New Law Alert No. 11 April 2002 California edition Patient access to medical records Acupuncture treatment modalities are expanded Cervical cancer screening CME required for pain management Mental health continuity of care Pharmacists can initiate emergency contraception drug therapy Prescribing over the Internet Office-based opiate treatment programs To reach MIEC Patient access to medical records Patients, former patients or representatives of the same appealing eligibility for a public benefit program are entitled to a copy of their medical information at no charge, according to newly amended Health & Safety Code 123110. The patient may receive the relevant portion of the... record upon the presentation of a written request and proof that the information is needed to support the appeal for the Medi-Cal program, Social Security disability insurance benefits, or Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled benefits. The relevant portion of the record is defined as records regarding services rendered to the patient during the time period beginning with the date of the patient's initial application for public benefits up to and including the date that a final determination is made by the public benefits program with which the patient's application is pending. A patient is entitled to one free copy. A physician has 30 days after receiving the patient's written authorization/ notice to furnish the copies. If the patient's appeal for participation in a public benefit program is successful, the physician who provided a free copy of the record can bill the patient 0.25 cents per page (or 0.50 cents if the information is on microfilm) plus reasonable clerical fees for the information previously provided at no charge. [Health & Safety Code 111230 (d)-(g)] Acupuncture treatment modalities are expanded Page 1 of 5
Recently amended Business & Professions Code 4937 (The Acupuncture Licensure Act) now allows licensed acupuncturists to...perform or prescribe the use of oriental massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements to promote, maintain, and restore health... As defined in the code section: magnets are a mineral or metal that produce a magnetic field without the use of an electric current; plant, animal, and mineral products are naturally occurring substances and do not include synthetic compounds, controlled substances...or dangerous drugs...; and a dietary supplement, defined in the United States Code Title 21, Section 321, ff, constitutes a product (other than tobacco) intended to supplement the diet and must contain one or more vitamins, minerals, herbs or other botanicals, amino acids, or dietary substances. Cervical cancer screening test Physicians may be interested to learn that individual or group health care service plan contracts that are issued, amended, or renewed on or after January 1, 2002, and that furnish coverage for cervical cancer treatment or surgery, must provide coverage for an annual cervical cancer screening test. The patient must be referred for the test by a doctor, a nurse practitioner, or certified nurse midwife, who is treating the patient and operating within the appropriate scope of practice. The screening test will include a Pap smear and any other FDA-approved cervical cancer screening. [Health & Safety Code 1367.66] CME required for pain management It was the California Legislature s and Governor Gray Davis intention to help broaden and update the knowledge base of all physicians related to the appropriate care and treatment of patients suffering from pain... with the passing of the Business & Professions (B&P) Code 2190.5 (a)-(c). As directed by the new B&P Code: (a) All physicians and surgeons shall complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The board may verify completion of this requirement on the renewal application form. Page 2 of 5
By regulatory action the Medical Board of California may exempt doctors from the requirement if the physician does not engage in direct patient contact, does not provide patient consultations, and does not reside in the State of California. Radiologists and pathologists are not required to complete this continuing education course work. Mental health continuity of care On or before July 1, 2002, when an enrollee s employer changes health care service plans, the new plan must file with the Department of Mental Health Care a written policy outlining how the plan will facilitate the continuity of mental health care for new enrollees who have received mental health services for an acute, serious or chronic condition from a nonparticipating psychiatrist, licensed psychologist, licensed marriage and family therapist, or licensed clinical social worker. The written policy must allow the new enrollee a reasonable transition period before he or she must move to a participating provider. When determining what constitutes a reasonable transition period, the plan must consider the severity of the enrollee s condition and how much time is needed to effect a safe transfer. [Health & Safety Code 1373.95(2)] [A similar law applying to disability insurers is delineated in Insurance Code 10133.55.] Pharmacists can initiate emergency contraception drug therapy Effective January 1, 2002, a pharmacist can initiate emergency contraception drug therapy in accordance with standardized procedures or protocols developed by the pharmacist and an authorized prescriber who is acting within his or her scope of practice. Before performing any procedure authorized under amended B&P Code 4052, the pharmacist must complete a training program on emergency contraception which includes...sensitive communications, quality assurance, referral to additional services, and documentation. When providing emergency contraception drugs, a pharmacist must give the recipient a standardized fact sheet the includes information about indications for and the appropriate method for use of the drug, the need for medical follow-up, and other appropriate information. The Board of Pharmacy, in consultation with the State Department of Health Services, the American College of Obstetricians and Gynecologists, the California Pharmacists Association and other health care organizations, will develop the fact sheet; however, pharmacists are not precluded from using any existing publications developed by nationally recognized organizations.[business & Professions Code 4052(a)(8)-(b)(3)] Page 3 of 5
Prescribing over the Internet California s Business & Professions Code 2242.1 (enacted in September 2000) makes it unlawful for any person or entity to prescribe, dispense, or furnish or cause to be prescribed, dispensed or furnished, dangerous drugs or devices...on the Internet... without a good faith prior examination and medical indication therefor, except as authorized by Section 2242. [B&P Code 4022 defines dangerous drugs as prescription medications.] A violator of the code section may be fined up to $25,000 per occurrence by the Medical Board, or made to pay a $25,000 civil penalty per occurrence. The Attorney General is authorized to bring an action against a person or entity to enforce the B&P code section and collect the fines or civil penalties. The Medical Board may commence a disciplinary action against a physician and surgeon who violates the code section. Office-based opiate treatment programs In effect since September 2000, Health & Safety Code 11877.2 allows physicians to provide addiction treatment services through an office-based opiate treatment program if the program meets either of the following conditions: (1) It holds a primary narcotics treatment program license, or (2) it is affiliated and associated with a primary licensed narcotics treatment program. As part of the office-based opiate treatment program, community pharmacies supply necessary medication both to these physicians for distribution to patients and through direct administration and specified dispensing services... The state department may approve an office-based program in a remote site that is affiliated and associated with a licensed program if: (a) Patients receiving opiate addiction treatment are registered with the licensed narcotic treatment program; (b) Both the office-based program and affiliated licensed narcotic treatment program are in compliance with the management of all opiated addiction patients as specified in California s Code of Regulations, Title 9, Division 4, Chapter 4 commencing with Section 10000; (c) Each physician in the office-based program treats a maximum 20 opiate addicted patients under the appropriate United States Drug Enforcement Administration registration; (d) Physicians in the office-based opiate treatment program dispense or administer pharmacologic treatment approved by the FDA such as levoalphacetylmethadol (LAAM) or methadone; Page 4 of 5
(e) The office-based program and associated licensed narcotic treatment program develop protocols to prevent the diversion of methadone...; and (f) When considering an office-based opiate treatment program application, the state department will consider the treatment needs and concerns of the county, city, or areas to be served by the program. [Health & Safety Code 11877.2 (a)-(e)] To reach MIEC Bay Area: 510/428-9411 Outside 510: 800/227-4527 Loss Prevention Fax: 510/420-7066 Main Oakland Fax: 510/654-4634 E-Mail: Lossprevention@miec.com E-Mail: Underwriting@miec.com E-Mail: Claims@miec.com 6250 Claremont Avenue, Oakland, CA 94618 800.227.4527 Fax 510.654.4634 Copyright 2002 Medical Insurance Exchange of CA Page 5 of 5