BILL NUMBER: SB 631 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 8, 2013
INTRODUCED BY Senator Beall
FEBRUARY 22, 2013
An act to amend Sections 1255, 1275, 127170, and 128740 of,
and to add Section 1253.7 to, the Health and Safety Code,
relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 631, as amended, Beall. Health care.
care: health facilities: observation and short-stay observation
services.
Existing law provides for the licensure and regulation of health
facilities, including general acute care hospitals, by the State
Department of Public Health. A violation of these provisions is a
crime. Existing law provides that a general acute care hospital may
be approved to offer special services, as specified, and requires 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.
This bill would require a general acute care hospital that
provides observation and short-stay observation services, as defined,
to apply for approval from the department to provide the services as
a supplemental service, and would require a general acute care
hospital to obtain a special permit to provide short-stay observation
services. The 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.
By expanding the definition of a crime, this bill would create 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.
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
yes . State-mandated local program: no
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) For purposes of this chapter, "observation services"
and "short-stay observation" services mean 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 and short-stay 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.
(1) Observation services may be provided for a period of no more
than 24 hours.
(2) Short-stay observation services may be provided for a period
of no more than 48 hours.
(b) A general acute care hospital that provides observation or
short-stay observation services shall, pursuant to Section 1253.6,
apply for approval from the department to provide the services as a
supplemental service.
(c) The department shall adopt standards and regulations, pursuant
to subdivision (a) of Section 1275, for the provision of observation
and short-stay observation services as a supplemental service under
the general acute care hospital's license.
(d) Short-stay observation services shall be a special service, as
defined in Section 1252, and shall require a special permit, as
defined in Section 1251.5.
(e) (1) Observation and short-stay observation services may only
be ordered by an appropriately licensed practitioner for any of the
following:
(A) A patient who has received triage services in the emergency
department but who has not been admitted as an inpatient.
(B) A patient who has received outpatient surgical services and
procedures.
(C) A patient who has been admitted as an inpatient and is
discharged to an observation center or short-stay observation center.
(D) A patient previously seen in a physician's office or
outpatient clinic.
(f) Notwithstanding subdivisions (d) and (e) of Section 1275,
observation and short-stay observation services provided by the
general acute care hospital, 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
licensed nurse-to-patient ratios, as supplemental emergency services.
(g) A patient receiving observation or short-stay observation
services shall receive written notice that his or her care is being
provided in an outpatient setting, and that the provision of
observation or short-stay observation services in an outpatient
setting 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 or short-stay observation
services are provided 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 or short-stay observation
services provided in the center are not inpatient services.
(i) Observation and short-stay 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
or short-stay observation service by a name or term other than that
used in this subdivision shall not exempt the general acute care
hospital from the requirement of providing observation or short-stay
observation services as a distinct supplemental service or a distinct
supplemental special permit service, as applicable.
(j) This section shall not modify standards for any other
outpatient services in health facilities licensed under Section 1250,
or clinics licensed under Chapter 1 (commencing with Section 1200),
which limit the presence of patients in outpatient or clinic
facilities to less than 24 hours.
(k) Observation and short-stay observation service data reported
to the Office of Statewide Health Planning and Development pursuant
to subdivision (a) of Section 128740, shall be aggregated for
supplemental observation services and supplemental special permit
short-stay observation services when health facilities subject to
this section have multiple units or clinics that are approved for
both types of centers. For purposes of this subdivision, "aggregated"
means that both observation and short-stay observation services
provided in general acute care hospitals shall be reported under
"observation services" pursuant to paragraphs (7), (11), and (15) of
subdivision (a) of Section 128740.
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) Short-stay observation, as defined in Section 1253.7.
(4)
(5) Hemodialysis center (or unit).
(5)
(6) Psychiatric.
(6)
(7) Intensive care newborn nursery.
(7)
(8) Cardiac surgery.
(8)
(9) Cardiac catheterization laboratory.
(9)
(10) Renal transplant.
(10)
(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 state 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 state 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 provision
of 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 state 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 state
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 post-anesthesia care provided in
general acute care hospitals and that shall apply when the
freestanding physical plant provides outpatient services and
anesthesia, except local anesthesia or peripheral nerve blocks, or
both, is used in compliance with the community standard of practice,
in doses that, when administered, 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
post-anesthesia care provided in general acute care hospitals and
that shall apply when anesthesia, except local anesthesia or
peripheral nerve blocks, or both, is used in compliance with the
community standard of practice, in doses that, when administered,
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
post-anesthesia care provided in general acute care hospitals and
that shall apply when the ambulatory surgery center provides
outpatient services and anesthesia, except local anesthesia or
peripheral nerve blocks, or both, is used in compliance with the
community standard of practice, in doses that, when administered,
have the probability of placing a patient at risk for loss of the
patient's life-preserving protective reflexes.
SEC. 4. Section 127170 of the Health
and Safety Code is amended to read:
127170. Except as otherwise exempted by any other provision of
law, projects requiring a certificate of need issued by the office
are the following:
(a) Construction of a new health facility, relocation of a health
facility or specialty clinic on a site that is not the same site or
adjacent thereto, the increase of bed capacity in an existing health
facility, the conversion of an entire existing health facility from
one license category to another, or the conversion of a health
facility's existing beds from any bed classification set forth in
Section 1250.1 to skilled nursing beds, psychiatric beds, or
intermediate care beds, and the conversion of skilled nursing beds,
psychiatric beds, or intermediate care beds to any other bed
classification set forth in Section 1250.1, except for skilled
nursing beds or intermediate care beds licensed as of March 1, 1983,
as part of a general acute care hospital. The conversion may not
exceed during any three-year period 5 percent of the existing beds of
the bed classification to which the conversion is made.
A health facility may use beds in one bed classification that,
pursuant to the facility's license, have been designated in another
bed classification, if all of these bed classification changes do not
at any time exceed 5 percent of the total number of the facility's
beds as set forth by the facility's license and if this use meets the
requirements of Chapter 2 (commencing with Section 1250) of Division
2. In addition, a facility may use an additional 5 percent of its
beds in this manner if the director finds that seasonal fluctuations
justify it.
For purposes of this subdivision, "adjacent," means real property
within a 400-yard radius of the site where a health facility or
specialty clinic currently exists.
(b) Establishment of a new specialty clinic, as defined in
paragraphs (1) and (3) of subdivision (b) of Section 1204, a project
by a health facility for expanded outpatient surgical capacity, the
conversion of an existing primary care clinic to a specialty clinic,
or the conversion of an existing specialty clinic to a different
category of specialty-clinic licensure. It does not constitute a
project and no certificate of need is required for the establishment
of a primary care clinic, as defined in subdivision (a) of Section
1204, the conversion of an existing specialty clinic to a primary
care clinic, or the conversion of an existing primary care clinic to
a different category of primary-care-clinic licensure. Any capital
expenditure involved in the establishment of a primary care clinic
also does not constitute a project, except as provided in subdivision
(d).
(c) The establishment of a new special service delineated in
subdivision (a), (b), (c), (e), (f), (g), or (h)
paragraph (1), (2), (3), (6), (7), (8), or (9) of subdivision
(a) of Section 1255, or the establishment by a specialty
clinic, as defined in paragraphs (1) and (3) of subdivision (b) of
Section 1204, of a new special service identified by or pursuant to
Section 1203.
(d) The initial purchase or lease by a clinic subject to
licensure under Chapter 1 (commencing with Section 1200) of Division
2, of diagnostic or therapeutic equipment with a value in excess of
one million dollars ($1,000,000) in a single fiscal year, or where
the cumulative cost exceeds this amount in more than one fiscal year.
For purposes of this subdivision, the purchase or lease of one or
more articles of functionally related diagnostic or therapeutic
equipment, as determined by the office, shall be considered together.
(e) (1) Any project requiring a capital expenditure for a
specialty clinic, as defined in paragraphs (1) and (3) of subdivision
(b) of Section 1204, or for the services, equipment or modernization
of a specialty clinic in excess of one million dollars ($1,000,000)
in the current fiscal year or cumulation to an expenditure of one
million dollars ($1,000,000) in the same fiscal year or subsequent
fiscal years for a single project.
(2) The threshold exemptions from certificate-of-need
requirements provided for in this subdivision do not apply to
projects for expanded outpatient surgical capacity.
(3) For the purposes of this subdivision, "capital expenditure"
means any of the following:
(A) An expenditure, including an expenditure for a construction
project undertaken by the specialty clinic as its own contractor,
that under generally accepted accounting principles is not properly
chargeable as an expense of operation and maintenance and that
exceeds one million dollars ($1,000,000). The cost of studies,
surveys, legal fees, land, offsite improvements, designs, plans,
working drawings, specifications, and other activities essential to
the acquisition, improvement, expansion, or replacement of the
physical plant and equipment for which the expenditure is made shall
be included in determining whether the cost exceeds one million
dollars ($1,000,000). Where the estimated cost of a proposed project,
including cost escalation factors appropriate to the area where the
project is located, is, within 60 days of the date that the
obligation for the expenditure is incurred, certified by a licensed
architect or engineer to be one million dollars ($1,000,000) or less,
that expenditure shall be deemed not to exceed one million dollars
($1,000,000) regardless of the actual cost of the project. However,
in any case where the actual cost of the project exceeds one million
dollars ($1,000,000) the specialty clinic on whose behalf the
expenditure is made shall provide written notification of the cost to
the office not more than 30 days after the date that the expenditure
is incurred. The notification shall include a copy of the certified
estimate.
(B) The acquisition, under lease or comparable arrangement, or
through donation, of equipment for a specialty clinic, the
expenditure for which would have been considered a capital
expenditure if the person had acquired it by purchase. For the
purposes of this paragraph, "donation" does not include a bequest.
(C) Any change in a proposed capital expenditure that meets the
criteria set forth in this subdivision.
(4) "Capital expenditure" includes the total cost of the proposed
project as certified by a licensed architect or engineer based on
preliminary plans or specifications and concurred in by the state
department.
(5) For the purposes of this subdivision, "project" does not
include the purchase of real property for future use or the transfer
of ownership, in whole or part, of an existing specialty clinic or
the acquisition of all or substantially all of the assets or stock
thereof, or the construction, modernization, purchase, lease, or
other acquisition of parking lots or parking structures, telephone
systems, and nonclinical data-processing systems.
(6) For the purposes of this subdivision, "modernization" means
the alteration, expansion, repair, remodeling, replacement, or
renovation of existing buildings, including initial equipment
thereof, and the replacement of equipment of existing buildings.
(f) Except as provided in subdivision (g), only those projects
where 25 percent or less of the patients are covered by prepaid
health care.
(g) Projects otherwise subject to review under subdivision (a)
that are for the addition of new licensed skilled nursing beds by
construction or conversion, regardless of the percentage of patients
served who are covered by prepaid health care.
(h) (1) Except as provided in paragraph (2), the office shall
annually adjust the dollar thresholds set forth in subdivisions (d)
and (e) to reflect changes in the cost of living, as determined by
the Department of Finance, using 1981 as the base year.
(2) Notwithstanding the amount of the dollar thresholds specified
in paragraph (1), in the event Congress increases or repeals the
amount or amounts of the thresholds, the dollar thresholds set forth
in subdivisions (d) and (e) shall be the highest amount
or amounts permitted by Public Law
93-641, as amended, or one million dollars ($1,000,000), whichever is
less, on the date congressional action is effective.
(i) This section is not applicable to an intermediate care
facility/developmentally disabled habilitative or an intermediate
care facility/developmentally disabled--nursing.
SEC. 5. 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 and
short-stay observation service visits .
(7) Number of observation and short-stay observation service
visits and number of hours of services provided.
(7)
(8) Total operating expenses.
(8)
(9) Total inpatient gross revenues by payer, including
Medicare, Medi-Cal, county indigent programs, other third parties,
and other payers.
(9)
(10) Total outpatient gross revenues by payer,
including Medicare, Medi-Cal, county indigent programs, other third
parties, and other payers.
(11) Total observation and short-stay observation service gross
revenues by payer, including Medicare, Medi-Cal, county indigent
programs, other third parties, and other payers.
(10)
(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.
(11)
(13) Total capital expenditures.
(12)
(14) Total net fixed assets.
(13)
(15) Total number of inpatient days, outpatient visits,
excluding observation and short-stay observation service visits,
and discharges by payer, including Medicare, Medi-Cal, county
indigent programs, other third parties, self-pay, charity, and other
payers.
(14)
(16) Total net patient revenues by payer including
Medicare, Medi-Cal, county indigent programs, other third parties,
and other payers.
(15)
(17) Other operating revenue.
(16)
(18) Nonoperating revenue net of nonoperating expenses.
(b) Hospitals reporting pursuant to subdivision (d) of Section
128760 may provide the items in paragraphs (7), (8), (9),
(10), (14), (15), and (16) (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.
This section shall become operative January 1, 1992.
SEC. 6. 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.
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.