BILL NUMBER: AB 542 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 18, 2009
AMENDED IN ASSEMBLY MAY 5, 2009
AMENDED IN ASSEMBLY APRIL 22, 2009
INTRODUCED BY Assembly Member Feuer
FEBRUARY 25, 2009
An act to amend Sections 1279.1 and 1279.2 of, to
add Sections 1279.4 and 1371.6 to, and to add Part 5.5
(commencing with Section 128870) to Division 107 of, the Health and
Safety Code, to add Sections 10191.5, 12693.56, 12699.06, and 12739.5
to the Insurance Code, and to add Article 5.4 (commencing with
Section 14182) to Chapter 7 of Part 3 of Division 9 of the Welfare
and Institutions Code, relating to public health.
LEGISLATIVE COUNSEL'S DIGEST
AB 542, as amended, Feuer. Adverse medical events.
Hospital acquired conditions.
Existing law establishes various programs for the prevention of
disease and the promotion of health, including, but not limited to,
the licensing and regulation of health facilities to be administered
by the State Department of Public Health. Existing law requires
specified health facilities to report patient adverse events to the
department within 5 days. A violation of these provisions is a
misdemeanor.
This bill would expand the specified adverse events requiring
reporting to include, among others, manifestations of poor glycemic
control, catheter-associated urinary tract infection, and
surgical-site infection, and would require a surgical clinic to
comply with these health facility adverse event reporting
requirements. The bill would require the department to collect
adverse event information, and investigate adverse events.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
administered by the Department of Managed Health Care, regulates
health care service plans. A willful violation of these provisions is
a crime.
This bill would require the medical director and the director of
nursing of a hospital to annually report adverse events and
hospital acquired conditions to its governing board.
The bill would require a contract between a hospital or licensed
surgical clinic and a health care service plan to be consistent with
policies of nonpayment for substantiated adverse events
hospital acquired conditions .
This bill would require the Department of Managed Health Care, in
collaboration with the State Department of Public Health, the State
Department of Health Care Services, the Managed Risk Medical
Insurance Board, the California Public Employees' Retirement System,
and the Department of Insurance, to adopt and implement regulations
that establish uniform policies and practices governing the
nonpayment of a hospital or licensed surgical clinic for
substantiated adverse events hospital acquired
conditions by state public health programs. The bill would
require, after the adoption of these regulations, that the State
Department of Public Health, the State Department of Health Care
Services, the Managed Risk Medical Insurance Board, the California
Public Employees' Retirement System, and the Department of Insurance,
adopt and implement similar regulations. The bill would prohibit a
hospital or licensed surgical clinic from charging for services
related to a substantiated adverse event
hospital acquired condition .
By changing the definition of existing crimes, this bill would
impose a state-mandated local program.
Existing law provides for the Healthy Families Program,
administered by the Managed Risk Medical Insurance Board, under which
health care services are provided to qualified low-income children.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services , under which
health care services are provided to qualified low-income persons.
This bill would require that contracts between a hospital or
licensed surgical clinic and a health care service plan, an insurer,
the Healthy Families Program, or the Medi-Cal program be consistent
with those nonpayment policies for substantiated adverse
events hospital acquired conditions .
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. The Legislature finds and declares all of the
following:
(a) Patients seeking medical treatment have a right to quality
medical care delivered in a timely, safe, and appropriate manner.
(b) Licensed health facilities are vital community resources that
perform life-saving procedures and ensure the health and welfare of
the general public.
(c) Despite the best intentions of a health facility, when
an adverse event a hospital acquired
condition occurs, a patient can be harmed, potentially leading
to serious disability or even death.
(d) Most adverse events hospital acquired
conditions can be prevented through ongoing health care
provider education and established safety plans and procedures. It is
the policy of the State of California to encourage constant
monitoring and continuous improvement in health care quality
processes to ensure patient safety.
(e) It is the policy of the State of California that patients and
purchasers of health care services should not be billed for
substantiated adverse events hospital acquired
conditions . It is also the policy of the State of California
that adverse events, when substantiated,
hospital acquired conditions should not be reimbursed by
patients or purchasers of health care services.
(f) Patients who have been harmed by an adverse event
a hospital acquired condition must receive the
medically necessary followup care to correct or treat the
complications or consequences of the adverse event
hospital acquired condition , to the extent possible.
Medically necessary followup care and services should be reimbursed.
(g) The development of policies and procedures for the nonbilling
and nonpayment of adverse events hospital
acquired conditions is a complex process that requires
expertise from many sectors of the health care delivery system. While
these policies and procedures are being established, the State of
California encourages private sector solutions that bring improvement
in the delivery of health care services and a reduction in the
occurrence of adverse events hospital
acquired conditions .
SEC. 2. Section 1279.1 of the Health and Safety
Code is amended to read:
1279.1. (a) A health facility licensed pursuant to subdivision
(a), (b), or (f) of Section 1250 or a surgical clinic licensed
pursuant to paragraph (1) of subdivision (b) of Section 1204 shall
report an adverse event to the licensing and certification division
of the department no later than five days after the adverse event has
been detected, or, if that event is an ongoing urgent or emergent
threat to the welfare, health, or safety of patients, personnel, or
visitors, not later than 24 hours after the adverse event has been
detected. Disclosure of individually identifiable patient information
shall be consistent with applicable law.
(b) For purposes of this section, "adverse event" includes any of
the following:
(1) Surgical events, including the following:
(A) Surgery performed on a wrong body part that is inconsistent
with the documented informed consent for that patient. A reportable
event under this subparagraph does not include a situation requiring
prompt action that occurs in the course of surgery or a situation
that is so urgent as to preclude obtaining informed consent.
(B) Surgery performed on the wrong patient.
(C) The wrong surgical procedure performed on a patient, which is
a surgical procedure performed on a patient that is inconsistent with
the documented informed consent for that patient. A reportable event
under this subparagraph does not include a situation requiring
prompt action that occurs in the course of surgery, or a situation
that is so urgent as to preclude the obtaining of informed consent.
(D) Retention of a foreign object in a patient after surgery or
other procedure, excluding objects intentionally implanted as part of
a planned intervention and objects present prior to surgery that are
intentionally retained.
(E) Death during or up to 24 hours after induction of anesthesia
after surgery of a normal, healthy patient who has no organic,
physiologic, biochemical, or psychiatric disturbance and for whom the
pathologic processes for which the operation is to be performed are
localized and do not entail a systemic disturbance.
(2) Product or device events, including the following:
(A) Patient death or serious disability associated with the use of
a contaminated drug, device, or biologic provided by the health
facility when the contamination is the result of generally detectable
contaminants in the drug, device, or biologic, regardless of the
source of the contamination or the product.
(B) Patient death or serious disability associated with the use or
function of a device in patient care in which the device is used or
functions other than as intended. For purposes of this subparagraph,
"device" includes, but is not limited to, a catheter, drain, or other
specialized tube, infusion pump, or ventilator.
(C) Patient death or serious disability associated with
intravascular air embolism that occurs while being cared for in a
facility, excluding deaths associated with neurosurgical procedures
known to present a high risk of intravascular air embolism.
(3) Patient protection events, including the following:
(A) An infant discharged to the wrong person.
(B) Patient death or serious disability associated with patient
disappearance for more than four hours, excluding events involving
adults who have competency or decisionmaking capacity.
(C) A patient suicide or attempted suicide resulting in serious
disability while being cared for in a health facility due to patient
actions after admission to the health facility, excluding deaths
resulting from self-inflicted injuries that were the reason for
admission to the health facility.
(4) Care management events, including the following:
(A) A patient death or serious disability associated with a
medication error, including, but not limited to, an error involving
the wrong drug, the wrong dose, the wrong patient, the wrong time,
the wrong rate, the wrong preparation, or the wrong route of
administration, excluding reasonable differences in clinical judgment
on drug selection and dose.
(B) A patient death or serious disability associated with a
hemolytic reaction due to the administration of ABO-incompatible
blood or blood products.
(C) Maternal death or serious disability associated with labor or
delivery in a low-risk pregnancy while being cared for in a facility,
including events that occur within 42 days postdelivery and
excluding deaths from pulmonary or amniotic fluid embolism, acute
fatty liver of pregnancy, or cardiomyopathy.
(D) Patient death or serious disability directly related to
manifestations of poor glycemic control, the onset of which occurs
while the patient is being cared for in a health facility. For the
purposes of this section, "manifestations of poor glycemic control"
include, but are not limited to, hypoglycemia, diabetic ketoacidosis,
nonketotic hyperosmolar coma, hypoglycemic coma, secondary diabetes
with ketoacidosis, or secondary diabetes with hyperosmolarity.
(E) Death or serious disability, including kernicterus, associated
with failure to identify and treat hyperbilirubinemia in neonates
during the first 28 days of life. For purposes of this subparagraph,
"hyperbilirubinemia" means bilirubin levels greater than 30
milligrams per deciliter.
(F) A Stage 3 or 4 ulcer, acquired after admission to a health
facility, excluding progression from Stage 2 to Stage 3 if Stage 2
was recognized upon admission.
(G) A patient death or serious disability due to spinal
manipulative therapy performed at the health facility.
(H) Patient death or serious disability due to a
catheter-associated urinary tract infection (UTI).
(I) Vascular catheter-associated infection.
(J) Mediastinitis after coronary bypass graft.
(K) Surgical site infection following orthopedic procedures, as
defined in subparagraph (O).
(L) Surgical site infection following bariatric surgery for
obesity.
(M) Deep vein thrombosis following orthopedic procedures, as
defined in subparagraph (O).
(N) Pulmonary embolism following orthopedic procedures, as defined
in subparagraph (O).
(O) For the purposes of subparagraphs (K), (M), and (N),
"orthopedic procedures" means one or more of the following
procedures: atlas-axis fusion, other cervical fusion, dorsal/dorsulum
fusion, lumbar/lumbosac fusion, arthrodesis of shoulder, arthrodesis
of elbow, refusion of atlas-axis, refusion of cervical spine,
refusion of dorsal spine, refusion of lumbar spine, shoulder
arthroplast, or elbow arthroplast.
(5) Environmental events, including the following:
(A) A patient death or serious disability associated with an
electric shock while being cared for in a health facility, excluding
events involving planned treatments, such as electric countershock.
(B) Any incident in which a line designated for oxygen or other
gas to be delivered to a patient contains the wrong gas or is
contaminated by a toxic substance.
(C) A patient death or serious disability associated with a burn
incurred from any source while being cared for in a health facility.
(D) A patient death associated with a fall while being cared for
in a health facility.
(E) A patient death or serious disability associated with the use
of restraints or bedrails while being cared for in a health facility.
(6) Criminal events, including the following:
(A) Any instance of care ordered by or provided by someone
impersonating a physician, nurse, pharmacist, or other licensed
health care provider.
(B) The abduction of a patient of any age.
(C) The sexual assault on a patient within or on the grounds of a
health facility.
(D) The death or significant injury of a patient or staff member
resulting from a physical assault that occurs within or on the
grounds of a facility.
(7) An adverse event or series of adverse events that cause the
death or serious disability of a patient, personnel, or visitor.
(c) The facility shall inform the patient or the party responsible
for the patient of the adverse event by the time the report is made.
(d) "Serious disability" means a physical or mental impairment
that substantially limits one or more of the major life activities of
an individual, or the loss of bodily function, if the impairment or
loss lasts more than seven days or is still present at the time of
discharge from an inpatient health care facility, or the loss of a
body part.
(e) Nothing in this section shall be interpreted to change or
otherwise affect hospital reporting requirements regarding reportable
diseases or unusual occurrences, as provided in Section 70737 of
Title 22 of the California Code of Regulations. The department shall
review Section 70737 of Title 22 of the California Code of
Regulations requiring hospitals to report "unusual occurrences" and
consider amending the section to enhance the clarity and specificity
of this hospital reporting requirement.
(f) (1) Notwithstanding any other provision of law, the licensing
and certification division of the department shall collect
information regarding substantiated adverse events. The information
shall include, but need not be limited to, patient name and payer
source, and shall be provided to state government payers, including,
but not limited to, the State Department of Health Care Services and
the Managed Risk Medical Insurance Board.
(2) State payers shall maintain the confidentiality of the
information obtained and only use the information for program
administration. The information shall not be disclosed further,
except to consultants and contractors with whom the payers share the
information for the purposes of program administration, including the
purposes of this section and of Part 5.5 (commencing with Section
128870) of Division 107.
(3) Any costs associated with the compilation and distribution of
information gathered pursuant to this subdivision shall be shared on
a pro rata basis by the state agencies receiving this information.
SEC. 3. Section 1279.2 of the Health and Safety
Code is amended to read:
1279.2. (a) (1) In any case in which the department receives a
report from a facility pursuant to Section 1279.1, or a written or
oral complaint involving a health facility licensed pursuant to
subdivision (a), (b), or (f) of Section 1250, that indicates an
ongoing threat of imminent danger of death or serious bodily harm,
the department shall make an onsite inspection or investigation
within 48 hours or two business days, whichever is greater, of the
receipt of the report or complaint and shall complete that
investigation within 45 days.
(2) Until the department has determined by onsite inspection that
the adverse event has been resolved, the department shall, not less
than once a year, conduct an unannounced inspection of any health
facility that has reported an adverse event pursuant to Section
1279.1.
(b) In any case in which the department is able to determine from
the information available to it that there is no threat of imminent
danger of death or serious bodily harm to that patient or other
patients, the department shall complete an investigation of the
report within 45 days.
(c) (1) The department shall notify the complainant and licensee
in writing of the department's determination as a result of an
inspection or report.
(2) In concluding the investigation of a reported adverse event,
the department shall determine whether the adverse event was
substantiated or not.
(d) For purposes of this section, "complaint" means any oral or
written notice to the department, other than a report from the health
facility, of an alleged violation of applicable requirements of
state or federal law or an allegation of facts that might constitute
a violation of applicable requirements of state or federal law.
(e) The costs of administering and implementing this section shall
be paid from funds derived from existing licensing fees paid by
general acute care hospitals, acute psychiatric hospitals, and
special hospitals.
(f) In enforcing this section and Sections 1279 and 1279.1, the
department shall take into account the special circumstances of small
and rural hospitals, as defined in Section 124840, in order to
protect the quality of patient care in those hospitals.
(g) In preparing the staffing and systems analysis required
pursuant to Section 1266, the department shall also report regarding
the number and timeliness of investigations of adverse events
initiated in response to reports of adverse events.
SEC. 4. SEC. 2. Section 1279.4 is
added to the Health and Safety Code, to read:
1279.4. (a) The medical director and the director of nursing of
each health facility, as defined by subdivision (a), (b), or (f) of
Section 1250, shall report annually to the board of directors or
other similar governing body the following:
(1) The number of adverse events and hospital acquired
conditions that occurred in the facility in the most recent
12-month period.
(2) The outcomes for each patient involved.
(3) A comparison to comparable institutions of rates of adverse
events and hospital acquired conditions , if this data
exists and is publicly available.
(b) No communication of data or information pursuant to this
section by an officer or employee of the corporation to the governing
body shall constitute a waiver of privileges preserved by Section
1156, 1156.1, or 1157 of the Evidence Code or Section 1370.
SEC. 5. SEC. 3. Section 1371.6 is
added to the Health and Safety Code, to read:
1371.6. (a) A contract between a health facility and a health
care service plan shall be consistent with the adoption,
implementation, and exercise of nonpayment policies and practices for
substantiated adverse events hospital
acquired conditions , as defined by the regulations adopted
pursuant to Section 128871.
(b) A health facility shall not charge a patient for care and
services for which payment is denied by a health care service plan
pursuant to nonpayment policies and practices for
substantiated adverse events hospital acquired
conditions pursuant to this section.
(c) The director may require additional documentation from a
health care service plan to ensure that any contract authorized under
this section shall provide medically necessary care and
reimbursement for patients in compliance with this section.
(d) Nothing in this section shall be construed to impair or impede
the application of any other provision of this chapter, including,
but not limited to, Sections 1367, 1371, 1371.37, and 1375.7.
(e) For the purposes of this section, "health facility" means a
health care entity licensed pursuant to subdivision (a), (b), or (f)
of Section 1250, and a surgical clinic licensed pursuant to paragraph
(1) of subdivision (b) of Section 1204.
SEC. 6. SEC. 4. Part 5.5 (commencing
with Section 128870) is added to Division 107 of the Health and
Safety Code, to read:
PART 5.5. Adverse Events HOSPITAL
ACQUIRED CONDITIONS
128870. For purposes of this part, the following definitions
shall apply:
(a) "Health facility" means a health care entity licensed pursuant
to subdivision (a), (b), or (f) of Section 1250 or a surgical clinic
licensed pursuant to paragraph (1) of subdivision (b) of Section
1204.
(b) "Patient" means a person who receives or should have received
health care or treatment from a health facility or clinic regardless
of insurance status or health benefits.
(c) "Payer" means all health care insurers, health care service
plans, Medi-Cal managed care plans contracting with the State
Department of Health Care Services pursuant to Chapter 7 (commencing
with Section 14000), Chapter 8 (commencing with Section 14200), or
Chapter 8.75 (commencing with Section 14590) of Part 3 of Division 9
of the Welfare and Institutions Code, self-insured employers, and any
state or local government entity that pays claims for the provision
of health care services by a health care provider.
128871. (a) The Department of Managed Health Care, in
collaboration with the State Department of Public Health, the State
Department of Health Care Services, the Managed Risk Medical
Insurance Board, the California Public Employees' Retirement System,
and the Department of Insurance, shall adopt and implement
regulations that establish uniform policies and practices governing
the nonpayment of a health facility for substantiated
adverse events hospital acquired conditions by
state public health programs as follows:
(1) On or before September 1, 2010, adopt payment policies and
practices regarding nonpayment for substantiated adverse
events hospital acquired conditions that are
consistent with those developed by the federal Centers for Medicare
and Medicaid Services (CMS) pursuant to Section 5001(c) of the
Deficit Reduction Act of 2005 (42 U.S.C. Sec. 1395ww(d)(4)) and that
have the following characteristics, as defined by CMS:
(A) High cost or high volume, or both.
(B) Not present on admission.
(C) Reasonably could have been prevented through the application
of evidence-based guidelines. .
(2) Synchronize definitions, coding, and practices,
practices, and payment methodologies, to the
extent feasible, with CMS regarding nonpayment for
substantiated adverse events hospital acquired
conditions .
(3) On or before January 1, 2012, and annually thereafter, update
payment policies and practices regarding nonpayment for
substantiated adverse events hospital acquired
conditions to reflect changes made to those developed and
implemented by CMS.
(4) Establish guidelines and procedures for health facilities to
report the occurrence of hospital acquired conditions to the State
Department of Public Health, the Office of Statewide Health Planning
and Development, or any other appropriate agency or department.
(b) The Department of Managed Health Care, in collaboration with
the State Department of Public Health, the State Department of Health
Care Services, the Managed Risk Medical Insurance Board, the
California Public Employees' Retirement System, and the Department of
Insurance, may consult with individuals with relevant clinical and
other health care expertise to assist in the development of the
regulations adopted pursuant to this section.
(c) After the Department of Managed Health Care has adopted the
regulations required pursuant to this section, the State Department
of Public Health, the State Department of Health Care Services, the
Managed Risk Medical Insurance Board, the California Public Employees'
Retirement System, and the Department of Insurance shall adopt
regulations that are identical or substantially similar to those
regulations adopted pursuant to subdivision (a).
128872. In accordance with the nonpayment policies and practices
adopted by regulation pursuant to Section 128871, a health facility
shall not charge, nor is a patient or payer required to pay, for
substantiated adverse events hospital
acquired conditions . When a substantiated adverse
event hospital acquired condition occurs, the
health facility shall disclose the occurrence of the event
hospital acquired condition to the applicable
payer.
128873. (a) This part shall not be interpreted or implemented in
a way that would limit patient access to needed health care services
or payment to a health facility for medically necessary followup care
to correct or treat the complications or consequences of the
adverse event hospital acquired condition
or for the care originally sought by the patient.
(b) For state and local government health care programs that
receive federal funds, this part shall be implemented only to the
extent that federal financial participation for those programs is not
jeopardized.
SEC. 7. SEC. 5. Section 10191.5 is
added to the Insurance Code, to read:
10191.5. (a) A contract between a health facility and an insurer
shall be consistent with the adoption, implementation, and exercise
of nonpayment policies and practices for substantiated
adverse events hospital acquired conditions as
defined by the federal Centers for Medicare and Medicaid Services and
the regulations adopted pursuant to Section 128871 of the Health and
Safety Code.
(b) Pursuant to this section, a health facility shall not charge a
patient for care and services for which payment is denied by an
insurer pursuant to nonpayment policies and practices for
substantiated adverse events hospital acquired
conditions .
(c) The commissioner may require additional documentation from an
insurer to ensure that any contract authorized under this section
shall provide medically necessary care and reimbursement for patients
in compliance with this section.
(d) For purposes of this section, "health facility" means any
health care entity licensed pursuant to subdivision (a), (b), or (f)
of Section 1250 of the Health and Safety Code, and a surgical clinic
licensed pursuant to paragraph (1) of subdivision (b) of Section 1204
of the Health and Safety Code.
SEC. 8. SEC. 6. Section 12693.56 is
added to the Insurance Code, to read:
12693.56. (a) For the purposes of this
section, "health facility" means a health care entity licensed
pursuant to subdivision (a), (b), or (f) of Section 1250 of the
Health and Safety Code, and a surgical clinic licensed pursuant to
paragraph (1) of subdivision (b) of Section 1204 of the Health and
Safety Code.
(b) The board shall implement nonpayment policies and practices,
alone or in combination, consistent with the regulations adopted
pursuant to Section 128871 of the Health and Safety Code, for the
program. This subdivision shall be implemented only if, and to the
extent that, federal financial participation is available and is not
jeopardized.
(c) A health facility shall not charge a patient for care and
services for which payment is denied by the program, including its
participating health, dental, and vision plans.
(d) The board may contract with a review organization that meets
all applicable state and federal requirements, including Sections
1320c-1 and 1320c-3 of Title 42 of the United States Code, in terms
of composition and function, for the purposes of carrying out the
regulations adopted pursuant to Section 128871 of the Health and
Safety Code, for the Healthy Families Program and to the extent
feasible, for all other programs administered by the board.
SEC. 9. SEC. 7. Section
12699.06 is added to the Insurance Code, to read:
12699.06. (a) For the purposes of this part,
"health facility" means a health care entity licensed pursuant to
subdivision (a), (b), or (f) of Section 1250 of the Health and Safety
Code, and a surgical clinic licensed pursuant to paragraph (1) of
subdivision (b) of Section 1204 of the Health and Safety Code.
(b) The board shall implement nonpayment policies and practices,
alone or in combination, consistent with the regulations adopted
pursuant to Section 128871 of the Health and Safety Code, for the
program. This subdivision shall be implemented only if, and to the
extent that, federal financial participation is available and is not
jeopardized.
(c) A health facility shall not charge a patient for care and
services for which payment is denied by the program, including its
participating health plans.
(d) The board may contract with a review organization that meets
all applicable state and federal requirements, including Sections
1320c-1 and 1320c-3 of Title 42 of the United States Code, in terms
of composition and function, for the purposes of carrying out the
regulations adopted pursuant to Section 128871 of the Health and
Safety Code, for the Healthy Families Program and to the extent
feasible, for all other programs administered by the board.
SEC. 10. SEC. 8. Section 12739.5 is
added to the Insurance Code, to read:
12739.5. (a) For the purposes of this part,
"health facility" means a health care entity licensed pursuant to
subdivision (a), (b), or (f) of Section 1250 of the Health and Safety
Code, and a surgical clinic licensed pursuant to paragraph (1) of
subdivision (b) of Section 1204 of the Health and Safety Code.
(b) The board shall implement nonpayment policies and practices,
alone or in combination, consistent with the regulations adopted
pursuant to Section 128871 of the Health and Safety Code, for the
program.
(c) A health facility shall not charge a patient for care and
services for which payment is denied by the program, including its
participating health plans.
(d) The board may contract with a review organization that meets
all applicable state and federal requirements, including Sections
1320c-1 and 1320c-3 of Title 42 of the United States Code, in terms
of composition and function, for the purposes of carrying out the
regulations adopted pursuant to Section 128871 of the Health and
Safety Code, for the Healthy Families Program and to the extent
feasible, for all other programs administered by the board.
SEC. 11. SEC. 9. Article 5.4
(commencing with Section 14182) is added to Chapter 7 of Part 3 of
Division 9 of the Welfare and Institutions Code, to read:
Article 5.4. Adverse Events Hospital
Acquired Conditions
14182. (a) The department shall implement the nonpayment policies
and practices adopted by regulations pursuant to Section 128871 of
the Health and Safety Code, for the fee-for-service Medi-Cal program,
and to the extent feasible, for all other programs administered by
the department. Medi-Cal managed care plans contracting with the
department pursuant to Chapter 7 (commencing with Section 14000),
Chapter 8 (commencing with Section 14200), or Chapter 8.75
(commencing with Section 14590) of Part 3 of Division 9, shall be
required to implement similar nonpayment policies and practices
through their contracts with health facilities.
(b) A health facility shall not charge a patient for care and
services for which payment is denied by the Medi-Cal program or any
other program administered by the department pursuant to this
article.
(c) Notwithstanding any other provision of law,
and subject to applicable federal requirements, a health facility
shall exclude its costs related to adverse events
hospital acq uired conditions subject to the
nonpayment policies implemented pursuant to subdivision (a) from both
of the following:
(1) The Annual Disclosure Report submitted by the health facility
to the Office of Statewide Health Planning and Development and which
is used in the calculation of payment adjustments under the
Disproportionate Share Hospital Program pursuant to Article 5.2
(commencing with Section 14166).
(2) The Medi-Cal 2552-96 cost report, and any other data,
submitted by the health facility to the department and which is used
for claiming reimbursement from the Safety Net Care Pool pursuant to
Article 5.2 (commencing with Section 14166).
(d) This section shall be implemented only if, and to the extent
that, federal financial participation is available and is not
jeopardized for programs receiving federal funds.
(e) The department may contract with a review organization that
meets all applicable state and federal requirements, including
Sections 1320c-1 and 1320c-3 of Title 42 of the United States Code,
in terms of composition and function, for the purposes of carrying
out the regulations adopted pursuant to Section 128871 of the Health
and Safety Code, for the Medi-Cal program and to the extent feasible,
for all other programs administered by the department.
(f) For purposes of this article, "health facility" means a health
care entity licensed pursuant to subdivision (a), (b), or (f) of
Section 1250 of the Health and Safety Code, and a surgical clinic
licensed pursuant to paragraph (1) of subdivision (b) of Section 1204
of the Health and Safety Code.
SEC. 12. SEC. 10. 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.