(a)A general acute care hospital, as defined in subdivision (a) of Section 1250, shall report information, including, but not limited to, staffing, including staffing shortages, bed counts, and patient census, to the department on a form and schedule determined by the department.

(b)The department shall publicly post information received pursuant to this section and update it on a weekly basis during a statewide health-related state of emergency in California proclaimed by the President of the United States or health-related state of emergency proclaimed by the Governor, and on a monthly basis at all other times.

(c)Notwithstanding any other law, the department may, without taking any regulatory action pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, require general acute care hospitals to submit data by means of an All Facilities Letter (AFL). Except in the case of an emergency or other circumstance when delay may impact patient health and safety, when using the AFL process to require specified data submission, the department will do so in consultation with stakeholders.

(d)This section does not limit the department’s ability to request or require hospitals to report additional information not listed in this section or on a more frequent schedule.

(e)Pursuant to subdivision (a), a general acute care hospital shall report the following information regarding staffing:

(1)Whether the hospital is experiencing staffing shortage of nurses since the last time of reporting.

(2)Whether the hospital experienced any layoffs of nurses since the time of last reporting and, if so, how many nurses and on what calendar day were they laid off.

(3)Whether the hospital experienced any furloughs of nurses since the time of last reporting and if so, how many nurses were furloughed and on what calendar day were they furloughed.

(4)Whether the hospital experienced any repeated cancellation of shifts of nurses since the time of last reporting. Repeated cancellation means more than two shifts canceled by the employer within a one-calendar-month period. Reports of cancelled shifts shall include information regarding the unit the nurses were scheduled to work in and the reason for the cancellation.

(f)Until January 1, 2025, or when the Governor declares the end of the COVID-19 emergency, whichever comes first, pursuant to subdivision (a), a general acute care hospital shall also report the following information regarding staffing:

(1)Numeric total of COVID-19-positive staff, including the total number of staff and facility personnel who have tested positive for COVID-19, whether by laboratory confirmation or clinical diagnosis. Reports of COVID-19-positive staff shall include the numbers of COVID-19-positive staff for each reporting period and as a total number since the first report.

(2)Numeric total of newly suspected COVID-19-positive staff, including the total number of staff and facility personnel routinely scheduled to work at the hospital, but not necessarily present at the time of data entry, who are being managed as though they have COVID-19 but who do not have a positive laboratory test result.

(3)Numeric total of new COVID-19-related deaths of staff, including the total number of deaths of staff and facility personnel routinely scheduled to work at the hospital and with suspected or laboratory-confirmed COVID-19, that occurred on the previous calendar day.

(g)If a general acute care hospital fails to comply with this section, the department may impose fines or other penalties on, and may suspend, revoke, or refuse to renew the license of, the hospital in accordance with any applicable provisions of this chapter.

(h)For purposes of this section, the following definitions apply:

(1)“COVID-19” means the 2019 novel coronavirus disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

(2)“General acute care hospital” has the same meaning as defined in subdivision (a) of Section 1250.

(a)The building standards published in the California Building Standards Code by the Department of Health Care Access and Information, 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 Department of Health Care Access and Information, as applicable. The approval of the department or the Department of Health Care Access and Information 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 the Department of Health Care Access and Information, 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)(1)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.

(2)A health facility shall post any approval by the department granted under this section, or a true copy thereof, immediately adjacent to the health facility’s license and on the facility’s internet website. The department may not waive or flex this requirement and may not permit health facilities to maintain program flexibility approvals only in a binder or other location separate from the location stated in this subdivision.

(e)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.

(a)The building standards published in the California Building Standards Code by the Department of Health Care Access and Information, and the regulations adopted by the State Department of Public Health 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 State Department of Public Health or the Department of Health Care Access and Information, as applicable. The approval of the department or the Department of Health Care Access and Information 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 Department of Health Care Access and Information 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 of Public Health 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)(1)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.

(2)A health facility shall post any approval by the department granted under this section, or a true copy thereof, immediately adjacent to the health facility’s license and on the facility’s internet website. The department may not waive or flex this requirement and may not permit health facilities to maintain program flexibility approvals only in a binder or other location separate from the location stated in this subdivision.

(e)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 or multiple beds 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 “critical care unit program flexibility request.” This subdivision and subdivision (f) do not confer on the department any new or additional authority to modify staffing ratios.

(f)(1)The department shall require, as support for a critical care unit 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 critical care unit program flexibility request, including supporting evidence submitted with the request, shall be posted on the department’s publicly accessible internet website within five calendar days of receipt by the department.

(B)The department, at the time it posts a health facility’s critical care unit program flexibility request, shall provide a method to electronically collect public comment specifically on the application for a period of 30 days.

(C)The 60-day timeframe provided for in subdivision (d) shall not commence until a facility’s critical care unit program flexibility request and supporting evidence have been posted on the department’s internet website.

(2)(A)A health facility that makes a critical care unit program flexibility request shall comply with both of the following requirements:

(i)Conspicuously post the critical care unit program flexibility request form and a notice next to its license stating that a critical care unit 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 critical care unit program flexibility request and direction to where to find the request and supporting evidence, and where to provide public comment.

(B)A facility’s critical care unit 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 critical care unit program flexibility request for a period of more than one year.

(4)Any approval of a health facility’s critical care unit 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.

(5)(A)The 30-day comment period required by subparagraph (B) of paragraph (1) shall not apply when a hospital submits a critical care unit program flexibility request due to a health care emergency. Critical care unit 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 critical care unit 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 subdivision shall become operative on January 1, 2023.

(g)Notwithstanding any other law or regulation, the State Department of Public Health 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)On or before February 1, 2023, the department shall post all of the following information on its internet website:

(1)A list of applicants for critical care unit program flexibility and the date of the application.

(2)A list of health facilities with approved critical care unit program flexibility and the effective start and end date of the approval.

(3)If approved, the notification of approval for critical care unit program flexibility, which shall include the application for critical care unit program flexibility; the regulation or regulations impacted; beds, units, or departments affected; and any conditions placed on the approval.

(4)A department contact for the public to submit a complaint related to an approved critical care unit program flexibility.