnitude of this public health problem, the State Department of Public Health does not monitor or track the occurrence of antibiotic-resistant infections or deaths caused by those infections. Although the department is required by law to establish a list of reportable diseases, that list does not include the tracking and monitoring of antibiotic-resistant infections. The department also is mandated by existing law to track three antibiotic-resistant infections, but only when those infections are health care acquired and in a patient’s bloodstream.

SEC. 2.Part 5.5 (commencing with Section 121565) is added to Division 105 of the Health and Safety Code, to read:
5.5.ANTIMICROBIAL-RESISTANT INFECTION
121565.

The following definitions shall apply for purposes of this part:

(a)“Antibiogram” means an annual summary of antimicrobial susceptibility of bacterial isolates, as defined by the Clinical and Laboratory Standards Institute (CLSI) M39 guidelines and subsequent updates.

(b)“Antimicrobial resistance” means a bacterial infection caused by a bacterium that demonstrates in vitro a minimum antimicrobial inhibitory concentration that exceeds susceptibility breakpoints, using the most recent diagnostic test standards approved by the United States Food and Drug Administration pursuant to the Federal Food, Drug, and Cosmetic Act.

(c)“Clinical laboratory” has the same meaning as defined in paragraph (8) of subdivision (a) of Section 1206 of the Business and Professions Code.

(d)“Department” means the State Department of Public Health.

(e)“General acute care hospital” has the same meaning as defined in subdivision (a) of Section 1250.

(f)“Subcommittee” means the Antimicrobial Stewardship and Resistance Subcommittee of the Healthcare Associated Infections Advisory Committee of the State Department of Public Health.

121566.

(a)Commencing on July 1, 2019, and each July 1 thereafter, each general acute care hospital that operates a clinical laboratory that conducts tests for antimicrobial resistance and each clinical laboratory that is not part of a hospital and that conducts tests for antimicrobial resistance shall submit a report to the department, in an acceptable electronic format, containing an antibiogram of the facility for the previous year.

(b)(1)On or before January 1, 2019, the subcommittee shall develop and recommend both of the following to the department:

(A)The acceptable electronic format for the report. The format may be updated as the subcommittee or department deems necessary as new information or data on antimicrobial resistance becomes available. In developing the acceptable electronic format, the subcommittee shall select the types of antimicrobial resistance infections that should be included in the report, which may include, but not be limited to, antimicrobial resistant infections identified by the federal Centers for Disease Control and Prevention as urgent, serious, or concerning.

(B)A method for the department to accurately estimate the number of deaths that result from antimicrobial resistant infections for the types of antimicrobial infections selected pursuant to subparagraph (A). The method may rely on data from certificates of death or other sources of data available to the subcommittee or department.

(2)The subcommittee or department may consult with any subject matter experts or stakeholders for purposes of this subdivision.

121567.

(a)Commencing on January 1, 2020, and each January 1 thereafter, based on the data reported by general acute care hospitals and clinical laboratories pursuant to Section 121566, as well as from the information on deaths that result from antimicrobial resistant infections determined based on the method developed pursuant to Section 121566, the department shall publish and post on its Internet Web site a report that includes the following information:

(1)The incidence, type, and distribution of antimicrobial-resistant infections statewide, and within regions of the state, as defined by the department, and by facility type.

(2)The incidence, type, and distribution of the estimated number of deaths that result from antimicrobial resistant infections, and within regions of the state, as defined by the department, and by facility type.

(b)The report shall not identify information specific to any one health facility or general acute care hospital. Data collected pursuant to this part shall not be disclosed to the public on a facility-specific basis, except that the department may release case-specific information to other facilities, physicians, and the public if the department determines, on a case-by-case basis, that the release of the information is necessary to protect persons in a public health emergency.