BILL NUMBER: SB 1083 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 28, 2010
INTRODUCED BY Senator Correa
FEBRUARY 17, 2010
An act to amend Section 1250.8 of the Health and Safety Code,
relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 1083, as amended, Correa. Health facilities: licensure.
Existing law provides for the licensure and regulation of health
facilities, including general acute care hospitals, by the State
Department of Public Health. Existing law requires the department,
when an applicant for a general acute care hospital license meets the
applicable requirements of licensure, to issue a single consolidated
general acute care hospital license that includes more than one
physical plant maintained and operated on separate premises or that
has multiple licenses for a single health facility on the same
premises if any of specified criteria are met. One of these criteria
is that the physical plants maintained and operated by the licensee
that are to be covered by the single consolidated license are located
not more than 15 miles apart. If the physical plants are located
more than 15 miles apart, a single consolidated license may be issued
to a children's hospital under specified circumstances.
Existing law also authorizes the State Public Health Officer to
issue a single consolidated license for a general acute care hospital
to Children's Hospital Oakland and San Ramon Regional Medical
Center, as well as a single consolidated license for a general acute
care hospital to Children's Hospital Oakland and the John Muir
Medical Center, Concord Campus.
This bill would eliminate the above-mentioned provisions
applicable to single consolidated licenses for children's hospitals,
and would, instead, permit the department to issue a single
consolidated license for a children's hospital that has physical
plants located not more than 35 miles apart if prescribed
conditions are met .
The bill would require, to the extent permitted by federal law,
the payments to prescribed children's hospitals under the Medi-Cal
Hospital/Uninsured Care Demonstration Project be adjusted in a
specified manner, as prescribed until January 1, 2016, or the
extension of prescribed federal waiver, whichever occurs first.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1250.8 of the Health and Safety Code is amended
to read:
1250.8. (a) Notwithstanding subdivision (a) of Section 127170,
the department, upon application of a general acute care hospital
that meets all the criteria of subdivision (b), and other applicable
requirements of licensure, shall issue a single consolidated license
to a general acute care hospital that includes more than one physical
plant maintained and operated on separate premises or that has
multiple licenses for a single health facility on the same premises.
A single consolidated license shall not be issued where the separate
freestanding physical plant is a skilled nursing facility or an
intermediate care facility, whether or not the location of the
skilled nursing facility or intermediate care facility is contiguous
to the general acute care hospital unless the hospital is exempt from
the requirements of subdivision (b) of Section 1254, or the facility
is part of the physical structure licensed to provide acute care.
(b) The issuance of a single consolidated license shall be based
on the following criteria:
(1) There is a single governing body for all the facilities
maintained and operated by the licensee.
(2) There is a single administration for all the facilities
maintained and operated by the licensee.
(3) There is a single medical staff for all the facilities
maintained and operated by the licensee, with a single set of bylaws,
rules, and regulations, which prescribe a single committee
structure.
(4) Except as provided otherwise in this paragraph, the physical
plants maintained and operated by the licensee which are to be
covered by the single consolidated license are located not more than
15 miles apart or, in the case of a children's hospital described in
Section 10727 of the Welfare and Institutions Code, are located not
more than 35 miles apart. If apart if the
children's hospital provides evidence satisfactory to the department
that it can comply with all requirements of licensure and provide
quality care and adequate administrative and professional
supervision.
(5) If an applicant provides
evidence satisfactory to the department that it can comply with all
requirements of licensure and provide quality care and adequate
administrative and professional supervision, the director may issue a
single consolidated license to a general acute care hospital that
operates two or more physical plants located more than 15 miles apart
under either of the following circumstances:
(A) One or more of the physical plants is located in a rural area,
as defined by regulations of the director.
(B) One or more of the physical plants provides only outpatient
services, as defined by the department.
(c) In issuing the single consolidated license, the state
department shall specify the location of each supplemental service
and the location of the number and category of beds provided by the
licensee. The single consolidated license shall be renewed annually.
(d) To the extent required by Chapter 1 (commencing with
Section127125) of Part 2 of Division 107, a general acute care
hospital that has been issued a single consolidated license:
(1) Shall not transfer from one facility to another a special
service described in Section 1255 without first obtaining a
certificate of need.
(2) Shall not transfer, in whole or in part, from one facility to
another, a supplemental service, as defined in regulations of the
director pursuant to this chapter, without first obtaining a
certificate of need, unless the licensee, 30 days prior to the
relocation, notifies the Office of Statewide Health Planning and
Development, the applicable health systems agency, and the state
department of the licensee's intent to relocate the supplemental
service, and includes with this notice a cost estimate, certified by
a person qualified by experience or training to render the estimates,
which estimates that the cost of the transfer will not exceed the
capital expenditure threshold established by the Office of Statewide
Health Planning and Development pursuant to Section 127170.
(3) Shall not transfer beds from one facility to another facility,
without first obtaining a certificate of need unless, 30 days prior
to the relocation, the licensee notifies the Office of Statewide
Health Planning and Development, the applicable health systems
agency, and the state department of the licensee's intent to relocate
health facility beds, and includes with this notice both of the
following:
(A) A cost estimate, certified by a person qualified by experience
or training to render the estimates, which estimates that the cost
of the relocation will not exceed the capital expenditure threshold
established by the Office of Statewide Health Planning and
Development pursuant to Section 127170.
(B) The identification of the number, classification, and location
of the health facility beds in the transferor facility and the
proposed number, classification, and location of the health facility
beds in the transferee facility.
Except as otherwise permitted in Chapter 1 (commencing with
Section 127125) of Part 2 of Division 107, or as authorized in an
approved certificate of need pursuant to that chapter, health
facility beds transferred pursuant to this section shall be used in
the transferee facility in the same bed classification as defined in
Section 1250.1, as the beds were classified in the transferor
facility.
Health facility beds transferred pursuant to this section shall
not be transferred back to the transferor facility for two years from
the date of the transfer, regardless of cost, without first
obtaining a certificate of need pursuant to Chapter 1 (commencing
with Section 127125) of Part 2 of Division 107.
(e) Transfers pursuant to subdivision (d) shall satisfy all
applicable requirements of licensure and shall be subject to the
written approval, if required, of the state department. The state
department may adopt regulations that are necessary to implement this
section. These regulations may include a requirement that each
facility of a health facility subject to a single consolidated
license have an onsite full-time or part-time administrator.
(f) As used in this section, "facility" means a physical plant
operated or maintained by a health facility subject to a single,
consolidated license issued pursuant to this section.
(g) For purposes of selective provider contracts negotiated under
the Medi-Cal program, the treatment of a health facility with a
single consolidated license issued pursuant to this section shall be
subject to negotiation between the health facility and the California
Medical Assistance Commission. A general acute care hospital that is
issued a single consolidated license pursuant to this section may,
at its option, be enrolled in the Medi-Cal program as a single
business address or as separate business addresses for one or more of
the facilities subject to the single consolidated license.
Irrespective of whether the general acute care hospital is enrolled
at one or more business addresses, the department may require the
hospital to file separate cost reports for each facility pursuant to
Section 14170 of the Welfare and Institutions Code.
(h) For purposes of the Annual Report of Hospitals required by
regulations adopted by the state department pursuant to this part,
the state department and the Office of Statewide Health Planning and
Development may require reporting of bed and service utilization data
separately by each facility of a general acute care hospital issued
a single consolidated license pursuant to this section.
(i) The amendments made to this section during the 1985-86 Regular
Session of the Legislature pertaining to the issuance of a single
consolidated license to a general acute care hospital in the case
where the separate physical plant is a skilled nursing facility or
intermediate care facility shall not apply to the following
facilities:
(1) A facility that obtained a certificate of need after August 1,
1984, and prior to February 14, 1985, as described in this
subdivision. The certificate of need shall be for the construction of
a skilled nursing facility or intermediate care facility that is the
same facility for which the hospital applies for a single
consolidated license, pursuant to subdivision (a).
(2) A facility for which a single consolidated license has been
issued pursuant to subdivision (a), as described in this subdivision,
prior to the effective date of the amendments made to this section
during the 1985-86 Regular Session of the Legislature.
A facility that has been issued a single consolidated license
pursuant to subdivision (a), as described in this subdivision, shall
be granted renewal licenses based upon the same criteria used for the
initial consolidated license.
(j) If the state department issues a single consolidated license
pursuant to this section, the state department may take any action
authorized by this chapter, including, but not limited to, any action
specified in Article 5 (commencing with Section 1294), with respect
to a facility, or a service provided in a facility, that is included
in the consolidated license.
(k) The eligibility for participation in the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code) of a facility that is included in
a consolidated license issued pursuant to this section, provides
outpatient services, and is located more than 15 miles from the
health facility issued the consolidated license shall be subject to a
determination of eligibility by the state department. This
subdivision shall not apply to a facility that is located in a rural
area and is included in a consolidated license issued pursuant to
subparagraphs (A), (B), and (C) of paragraph (4) of subdivision (b).
Regardless of whether a facility has received or not received a
determination of eligibility pursuant to this subdivision, this
subdivision shall not affect the ability of a licensed professional,
providing services covered by the Medi-Cal program to a person
eligible for Medi-Cal in a facility subject to a determination of
eligibility pursuant to this subdivision, to bill the Medi-Cal
program for those services provided in accordance with applicable
regulations.
(l) (1) To the extent permitted by federal law, payments made to
Children's Hospital Medical Center of Northern California,
Oakland pursuant to Section 14166.11 of the Welfare and Institutions
Code shall be adjusted as follows:
(A) The number of Medi-Cal payment days and net revenues
calculated for the John Muir Medical Center, Concord Campus under the
consolidated license shall not be used for eligibility purposes for
the private hospital disproportionate share hospital replacement
funds for Children's Hospital Medical Center of Northern
California, Oakland.
(B) The number of Medi-Cal payment days calculated for hospital
beds located at John Muir Medical Center, Concord Campus that are
included in the consolidated license beginning in the 2007-08 fiscal
year shall only be used for purposes of calculating disproportionate
share hospital payments authorized under Section 14166.11 of the
Welfare and Institutions Code at Children's Hospital Medical
Center of Northern California, Oakland to the extent that the
inclusion of those days does not exceed the total Medi-Cal payment
days used to calculate Children's Hospital Medical Center of
Northe rn California, Oakland payments for the
2006-07 fiscal year disproportionate share replacement.
(2) This subdivision shall become inoperative in the event that
the two facilities covered under the consolidated license described
in subdivision (a) are located within a 15-mile radius of each other.
(m) (1) To the extent permitted by federal law, payments made to
children's hospitals described in Section 10727 of the Welfare and
Institutions Code pursuant to Section 14166.11 of the Welfare and
Institutions Code shall be adjusted as follows:
(A) The number of Medi-Cal payment days and net revenues
calculated for satellite units of a children's hospital described in
Section 10727 of the Welfare and Institutions Code that are between
15 and 35 miles, inclusive, from the children's hospital's main
campus shall not be considered for purposes of calculating
eligibility for the private hospital disproportionate share hospital
replacement funds for the children's hospital.
(B) The number of Medi-Cal payment days calculated for hospital
beds located in hospitals that house satellite units of a children's
hospital that are located between 15 and 35 miles, inclusive, from
the children's hospitals' main campus that are included in the
children's hospitals' consolidated license shall be used only for
purposes of calculating disproportionate share hospital payments
authorized pursuant to Section 14166.11 of the Welfare and
Institutions Code to the extent that the hospital that houses the
satellite unit that is located between 15 and 35 miles, inclusive,
from the children's hospital's main campus is eligible for private
hospital disproportionate share hospital replacement funds.
(C) The total additional disproportionate share hospital
replacement payments calculated under subparagraph (B) of paragraph
(1) of subdivision (l) made to children's hospitals shall not exceed
five million dollars ($5,000,000) per disproportionate share hospital
replacement year. If the adjusted payment calculation exceeds five
million dollars ($5,000,000) for a payment year, the payment
distribution under this subdivision to children's hospitals shall be
determined on a pro rata basis based on Medi-Cal payment days
calculated for hospital beds located in hospitals that house
satellite units that are located between 15 and 35 miles, inclusive,
from the main hospital campus that are included in the children's
hospitals' consolidated licenses.
(2) Paragraph (1) shall become inoperative on the earlier of
January 1, 2016, or upon the expiration of the federal waiver under
Section 1115 of the Social Security Act (42 U.S.C. Sec. 1315) that is
approved after June 30, 2010, and has substantive provisions
relating to hospital financing. Thereafter, Medi-Cal payment days and
net revenues for hospital beds located in hospitals that house
satellite units that are located between 15 and 35 miles, inclusive,
from the main hospital campus that are included in the children's
hospitals' consolidated license shall not be included in the
calculation of disproportionate share replacement payment program for
eligibility and payment purposes.