California Legislation
The California legislative session opened in January, and all bills must be introduced by February 20. CCCC will review all bills and, with input from the Board of Directors and Public Policy Advisory Council, identify those most relevant to the quality and delivery of serious illness care, including those that affect the use of AI in healthcare. Updates will be made weekly to reflect the bills’ passage through the legislative process.
Priority Bills
SB-1088. Healthcare decisions: life-sustaining treatment.
It is CCCC's honor and pleasure to be working with Senator Blakespear (R-38) and her staff on Senate Bill 1088, to modernize the POLST and prehospital DNR statute.
Status: PASSED by the Senate Judiciary Committee unanimously (12-0) on April 28; 4/30: Ordered to 3rd Reading. Bill analysis HERE.
The bill is scheduled for a hearing in the Senate Judiciary Committee on April 28. Please support this legislation by downloading this sample support letter, customizing it with your letterhead and name, and submit it through the online portal at: https://calegislation.lc.ca.gov/Advocates/ by April 21.
Specifically, the proposed amendments intend to:
- Change the name of the form from "Physician Orders for Life Sustaining Treatment (POLST)" to "POLST (Portable Orders Listing Scope of Treatment)."
- Why? Because in California, not only physicians but also nurse practitioners and physician assistants/associates can sign POLST and because we want to move away from the emphasis on "life-sustaining treatment" to a broader understanding of the application of POLST as medical orders. "POLST: A portable medical order" is how the National POLST Collaborative refers to the program, so this brings the California program closer to national recommendations.
- Authorize nurse practitioners and physician assistants/associates to also sign the prehospital DNR form.
- Why? Limiting signature of the prehospital DNR to physicians only creates problems for patients and their surrogates in regions and settings where physicians are scarce. It also makes no sense to allow NPs and PAs to sign POLST but not a prehospital DNR. This inconsistency creates an unnecessary confusion about how is authorized to sign what form.
- Specify who, exactly, is a "legally recognized decisionmaker" who can sign a POLST on behalf of an incapacitated patient.
- Why? "Legally recognized decisionmaker" has no real meaning in healthcare decisions law, but some people are and other people are not authorized to sign a POLST for an incapacitated patient. The bill will clarify/specify that the only authorized signers of a POLST for an incapacitated patient are the person's appointed healthcare agent (healthcare power of attorney), guardian or conservator with healthcare decision-making authority, or a surrogate orally designated by the patient when they had capacity or selected by a healthcare provider according to the specified process (sections 4711 and 4712 of the Probate Code), or a SNF IDT with patient representation.
- Emphasize that POLST is entirely voluntary and the provision of care or admission to a facility cannot be conditioned on completion of or refusal to complete a POLST or prehospital “do not resuscitate” order.
- Why? Because too often facilities present POLST as required for admission, either by implication when it is included with all the other admission paperwork, or more explicitly. We've even heard of ambulance services refusing to transport a patient without a POLST. No one can be required to complete a POLST as a condition of health care or service.
- Authorize electronic signature of POLST for electronic health records and the POLST eRegistry.
- Why? POLSTs are already being completed electronically, yet there is no specific provision in the law to say that electronic signatures are valid. We hope to clarify that and the type of electronic signature that is required, striking a balance between security and convenience.
- Require the form to be dated!
- Why? Currently, the statute does not specify that POLST forms must be dated, and yet we rely on the date on the form to determine which orders take precedence when there is a conflict! POLST forms are intended to be updated as a patient's condition and preferences change, so it's essential to know which form is most current.
- Honor POLSTs and POLST-like forms and prehospital DNRs executed in other states.
- Why? All 50 states now have some kind of POLST program, with substantially similar forms and nearly identical basic provisions. A tourist visiting California or someone who has recently moved to the state should have confidence that their prior POLST form will be honored.
These amendments were largely motivated by the results of our statewide survey of POLST knowledge in 2024, which revealed broad misunderstandings and broken practice points across all facility and provider types. The law can only do so much -- best POLST practice largely lives outside statutes and even regulations! -- but we believe these amendments will help address important points of confusion and inconsistency.
Please feel free to contact us ([email protected]) with any concerns or questions -- we are open to your suggestions and comments as the legislative process continues!
Other Priority Bills (Red text indicates amendments)
AB 2283. State Public Guardian. (Gonzalez)
This bill would require, upon appropriation by the Legislature, the State Department of Social Services to establish the position of the State Public Guardian to assist counties with performing their duties as a public guardian or public conservator. . . . The bill would limit the duties of the State Public Guardian to support of public guardianships and public conservatorships under the Probate Code and, to the extent possible, not those conservatorships for persons with a grave disability pursuant to the Lanterman-Petris-Short Act. Bill analysis HERE.
Actions: 2/19: Introduced; 3/9: referred to Assembly JUDICIARY com; set for HEARING 3/24; 3/24: PASSED by committee with amendments; referred to APPROPRIATIONS; 3/25: 2nd Reading; 3/26: Re-referred to APPR.
CCCC Position: Following.
AB 2382. Electronic death registration system. (Patterson)
This bill would require the State Registrar to use updated technology, including computer and mobile telephone applications, to upgrade the [death registration] system. The bill would also require that specified individuals, including a physician, medical examiner, and local registrar, have the ability to access the electronic death registration system in addition to the individuals currently responsible for completing a certificate of death. The bill would also authorize specified individuals to attest to a death within the system using electronic, voice, or facsimile methods. The bill would require the department to update the system to allow this. Bill analysis HERE.
Actions: 2/20: Introduced; 3/9: referred to Assembly HEALTH com; 4/22: AMENDED, referred to consent calendar; PASSED (16-0); 4/23: 2nd Reading; 4/27: Referred to APPROP.; 5/6: Referred to APPROP suspense file.
CCCC Position: SUPPORT.
SB 1002. Out-of-state physicians and surgeons: telehealth: license exemption. (Niello)
[Amendment to 2023 act that permits "eligible" patients to utilize services of out-of-state physicians under specified circumstances via telehealth. This amendment would add to definition of "eligible" patients] "whose immediately life-threatening disease or condition is in remission and the patient is continuing care with the previously established eligible out-of-state physician and surgeon, and would provide that those patients are not subject to the clinical trial requirement, as specified." Bill analysis HERE.
Actions: 2/9: Introduced; 2/18: Referred to LABOR, PUB EMP & RETIREMENT com; set for HEARING 3/23; 3/23: PASSED (unan.) from committee; re-referred to APPROPRIATIONS; HEARING set for 4/13; 4/13: From committee, 2nd Reading; 4/14: Ordered to 3rd Reading; 4/27: PASSED (35-0); ordered to ASSEMBLY; 1st Reading.; 5/11: Referred to BUSINESS & PROFESSIONS com.
CCCC Position: SUPPORT.
SB 1149. Employees: bereavement leave. (Durazo)
[Allows employees to add a "designated person" to the list of "family members" for whom they would be eligible to take bereavement leave in the case of the person's death.] Bill analysis HERE.
Actions: 2/18: Introduced; 2/26: Referred to LABOR, PUB EMP & RETIREMENT com; set for HEARING 3/23; 3/23: PASSED by committee; re-referred to APPROPRIATIONS; 3/26: 2nd Reading; re-referred to APPR; 4/2: HEARING set for 4/13; 4/9: Hearing postponed; HEARING set for 4/20; 4/20: PASSED by com; placed on APPR suspense file; 5/8: HEARING set for 5/14.
CCCC Position: SUPPORT.
SB 1189. Advance health care directive of a skilled nursing facility patient. (Valladares)
Under existing law, the advance health care directive of a patient in a skilled nursing facility must be witnessed by two persons, neither of whom can be employed by the facility and one of which must be either a patient advocate or ombudsperson. This bill would delete a "patient advocate" from the above-described witness duties, thus requiring that an ombudsperson witness the advance health care directive of a patient in a skilled nursing facility. Bill analysis HERE.
Actions: 2/19: Introduced; 3/4: Referred to JUDICIARY and APPROPRIATIONS; 3/10: Set for hearing in JUDICIARY 3/24; 3/24: PASSED (unan.) from committee; re-referred to APPROPRIATIONS; HEARING set for 4/13; 4/13: from committee; ordered to consent calendar; 4/16: 3rd Reading; PASSED SENATE (38-0); ordered to ASSEMBLY; 4/16: 1st Reading in Assembly; 5/11: Referred to JUDICIARY com.
CCCC Position: SUPPORT.
AI & Healthcare
SB 903. Mental health professionals: artificial intelligence. (Padilla)
This bill would regulate the use of [AI] by licensed professionals providing psychotherapy services, as defined; prohibit an individual, corporation, or entity from using [AI] to record or transcribe psychotherapeutic communications or sessions or to triage or screen a person for the need for psychotherapy services unless the patient or their authorized representative is informed that [AI] will be used and provides consent, as specified; prohibit a licensed professional from allowing [AI] to perform certain acts; require the use of [AI] in psychotherapy records to comply with the confidentiality requirements of [provision] of the Confidentiality of Medical Information Act. Bill analysis HERE.
Actions: 1/21: Introduced; 2/18: Referred to BUSINESS, PROFESSIONS & ECON DEVELOPMENT and PRIVACY, DIGITAL TECHNOLOGIES, & CONSUMER PROTECTION coms; 4/7: AMENDED by author; Read 2nd time; re-referred to B. P. & E.D. com; 4/8: HEARING in B.P. & E.D. com set for 4/13; 4/10: HEARING in P.D.T.&C. com set for 4/20; 4/13: PASSED by com; 4/21: Re-referred to APPROP; 4/24: HEARING set for 5/4; 5/4: Placed in APPROP. suspense file.; 5/8: HEARING set for 5/14.
CCCC Position: Following.
Federal Legislation
Legislation can be introduced in the U.S. Congress (House and Senate) throughout the year. We will continue to monitor for new bills relevant to our work. Very few bills are passed at the federal level. Many don’t move past introduction; some are consolidated into packages of related bills or omnibus bills. It is unlikely that any of these bills will pass, especially if they require an appropriation of funds; however, they are indicative of legislator’s priorities and preoccupations.
Priority Bills
S.1935. Expanding Access to Palliative Care Act. (Rosen, D-NV)
A bill to amend title XI of the Social Security Act to provide for the testing of a community-based palliative care model.
S.1936. Improving Access to Transfusion Care for Hospice Patients Act of 2025 (Rosen, D-NV)
A bill to require the Center for Medicare and Medicaid Innovation to test allowing blood transfusions to be paid separately from the Medicare hospice all-inclusive per diem payment.
S.2287 / H.R.4425. Palliative Care and Hospice Education and Training Act. (Senate: Baldwin, D-WI, & 17 bipartisan cosponsors; House: Carter, R-GA-1 & Bera, D-CA-6)
A bill to amend the Public Health Service Act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, and other programs, including social work, physician assistant, and chaplaincy education programs, to promote education and research in palliative care and hospice, and to support the development of faculty careers in academic palliative and hospice care.
NOTE: This is the 7th time this bill has been introduced in one or another or both of the U.S. Congress chambers. CCCC strongly supports the bill and is a member of the Patient Quality of Life Coalition, which has coordinated advocacy and outreach to gain support.
S.2521. Provider Training in Palliative Care Act. (Rosen, D-NV)
To allow participants in the National Health Service Corps to defer their obligated service in order to receive training in palliative care services.
S.2865. Improving Access to Advance Care Planning Act. (Warner, D-VA)
To amend title XVIII of the Social Security Act to waive cost-sharing for advance care planning services, and for other purposes.
S.3473. MAP for Care Act. (Cassidy, R-LA)
To establish and implement an Advance Directive Certification Program (in this section referred to as the ‘Program’) under which the Secretary shall encourage eligible beneficiaries to adopt and maintain certified advance directives to guide the delivery of health care to such beneficiaries.
H.R.2437. EASE (End-of-life Access to Supportive and Essential care) Act of 2025. (Houchin, R-IN-9)
To amend title XVIII of the Social Security Act to require hospitals to provide information on available hospice programs to certain individuals upon discharge under the Medicare program.
H.R.5861. Legacy Act. (Suozzi, D-NY-3)
The Secretary shall seek to enter into an agreement with the National Academies under which the National Academies conduct a study on establishing and maintaining a national, confidential, and secure system for storing and retrieving by an authorized agent a last wish document of an individual, at no cost to such individual.
H.R.6721. To amend title XVIII of the Social Security Act to encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive. (Murphy, R-NC-3)
H.R.7966. Hospice CARE Act. (Sanchez, D-CA-38)
To amend title XVIII of the Social Security Act to ensure the integrity of hospice care furnished under the Medicare program, and for other purposes.
H.R.8376. To amend title XVIII of the Social Security Act to clarify the policy for coverage under the Medicare program for palliative dialysis services, and clarify separate payment for such palliative dialysis services, furnished by renal dialysis facilities and providers of services to certain individuals electing hospice care, and for other purposes. (Kelly, R-PA-16)
Artificial Intelligence & Health
H.R. 193. Maintaining Innovation and Safe Technologies Act. (Schweikert, R-AZ)
To direct the Secretary of Health and Human Services to issue guidance on payment under the Medicare program for remote monitoring devices.
H.R.238. Healthy Technology Act of 2025. (Schweikert, R-AZ)
This bill establishes that artificial intelligence (AI) or machine learning technology may be eligible to prescribe drugs. Currently, certain drugs may be dispensed only upon a prescription provided by a practitioner licensed by law to administer the drug. Under this bill, an AI or machine learning technology may qualify as such a prescribing practitioner if the technology is (1) authorized by state law to prescribe the drug involved; and (2) approved, cleared, or authorized under certain federal provisions pertaining to medical devices and products.
H.R.5045. Health AI. (Lieu, D-CA-36)
To direct the Secretary of Health and Human Services to establish a grant program to facilitate research regarding the use of generative artificial intelligence in health care, and for other purposes.
H.R.6077. HEAL-AI Act. (Barragan, D-CA-44)
To amend the Public Health Service Act to ensure that medical students, medical residents, and medical faculty receive education and training in the deployment of artificial intelligence in the medical profession, and for other purposes.
H.R.7064. AI in Health Care Efficiency and Study Act. (Hernandez, D-PR-At large)
To require the Secretary of Health and Human Services to conduct a study on strategies for the application of artificial intelligence technologies that can be used in the health care industry to improve administrative and clerical work and preserve the privacy and security of patient data, and for other purposes.
H.Res.694. Expressing the sense of the House of Representatives that the Centers for Medicare & Medicaid Services should halt the pilot program and should not jeopardize seniors' access to critical health care by utilizing artificial intelligence to determine Medicare coverage. (Landsman, D-OH-1)
S.501. Strategy for Public Health Preparedness and Response to Artificial Intelligence Threats. (Budd, R-NC)
A bill to require the Secretary of Health and Human Services to develop a strategy for public health preparedness and response to artificial intelligence threats, and for other purposes.