While the battle for Medi-Cal funding has been CMA’s top priority this year, the association engaged on multiple fronts on behalf of the physician community.
Key Legislative Battles
In 2024, the California Legislature introduced a total of 2,124 bills. Of the bills that made it to Governor Newsom’s desk, 1,017 were signed and 189 were vetoed. The most common reason given by the governor for a veto over the past two legislative cycles was that the legislation would strain the budget. The second most common reason cited for a veto this year was a simple disagreement with the policy.
In the end, four of CMA’s priority bills made it to the governor’s desk and all four were signed.
CMA was also at the forefront of key legislative battles, ensuring that many bills that would have negatively impacted patients and the practice of medicine would not move forward through the legislative process.
CMA successfully defeated several pieces of legislation that would have jeopardized patient safety by creating an exemption to the ban on the corporate practice of medicine; imposed burdensome regulations on physician practices; heightened the risk of unnecessary lawsuits against physician practices; and legislated the practice of medicine.
Prior Authorization
CMA sponsored a bill on prior authorization and its intersection with the growing utilization of augmented intelligence (AI) in health care decision-making. SB 1120 (BECKER), the Physicians Make Decisions Act, prohibits a health plan from using AI for prior authorizations or utilization review unless a physician is overseeing the process. The bill passed out of the legislature and was signed by the Governor. It was one of the few bills on regulating AI that were signed by the Governor this year and it is likely to be replicated in many other states. CMA also sponsored SB 598 (SKINNER), which would have required health plans to institute a one-year prior authorization exemption for physicians who practice within the plan’s criteria 90% of the time. It would also have granted treating physicians the right to have their appeals of prior authorization denials conducted by a physician in the same or similar specialty. Unfortunately, this bill stalled over opposition from the administration. CMA subsequently worked with the administration to create a pilot program where prior authorization would be eliminated on a code-by-code basis as determined by the California Department of Managed Health Care (DMHC). CMA was successful in getting this language inserted into a bill that was amended out of Assembly appropriations Committee in August (SB 516, SKINNER). However, the new Assembly Health Chair, Mia Bonta, insisted on reporting requirements that would have increased administrative burdens on many physician practices, and we were forced to hold the bill this year.
Health System Consolidation
CMA engaged on AB 3129 (WOOD), which would have granted the Attorney General new enforcement powers over private equity transactions of health care entities. CMA worked to ensure critical amendments were included in the bill that would strengthen the bar on the corporate practice of medicine and give the attorney general new powers to independently bring actions against violators. Additionally, CMA secured amendments that made the reporting thresholds consistent with those of the California Office of Health Care Affordability (OHCA). CMA initially started in a support if amended position, but moved to support after these amendments were taken.
The bill took hostile amendments out of Senate Appropriations committee, which exempted hospitals and physician groups who primarily provide dermatologic services. It remains a Sacramento-wide mystery as to who requested these amendments as they did temper CMA support. The bill did pass out of the legislature but was vetoed by the governor with the veto message claiming that OHCA already has sufficient powers to oversee private equity activity.
Scope of Practice
CMA and the California Academy of Eye Physicians and Surgeons (CAEPS) jumped into early action this year to stop a bill (AB 1570, LOW) that would have authorized optometrists to perform six new procedures using lasers and scalpels in and around the eye with minimal training, at a great risk to patient safety. It is not hard to see why this bill was a bad idea. Thanks to the grassroots efforts of CMA physicians, we were successful in holding this bill on the suspense file in the Appropriations Committee, ensuring it would not move forward in the legislature.
SB 1451 (ASHBY) was a Business and Professions omnibus bill that required CMA to advocate for and against different pieces of the bill. CMA was successful in including title transparency language that prevents anyone other than an MD or DO from using the term “doctor or other like terms” in a medical setting where the patient would believe that licensee was a physician. Combined with our badge requirements, California has some of the strongest title transparency laws in the nation.
The bill included CMA-opposed changes to the Nurse Practitioner Practice Act that loosen training requirements for independent practice. CMA was successful in obtaining an amendment that requires all clinical experience required for independent practice to occur entirely within California, preventing the bill from creating a back door nursing licensing compact for nurse practitioners.
CMA partnered with the California Society of Anesthesiologists in opposing AB 2526 (GIPSON), which would have allowed nurse anesthetists to prescribe and administer sedation independently in dental offices. This bill was successfully held in Assembly Appropriations Committee.
CMA also successfully collaborated with Senator Lena Gonzalez, the author of SB 1131, to remove problematic provisions from the bill that would have significantly expanded the scope of practice for physician assistants, by allowing them to independently bill in the Medi-Cal program.
Public Health
CMA supported a number of public health measures this year. CMA worked with the California Attorney General on AB 3128 (WOOD) to close loopholes to the flavored tobacco ban that tobacco companies were exploiting.
We worked closely with Asssemblymember Hart’s office on AB 1866, which requires oil companies to accelerate the plugging and cleanup of idle wells, which pose health and safety threats to the surrounding communities.
CMA sponsored SB 963 (ASHBY), which requires emergency departments to deploy anonymous identification systems to help health care workers intervene and provide resources to victims of domestic violence and human trafficking in a safe, confidential and timely manner. Signed into law by the governor, SB 963 will allow emergency room staff to connect victims of trafficking to services and break the cycle of abuse.
CMA also successfully defeated SB 1250 (NGUYEN), which threatened to undermine the effectiveness of California’s newborn genetic screening program. The bill aimed to transition the program from a patient opt-out to an opt-in system. Requiring parents to proactively opt in to the program would have risked a significant decline in participation, hampering research and other scientific efforts. Such a shift would have jeopardized the early detection of life-threatening genetic conditions in newborns, leaving countless infants vulnerable. CMA preserved the integrity of this vital screening program, ensuring that it continues to safeguard the health and well-being of California’s youngest patients.
Protecting Physician Safety
Governor Gavin Newsom signed CMA-sponsored AB 977 (RODRIGUEZ) to protect health care workers while at work in emergency departments. Previously, assaults against health care workers inside an emergency department carried lesser penalties than assaults committed outside an emergency department. AB 977 will ensure that health care workers are not treated differently simply because they work in a hospital emergency department.
Another important bill CMA successfully sponsored was AB 2164 (BERMAN), which prohibits physician licensure applications from requiring the disclosure of personal medical information that does not impact their ability to practice medicine, helping reduce the stigma around mental health support for physicians.
Legislating the Practice of Medicine
CMA successfully stopped AB 2960 (LEE), which sought to legislate the practice of medicine by mandating yearly syphilis testing in all primary care clinics and hospital emergency departments for every sexually active patient aged 15 and older, whether it was clinically indicated or not. While the bill may have been well-intentioned, it posed a significant overreach by interfering with the trusted relationship between physicians and their patients and would have unnecessarily raised the cost of care.
Unfortunately, one bill CMA opposed, SB 607 (PORTANTINO) did pass and was signed by the governor. Current law requires physician to have discussions with minor patients for whom they are prescribing opioids about the risks of addiction and overdose associated with such drugs. This bill extends that requirement to all patients. CMA is currently working on potential clean up language centered around liability and the administrative burden this expanded requirement creates.