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AB-844 Health facilities: mandated hospital services and activities.(2019-2020)

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Date Published: 03/05/2019 09:00 PM
AB844:v98#DOCUMENT

Amended  IN  Assembly  March 05, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 844


Introduced by Assembly Member Irwin

February 20, 2019


An act to amend Section 1266 of the Business and Professions Code, and to amend Section 1259 of, and to add Section 1258.5 to, add Part 7 (commencing with Section 1179.200) to Division 1 of the Health and Safety Code, relating to health facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 844, as amended, Irwin. Health facilities: operations. mandated hospital services and activities.
Existing law, until July 1, 2020, requests that the University of California to establish the California Health Benefit Review Program to assess legislation proposing to mandate a benefit or service of a health care service plan or health insurer or proposing to repeal an existing mandated benefit or service of a health care service plan or health insurer. Under existing law, specified members of the Legislature are authorized to request analysis of that legislation by the university. Existing law requests that the university provide that analysis to the appropriate policy and fiscal committees of the Legislature not later than 60 days after receiving a request for the analysis.
This bill would establish an independent, nonpartisan body to advise the Governor and Legislature on the financial impact of proposed mandated hospital services and activities. The bill would require the chair of a policy or fiscal committee that will consider a bill proposing mandated hospital services or activities to ensure that the bill is forwarded to the body to estimate its financial impacts, and would require a bill’s author to prepare detailed background information regarding the proposal. The bill would require the body to prepare an analysis estimating the costs of the proposed legislation and analyzing specified information, including the results of research demonstrating the efficacy of the proposed mandated service or activity compared to alternatives, to provide that analysis to the appropriate policy and fiscal committees not later than 60 days after receiving the request, and to post that analysis on the internet. The bill would authorize the body to engage professional consultants and to execute contracts and interagency agreements in order to assess legislation and prepare analyses. The bill would also make related findings and declarations.

Existing law provides for the licensure and regulation of clinical laboratories and various clinical laboratory healthcare professionals by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires a clinical laboratory license and the license or current renewal permit of each person performing tests to be conspicuously posted in the clinical laboratory.

This bill would further authorize those licenses or renewal permits to be stored in a file or maintained electronically, and would require them to be produced to the department upon request. By expanding the circumstances upon which a crime may apply, the bill would impose a state-mandated local program.

Existing law provides for the licensure and regulation by the State Department of Public Health of health facilities, as defined. A violation of these provisions is a crime. Existing law prescribes standards of adequacy, safety, sanitation, staffing, and services that apply to health facilities, based on the type of health facility and the needs of the persons served by those facilities. Notwithstanding those provisions, existing law authorizes the department to review and approve, if appropriate, applications for program flexibility.

This bill would require a health facility that has been granted program flexibility to post a single notification immediately adjacent to the facility’s license, stating that program flexibility has been granted by the department and the location where each program flexibility request and approval may be viewed. By expanding the circumstances upon which a crime may apply, the bill would impose a state-mandated local program.

Existing law requires a general acute care hospital to annually post on its internet website its updated policy with respect to the availability of language assistance services to the public. Existing law also requires the hospital to annually provide that updated policy to the department, and a description of its efforts to ensure adequate communication between patients with language or communication barriers. Existing law requires the department to further make those updated policies available on its internet website.

This bill would repeal the requirement that a hospital provide those updated policies to the department, and repeal the requirement that the department also post those policies on its internet website.

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   Local Program: YESNO  

The people of the State of California do enact as follows:


SECTION 1.

 Part 7 (commencing with Section 1179.200) is added to Division 1 of the Health and Safety Code, to read:

PART 7. Consumer Health Care Affordability Act Estimates of Legislation Proposing Mandated Hospital Services or Activities

1179.200.
 (a) This act shall be known and may be cited as the Consumer Health Care Affordability Act.
(b) The intent of the Legislature in enacting this act is:
(1) To promote the public interest to assure that all residents of this state have reasonable access to affordable, high-quality health care.
(2) To identify an independent, nonpartisan body to estimate the cost to Californians of legislative proposals that mandate specific hospital services or activities.
(3) To facilitate the provision of quality, cost-effective health services by providing current, accurate data and information to the Governor and the Legislature for the purpose of evaluating proposed legislation.
(4) To ensure that the independent, nonpartisan body publish a written analysis of the estimated costs of each legislative proposal.
(c) The Legislature finds that there is an increasing number of proposals that mandate hospitals to provide specific services or activities. The Legislature further finds that some of these services or activities could potentially result in better health outcomes that would be in the public interest. However, the Legislature also recognizes that mandated services and activities contribute to the cost and lack of affordability of hospital care for patients, health plans, health insurers, employers, taxpayers, the Public Employees’ Retirement System, other retirement systems funded by the state or by a local government, individuals purchasing individual health insurance, Covered California, and publicly funded state health insurance programs, including the Medi-Cal program and the Healthy Families Program and others. Therefore, it is the intent of the Legislature that the independent, nonpartisan body conduct a systematic review of proposed mandated or mandatorily offered hospital services and activities. This review will assist the Governor and the Legislature in determining whether mandating a particular service or activity is in the public interest.

1179.202.
 There is hereby established an independent, nonpartisan body whose purpose is to advise the Governor and the Legislature on the financial impact of proposed mandated hospital services and activities.

1179.204.
 (a) The chair of a policy or fiscal committee that will consider a bill proposing mandated specific hospital services or activities shall ensure that the bill is forwarded to the independent, nonpartisan body to estimate the financial impacts of the proposed mandate pursuant to this part. To ensure the independent, nonpartisan body has all the pertinent information, an author of a bill requiring hospitals to offer or provide a mandated service or activity that has not previously been required shall prepare detailed background information regarding the proposal.
(b) In assessing a proposed mandate, the independent, nonpartisan body shall prepare a written analysis estimating the cost of the proposed mandate. The analysis shall include, to the extent relevant, the following:
(1) The extent to which the proposed mandated service or activity is generally recognized by the medical community as being effective in the screening, diagnosis, or treatment of a condition or disease, as demonstrated by a review of scientific and peer reviewed medical literature.
(2) The extent to which the proposed mandated service or activity is generally utilized by treating physicians.
(3) The results of research demonstrating the efficacy of the proposed mandated service or activity compared to alternatives, including not providing the service or activity.
(4) Whether the proposed mandated service or activity can be provided more cost-efficiently in another setting.
(5) The extent to which the proposed mandated service or activity does not reduce or eliminate access to currently available hospital services.
(6) The extent to which the proposed mandated service or activity will increase the direct costs and the administrative expenses of hospitals and, by extension, the expenses of patients, health plans, health insurers, employers, taxpayers, the Public Employees’ Retirement System, other retirement systems funded by the state or by a local government, individuals purchasing individual health insurance, Covered California, publicly funded state health insurance programs, including the Medi-Cal program and the Healthy Families Program, and others.
(7) The total cost of the proposed mandated service or activity to the cost of health care in California.

1179.206.
 The independent, nonpartisan body shall provide an analysis to the appropriate policy and fiscal committees of the Legislature not later than 60 days after receiving a request made pursuant to Section 1179.204. In addition, the independent, nonpartisan body shall post an analysis on the internet.

1179.208.
 (a) In assessing and preparing a written analysis of the financial impact of a proposed mandated hospital service or activity pursuant to this part, the independent, nonpartisan body shall use individuals with appropriate knowledge and expertise to determine the estimated financial impact.
(b) The independent, nonpartisan body shall have the authority to engage professional consultants and consider relevant information, including, but not limited to, information from medical research studies, the Office of Statewide Health Planning and Development, the State Department of Health Care Services, the Public Employees’ Retirement System, Covered California, and California-specific hospital wage surveys.
(c) The independent, nonpartisan body shall have the authority to make and execute contracts and interagency agreements.

SECTION 1.Section 1266 of the Business and Professions Code is amended to read:
1266.

The clinical laboratory license and the license or current renewal permit of each person performing tests in the laboratory shall be conspicuously posted in the clinical laboratory, stored in a file or files, or maintained electronically, and produced to the department upon request.

SEC. 2.Section 1258.5 is added to the Health and Safety Code, to read:
1258.5.

A health facility, as defined in Section 1250, that has been granted program flexibility pursuant to Section 1276, shall post a single notification immediately adjacent to the facility’s license, stating that program flexibility has been granted by the department and the location where each program flexibility request and approval may be viewed.

SEC. 3.Section 1259 of the Health and Safety Code is amended to read:
1259.

(a)(1)The Legislature finds and declares that California is becoming a land of people whose languages and cultures give the state a global quality. The Legislature further finds and declares that access to basic healthcare services is the right of every resident of the state, and that access to information regarding basic healthcare services is an essential element of that right.

(2)Therefore, it is the intent of the Legislature that when language or communication barriers exist between patients and the staff of any general acute care hospital, arrangements shall be made for interpreters or bilingual professional staff to ensure adequate and speedy communication between patients and staff.

(b)As used in this section:

(1)“Interpreter” means a person fluent in English and in the necessary second language, who can accurately speak, read, and readily interpret the necessary second language, or a person who can accurately sign and read sign language. Interpreters shall have the ability to translate the names of body parts and to describe competently symptoms and injuries in both languages. Interpreters may include members of the medical or professional staff.

(2)“Language or communication barriers” means:

(A)With respect to spoken language, barriers that are experienced by individuals who are limited-English-speaking or non-English-speaking individuals who speak the same primary language and who comprise at least 5 percent of the population of the geographical area served by the hospital or of the actual patient population of the hospital. In cases of dispute, the State Department of Public Health shall determine, based on objective data, whether the 5 percent population standard applies to a given hospital.

(B)With respect to sign language, barriers that are experienced by individuals who are deaf and whose primary language is sign language.

(c)To ensure access to healthcare information and services for limited-English-speaking or non-English-speaking residents and deaf residents, licensed general acute care hospitals shall:

(1)Review existing policies regarding interpreters for patients with limited-English proficiency and for patients who are deaf, including the availability of staff to act as interpreters.

(2)(A)Adopt and review annually a policy for providing language assistance services to patients with language or communication barriers. The policy shall include procedures for providing, to the extent possible, as determined by the hospital, the use of an interpreter whenever a language or communication barrier exists, except when the patient, after being informed of the availability of the interpreter service, chooses to use a family member or friend who volunteers to interpret. The procedures shall be designed to maximize efficient use of interpreters and minimize delays in providing interpreters to patients. The procedures shall ensure, to the extent possible, as determined by the hospital, that interpreters are available, either on the premises or accessible by telephone, 24 hours a day.

(B)The hospital shall, on or before July 1, 2016, and every January 1 thereafter, make the updated policy and a notice of availability of language assistance services available to the public on its internet website. The notice shall be in English and in the other languages most commonly spoken in the hospital’s service area. For purposes of this paragraph, the hospital shall make the notice available in the language of individuals who meet the definition of having a language barrier pursuant to subparagraph (A) of paragraph (2) of subdivision (b). However, a hospital is not required to make the notice available in more than five languages other than English.

(3)Develop, and post in conspicuous locations, notices that advise patients and their families of the availability of interpreters, the procedure for obtaining an interpreter, and the telephone numbers where complaints may be filed concerning interpreter service problems, including, but not limited to, a TDD number for the deaf or hard of hearing. The notices shall be posted, at a minimum, in the emergency room, the admitting area, the entrance, and in outpatient areas. Notices shall inform patients that interpreter services are available upon request, shall list the languages for which interpreter services are available, shall instruct patients to direct complaints regarding interpreter services to the department, and shall provide the local address and telephone number of the department, including, but not limited to, a TDD number for the deaf or hard of hearing.

(4)Identify and record a patient’s primary language and dialect on one or more of the following: patient medical chart, hospital bracelet, bedside notice, or nursing card.

(5)Prepare and maintain as needed a list of interpreters who have been identified as proficient in sign language and in the languages of the population of the geographical area serviced who have the ability to translate the names of body parts, injuries, and symptoms.

(6)Notify employees of the hospital’s commitment to provide interpreters to all patients who request them.

(7)Review all standardized written forms, waivers, documents, and informational materials available to patients upon admission to determine which to translate into languages other than English.

(8)Consider providing its nonbilingual staff with standardized picture and phrase sheets for use in routine communications with patients who have language or communication barriers.

(9)Consider developing community liaison groups to enable the hospital and the limited-English-speaking and deaf communities to ensure the adequacy of the interpreter services.

(d)Noncompliance with this section shall be reportable to licensing authorities.

(e)Section 1290 does not apply to this section.

SEC. 4.

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.