Governor Gavin Newsom’s very public budget focus on healthcare will gain statutory support in 2020 following a slate of healthcare funding bills passed by the Legislature.
The following highlights many of the laws effective January 1, 2020, that will affect physicians, from the business operations of their medical office to actual patient care.
New laws affecting the workplace include:
AB 5: Re-classification of Workers with ABC Test
The bill codifies a ruling from the California Supreme Court that included a new test restricting workplace determinations for individuals seeking to work as independent contractors. A coalition including the California Medical Association successfully secured an exemption for physicians from the legislation. Dentists, podiatrists, psychologists, and veterinarians were among those also securing exemptions. However, other healthcare workers, including physician assistants, nurses, and behavioral health providers, still fall within the scope of the new law.
AB 51: New Arbitration Law in California
This prohibits mandatory employment arbitration agreements (with limited exceptions). It will be important for employers who wish to use arbitration agreements (or jury trial or class action waivers) in California to ensure that employees voluntarily and affirmatively elect to enter into such agreements. This may require some employers to revise their agreements and to implement new practices.
SB 778: Sexual Harassment Avoidance Training Extension
This requires an employer with five or more employees to provide sexual harassment avoidance training and education by January 1, 2021 and thereafter once every two years. The new law requires that new nonsupervisory employees be provided sexual harassment avoidance training within six months of hire. New supervisory employees (including physicians) must be provided sexual harassment avoidance training within six months of assuming a supervisory position. The law clarifies that an employer who has provided this training and education in 2019 is not required to provide it again until two years thereafter.
New laws affecting access to healthcare coverage include:
Health Coverage Subsidies
Through the passage of the annual budget bill, the state will begin to provide subsidies to pay for health plans on the state insurance exchange. In addition to federal subsidies for Covered California health plans, eligible residents will also receive an additional state-funded subsidy. Also starting in 2020, state residents who are uninsured for more than three months will be hit with a tax penalty for not having coverage. California is now the first state to impose an “individual mandate” previously required under the Affordable Care Act.
SB 159: HIV Prevention Drugs
California will be the first state to allow people to access HIV prevention drugs from pharmacies without a doctor’s prescription. Pre-exposure prophylaxis (PrEP) is a once-a-day pill for HIV-negative people that may keep them from becoming infected; post-exposure prophylaxis (PEP) is medication that can help prevent the virus from taking hold if an individual has been exposed. SB 159 by state Senator Scott Wiener (D-San Francisco) will allow pharmacists to dispense a 60-day supply of PrEP, or a 28-day course of PEP. Patients will need to see a physician to obtain more medication. The bill prohibits insurance companies from requiring patients to obtain prior authorization before obtaining the medication.
AB 744: New Telehealth Parity
AB 744 will require contracts issued, amended, or renewed after January 1, 2021, between a healthcare service plan and a healthcare provider to specify that the provider who delivers services appropriately through telehealth be reimbursed on the same basis and to the same extent that the plan would have had the same service been provided in-person. The health plan cannot require the use of telehealth if the healthcare provider has determined that it is not appropriate. Also, the new law does not limit the ability of the health plan and provider to negotiate the rate of reimbursement for a service.
SB 600: Fertility Treatments
Some Californians undergoing cancer treatment such as radiation or chemotherapy will have insurance coverage for fertility preservation treatments. Private health plans regulated by the state must cover procedures such as the freezing of eggs, sperm, or embryos for patients undergoing therapy who want to try to have children in the future.
SB 276 and SB 714: Medical Exemptions for Immunizations
SB 714 will allow a child with a medical exemption issued before January 1, 2020, to continue enrollment with current exemption until the child enrolls in the next grade span.
SB 276, effective January 1, 2021, directs the California Department of Public Health (CDPH) to develop and make available for use by licensed physicians and surgeons an electronic, standardized, statewide medical exemption certification form that shall be transmitted directly to the department’s California Immunization Registry (CAIR). CDPH will review annually exemption forms that meet any of the following criteria: 1) submitted to schools with overall immunizations rates less than 95 percent; 2) submitted by physicians who have submitted more than five medical exemptions in one year; or 3) submitted to schools that have failed to report their immunization records to CDPH.
The State Public Health Officer or a physician designee may deny or revoke medical exemptions that do not align with CDC/ACIP or AAP guidelines.
The Department will notify the Medical Board of California of any physician who submits an exemption that is denied or revoked, and of any physician from whom the Department is not accepting exemptions.
SB 1448: Probation Status Disclosure
The first-in-the-nation law requiring physicians and surgeons to notify their patients if their license is on probation passed in 2018 and went into effect July 1, 2019. Patients must be notified of the following offenses (the new law also applies to naturopathic doctors, chiropractors, podiatrists, and acupuncturists):
Any act of sexual abuse, misconduct, or relations with a patient or client;
Drug or alcohol abuse directly resulting in harm to patients or to the extent that such use impairs the ability of the practitioner to practice safely;
Criminal conviction directly involving harm to patient health; or
Inappropriate prescribing resulting in harm to patients and a probationary period of five years or more.
Gabriela Villanueva is CAP’s Public Affairs Analyst. Questions or comments related to this article should be directed to gvillanueva@CAPphysicians.com.