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AB-1422 Nurse-to-patient ratios.(2021-2022)

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Date Published: 02/19/2021 09:00 PM
AB1422:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 1422


Introduced by Assembly Member Gabriel
(Coauthors: Assembly Members Santiago and Stone)

February 19, 2021


An act to amend Section 1276 of the Health and Safety Code, relating to health facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 1422, as introduced, Gabriel. Nurse-to-patient ratios.
Existing law requires the State Department of Public Health to adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios for all licensed general acute care hospitals, acute psychiatric hospitals, or special hospitals. Existing law generally authorizes the department or the Office of Statewide Health Planning and Development to permit program flexibility as to various prescribed standards relating to a health facility’s physical plant or staffing as long as statutory requirements are met and the program flexibility has prior written approval. A person who violates specified licensing provisions related to these health facilities is guilty of a crime.
This bill would additionally require any program flexibility granted by the department or the office to not compromise patient care. The bill would specifically authorize the department to grant a staffing ratio program flexibility request, relating to nurse-to-patient ratios, pursuant to a prescribed procedure that includes, among other things, a requirement that the department post a staffing ratio program flexibility request on the department’s publicly accessible internet website and solicit public comment on the request. The bill would require the department, on or before July 1, 2022, to create a standardized form and format for any staffing ratio program flexibility request. The bill would also require a health facility that submits a staffing ratio program flexibility to also post a copy of its staffing ratio program flexibility request and make copies available, as specified. The bill would require the department to post all program flexibility waivers on the department’s website and include various information in that posting.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 1276 of the Health and Safety Code is amended to read:

1276.
 (a) The building standards published in the State Building Standards Code by the Office of Statewide Health Planning and Development, and the regulations adopted by the state department shall, as applicable, prescribe standards of adequacy, safety, and sanitation of the physical plant, of staffing with duly qualified licensed personnel, and of services, based on the type of health facility and the needs of the persons served thereby.
(b) These regulations shall permit program flexibility by the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, bulk purchasing of pharmaceuticals, or conducting of pilot projects as long as statutory requirements are met met, the proposed alternative does not compromise patient care, and the use has the prior written approval of the department or the office, as applicable. The approval of the department or the office shall provide for the terms and conditions under which the exception is granted. A written request plus supporting evidence shall be submitted by the applicant or licensee to the department or office regarding the exception, as applicable.
(c) While it is the intent of the Legislature that health facilities shall maintain continuous, ongoing compliance with the licensing rules and regulations, it is the further intent of the Legislature that the state department expeditiously review and approve, if appropriate, applications for program flexibility. The Legislature recognizes that health care technology, practice, pharmaceutical procurement systems, and personnel qualifications and availability are changing rapidly. Therefore, requests for program flexibility require expeditious consideration.
(d) The state department shall, on or before April 1, 1989, develop a standardized form and format for requests by health facilities for program flexibility. Health facilities shall thereafter apply to the state department for program flexibility in the prescribed manner. After the state department receives a complete application requesting program flexibility, it shall have 60 days within which to approve, approve with conditions or modifications, or deny the application. Denials and approvals with conditions or modifications shall be accompanied by an analysis and a detailed justification for any conditions or modifications imposed. Summary denials to meet the 60-day timeframe shall not be permitted.
(e) (1) For purposes of this section, an application by a health facility for program flexibility, or for an extension of program flexibility, pursuant to Section 1276.4 and the staffing ratios established by the state department pursuant to that section shall be referred to as a “staffing ratio program flexibility request.”
(2) On or before July 1, 2022, the state department shall create a standardized form and format for any staffing ratio program flexibility request.
(3) The state department shall require, as support for a staffing ratio program flexibility request, the applicant or licensee to submit supporting evidence that includes documentation establishing the need for program flexibility and that the proposed alternative will not compromise patient care.
(f) (1) Any staffing ratio program flexibility request, including supporting evidence submitted with the request, shall be posted on the state department’s publicly accessible website within five calendar days of receipt by the state department.
(2) The state department, at the time it posts a health facility’s staffing ratio program flexibility request, shall solicit public comment on the application and provide a period of at least forty days for public comment.
(3) The state department may extend the 60-day timeframe provided for in subdivision (d) to solicit additional public comments or to consider public comments.
(4) The 60-day timeframe provided for in subdivision (d) shall not commence until a facility’s staffing ratio program flexibility request and supporting evidence has been posted on the state department’s website.
(g) (1) A health facility’s staffing ratio program flexibility request shall contain a description of each unit and area of the facility for which such program flexibility is requested.
(2) A health facility that requests a staffing ratio program flexibility request shall meet comply with both of the following requirements:
(A) Conspicuously post a copy of its staffing ratio program flexibility request and supporting evidence in a location accessible to patients and employees.
(B) Make copies of the staffing ratio program flexibility request and supporting evidence available to affected employees and employee representatives. Copies shall be posted and made available at the same time a facility submits its staffing ratio program flexibility request to the state department.
(3) A facility’s staffing ratio program flexibility request will not be deemed complete for purposes of the 60-day timeframe pursuant to subdivision (d) until the facility has complied with this subdivision.
(h) In no event shall the state department approve a health facility’s staffing ratio program flexibility request for a period of more than one year.
(i) An approval of a health facility’s staffing ratio program flexibility request may be revoked by the state department at any time, including on the grounds that there is no longer a need for program flexibility, that the approved alternative compromises patient care, or that the approved alternative does not adequately protect patient safety. The public shall have the right to request that the state department review and consider revocation of an approval of a health facility’s staffing ratio program flexibility request. On or before January 1, 2022, the state department shall develop a standardized form and format for the public to use to request such review.

(e)

(j) Notwithstanding any other provision of law or regulation, the State Department of Health Services shall provide flexibility in its pharmaceutical services requirements to permit any state department that operates state facilities subject to these provisions to establish a single statewide formulary or to procure pharmaceuticals through a departmentwide or multidepartment bulk purchasing arrangement. It is the intent of the Legislature that consolidation of these activities be permitted in order to allow the more cost-effective use and procurement of pharmaceuticals for the benefit of patients and residents of state facilities.
(k) The department shall post on its internet website all program flexibility waivers. The posting shall include all of the following information:
(1) The dates waiver is effective.
(2) The regulation or regulations impacted.
(3) The units and departments affected.
(4) The conditions under which program flexibility will be used.
(5) Description of how it will be implemented, including everything nurses need to know about changes in methods, procedures, techniques, equipment or personnel to be used.