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AB-1422 Health facilities: critical care units: bed designation program flexibility.(2021-2022)

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Date Published: 07/08/2021 09:00 PM
AB1422:v94#DOCUMENT

Amended  IN  Senate  July 08, 2021
Amended  IN  Senate  June 29, 2021
Amended  IN  Assembly  May 24, 2021
Amended  IN  Assembly  April 22, 2021
Amended  IN  Assembly  April 12, 2021

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 amended, Gabriel. Health facilities: critical care units: bed designation program flexibility.
Existing law requires the State Department of Public Health to license and regulate health facilities, and requires the department to define specified bed classifications for health facilities, including general acute care, intermediate care, and specialized care, among others. 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 jeopardize the health, safety, and well-being of patients. The bill would specifically authorize the department to grant a bed designation program flexibility request pursuant to a prescribed procedure that includes, among other things, a requirement that, on and after July 1, 2022, the department post a bed designation 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 March 1, 2022, to create a standardized form and format for any bed designation program flexibility request. On and after July 1, 2022, the bill would also require a health facility that submits a bed designation program flexibility request to also post its bed designation program flexibility request form and immediately notify affected employees, as specified. The bill would require the department to post all approved bed designation program flexibility requests 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 California Building Standards Code by the Office of Statewide Health Planning and Development, and the regulations adopted by the 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 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 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 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 department for program flexibility in the prescribed manner. After the 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) To the extent that an application by a health facility for program flexibility, or for an extension of program flexibility, includes a request to allow the health facility to designate a bed in a critical care unit as requiring a lower level of care, including, but not limited to, the level of care provided in an intermediate care, step-down, telemetry, medical-surgical, specialty care, or pediatric services unit, that application shall be referred to as a “bed designation program flexibility request.” This subdivision and subdivision (f) do not confer on the department any new or additional authority to modify staffing ratios.
(2) On or before March 1, 2022, the department shall create a standardized form and format for any bed designation program flexibility request.
(f) (1) The department shall require, as support for a bed designation 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 jeopardize the health, safety, and well-being of patients and is needed for increased operational efficiency.
(A) Any bed designation program flexibility request, including supporting evidence submitted with the request, shall be posted on the department’s publicly accessible website within five calendar days of receipt by the department.
(B) The department, at the time it posts a health facility’s bed designation program flexibility request, shall solicit public comment on the application and provide a period of at least 30 days for public comment.
(C) The 60-day timeframe provided for in subdivision (d) shall not commence until a facility’s bed designation program flexibility request and supporting evidence has been posted on the department’s website.
(2) (A) A health facility that makes a bed designation program flexibility request shall comply with both of the following requirements:
(i) Conspicuously post the bed designation program flexibility request form and a notice next to its license stating that a bed designation program flexibility request and supporting evidence have been submitted to the department.
(ii) Immediately make its best effort to notify affected employees and employee representatives of the bed designation program flexibility request and direction to where to find the request and supporting evidence, and where to provide public comment.
(B) A facility’s bed designation 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 paragraph.
(3) In no event shall the department approve a health facility’s bed designation program flexibility request for a period of more than one year.
(4) Any approval of a health facility’s bed designation program flexibility request may be revoked by the department at any time, including on the grounds that there is no longer a need for program flexibility, that the approved alternative jeopardizes the health, safety, and well-being of patients, or that the approved alternative does not adequately protect patient safety. The public may request that the department review and consider revocation of an approval of a health facility’s bed designation program flexibility request. On or before January 1, 2022, the department shall develop a standardized form and format for the public to use to request such review.
(5) On or before March 1, 2022, the department shall develop a standardized form and format for the public to use to request the review described in paragraph (4).

(5)

(6) (A) The 30-day comment period required by subparagraph (B) of paragraph (1) shall not apply when a hospital submits a bed designation program flexibility request due to a health care emergency. Bed designation program flexibility requests approved pursuant to this paragraph shall not be effective for more than 90 days, and any request to extend the term of bed designation program flexibility that was approved pursuant to this paragraph shall be subject to the regular process provided for in this subdivision.
(B) For purposes of this paragraph, “health care emergency” means an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to health care delivery requiring immediate medical interventions and care.
(6) This Except for paragraph (5), this subdivision shall become operative on July 1, 2022.
(g) Notwithstanding any other law or regulation, the department 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.
(h) To the extent that the department approves any requests by a health facility for bed designation program flexibility, it shall post that approval on its internet website. The posting shall include all of the following information:
(1) The time period during which the approval is effective.
(2) Any regulation or regulations impacted.
(3) The units or departments affected.
(4) The circumstances in which program flexibility will be used and any limitations on its use.
(5) A description of how the program flexibility will be implemented, including information regarding any changes affecting methods, procedures, techniques, equipment, or personnel used in the affected unit or department.