BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 1094
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          SENATE THIRD READING
          SB 1094 (Lara)
          As Amended August 22, 2014
          Majority vote

           SENATE VOTE  :21-15  
           
           HEALTH              11-6        APPROPRIATIONS      11-6        
           
           ----------------------------------------------------------------- 
          |Ayes:|Pan, Bonilla, Bonta,      |Ayes:|Gatto, Bocanegra,         |
          |     |Chesbro, Gomez, Gonzalez, |     |Bradford,                 |
          |     |Roger Hern�ndez,          |     |Ian Calderon, Campos,     |
          |     |Lowenthal, Ridley-Thomas, |     |Eggman, Gomez, Holden,    |
          |     |Rodriguez, Wieckowski     |     |Pan, Quirk, Weber         |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Maienschein, Ch�vez,      |Nays:|Bigelow, Donnelly, Jones, |
          |     |Mansoor, Waldron,         |     |Linder, Ridley-Thomas,    |
          |     |Patterson, Wagner         |     |Wagner                    |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Provides an additional 30 days for the Attorney  
          General (AG) to review proposed transactions involving  
          non-profit health facilities.  Allows the AG to enforce the  
          conditions of an approved agreement, and to amend the conditions  
          of an agreement or transaction involving a non-profit health  
          facility if a party to the transaction or agreement made  
          material misrepresentations to the AG.  Requires the AG, prior  
          to imposing an amended condition, to provide the parties to the  
          agreement written notice of the proposed condition and allows  
          the parties 30 days to respond.  Specifically,  this bill  :

          1)Extends the time in which the AG must notify a non-profit  
            corporation in writing of the decision to consent or not  
            consent to a proposed transaction from 60 days to 90 days.

          2)Permits the AG to enforce conditions imposed on the AG's  
            approval of an agreement or transaction involving a nonprofit  
            health facility and to require the transferee to fulfill all  
            representations material to the enforcement of the conditions  
            made during the application process, including those regarding  
            the availability or accessibility of health care services to  
            the affected community.









                                                                  SB 1094
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          3)Allows the AG to amend the conditions of an agreement after  
            the AG's decision has been issued if an entity required to  
            comply with the conditions contained in the transaction or  
            agreement made material misrepresentations to the AG.   
            Requires an amended condition to be made within five years of  
            the completion of an agreement or transaction. 

          4)Specifies that amended conditions imposed by the AG pursuant  
            to 3) above, must be substantially related to the material  
            misrepresentation or the violation made by the entity to the  
            transaction, and shall be necessary to mitigate and provide  
            restitution for the effects of the violation. 

          5)Specifies that, before imposing an amended condition pursuant  
            to 3) above, the AG will provide the parties to the agreement  
            written notice of the proposed condition, and that the parties  
            to the agreement or transaction have 30 days from the date of  
            the AG's notice to provide a written response.

          6)Specifies that, within 30 days of receiving the parties'  
            response the AG may:

             a)   Withdraw the written notice without prejudice;

             b)   Meet and confer in good faith with the parties to the  
               transaction or agreement; or, 

             c)   Impose an amended condition pursuant to 3) above.

          7)Provides that an amended condition is subject to judicial  
            review. 

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee, negligible state fiscal effect.  Although this bill  
          allows the AG to use additional enforcement mechanisms, it  
          should not increase costs to the Department of Justice.

           COMMENTS  :  According to the author, this bill seeks to further  
          protect the interests and welfare of communities by maintaining  
          access to crucial hospital services and holding health  
          facilities accountable for agreements made when transferring  
          control or operation of the facility.  The author further states  
          that the process for reviewing proposed transactions is complex  
          and time intensive.  Finally, the author notes that the AG is  
          currently prevented from amending conditions or imposing new  








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          conditions related to proposed nonprofit hospital transaction  
          agreements that would be in the public's interest, even if the  
          parties to the transaction withheld material information from  
          the AG during the review process, or acted against the  
          conditions set forth by the AG when the transaction was  
          approved.

          This bill is sponsored by the AG, which states that since the  
          AG's role in overseeing non-profit health facility transactions  
          was first conceptualized, the proposed transactions have become  
          more complex and numerous, including a notable spike observed in  
          recent years.  This has resulted in an increased amount of time  
          needed for review by the AG.  In addition, the AG states that  
          recent cases have revealed scenarios in which the AG's inability  
          to revisit approved transactions following significant new  
          developments seriously hinders its ability to preserve the level  
          of access to care for patients in accordance with the public  
          trust.  The AG states that this bill is designed to provide  
          modest but crucial updates to the AG's oversight authority to  
          account for these developments. 

          The California Hospital Association (CHA) opposes this bill  
          stating that the most recent amendment does not change the  
          primary issue of the hospitals and noting that no change was  
          made to the provision in the bill that allows the AG to  
          retroactively amend a contract.  CHA further argues that the  
          amendment simply requires the AG to give the parties 30 days'  
          notice before unilaterally imposing amended contract terms.   
          Finally, CHA argues that this bill still creates uncertainty for  
          hospital purchasing and financing. 


           Analysis Prepared by  :    Lara Flynn / HEALTH / (916) 319-2097 


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