2005 California Business and Professions Code Sections 4999-4999.9 CHAPTER 15. TELEPHONE MEDICAL ADVICE SERVICES

4999.  (a) On and after January 1, 2000, no business entity that
employs, or contracts or subcontracts, directly or indirectly, with,
the full-time equivalent of five or more persons functioning as
health care professionals, whose primary function is to provide
telephone medical advice, shall engage in the business of providing
telephone medical advice services to a patient at a California
address unless the business is registered with the Telephone Medical
Advice Services Bureau.  The department may adopt emergency
regulations further defining when a health care professional's
primary function is providing telephone medical advice.
   (b) Any business entity required to be registered under
subdivision (a) that submits proof of accreditation by the American
Accreditation Healthcare Commission, URAC, the National Committee for
Quality Assurance, the National Quality Health Council, or the Joint
Commission on Accreditation of Healthcare Organizations shall be
deemed provisionally registered by the bureau until the earlier of
the following:
   (1) December 31, 2000.
   (2) The granting or denial of an application for registration
pursuant to subdivision (a).
   (c) A medical group that operates in multiple locations in
California shall not be required to register pursuant to this section
if no more than five full-time equivalent persons at any one
location perform telephone medical advice services and those persons
limit the telephone medical advice services to patients being treated
at that location.
   (d) Protection of the public shall be the highest priority for the
bureau in exercising its registration, regulatory, and disciplinary
functions.  Whenever the protection of the public is inconsistent
with other interests sought to be promoted, the protection of the
public shall be paramount.
4999.1.  Application for registration as an in-state or out-of-state
telephone medical advice service shall be made on a form prescribed
by the department, accompanied by the fee prescribed pursuant to
Section 4999.5.  The department shall make application forms
available no later than July 1, 2000.  Applications shall contain all
of the following:
   (a) The signature of the individual owner of the in-state or
out-of-state telephone medical advice service, or of all of the
partners if the service is a partnership, or of the president or
secretary if the service is a corporation.  The signature shall be
accompanied by a resolution or other written communication
identifying the individual whose signature is on the form as owner,
partner, president, or secretary.
   (b) The name under which the person applying for the in-state or
out-of-state telephone medical advice service proposes to do
business.
   (c) The physical address, mailing address, and telephone number of
the business entity.
   (d) The designation of an agent for service of process in
California.
   (e) A list of all in-state or out-of-state staff providing
telephone medical advice services that are required to be licensed,
registered, or certified pursuant to this chapter.  This list shall
be submitted to the department on a quarterly basis on a form to be
prescribed by the department and shall include, but not be limited
to, the name, address, state of licensure, category of license, and
license number.
   (f) The department shall be notified within 30 days of any change
of name, location of business, corporate officer, or agent of
service.
4999.2.  (a) In order to obtain and maintain a registration,
in-state or out-of-state telephone medical advice services shall
comply with the requirements established by the department.  Those
requirements shall include, but shall not be limited to, all of the
following:
   (1) (A) Ensuring that all staff who provide medical advice
services are appropriately licensed, certified, or registered as a
physician and surgeon pursuant to Chapter 5 (commencing with Section
2000) or the Osteopathic Initiative Act, as a dentist pursuant to
Chapter 4 (commencing with Section 1600), as a dental hygienist
pursuant to Sections 1760 to 1775, inclusive, as a psychologist
pursuant to Chapter 6.6 (commencing with Section 2900), as a marriage
and family therapist pursuant to Chapter 13 (commencing with Section
4980), as a licensed clinical social worker pursuant to Chapter 14
(commencing with Section 4990), as an optometrist pursuant to Chapter
7 (commencing with Section 3000), or as a chiropractor pursuant to
the Chiropractic Initiative Act, and operating consistent with the
laws governing their respective scopes of practice in the state
within which they provide telephone medical advice services, except
as provided in paragraph (2).
   (B) Ensuring that all staff who provide telephone medical advice
services from an out-of-state location are health care professionals,
as identified in subparagraph (A), who are licensed, registered, or
certified in the state within which they are providing the telephone
medical advice services and are operating consistent with the laws
governing their respective scopes of practice.
   (2) Ensuring that all registered nurses providing telephone
medical advice services to both in-state and out-of-state business
entities registered pursuant to this chapter are licensed pursuant to
Chapter 6 (commencing with Section 2700).
   (3) Ensuring that the telephone medical advice provided is
consistent with good professional practice.
   (4) Maintaining records of telephone medical advice services,
including records of complaints, provided to patients in California
for a period of at least five years.
   (5) Ensuring that no staff member uses a title or designation when
speaking to an enrollee or subscriber that may cause a reasonable
person to believe that the staff member is a licensed, certified, or
registered professional described in subparagraph (A) of paragraph
(1), unless the staff member is a licensed, certified, or registered
professional.
   (6) Complying with all directions and requests for information
made by the department.
   (b) To the extent permitted by Article VII of the California
Constitution, the department may contract with a private nonprofit
accrediting agency to evaluate the qualifications of applicants for
registration pursuant to this chapter and to make recommendations to
the department.
4999.3.  (a) The department may suspend, revoke, or otherwise
discipline a registrant or deny an application for registration as an
in-state or out-of-state telephone medical advice service based on
any of the following:
   (1) Incompetence, gross negligence, or repeated similar negligent
acts performed by the registrant or any employee of the registrant.
   (2) An act of dishonesty or fraud by the registrant or any
employee of the registrant.
   (3) The commission of any act, or being convicted of a crime, that
constitutes grounds for denial or revocation of licensure pursuant
to any provision of this division.
   (b) The proceedings shall be conducted in accordance with Chapter
5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2
of the Government Code, and the department shall have all powers
granted therein.
   (c) Copies of any complaint against an in-state or out-of-state
telephone medical advice service shall be forwarded to the Department
of Managed Care.
   (d) The department shall forward a copy of any complaint submitted
to the department pursuant to this chapter to the entity that issued
the license to the licensee involved in the advice provided to the
patient.
4999.4.  (a) Every registration issued a telephone medical advice
service shall expire 24 months after the initial date of issuance.
   (b) To renew an unexpired registration, the registrant shall,
before the time at which the license registration would otherwise
expire, apply for renewal on a form prescribed by the bureau, and pay
the renewal fee authorized by Section 4999.5.
   (c) A registration that is not renewed within three years
following its expiration shall not be renewed, restored, or
reinstated thereafter, and the delinquent registration shall be
canceled immediately upon expiration of the three-year period.  An
expired registration may be renewed at any time within three years
after its expiration upon filling of an application for renewal on a
form prescribed by the bureau and the payment of all fees authorized
by Section 4999.5.
4999.5.  The department may set fees for registration, as an
in-state or out-of-state telephone medical advice service sufficient
to pay the costs of administration of this chapter.
4999.6.  The department may adopt, amend, or repeal any rules and
regulations that are reasonably necessary to carry out this chapter.
A telephone medical advice services provider who provides telephone
medical advice to a significant total number of charity or medically
indigent patients may, at the discretion of the director, be exempt
from the fee requirements imposed by this chapter.  However, those
providers shall comply with all other provisions of this chapter.
4999.7.  (a) Nothing in this section shall limit, preclude, or
otherwise interfere with the practices of other persons licensed or
otherwise authorized to practice, under any other provision of this
division, telephone medical advice services consistent with the laws
governing their respective scopes of practice, or licensed under the
Osteopathic Initiative Act or the Chiropractic Initiative Act and
operating consistent with the laws governing their respective scopes
of practice.
   (b) For the purposes of this chapter, "telephone medical advice"
means a telephonic communication between a patient and a health care
professional in which the health care professional's primary function
is to provide to the patient a telephonic response to the patient's
questions regarding his or her or a family member's medical care or
treatment.  "Telephone medical advice" includes assessment,
evaluation, or advice provided to patients or their family members.
   (c) For the purposes of this chapter, "health care professional"
is a staff person described in Section 4999.2 who provides medical
advice services and is appropriately licensed, certified, or
registered as a registered nurse pursuant to Chapter 6 (commencing
with Section 2700), as a physician and surgeon pursuant to Chapter 5
(commencing with Section 2000) or the Osteopathic Initiative Act, as
a dentist pursuant to Chapter 4 (commencing with Section 1600), as a
dental hygienist pursuant to Sections 1760 to 1775, inclusive, as a
psychologist pursuant to Chapter 6.6 (commencing with Section 2900),
as a marriage and family therapist pursuant to Chapter 13 (commencing
with Section 4980), as a licensed clinical social worker pursuant to
Chapter 14 (commencing with Section 4990), as an optometrist
pursuant to Chapter 7 (commencing with Section 3000), or as a
chiropractor pursuant to the Chiropractic Initiative Act, and who is
operating consistent with the laws governing his or her respective
scopes of practice in the state in which he or she provides telephone
medical advice services.
4999.8.  (a) The department shall conduct a study of issues
pertaining to the provision of telephone medical advice services
provided by registered and provisionally registered telephone medical
advice services providers to patients in California by health care
professionals licensed, certified, or registered in other states.
All data required for the study shall be submitted to the department
within 30 days of the end of each calendar quarter.  The study shall
be based upon information of telephone medical advice service
activities occurring between January 1, 2000, and December 31, 2000.
The study shall include, and not be limited to, all of the
following:
   (1) The number of complaints that were filed with the telephone
medical advice service.
   (2) The number of complaints that involved health care
professionals licensed in other states.
   (3) The number of complaints referred to licensing entities in
California and other states.
   (4) The disposition of complaints filed with the department
pursuant to this chapter.
   (5) Complaint information submitted by the Director of the
Department of Managed Care pursuant to subdivision (b) of Section
1348.8.
   (6) Any other information the department determines to be
necessary to evaluate the impact of out-of-state licensees providing
telephone medical advice services on the quality of care provided to
patients in California.
   (b) On or before March 1, 2001, the department shall deliver a
report summarizing the findings of the study to both the Assembly
Committee on Rules and the Senate Committee on Rules, which shall
refer the report to appropriate policy committees.  The report shall
be prepared utilizing existing agency resources.
   (c) The department shall conduct a study of issues pertaining to
the provision of medical advice services provided by registered
telephone medical advice services to patients in California by health
care professionals licensed, certified, or registered in other
states.  All data required for the study shall be submitted to the
department within 30 days of the end of each calendar quarter.  The
study shall be based upon information of telephone medical advice
service activities occurring between January 1, 2001, and December
31, 2001, and shall include, but not limited to, the following:
   (1) The number of complaints that were filed with the telephone
medical advice service.
   (2) The number of complaints that were filed with the department
pursuant to this chapter.
   (3) The number of complaints that involved health care
professionals licensed in other states.
   (4) The number of complaints referred to licensing entities in
California and other states.
   (5) The disposition of complaints filed with the department
pursuant to this chapter.
   (6) Complaint information submitted by the Director of the
Department of Managed Care pursuant to subdivision (b) of Section
1348.8.
   (7) Any other information the department determines to be
necessary to evaluate the impact of out-of-state licensees providing
telephone medical advice services on the quality of care provided to
patients in California.
   (d) On or before March 1, 2002, the department shall deliver a
report summarizing the findings of the study to both the Assembly
Committee on Rules and the Senate Committee on Rules, which shall
refer the report to appropriate policy committees.  The report shall
be prepared from then existing agency resources.
4999.9.  The director shall, on or before June 30, 2000, adopt
emergency regulations to implement this chapter in accordance with
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 adoption of emergency regulations described in this section
shall be deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, or general
welfare.  Emergency regulations adopted pursuant to this section
shall be exempt from review by the Office of Administrative Law.  The
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and publication in the California Code of Regulations and shall
remain in effect for no more than 180 days.