Bill Text: CA SB1269 | 2013-2014 | Regular Session | Amended
Bill Title: General acute care hospitals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-05-23 - Held in committee and under submission. [SB1269 Detail]
Download: California-2013-SB1269-Amended.html
BILL NUMBER: SB 1269 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 5, 2014
INTRODUCED BY Senator Beall
FEBRUARY 21, 2014
An act to amend Sections 1255, 1275, 1255
and 128740 of, and to add Section 1253.7 to, the Health and
Safety Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 1269, as amended, Beall. General acute care hospitals.
(1) Existing
Existing law establishes the State Department of Public
health Health and sets forth its
powers and duties, including , but not limited to,
the licensing and regulation of health facilities,
including, but not limited to, which include
general acute care hospitals. A violation of these provisions is a
crime.
Existing law authorizes the department to issue a special permit
authorizing a health facility to offer one or more special services
when specified requirements are met. Existing law provides for the
application by general acute care hospitals for supplemental services
approval and requires the department to, upon issuance and renewal
of a license for certain health facilities, separately identify on
the license each supplemental service. Existing law requires a
hospital to report specified summary financial and utilization data
to the Office of Statewide Health Planning and Development (OSHPD)
within 45 days of the end of the every calendar quarter.
This bill would require a general acute care hospital that
provides observation services, as defined, in an observation
unit, as defined, to apply for approval from the department to
provide these services either as supplemental services or under a
special permit.
The bill would require the department to adopt regulations for
the provision of observation services in an observation unit
under a special permit and as an approved
a supplemental service under the general acute care
hospital's license. The bill would additionally set forth
standards that apply to a hospital when providing observation
services, generally, and, more specifically, to a hospital
when providing observation services in an observation unit.
The bill would require hospitals to include certain data relating
to observation service visits and total observation service gross
revenues in the reports filed with OSHPD.
(2) This bill would require the department to adopt and enforce
staffing standards for certain outpatient services and all ambulatory
surgery centers, as specified, and would make other conforming
changes.
(3) Because
Because a violation of these provisions by a health
facility 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1253.7 is added to the Health and Safety Code,
to read:
1253.7. (a) (1) For purposes of this
chapter, "observation services" means outpatient services provided by
a general acute care hospital to those patients described in
subdivision (e) who have unstable or uncertain conditions potentially
serious enough to warrant close observation, but not so serious as
to warrant inpatient admission to the hospital. Observation services
may include the use of a bed, monitoring by nursing and other staff,
and any other services that are reasonable and necessary to safely
evaluate a patient's condition or determine the need for a possible
inpatient admission to the hospital.
(2) For purposes of this chapter, "observation unit" means an area
where observation services are provided in a setting outside of an
inpatient unit of a general acute care hospital.
(b) Observation services may be provided for a period of no more
than 24 hours.
(c) A general acute care hospital that provides observation
services in an observation unit shall do either of the
following:
(1) Apply for approval from the department, pursuant to
subdivision (a) of Section 1253.6, to provide the services in an
observation unit as a supplemental service.
(2) Apply for a special permit from the department pursuant to
subdivision (c) of Section 1277 to provide the services in an
observation unit as a special service.
(d) The department shall adopt standards and regulations,
pursuant to subdivision (a) of Section 1275, for the provision of
observation services in an observation unit under a
special permit and as a supplemental service under the general acute
care hospital's license.
(e) Observation services may be ordered by an appropriately
licensed practitioner only for any of the following:
(1) A patient who has received triage services in the emergency
department but has not been admitted as an inpatient.
(2) A patient who has received outpatient surgical services and
procedures.
(3) A patient who has been admitted as an inpatient and is
discharged to an observation center receive
observation services .
(4) A patient previously seen in a physician's office or
outpatient clinic.
(f) Notwithstanding subdivisions (d) and (e) of Section 1275,
observation services provided by the general acute care hospital
in an observation unit , including the services provided in a
freestanding physical plant, as defined in subdivision (g) of Section
1275, shall comply with the same staffing standards, including, but
not limited to, licensed nurse-to-patient ratios, as supplemental
emergency services.
(g) A patient receiving observation services shall receive written
notice that his or her care is being provided in
on an outpatient setting basis
, and that this may impact reimbursement by Medicare, Medi-Cal,
or private payers of health care services, or cost-sharing
arrangements through his or her health care coverage.
(h) All areas in which observation services are provided
Observation units shall be marked by
signage identifying the area as an outpatient area. The signage shall
use the term "outpatient" in the title of the area to clearly
indicate to all patients and family members that the observation
services provided in the center are not inpatient services.
(i) Observation services shall be deemed outpatient or ambulatory
services that are revenue-producing cost centers associated with
hospital-based or satellite service locations that emphasize
outpatient care. Identifying an observation service
unit by a name or term other than that used in
this subdivision does not exempt the general acute care hospital from
the requirement of providing
to obtain approval from the department to provide
observation services as a distinct supplemental service or a distinct
special permit service, as applicable , when the
observation services are provided in a setting out side of
an inpatient unit of a general acute care hospital .
SEC. 2. Section 1255 of the Health and Safety Code is amended to
read:
1255. (a) In addition to the basic services offered under the
license, a general acute care hospital may be approved in accordance
with subdivision (c) of Section 1277 to offer special services,
including, but not limited to, the following:
(1) Radiation therapy department.
(2) Burn center.
(3) Emergency center.
(4) Hemodialysis center (or unit).
(5) Psychiatric.
(6) Intensive care newborn nursery.
(7) Cardiac surgery.
(8) Cardiac catheterization laboratory.
(9) Renal transplant.
(10) Observation services provided in an observation unit
as defined in Section 1253.7 1253.7.
(11) Other special services as the department may prescribe by
regulation.
(b) A general acute care hospital that exclusively provides acute
medical rehabilitation center services may be approved in accordance
with subdivision (b) of Section 1277 to offer special services not
requiring surgical facilities.
(c) The department shall adopt standards for special services and
other regulations as may be necessary to implement this section.
(d) (1) For cardiac catheterization laboratory service, the
department shall, at a minimum, adopt standards and regulations that
specify that only diagnostic services, and what diagnostic services,
may be offered by a general acute care hospital or a multispecialty
clinic as defined in subdivision ( l ) of Section 1206
that is approved to provide cardiac catheterization laboratory
service but is not also approved to provide cardiac surgery service,
together with the conditions under which the cardiac catheterization
laboratory service may be offered.
(2) Except as provided in paragraph (3), a cardiac catheterization
laboratory service shall be located in a general acute care hospital
that is either licensed to perform cardiovascular procedures
requiring extracorporeal coronary artery bypass that meets all of the
applicable licensing requirements relating to staff, equipment, and
space for service, or shall, at a minimum, have a licensed intensive
care service and coronary care service and maintain a written
agreement for the transfer of patients to a general acute care
hospital that is licensed for cardiac surgery or shall be located in
a multispecialty clinic as defined in subdivision ( l ) of
Section 1206. The transfer agreement shall include protocols that
will minimize the need for duplicative cardiac catheterizations at
the hospital in which the cardiac surgery is to be performed.
(3) Commencing March 1, 2013, a general acute care hospital that
has applied for program flexibility on or before July 1, 2012, to
expand cardiac catheterization laboratory services may utilize
cardiac catheterization space that is in conformance with applicable
building code standards, including those promulgated by the Office of
Statewide Health Planning and Development, provided that all of the
following conditions are met:
(A) The expanded laboratory space is located in the building so
that the space is connected to the general acute care hospital by an
enclosed all-weather passageway that is accessible by staff and
patients who are accompanied by staff.
(B) The service performs cardiac catheterization services on no
more than 25 percent of the hospital's inpatients who need cardiac
catheterizations.
(C) The service complies with the same policies and procedures
approved by hospital medical staff for cardiac catheterization
laboratories that are located within the general acute care hospital,
and the same standards and regulations prescribed by the department
for cardiac catheterization laboratories located inside general acute
care hospitals, including, but not limited to, appropriate
nurse-to-patient ratios under Section 1276.4, and with all standards
and regulations prescribed by the Office of Statewide Health Planning
and Development. Emergency regulations allowing a general acute care
hospital to operate a cardiac catheterization laboratory service
shall be adopted by the department and by the Office of Statewide
Health Planning and Development by February 28, 2013.
(D) Emergency regulations implementing this paragraph have been
adopted by the department and by the Office of Statewide Health
Planning and Development by February 28, 2013.
(E) This paragraph shall not apply to more than two general acute
care hospitals.
(4) After March 1, 2014, an acute care hospital may only operate a
cardiac catheterization laboratory service pursuant to paragraph (3)
if the department and the Office of Statewide Health Planning and
Development have adopted regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code that provide
adequate protection to patient health and safety including, but not
limited to, building standards contained in Part 2.5 (commencing with
Section 18901) of Division 13.
(5) Notwithstanding Section 129885, cardiac catheterization
laboratory services expanded in accordance with paragraph (3) shall
be subject to all applicable building standards. The Office of
Statewide Health Planning and Development shall review the services
for compliance with the OSHPD 3 requirements of the most recent
version of the California Building Standards Code.
(e) For purposes of this section, "multispecialty clinic," as
defined in subdivision ( l ) of Section 1206, includes an
entity in which the multispecialty clinic holds at least a 50-percent
general partner interest and maintains responsibility for the
management of the service, if all of the following requirements are
met:
(1) The multispecialty clinic existed as of March 1, 1983.
(2) Prior to March 1, 1985, the multispecialty clinic did not
offer cardiac catheterization services, dynamic multiplane imaging,
or other types of coronary or similar angiography.
(3) The multispecialty clinic creates only one entity that
operates its service at one site.
(4) These entities shall have the equipment and procedures
necessary for the stabilization of patients in emergency situations
prior to transfer and patient transfer arrangements in emergency
situations that shall be in accordance with the standards established
by the Emergency Medical Services Authority, including the
availability of comprehensive care and the qualifications of any
general acute care hospital expected to provide emergency treatment.
(f) Except as provided in this section and in Sections 128525 and
128530, under no circumstances shall cardiac catheterizations be
performed outside of a general acute care hospital or a
multispecialty clinic, as defined in subdivision ( l ) of
Section 1206, that qualifies for this definition as of March 1, 1983.
SEC. 3. Section 1275 of the Health and Safety
Code is amended to read:
1275. (a) The department shall adopt, amend, or repeal, in
accordance with Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code and Chapter 4
(commencing with Section 18935) of Part 2.5 of Division 13, any
reasonable rules and regulations as may be necessary or proper to
carry out the purposes and intent of this chapter and to enable the
department to exercise the powers and perform the duties conferred
upon it by this chapter, not inconsistent with any statute of this
state including, but not limited to, the State Building Standards
Law, Part 2.5 (commencing with Section 18901) of Division 13.
All regulations in effect on December 31, 1973, which were adopted
by the State Board of Public Health, the State Department of Public
Health, the State Department of Mental Hygiene, or the State
Department of Health relating to licensed health facilities shall
remain in full force and effect until altered, amended, or repealed
by the director or pursuant to Section 25 or other provisions of law.
(b) Notwithstanding this section or any other law, the Office of
Statewide Health Planning and Development shall adopt and enforce
regulations prescribing building standards for the adequacy and
safety of health facility physical plants.
(c) The building standards adopted by the State Fire Marshal, and
the Office of Statewide Health Planning and Development pursuant to
subdivision (b), for the adequacy and safety of freestanding physical
plants housing outpatient services of a health facility licensed
under subdivision (a) or (b) of Section 1250 shall not be more
restrictive or comprehensive than the comparable building standards
established, or otherwise made applicable, by the State Fire Marshal
and the Office of Statewide Health Planning and Development to
clinics and other facilities licensed pursuant to Chapter 1
(commencing with Section 1200).
(d) Except as provided in subdivision (f), the licensing
standards adopted by the department under subdivision (a) for
outpatient services located in a freestanding physical plant of a
health facility licensed under subdivision (a) or (b) of Section 1250
shall not be more restrictive or comprehensive than the comparable
licensing standards applied by the department to clinics and other
facilities licensed under Chapter 1 (commencing with Section 1200).
(e) Except as provided in subdivision (f), the state agencies
specified in subdivisions (c) and (d) shall not enforce any standard
applicable to outpatient services located in a freestanding physical
plant of a health facility licensed pursuant to subdivision (a) or
(b) of Section 1250, to the extent that the standard is more
restrictive or comprehensive than the comparable licensing standards
applied to clinics and other facilities licensed under Chapter 1
(commencing with Section 1200).
(f) All health care professionals providing services in settings
authorized by this section shall be members of the organized medical
staff of the health facility to the extent medical staff membership
would be required for the provision of the services within the health
facility. All services shall be provided under the respective
responsibilities of the governing body and medical staff of the
health facility.
(g) For purposes of this section, "freestanding physical plant"
means any building which is not physically attached to a building in
which inpatient services are provided.
(h) Notwithstanding subdivisions (d) and (e), or any other law,
the department shall adopt and enforce staffing standards for
supplemental outpatient surgical services provided in a freestanding
physical plant of a health facility licensed under subdivision (a) of
Section 1250 that are consistent with the staffing standards for
inpatient surgical services and postanesthesia care provided in
general acute care hospitals and that shall apply when the
freestanding physical plant provides outpatient services and
administers anesthesia, except local anesthesia or peripheral nerve
blocks, or both, in compliance with the community standard of
practice and in doses that have the probability of placing a patient
at risk for loss of the patient's life-preserving protective
reflexes.
(i) Notwithstanding subdivisions (d) and (e), or any other law,
the department shall adopt and enforce staffing standards for
supplemental outpatient surgical services of a health facility
licensed under subdivision (a) of Section 1250 that are consistent
with the staffing standards for inpatient surgical services and
postanesthesia care provided in general acute care hospitals and that
shall apply when anesthesia, except local anesthesia or peripheral
nerve blocks, or both, is administered in compliance with the
community standard of practice and in doses that have the probability
of placing a patient at risk for loss of the patient's
life-preserving protective reflexes.
(j) Notwithstanding any other law, the department shall adopt and
enforce staffing standards for ambulatory surgery centers not
included in subdivisions (h) and (i) for a health facility licensed
under subdivision (a) of Section 1250 that are consistent with the
staffing standards for inpatient surgical services and postanesthesia
care provided in general acute care hospitals and that shall apply
when the ambulatory surgery center provides outpatient services and
administers anesthesia, except local anesthesia or peripheral nerve
blocks, or both, in compliance with the community standard of
practice, in doses that have the probability of placing a patient at
risk for loss of the patient's life-preserving protective reflexes.
SEC. 4. SEC. 3. Section 128740 of
the Health and Safety Code is amended to read:
128740. (a) Commencing with the first calendar quarter of 1992,
the following summary financial and utilization data shall be
reported to the office by each hospital within 45 days of the end of
every calendar quarter. Adjusted reports reflecting changes as a
result of audited financial statements may be filed within four
months of the close of the hospital's fiscal or calendar year. The
quarterly summary financial and utilization data shall conform to the
uniform description of accounts as contained in the Accounting and
Reporting Manual for California Hospitals and shall include all of
the following:
(1) Number of licensed beds.
(2) Average number of available beds.
(3) Average number of staffed beds.
(4) Number of discharges.
(5) Number of inpatient days.
(6) Number of outpatient visits, excluding observation service
visits.
(7) Number of observation service visits and number of hours of
services provided.
(8) Total operating expenses.
(9) Total inpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(10) Total outpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(11) Total observation service gross revenues by payer, including
Medicare, Medi-Cal, county indigent programs, other third parties,
and other payers.
(12) Deductions from revenue in total and by component, including
the following: Medicare contractual adjustments, Medi-Cal contractual
adjustments, and county indigent program contractual adjustments,
other contractual adjustments, bad debts, charity care, restricted
donations and subsidies for indigents, support for clinical teaching,
teaching allowances, and other deductions.
(13) Total capital expenditures.
(14) Total net fixed assets.
(15) Total number of inpatient days, outpatient visits, excluding
outpatient service visits, and discharges by payer, including
Medicare, Medi-Cal, county indigent programs, other third parties,
self-pay, charity, and other payers.
(16) Total net patient revenues by payer including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(17) Other operating revenue.
(18) Nonoperating revenue net of nonoperating expenses.
(b) Hospitals reporting pursuant to subdivision (d) of Section
128760 may provide the items in paragraphs (8), (9), (10), (12),
(16), (17), and (18) of subdivision (a) on a group basis, as
described in subdivision (d) of Section 128760.
(c) The office shall make available at cost, to any person, a hard
copy of any hospital report made pursuant to this section and in
addition to hard copies, shall make available at cost, a computer
tape of all reports made pursuant to this section within 105 days of
the end of every calendar quarter.
(d) The office shall adopt by regulation guidelines for the
identification, assessment, and reporting of charity care services.
In establishing the guidelines, the office shall consider the
principles and practices recommended by professional health care
industry accounting associations for differentiating between charity
services and bad debts. The office shall further conduct the onsite
validations of health facility accounting and reporting procedures
and records as are necessary to assure that reported data are
consistent with regulatory guidelines.
SEC. 5. SEC. 4. No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.
