127472.
The following definitions apply for the purposes of this chapter:(a) “Community” means the service area or patient population for which a private nonprofit hospital or nonprofit multispecialty clinic provides health care services. A private nonprofit hospital or nonprofit multispecialty clinic shall create a health equity assessment based on the key factors relating to health and mental health disparities and inequities described in paragraph (2) of subdivision (d) of Section 131019.5, and may not define its service area to exclude vulnerable populations, including, but not limited to,
medically underserved, low-income, or minority populations who are part of its patient populations, live in geographic areas in which its patient populations reside, otherwise should be included based on the method the hospital facility uses to define its community, or populations described in subdivision (l).
(b) (1) “Community benefits” means the unreimbursed goods, services, activities, programs, and other resources provided by a private nonprofit hospital or nonprofit multispecialty clinic that addresses community-identified health needs and concerns, and health disparities related to its healthy equity assessment, particularly for people who are uninsured, underserved, or members of a vulnerable population. Community benefits include, but are not
limited to, charity care, shortfalls in all of the following:
(A) Charity care.
(B) Shortfalls in Medi-Cal, California Children’s Services Program, or county indigent programs at cost up to 125 percent of the Medicare rate for the health care services or items provided on an inpatient basis, an outpatient
basis, or through other nonprofit or public outpatient clinics, hospitals, or health care organizations, the organizations.
(C) The cost of community building activities, the activities for vulnerable populations.
(D) The cost of community health improvement services and community benefit operations, the operations.
(E) The cost of school health centers, as defined in Section 124174, the
124174.
(F) The cost of health professions education and training provided without charge to community members or participants, amounts participants.
(G) Amounts
given, with no expectation of reimbursement or repayment, to employees from, or working among, a vulnerable population, for the purpose of satisfying or paying off, in full or in part, preemployment student educational loan obligations, subsidized obligations.
(H) Subsidized
health services for vulnerable populations, research, and contributions to community groups, vaccination programs and services for low-income families, chronic populations.
(I) Vaccination programs.
(J) Chronic illness prevention programs and services, home-based
services for vulnerable populations.
(K) Home-based health care programs for low-income families, or community-based vulnerable populations.
(L) Community-based mental
health and outreach, the key factors described in paragraph (2) of subdivision (d) of Section 131019.5, and assessment programs for vulnerable populations.
(M) Outreach and assessment programs for low-income families. For purposes of this
subdivision, “low-income families” means families or individuals with income less than or equal to 350 percent of the federal poverty level. vulnerable populations.
(2) For purposes of this subdivision, “community building activities” means the cost of various kinds of community building activities, including physical improvements and housing, economic development, community support, environmental improvements, community health improvement advocacy, coalition building, workforce development, the key factors described in paragraph (2) of subdivision (d) of Section 131019.5, and leadership development and training for community members.
(3) (A) For purposes of this subdivision, “charity care” means the unreimbursed cost to a private nonprofit hospital or nonprofit multispecialty clinic of providing services to the uninsured or underinsured, as well as providing health care services or items on an inpatient or outpatient basis to a financially qualified patient, as defined in Section 127400, with no expectation of payment.
(B) Charity care does not include any of the following:
(i) Uncollected fees or accounts written off as bad debt.
(ii) Care provided to patients for which a public program or public or private grant funds pay for any of the charges for the care.
(iii) Contractual adjustments in the provision of health care services below the amount identified as gross charges or “chargemaster” rates by the health care provider.
(iv) Any amount over 125 percent of the Medicare rate for the health care services or items provided on an inpatient or outpatient basis.
(v) Any amount over 125 percent of the Medicare rate for providing, funding, or otherwise financially supporting health care services or items with no expectation of payment provided to financially qualified patients through other nonprofit or public outpatient clinics, hospitals, or health care organizations.
(vi) The cost to a nonprofit hospital of paying a tax or
other governmental assessment.
(4) “Community benefits” does not include any of the following:
(A) The unreimbursed cost of providing services to those enrolled in Medicare or county indigent programs
or any goods, services, activities, programs, or other resources program or activity for which there is direct offsetting revenue.
(B) Uncollected fees or accounts written off as bad debt.
(C) Contractual adjustments in the provision of health care services below the amount identified as gross charges or “chargemaster” rates by the health care provider.
(D) Any amount over 125 percent of the Medicare rate for the health care services or items provided on an inpatient or outpatient basis.
(E) Any amount over 125 percent of the Medicare rate for providing, funding, or otherwise financially supporting health care services or items with no
expectation of payment provided to financially qualified patients through other nonprofit or public outpatient clinics, hospitals, or health care organizations.
(c) (1) “Community benefits planning committee” means a committee, designated by a private nonprofit hospital or nonprofit multispecialty clinic, that oversees the community needs assessment and the development of the community benefits plan implementation strategy to meet the community health needs identified through the community health needs assessment.
(2) The community benefits planning committee shall be composed of the following:
(A) One of the following:
(i) The
governing board of the hospital organization that operates the hospital facility or a committee or other party authorized by that governing body to the extent that the committee or other party is permitted under state law to act on behalf of the governing body.
(ii) If the hospital facility has its own governing body and is recognized as an entity under state law but is a disregarded entity for federal tax purposes, the governing body of that hospital facility or other committee or party authorized by that governing body to the extent that the committee or other party is permitted under state law to act on behalf of the governing body.
(B) At least one individual from the local, tribal, or regional governmental public health department, or an equivalent department or agency, with
knowledge, information, or expertise relevant to the health needs of that community.
(C) At least one individual from an underserved and vulnerable population.
(d)“Discounted care” means the cost for medical care provided consistent with Article 1 (commencing with Section 127400) of Chapter 2.5.
(e)
(d) (1) “Direct offsetting revenue” means revenue from goods, services, activities, programs, or other resources that offsets the total community benefit expense of the goods, services, activities, programs, or other resources.
(2) “Direct offsetting revenue” includes revenue generated by the goods, services, activities, programs, or other resources, including, but not limited to, payment or reimbursement for services provided to program patients as well as restricted grants or contributions that the private nonprofit hospital or nonprofit multispecialty clinic uses to provide a community benefit, such as a restricted grant to provide financial assistance or fund research.
(3) “Direct offsetting revenue” does not include unrestricted grants or
contributions that the private nonprofit hospital or
nonprofit multispecialty clinic uses to provide a community benefit, nor payments for Medi-Cal, the California Children’s Services Program, or county indigent programs.
(f)
(e) “Nonprofit multispecialty clinic” means a clinic as described in subdivision (l) of Section 1206.
(g)
(f) “Office” means the Office of Statewide Health Planning and Development.
(h)
(g) “Private nonprofit hospital” means a private nonprofit acute care hospital operated or controlled by a nonprofit corporation, as defined in Section 5046 of the Corporations Code, that has been determined to be exempt from taxation under the Internal Revenue Code. For purposes of this chapter, “private nonprofit hospital” does not include any of the following:
(1) A district hospital organized and governed pursuant to the Local Health Care District Law (Division 23 (commencing with Section 32000)) or a nonprofit corporation that is affiliated with the health care district hospital owner by means of the district’s status as the nonprofit corporation’s sole corporate member pursuant to subparagraph (B) of paragraph (1) of subdivision (h) of Section 14169.31 of the Welfare and Institutions Code.
(2) A rural general acute care hospital, as defined in subdivision (a) of Section 1250.
(3) A children’s hospital, as defined in Section 10727 of the Welfare and Institutions Code.
(4) A multispecialty clinic operated by a for-profit hospital, regardless of its net revenue.
(i)
(h) “Underserved population” or “vulnerable population” means any of the following:
(1) A population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal or a county indigent program.
(A) “Uninsured” means a self-pay patient as defined in Section 127400.
(B) “Underinsured” means a patient with high medical costs, as defined in Section 127400.
(2)A population, including, but not limited to, the following:
(A)A vulnerable community, as defined by Section 131019.5.
(B)Individuals with low educational attainment as measured by the percentage of the population over 25 years of age
with less than a high school diploma.
(C)Individuals who suffer from linguistic isolation as measured by the percentage of households in which no one who is 14 years of age or older speaks English with greater than elementary
proficiency.
(2) Individuals below 400 percent of the federal poverty level, unless the hospital serves a county in which the county has adopted an ordinance to provide financial assistance for health care to individuals with incomes above 400 percent of the federal poverty level, in which case the income threshold for the vulnerable population shall be the income threshold adopted by the county.
(3) Individuals with limited English proficiency.
(3)
(4) A population that meets the definition of disadvantaged community pursuant to Section 39711.
(4)Other populations that are specifically identified in the community health needs assessment required pursuant to Section 127475.