California Senate Bill SB19 Amended / Bill

 BILL NUMBER: SB 19AMENDED BILL TEXT AMENDED IN ASSEMBLY AUGUST 31, 2015 AMENDED IN ASSEMBLY JULY 16, 2015 AMENDED IN SENATE JUNE 2, 2015 AMENDED IN SENATE MAY 5, 2015 AMENDED IN SENATE MARCH 25, 2015 INTRODUCED BY Senator Wolk (Coauthors: Senators Hancock, Monning, and Vidak) (Coauthors: Assembly Members Bonilla, Dababneh, and Eggman) DECEMBER 1, 2014 An act to add  and repeal  Section 4788  to   of  the Probate Code, relating to resuscitative measures. LEGISLATIVE COUNSEL'S DIGEST SB 19, as amended, Wolk. Physician Orders for Life Sustaining Treatment form:  statewide registry.   electronic registry pilot.  Existing law defines a request regarding resuscitative measures as a written document, signed by an individual with capacity, or a legally recognized health care decisionmaker, and the individual's physician, directing a health care provider regarding resuscitative measures. Existing law defines a Physician Orders for Life Sustaining Treatment form, which is commonly referred to as a POLST form, and provides that a request regarding resuscitative measures includes a POLST form. Existing law requires that a POLST form and the medical intervention and procedures offered by the form be explained by a health care provider. Existing law distinguishes a request regarding resuscitative measures from an advance health care directive. This bill would enact the California POLST  Registry   eRegistry Pilot  Act. The bill would require the  California Health and Human Services Agency  Emergency Medical Services Authority  to establish  and operate a statewide registry system,   a pilot project, in consultation with stakeholders, to operate an electronic registry system on a pilot basis,  to be known as the California POLST  Registry,   eRegistry Pilot,  for the purpose of collecting POLST  forms   information  received from a physician or physician's designee.  The bill would require the authority to coordinate the POLST eRegistry Pilot, which would be operated by health information exchange networks, by an independent contractor, or by a combination thereof.  The bill would require the  agency   authority  to implement these provisions only after it determines that sufficient nonstate funds  have been received   are available  for development of the  registry and   POLST eRegistry Pilot,  any related startup  costs. A   costs, and an evaluation of the POLST eRegistry Pilot. When the POLST eRegistry Pilot is operable in the geographic area in which he or she operates or practices, a  physician or physician's designee who completes  a  POLST  form   information  would be required to include the POLST  form   information  in the patient's  medical   official electronic health  record and would be required to submit  the form to the registry,   a copy of the form to, or to enter the information into, the POLST eRegistry Pilot,  unless a patient or his or her health care decisionmaker chooses not to participate in the  registry.   The bill would require the agency to disseminate the information in the POLST form to an authorized user. The bill would define "authorized user" to include a health care provider.   POLST eRegistry Pilot.  The bill would require the  agency   authority  to adopt  rules   guidelines  for, among other things, the operation of the  registry,   POLST eRegistry Pilot,  including the means by which POLST  forms   information  would be submitted electronically,  revised, and revoked, the capability to check the POLST form for accuracy prior to it being made available,   modified, or withdrawn,  the appropriate and timely methods for dissemination of POLST form information, the procedures for verifying the identity of an authorized user, and rules for maintaining the confidentiality of  a  POLST  form   information  received by the  registry.   POLST eRegistry Pilot.  The bill would require that any disclosure of POLST  form  information in the  registry   POLST eRegistry Pilot  be made in accordance with applicable state and federal privacy and security laws and regulations. The bill would provide immunity from criminal prosecution, civil liability, discipline for unprofessional conduct, and any other sanction for a health care provider who honors a patient's request regarding resuscitative measures obtained from the  registry,   POLST eRegistry Pilot,  as specified.  The bill would require an independent contractor approved by the authority to conduct an evaluation of the POLST eRegistry Pilot. The provisions of the bill would be operative until January 1, 2020.  Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. This act shall be known, and may be cited, as the California POLST  Registry   eRegistry Pilot  Act. SEC. 2. Section 4788 is added to the Probate Code, to read: 4788. (a) For purposes of this section:  (1) "Agency" means the California Health and Human Services Agency.   (1) "Authority" means the Emergency Medical Services Authority.  (2) "Authorized user" means a person authorized by the  agency   authority  to submit information to, or to receive information from, the POLST  registry,   eRegistry Pilot,  including health care providers and their designees. (3) "Health care provider" has the meaning provided in Section  4621.   4781.  (4)  "POLST form"   "POLST"    means a Physician Orders for Life Sustaining Treatment  form  that fulfills the  requirements   requirements, in any format,  of Section 4780. (5)  "Registry"   "POLST eRegistry Pilot"  means the California POLST  Registry established by the agency   eRegistry Pilot Act established  pursuant to this  section.   section to make electronic, in addition to other modes of submission and transmission, POLST information available to authorized users.  (b) (1)  The agency shall establish and operate a statewide registry system, to be known as the California POLST Registry,   The authority shall establish a pilot project, in consultation with stakeholders, to operate an electronic registry system on a pilot basis, to be known as the California POLST eRegistry Pilot,  for the purpose of collecting a  patient' s  POLST  form   information  received from a physician or physician's designee and disseminating the information  in the form  to an authorized user. (2) The  agency   authority  shall implement this section only after determining that sufficient nonstate funds  have been received   are available  to allow for the development of the  registry and   POLST eRegistry Pilot,  any related startup  costs.   costs, and an evaluation of the POLST eRegistry Pilot.   (3) The registry may be operated and maintained by a contractor of the agency. The agency   (3) The authority shall coordinate the POLST eRegistry Pilot, which shall be operated by, and as a part of, the health information exchange networks, or by an independent contractor, or by a combination thereof. The POLST eRegistry Pilot may operate in a single geographic area or multiple geographic areas and may test various methods of making POLST information available electronically. The design of the POLST eRegistry Pilot shall be sufficiently robust, based on the success of the pilot, to inform the permanent, statewide operation of a POLST eRegistry.   (4)     The authority  shall adopt  all rules   guidelines  necessary for the operation of the  registry, which   POLST eRegistry Pilot. In developing these guidelines, the authority shall seek input from interested parties and hold at least one public meeting. The adoption, amendment, or repeal of the guidelines authorized by this paragraph is hereby exempted from 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 guidelines  shall include, but not be limited to, the following: (A) The means by which  an  initial or subsequent POLST  form   information  may be submitted to, or withdrawn from, the  registry,   POLST eRe   gistry Pilot,  which shall include a method for electronic delivery of this information and the use of legally sufficient electronic signatures. (B) Appropriate and timely methods by which the information in the  registry   POLST eRegistry Pilot  may be disseminated to an authorized user. (C) Procedures for verifying the identity of an authorized user. (D) Procedures to ensure the accuracy of, and to appropriately protect the confidentiality of, POLST  forms   information  submitted to the  registry.   POLST eRegistry Pilot.  (E) The requirement that a patient, or, when appropriate, his or her legally recognized health care decisionmaker, receive a confirmation or a receipt that the patient's POLST  form   information  has been received by the  registry.   POLST eRegistry Pilot.   (F) The ability of the physician who signed the POLST form, or his or her designee, and of a patient, or, when appropriate, his or her legally recognized health care decisionmaker, to review the information in the patient's POLST form after it has been entered into the registry, and to confirm that it is accurate, prior to the information being available to an authorized user.   (G)   (F)  The ability of a patient, or, when appropriate, his or her legally recognized health care decisionmaker,  to withdraw a POLST form from the registry.   with his or her health care provider, to modify or withdraw POLST information on the POLST eRegistry Pilot.   (6) (A) Prior to implementation of the POLST eRegistry Pilot, the authority shall submit a detailed plan to the Legislature that explains how the POLST eRegistry Pilot will operate.   (B) The plan to be submitted pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.  (c) The operation of the  registry   POLST eRegistry Pilot, for all users,  shall comply with state and federal privacy and security laws and regulations, including, but not limited to, compliance with the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the regulations promulgated pursuant to the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), found at Parts 160 and 164 of Title 45 of the Code of Federal Regulations. (d)  A   When the POLST eRegistry Pilot is operable in the geographic area in which he or she practices or operates, a  physician or physician's designee who completes  a POLST form   POLST information  with a patient or his or her legally recognized health care decisionmaker shall include the POLST  form   information  in the patient's official  medical record. The physician or physician's designee   electronic health record and  shall submit a copy of the POLST form  to the registry   to, or enter the POLST information into, the POLST eR   egistry Pilot,  unless the patient or the legally recognized health care decisionmaker chooses not to participate in the  registry.   POLST eRegistry Pilot.   (e) When the POLST eRegistry Pilot is operable in the geographic area in which they practice or operate, physicians, hospitals, and health information exchange networks shall make electronic POLST information available, for use during emergencies, through the POLST eRegistry Pilot to health care providers that also practice or operate in a geographic area where the POLST eRegistry Pilot is operable, but that are outside of their health information exchange networks.   (e)   (f)  In accordance with Section 4782, a health care provider who honors a patient's request regarding resuscitative measures obtained from the  registry   POLST eRegistry Pilot  shall not be subject to criminal prosecution, civil liability, discipline for unprofessional conduct, administrative sanction, or any other sanction, if the health care provider (1) believes in good faith that the action or decision is consistent with this part, and (2) has no knowledge that the action or decision would be inconsistent with a health care decision that the individual signing the request would have made on his or her own behalf under like circumstances.  (g) An independent contractor approved by the authority shall perform an evaluation of the POLST eRegistry Pilot.   (h) This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.