Healthcare

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law requires a health care service plan contract that includes terms requiring binding arbitration for dispute settlement to provide a specified disclosure to subscribers or enrollees. Existing law, the California Arbitration Act, provides a statutory framework for the enforcement of contractual arbitration under California law. Existing law establishes standards for arbitration, and requires a court to vacate an arbitration award if it makes certain findings. This bill would require the Attorney General to oversee compliance by health care service plans with specified provisions regulating the use of binding arbitration to settle disputes. The bill would authorize the Attorney General to require reports from health care service plans for this purpose. The bill would also require the Attorney General to notify the director of the department of any corrective action taken pursuant to these provisions.

Existing law, the Medical Practice Act, establishes the Medical Board of California to license and regulate the practice of medicine. Former law, repealed as of January 1, 2025, established the Licensed Physicians and Dentists from Mexico Pilot Program, which allowed up to 30 licensed physicians and up to 30 licensed dentists from Mexico to practice medicine or dentistry in California for a period not to exceed 3 years, in accordance with certain requirements. Existing law, operative January 1, 2025, instead, establishes within the act the Licensed Physicians from Mexico Program, which authorizes the board to issue a limited number of nonrenewable 3-year physician's and surgeon's licenses to licensed physicians from Mexico who meet specified criteria. This bill would require the board to issue a full and unrestricted physician's and surgeon's license to a person who has completed 2 3-year terms of the Licensed Physicians from Mexico Program or the former Licensed Physicians and Dentists from Mexico Pilot Program in good standing upon satisfaction of specified requirements, including having an offer of continued employment from a health care facility or practice in California. This bill would establish the California Physician Expansion Act, which would require the board to issue a provisional license to an applicant who holds a full and unrestricted license to practice medicine in another country who meets specified requirements, including that the applicant has not committed any acts or crimes constituting grounds for denial of a certificate, as specified. In this regard, the bill would require the board to submit to the Department of Justice fingerprint images and related information required by the department of all applicants for a provisional license to determine whether the applicant has a criminal conviction record, as specified, and would require the department to provide a state- and federal-level response pursuant to specified provisions for the board to determine whether the applicant is subject to denial of licensure, as specified. The bill would make the provisional license valid for 3 years and would authorize the board to grant a one-time renewal for an additional period of up to 3 years, as specified. The bill would require a provisional licensee to, among other things, be employed by, and practice medicine only within, a sponsoring entity, as specified. The bill would authorize the board to revoke a provisional license or take any other disciplinary action deemed appropriate by the board, as specified. The bill would deem a provisional licensee applicant who meets specified requirements, including having completed at least 36 months of practice under the provisional license without any disciplinary actions, to meet the professional instruction, preliminary education, and postgraduate training requirements for a certificate under the Medical Practice Act. The bill would require the board to establish application, initial licensure, renewal, and conversion fees for the provisional license, as specified. The bill would make findings and declarations relating to its provisions.

Existing law provides for the regulation of various chemicals, including chemicals contained in drugs, dietary supplements, and food products. This bill would prohibit an entity, as defined, from manufacturing, distributing, or offering for sale in this state a product that contains tianeptine or that is marketed as containing tianeptine. The bill would make a violation of these provisions punishable by a civil penalty not to exceed $2,500 for a first violation and not to exceed $5,000 for each subsequent violation, upon an action brought by the Attorney General, a city attorney, or a county counsel. The bill would entitle a prevailing plaintiff to an award of reasonable attorney's fees and costs.

Existing law, the Nevaeh Youth Sports Safety Act, requires a youth sports organization to ensure, by January 1, 2027, that its athletes have access to an automated external defibrillator (AED) during any practice or match. Existing law requires the AED to be administered by a medical professional or other certified and qualified person designated by a youth sports organization. This bill would delay the requirement to have access to an AED until January 1, 2028, would remove the requirement that it be administered by a medical professional, and would also require, by January 1, 2027, a youth sports organization to ensure that its coaches are certified, as specified, to perform cardiopulmonary resuscitation and to operate an AED. The bill would require, by January 1, 2027, a youth sports organization to have a written emergency response plan that includes certain information, including the location and procedures to be followed during a sudden cardiac event. The bill would require, by January 1, 2028, a youth sports organization to properly maintain and test its AED, as specified.

Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing. Existing law requires the utilization of a nurse anesthetist to provide anesthesia services in an acute care facility to be approved by the acute care facility administration and the appropriate committee, as defined, and at the discretion of the physician, dentist, or podiatrist. Existing law makes a nurse anesthetist who is not an employee of an acute care facility subject to the bylaws of the facility. This bill would expressly provide that a nurse anesthetist is authorized to perform anesthesia services. The bill would define "anesthesia services" for purposes of the act to mean, among other things, preoperative, intraoperative, and postoperative care and pain management provided by a nurse anesthetist for patients receiving anesthesia pursuant to an order by a physician, dentist, or podiatrist for anesthesia services. Under the bill, an order by a physician, dentist, or podiatrist for anesthesia services for a specific patient would be deemed the authorization for the nurse anesthetist to select and implement the modality of anesthesia for the patient and to abort or modify the modality of anesthesia during the course of care. The bill would provide that the selection and administration of medication by a nurse anesthetist for preoperative, intraoperative, and postoperative care and for pain management purposes pursuant to an order by a physician, dentist, or podiatrist shall not constitute a prescription as that term is defined in a specified provision of federal law. The bill would state that the provisions of the Nurse Anesthetists Act are declaratory of existing law and of an advisory opinion, including specified case law.

(1) Existing law, the Pharmacy Law, requires the California State Board of Pharmacy within the Department of Consumer Affairs to license and regulate the practice of pharmacy, including pharmacists, pharmacy technicians, and pharmacies. Existing law authorizes the board, with the approval of the Director of Consumer Affairs, to appoint an executive officer to exercise certain powers and to perform certain duties delegated by the board, as specified. Existing law repeals the provisions establishing the board and authorizing the appointment of an executive officer on January 1, 2026, rendering the board subject to review by the appropriate policy committees of the Legislature. This bill would provide that the board has exclusive authority to administer and enforce the Pharmacy Law related to the practice of pharmacy and the licensing of pharmacists and pharmacies, and would specify that its provisions do not prohibit the board from evaluating or acting regarding unlicensed activity, as provided. The bill would extend the repeal date of the above-described provisions to January 1, 2030. The bill would additionally require the board to establish a Pharmacy Technician Advisory Committee to advise and make recommendations to the board, as specified. Existing law specifies the fees for issuance or renewal of licenses issued pursuant to the Pharmacy Law, including, among others, pharmacy licenses. This bill would require the board to waive the application fee for a pharmacy operating a physical location in a medically underserved area, as defined, and would authorize the board to waive the fee for the annual renewal of a license if the licensee provides the board with certification of continued operation in the medically underserved area. (2) Existing law authorizes a pharmacist to perform various procedures and functions, including those related to dispensing or furnishing drugs or devices, as specified. Existing law generally requires a pharmacist's dispensing or furnishing drugs to be done pursuant to a valid prescription, except as provided in specified circumstances. Those exceptions include furnishing an FDA-approved opioid antagonist, emergency contraception drug therapy, self-administered hormonal contraceptives, nicotine replacement products, certain medications for individuals traveling outside of the United States, and certain HIV medications, as specified. Existing law requires certain conditions to be met for a pharmacist to authorize the initiation of a prescription under certain of those exceptions or to otherwise provide clinical advice, services, information, or patient consultation. This bill would revise and recast the above-described provisions to authorize a pharmacist to, among other things, furnish dangerous devices, to furnish FDA-approved or authorized medications as part of preventative health care services that do not require a diagnosis, as specified, and to complete missing information on a prescription for a noncontrolled medication if there is evidence to support the change. The bill would require that a pharmacist provide those and other specified services or activities consistent with the accepted standard of care, defined to mean the degree of care a prudent and reasonable pharmacist licensed under the Pharmacy Law, with similar education, training, experience, resources, and setting, would use in a similar situation. The bill would make nonsubstantive, conforming changes. Existing law requires the clinical advice, services, information, or patient consultation that a pharmacist provides to be provided to a health care professional or to a patient. This bill would authorize a pharmacist to provide the clinical advice, services, information, or patient consultation to a patient's agent. Existing law, until January 1, 2026, authorizes a pharmacist to furnish COVID-19 oral therapeutics, as defined, following a positive test for SARS-CoV-2, the virus that causes COVID-19, in accordance with specified requirements. This bill would delete the January 1, 2026, repeal date, thereby extending this authorization indefinitely. Existing law prohibits a dangerous drug from being refilled without the authorization of the prescriber, except under specified circumstances. Under those circumstances, existing law requires a pharmacist to make every reasonable effort to contact the prescriber. This bill would remove the above-described requirement that the pharmacist make every reasonable effort to contact the prescriber. Existing law authorizes a pharmacist to dispense not more than a 90-day supply of a dangerous drug other than a controlled substance pursuant to a valid prescription that specifies an initial quantity of less than a 90-day supply followed by periodic refills of that amount if certain requirements are met. Existing law prohibits a pharmacist from dispensing a greater supply pursuant to that provision if the prescriber indicates that there is to be no change to the quantity of the refill, as specified. This bill would remove that prohibition. Existing law authorizes a pharmacy to dispense epinephrine auto-injectors to a prehospital emergency medical care person or lay rescuer for the purpose of rendering emergency care, as specified. This bill would remove the above-described authorization. (3) Existing law authorizes a licensed pharmacist to perform additional functions if the licensee is recognized by the board as "an advanced practice pharmacist" by meeting certain requirements. Those additional functions include, among others, performing patient assessments, ordering and interpreting drug therapy-related tests, and initiating, adjusting, or discontinuing drug therapy, as specified. The requirements for recognition as an advanced practice pharmacist include having completed a combination of specified certifications, postgraduate residencies, or experience under a collaborative practice agreement or protocol with a physician. Existing law also requires an advanced practice pharmacist to complete 10 hours of continuing education in addition to the continuing education otherwise required at the time of a second or subsequent license renewal. This bill would revise those and other related provisions to refer to those licensees as "advanced pharmacist practitioners," instead of as "advanced practice pharmacists." (4) Existing law prohibits any person from furnishing or dispensing any dangerous drug or device on the internet for delivery to any person in California without a prescription issued pursuant to a "good faith prior examination," as provided. This bill would instead refer to that examination as an "appropriate prior examination." (5) Existing law authorizes the board to issue citations containing fines and orders of abatement for violations of specified law, as provided. Existing law authorizes the board to bring an action against a chain community pharmacy under common ownership or management for fines for a violation of the Pharmacy Law that was expressly encouraged by the common owner or manager, as provided. This bill would instead apply those fines for a violation that was expressly encouraged by any owner or manager of the chain community pharmacy. Existing law authorizes the board to bring an action for fines for repeated violations of materially similar provisions of the Pharmacy Law within 5 years by 3 or more pharmacies operating under common ownership or management within a chain community pharmacy, as specified. Existing law provides a pharmacy with a defense if it establishes that the violation was contrary to a written policy that was communicated by the common owner or manager to all employees where the violation occurred. Existing law also provides a defense if the pharmacy establishes that, within 6 months after the violation, the common owner or manager corrected all unlawful policies, communicated the change in policies, and provided the board with proof of abatement of the violation, as specified. This bill would, for the defense that the violation was contrary to a written policy, also require the entity to establish that it has complied with the policy. The bill would revise the above-described corrective-actions defense by allowing those actions to be undertaken by any owner or manager of the pharmacy. The bill would additionally authorize the board to bring an action for fines for repeated violations of materially similar provisions of the Pharmacy Law against a mail order pharmacy, defined as a nonresident pharmacy that dispenses medications and ships them to patients via the postal service or other mail delivery method, as provided. The bill would require the board, in determining the amount of the fine, to consider mitigating and aggregating factors, as specified. (6) Existing law prohibits the board from issuing a pharmacy license to a person who has a shared community or financial interest with a person authorized to prescribe or write a prescription, as provided. This bill would establish an exception to the above-described prohibition under which the applicant and the prescriber would be required to provide statements that the prescriber disavows any community or financial interest in the license and to transmute any interest in the license that is shared community property into the separate property of the applicant, as provided. The bill would prohibit a pharmacy granted a license pursuant to this exception from filling any prescriptions issued or prescribed by a person who shares a community or other financial interest with the licensee or a prescriber at the same place of business as that person if the prescriber owns an interest greater than 10% in the practice issuing the prescription. Existing law authorizes the board to issue a retired license to a licensed pharmacist, as specified. Existing law authorizes the holder of a retired license to restore their license to active status by passing the examination that is required for initial licensure with the board. This bill would instead authorize the holder of a retired license to request to restore their license to active status within 3 years of issuance of the retired license by paying a renewal fee and successfully completing certain continuing education within the 2 years preceding the request, as specified. If more than 3 years have elapsed since the issuance of the retired license, the bill would require the holder of the retired license to reapply for licensure as a pharmacist, as specified. Existing law authorizes the board to deny a license application if the applicant has been convicted of a crime or subjected to formal discipline that would be grounds for denial of a federal registration to distribute controlled substances. This bill would also authorize the board to deny a license application if the applicant has been convicted of a crime involving fraud in violation of state or federal laws related to health care or involving financial identity theft. Existing law requires certain licensed facilities to perform a self-assessment evaluating compliance with specified provisions of the Pharmacy Law, as provided. This bill would require all licensed facilities to complete a self-assessment every odd-numbered year and within 30 days of certain changes to the license, management personnel, and location, as provided. The bill would require this self-assessment to be signed under penalty of perjury, thereby imposing a state-mandated local program by expanding the crime of perjury. (7) Existing law requires a pharmacy to designate a pharmacist-in-charge and notify the board within 30 days of that designation, as specified. Existing law authorizes the pharmacist-in-charge to, among other things, make staffing decisions and notify store management of dangerous conditions, as specified. This bill would require the pharmacist-in-charge to determine the appropriate pharmacist-to-technician ratio, within prescribed limits, and prohibit anyone else from interfering with the exercise of the pharmacist-in-charge's independent professional judgment in setting this ratio. The bill would additionally require the pharmacist-in-charge to notify the owner or hospital administrator of dangerous conditions, as specified. Existing law provides for the licensing of nonresident pharmacies, as specified. Existing law prohibits a pharmacist at a nonresident pharmacy whose license has been revoked from prescribing a dangerous drug or providing other pharmacy-related services, as specified. This bill would, beginning July 1, 2026, require a nonresident pharmacy, as a prerequisite to registering with the board and ongoing licensure, to identify a California-licensed pharmacist employed and working at the nonresident pharmacy to be proposed to serve as the pharmacist-in-charge. The bill would also require the nonresident pharmacy, within 90 days of designating a pharmacist-in-charge, to notify the board of the identity and license number of that pharmacist and the date they were designated, as specified. The bill would require the nonresident pharmacy, within 90 days, to notify the board of a pharmacist-in-charge ceasing to act as the pharmacist-in-charge and to propose another pharmacist to take over as the pharmacist-in-charge. The bill would additionally, beginning July 1, 2026, prohibit a nonresident pharmacy from permitting a pharmacist-in-charge who is not licensed in California from working at a nonresident pharmacy. The bill would authorize the board to inspect a nonresident pharmacy. The bill would require a nonresident pharmacy to deposit a reasonable amount, as determined by the board, necessary to cover the board's estimated reasonable costs of performing the inspection, as specified. (8) Existing law limits a pharmacy with only one pharmacist to one pharmacy technician performing packaging, manipulative, repetitive, or other nondiscretionary tasks. This bill would increase this limit to 3 pharmacy technicians performing those tasks. (9) Existing law requires a pharmacy to preserve certain records, as provided. This bill would require a pharmacy to additionally maintain records related to prescribed policies and procedures in a readily retrievable format. The bill would also impose requirements related to electronically maintained records. (10) This bill would incorporate additional changes to Section 4064.5 of the Business and Professions Code proposed by SB 418 to be operative only if this bill and SB 418 is enacted and this bill is enacted last. This bill would incorporate additional changes to Section 4076 of the Business and Professions Code proposed by AB 260 to be operative only if this bill and AB 260 are enacted and this bill is enacted last. (11) Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.