BILL NUMBER: SB 631	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Beall

                        FEBRUARY 22, 2013

   An act relating to health care.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 631, as introduced, Beall. Health care.
   Existing federal law, the federal Patient Protection and
Affordable Care Act (PPACA), enacts various health care coverage
market reforms that take effect January 1, 2014. Existing law, the
Knox-Keene Health Care Service Plan Act of 1975, provides for the
licensure and regulation of health care service plans by the
Department of Managed Health Care and makes a willful violation of
the act a crime. Existing law also provides for the regulation of
health insurers by the Department of Insurance.
   This bill would make findings and declarations regarding the PPACA
and would declare the intent of the Legislature to evaluate the
current use of observational and outpatient settings for the delivery
of inpatient-level care, assess the volume of inpatient services
delivered in these settings, and determine policy changes necessary
to create safe care environments for patients receiving care in these
settings.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) The Legislature finds and declares the following:
   (1) The landscape of health care delivery is changing as we look
forward to the full implementation of the federal Patient Protection
Affordable Care Act (PPACA) in California, through which millions of
uninsured Californians will obtain health care coverage. As rates of
health care coverage increase, it is anticipated that more
individuals will seek health care services, including services in
general acute care hospitals. The increased demand may place
additional strains on already crowded emergency departments and
hospitals.
   (2) The PPACA imposes new requirements on general acute care
hospitals that will likely result in those hospitals making
significant organizational changes in order to promote the goals of
the PPACA to lower health care costs. These organizational changes
may range from reducing readmission rates, changing the ways in which
patient acuity is assessed, and making more efficient use of bed
space.
   (3) Currently, hospitals delay admission of some patients through
extensive use of observational settings. These settings are often
found adjacent to emergency departments, and are used as an
alternative to admitting patients who cannot be safely discharged to
their homes. In these settings, patients are placed for what can be
prolonged periods of time, often extending beyond 24 hours.
   (4) The use of outpatient services is expected to increase as
hospitals adapt to payment models that incent avoidance of hospital
readmission. Further, some hospitals have enacted models in which
inpatient services, including inpatient cardiac catheterization, are
provided in outpatient settings.
   (5) Observational and outpatient settings are not subject to many
of the laws and regulations aimed at ensuring patient safety and
adequate staffing standards, and the increasing use of these settings
for patients in need of inpatient care raises serious concerns about
patient access to safe levels of care and service.
   (b) To ensure that patients are not denied access to safe
inpatient care in today's health care delivery system, and as
hospitals adjust their business models to comport with new PPACA
requirements, it is the intent of the Legislature to evaluate the
current use of observational and outpatient settings for the delivery
of inpatient-level care, assess the volume of inpatient services
delivered in these settings, and determine policy changes necessary
to create safe care environments for patients receiving care in these
settings.