BILL NUMBER: AB 1544	AMENDED
	BILL TEXT

	AMENDED IN SENATE  SEPTEMBER 4, 2009
	AMENDED IN SENATE  AUGUST 17, 2009
	AMENDED IN SENATE  JULY 23, 2009

INTRODUCED BY    Committee on Health   (
  Jones (Chair), Fletcher (Vice Chair), Adams,
Ammiano, Block, Carter, Conway, De La Torre, Emmerson, Hayashi,
Hernandez, Bonnie Lowenthal, Nava, V. Manuel Perez, Salas, and Audra
Strickland   )   Assembly  
Members   Jones   and Fletcher 
    (   Coauthors:   Assembly Members 
 Adams,   Ammiano,   Block,   Carter,
  Conway,   De La Torre,   Emmerson, 
 Hayashi,   Hernandez,   Bonnie Lowenthal,
  Nava,   V. Manuel Perez,   Salas, 
 and Audra Strickland   ) 

                        MARCH 4, 2009

   An act to add Section 1253.6 to the Health and Safety Code,
relating to health facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1544, as amended,  Committee on Health  
Jones  . Health facilities:  licensure.  
licensure: outpatient clinic service. 
   Existing law provides for the licensure of health facilities,
including general acute care hospitals, acute psychiatric hospitals,
and special hospitals, as defined, by the State Department of Public
Health. Violation of these provisions is a misdemeanor.
   Existing law requires that, upon the issuance or renewal of a
general acute care, acute psychiatric, or special hospital license,
the department separately identify on the license each supplemental
service, including the address of where each outpatient service is
provided and the type of services provided at each outpatient
location.
   Existing law authorizes licensed general acute care hospitals and
acute psychiatric hospitals to provide in any alternative setting
health care services and programs that may be provided by any other
provider of health care outside of a hospital building or which are
not otherwise specifically prohibited by provisions of existing law
regulating these facilities. It also requires the state department
and the Office of Statewide Health Planning and Development to adopt
and enforce standards which permit these health facilities to use its
space for alternative purposes.
   This bill would, among other things, require the department to
approve a completed application by a licensed general acute care
hospital  , acute psychiatric hospital, or a special hospital
 that meets specified requirements to add or modify an
outpatient  clinic  service as a supplemental service, add
the outpatient service to the hospital license, and issue a new
license, within 100 days of receipt of the completed application,
unless the applicant does not meet specified requirements. The bill
would limit the outpatient  clinic  service that is the
subject of the application to providing only  nonemergency 
primary health care  service   services in a
clinical environment  to patients who remain in the outpatient
clinic for less than 24 hours.  The bill would also prohibit
the outpatient service that is the subject of the application from
providing chronic dialysis treatment or alternative birthing
services, performing outpatient surgeries that are provided by a
surgical clinic, or providing other services that are not consistent
with providing primary health care services for patients who remain
in the outpatient clinic for less than 24 hours.   The
bill would define "outpatient clinic services" for purposes of the
bill.  By creating a new crime, this 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.  The Legislature finds and declares all of the
following:
   (a) Hospitals in California are essential partners with the state
in providing a health care safety net for underserved, uninsured, and
underinsured populations in a cost-effective manner.
   (b) The need for primary care is growing dramatically due to
changes in the delivery of health care, demands of the market, and
the continuing increase of uninsured and underinsured patients in
California, an escalating unemployment rate, physician shortages, and
a severely depressed economy.
   (c) The current system of approving new hospital-based outpatient
services that provide primary care causes delays in timely access to
care and results in a significant and unnecessary waste of taxpayer
and community resources that could otherwise be devoted to patient
care.
   (d) Administrative streamlining of the approval process, without
compromising patient health and safety, will avoid an unnecessary
burden to the state's scarce resources and improve access to vital
community health care services in California.
  SEC. 2.  Section 1253.6 is added to the Health and Safety Code, to
read: 
   1253.6.  (a) Upon receipt of an initial application by a licensed
general acute care hospital, an acute psychiatric hospital, or a
special hospital 
    1253.6.   (a) This section shall govern applications
by general acute care hospitals for supplemental services approval
for outpatient clinic services. 
    (b)     Upon receipt of an initial
application by a licensed general acute care hospital  to add a
new or modify an existing outpatient service as a supplemental
service, the department shall, within 30 days of receipt of the
initial application, review the entire application, determine whether
the application is missing information or has insufficient
information, and, on the basis of this determination, provide the
hospital with guidance on how to provide the missing information.

   (b) 
    (c)  Upon determination by the department that an
application for an outpatient  clinic  service as a
supplemental service is complete pursuant to subdivision  (a)
  (b)  , the department shall investigate the
facts set forth in the application and, if the department finds that
the statements contained in the application are true, that the
establishment of the operation of the supplemental service are in
conformity with the intent and purpose of this chapter, and that the
applicant is in compliance with  the provision of 
this chapter and the rules and regulations of the department, the
department shall approve the additional or modified outpatient 
clinic  service, add it to the hospital license, and issue a new
license. However, if the department  determines in the course of
the investigation that additional information is needed to determine
whether the statements contained in the application are true or that
the establishment or   the continued operation of the
supplemental service are in conformity with the intent and purpose of
this chapter, or that the applicant is in compliance with this
chapter and the rules and regulations of the department, the
applicant shall provide the additional information to the department
upon request. If the department  finds that the statements
contained in the application are not true, or that the establishment
of the outpatient service as a supplemental service is not in
conformity with the intent and  purpose of this chapter, the
department shall deny the applicant the license  
purpose of this chapter, or if the applicant fails to provide any
additional information to the department within 30 days of the
request, the department shall deny the outpatient clinic services
application  . The department shall either grant or deny the
application for the outpatient  clinic  service as a
supplemental service within 100 days of the filing of a completed
application. 
   (c) 
    (d)  If a licensed general acute care hospital 
, acute psychiatric hospital, or a special hospital meets the
requirement of subdivision (d) and has been approved for an
outpatient service as a supplemental service in accordance with
subdivision (b), within   has previously been approved
for an outpatient clinic service within  30 days after receipt
of a completed application for an additional outpatient  clinic
 service, the department shall approve the additional or
modified outpatient  clinic  service, add it to the hospital
license, and issue a new license, unless the applicant does not meet
the requirements of this section. Notwithstanding any other law, the
 issuance of a new license pursuant to this section shall
not require an initial onsite survey   department shall
not be required to conduct an onsite inspection prior to approval of
an outpatient clinic service pursuant to this section  .
However, nothing shall preclude the department from conducting an
onsite inspection prior to approving an application for
supplemental services or denying an application if it finds licensing
deficiencies as a result of the inspection. If the   at
  any time, or denying an application, in accordance with
subdivision (c). If the  department determines that the
applicant does not meet the requirements of this section, the
department shall provide the hospital, in writing, the particular
basis for this determination. 
   (d) A hospital qualifies to submit an application pursuant to this
section only if both of the following conditions are met: 

   (1) The hospital has held for the five years immediately preceding
the submission of the completed application, a valid, unrevoked or
unsuspended license, does not have repeated or uncorrected violations
of state licensing or federal certification requirements that pose
immediate jeopardy to a patient, and does not have any pending
actions against it to suspend or revoke the license or terminate
Medicare or Medi-Cal certification.  
   (2) The hospital owns and operates the outpatient service that is
the subject of the application. 
   (e) A completed application for purposes of this section shall
include all of the following:
   (1) The appropriate forms, fees, and documentation, as determined
by the department.
   (2) A description of the type of outpatient  clinic 
service to be operated, the character and scope of the service to be
provided, and a complete description of the building, its location
and proximity to the main hospital building, facilities, equipment,
apparatus, and appliances to be furnished and used in the operation
of the outpatient  service   clinic service and
evidence satisfactory to the department that the hospital owns and
will operate the outpatient clinic service that is the subject of the
application  . 
   (3) A description of and documentation that the outpatient service
has written 
    (3)     Written  policies and
procedures governing the operation of the  outpatient clinic
 service and its reporting relationship to the applicant.
   (4) Evidence of the hospital's compliance with applicable building
standards and possession of a fire clearance  for the outpatient
clinic service space  .
   (f) The outpatient  clinic  service that is the subject
of the application shall be limited to providing  primary
health care service  nonemergency primary health care
services in a clinical environment  to patients who remain in
the outpatient clinic for less than 24 hours. 
   (g) The outpatient service that is the subject of the application
shall not provide chronic dialysis treatment or alternative birthing
services, perform outpatient surgeries that are provided by a
surgical clinic, or provide other services not consistent with those
described in subdivision (e).  
   (h) Nothing in this section shall prohibit the department from
conducting a licensing inspection or complaint investigation after
the application is approved.  
   (i) The outpatient service that is the subject of the application
shall comply with applicable standards for outpatient services,
including, but not limited to, requirements applicable to life
safety, building standards, infection control, medical records,
personnel policies, governance, and patient rights.  
   (g) For purposes of this section "outpatient clinic services"
shall have the same meaning as the services that may be provided by a
primary care clinic in accordance with subdivision (a) of Section
1204. Nothing in this section shall be interpreted to mean that
supplemental outpatient services established by a general acute care
hospital pursuant to this section shall be considered primary care
clinics for licensing, regulatory, or enforcement purposes. 
  SEC. 3.  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.