Bill Text: CA AB2190 | 2017-2018 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Hospitals: seismic safety.

Spectrum:

Status: (Passed) 2018-09-22 - Chaptered by Secretary of State - Chapter 673, Statutes of 2018. [AB2190 Detail]

Download: California-2017-AB2190-Amended.html

Amended  IN  Assembly  April 16, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2190


Introduced by Assembly Member Reyes

February 12, 2018


An act to amend Section 130060 of add Section 130061.6 to the Health and Safety Code, relating to hospitals.


LEGISLATIVE COUNSEL'S DIGEST


AB 2190, as amended, Reyes. Hospitals: seismic safety.
Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes, under the jurisdiction of the Office of Statewide Health Planning and Development, a program of seismic safety building standards for certain hospitals constructed on and after March 7, 1973.
Existing law provides that, after January 1, 2008, a general acute care hospital building that is determined to be a potential risk of collapse or to pose significant loss of life in the event of seismic activity be used only for nonacute care hospital purposes, except that the office may grant 5-year and 2-year extensions under prescribed circumstances. Existing law additionally allows the office to grant a hospital that has received extensions under specified provisions an extension of up to 7 years for a hospital building that it owns or operates if the hospital meets specified milestones. The office may revoke an extension granted pursuant to the latter authority if it determines that a hospital has falsified information, has failed to meet a milestone, or has abandoned or suspended a work of construction for a specified period, as prescribed. circumstances, except as specified. Existing law requires an owner of a general acute care hospital building that is classified as nonconforming to submit a report to the office no later than November 1, 2010, describing the status of each building in complying with the extension provisions, and to annually update the office with any changes or adjustments. Existing law authorizes certain hospital owners who do not have the financial capacity to bring certain buildings into compliance by the January 1, 2013, deadline to instead replace those buildings by January 1, 2020, as specified.

This bill would require the office to provide a 30-day notice to the hospital prior to revoking an additional extension as described above and to provide the hospital with the opportunity to provide evidence and information to challenge the revocation. The bill also would make various technical, nonsubstantive changes.

This bill would require all hospitals with buildings subject to the January 1, 2020, deadline described above to submit a binding application to the Office of Statewide Health Planning and Development by July 1, 2019, that specifies the seismic compliance method each building will use, as specified. The bill would require the office to grant an additional extension of time to an owner who is subject to the January 1, 2020, deadline if specified conditions are met. The bill would authorize the additional extension to be up to 30 months or 5 years depending on whether the compliance plan is based upon “replacement,” “retrofit,” or “rebuild,” as defined.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 130061.6 is added to the Health and Safety Code, to read:

130061.6.
 (a) For the purposes of this section, the following terms have the following meanings:
(1) “Rebuild plan” means a plan to meet seismic standards primarily by constructing a new compliant building for use in lieu of an SPC-1 building.
(2) “Removal plan” means a plan to meet seismic standards primarily by removing acute care service beds from the hospital’s license.
(3) “Replacement plan” means a plan to meet seismic standards primarily by relocating acute care service beds from noncompliant buildings into a compliant building.
(4) “Retrofit plan” means a plan to meet seismic standards primarily by modifying the building in a manner that brings the building up to SPC-2, SPC-4D, or SPC-5 standards.
(b) All hospitals with SPC-1 buildings shall submit a binding application to the office by July 1, 2019, that states which of the seismic compliance methods described in subdivision (a) will be used for each SPC-1 building.
(c) Notwithstanding any other law, including, but not limited to, subdivision (d) of Section 130061.5, for a hospital owner that has been granted an extension pursuant to subdivision (b) of Section 130061.5, the office shall grant an additional extension of time in order to comply with the requirements of that subdivision, as set forth in this section.
(d) (1) For a hospital that seeks an extension for compliance based on a retrofit plan, the office shall grant an extension of up to 30 months if the owner agrees in writing to submit a construction schedule and obtain a building permit by April 1, 2019.
(2) (A) The office may grant an extension of the January 1, 2020, deadline specified in Section 130061.5 as necessary to deal with contractor, labor, or materials delays, if any, experienced by the hospital.
(B) If an extension is granted pursuant to subparagraph (A), the owner shall submit a modified construction schedule that shall identify at least two major milestones, agreed upon by the hospital and the office, that will be used as the basis for determining whether the hospital is making adequate progress toward meeting the seismic compliance deadline.
(3) Failure to submit the construction documents by July 1, 2019, or meet the milestones agreed to pursuant to this subdivision shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted or the milestones are met.
(4) Final seismic compliance shall be achieved by July 1, 2022.
(e) (1) For a hospital that seeks an extension for compliance of an SPC-1 building based on a replacement plan, the office shall grant an extension of up to 30 months if the owner agrees in writing to submit a replacement plan by July 1, 2019.
(2) The agreement shall set forth construction schedules, timelines, and major milestones, related to the replacement plan.
(3) Failure to comply with this subdivision or with the terms of the agreement shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the owner complies.
(4) Final seismic compliance shall be achieved by July 1, 2022.
(f) (1) For a hospital that seeks an extension for compliance based on a rebuild plan, the office shall grant an extension of up to five years if the owner agrees in writing to submit the rebuild plan by July 1, 2020, and to submit a construction schedule, obtain a building permit, and begin construction by January 1, 2022.
(2) The construction schedule shall identify at least two major milestones, agreed upon by the hospital and the office, that will be used as the basis for determining whether the hospital is making adequate progress toward meeting the seismic compliance deadline.
(3) Failure to submit the rebuild plan by July 1, 2020, as set forth in paragraph (1), or failure to submit construction documents or meet the milestones agreed to pursuant to this subdivision by January 1, 2022, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted or the milestones are met.
(4) Final seismic compliance shall be achieved, and a certificate of occupancy shall be obtained, by January 1, 2025.
(g) The duration of an extension granted by the office pursuant to this section shall not exceed the maximums permitted by this section. Moreover, within that limit, the extension shall not exceed the amount of time needed by the owner to come into compliance. The determination by the office regarding the length of the extension to be granted shall be based upon a showing by the owner of the facts necessitating the additional time. It shall include a review of the plan and all the documentation submitted in the application for the extension, and shall permit only that additional time necessary to allow the owner to deal with compliance plan issues that cannot be fully met without the extension.
(h) No extension shall be granted pursuant to this section for SPC-1 facilities unless the owner has submitted to the office, by January 1, 2018, a ready-for-review retrofit plan or replacement plan.
(i) An extension shall not be granted pursuant to this section for seismic compliance based upon a removal plan.
(j) A hospital granted an extension pursuant to this section shall provide a quarterly status report to the office, with the first report due on July 1, 2019, and every October 1, January 1, April 1, and July 1 thereafter, until seismic compliance is achieved. The office shall post the status reports on its Internet Web site.
(k) Notwithstanding any other law, any fines assessed pursuant to this section shall be deposited into the General Fund following a determination on appeal, if any. A hospital assessed a fine pursuant to this section may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any fines to be held by the office pending the resolution of the appeal.

SECTION 1.Section 130060 of the Health and Safety Code is amended to read:
130060.

(a)(1)After January 1, 2008, a general acute care hospital building that is determined to be a potential risk of collapse or pose significant loss of life shall only be used for nonacute care hospital purposes, unless an extension of the January 1, 2008, deadline has been granted and either of the following occurs before the end of the extension:

(A)A replacement building has been constructed and a certificate of occupancy has been granted by the office for the replacement building.

(B)A retrofit has been performed on the building and a construction final has been obtained by the office.

(2)An extension of the deadline may be granted by the office upon a demonstration by the owner that compliance will result in a loss of health care capacity that may not be provided by other general acute care hospitals within a reasonable proximity. In its request for an extension of the deadline, a hospital shall state why the hospital is unable to comply with the January 1, 2008, deadline requirement.

(3)Prior to granting an extension of the January 1, 2008, deadline pursuant to this section, the office shall do all of the following:

(A)Provide public notice of a hospital’s request for an extension of the deadline. The notice, at a minimum, shall be posted on the office’s Internet Web site, and shall include the facility’s name and identification number, the status of the request, and the beginning and ending dates of the comment period, and shall advise the public of the opportunity to submit public comments pursuant to subparagraph (C). The office shall also provide notice of all requests for the deadline extension directly to interested parties upon request of the interested parties.

(B)Provide copies of extension requests to interested parties within 10 working days to allow interested parties to review and provide comment within the 45-day comment period. The copies shall include those records that are available to the public pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).

(C)Allow the public to submit written comments on the extension proposal for a period of not less than 45 days from the date of the public notice.

(b)(1)It is the intent of the Legislature, in enacting this subdivision, to facilitate the process of having more hospital buildings in substantial compliance with this chapter and to take nonconforming general acute care hospital inpatient buildings out of service more quickly.

(2)The functional contiguous grouping of hospital buildings of a general acute care hospital, each of which provides, as the primary source, one or more of the hospital’s eight basic services as specified in subdivision (a) of Section 1250, may receive a five-year extension of the January 1, 2008, deadline specified in subdivision (a) of this section pursuant to this subdivision for both structural and nonstructural requirements. A functional contiguous grouping refers to buildings containing one or more basic hospital services that are either attached or connected in a way that is acceptable to the State Department of Health Care Services. These buildings may be either on the existing site or a new site.

(3)To receive the five-year extension, a single building containing all of the basic services or at least one building within the contiguous grouping of hospital buildings shall have obtained a building permit prior to 1973 and this building shall be evaluated and classified as a nonconforming, Structural Performance Category-1 (SPC-1) building. The classification shall be submitted to and accepted by the Office of Statewide Health Planning and Development. The identified hospital building shall be exempt from the requirement in subdivision (a) until January 1, 2013, if the hospital agrees that the basic service or services that were provided in that building shall be provided, on or before January 1, 2013, as follows:

(A)Moved into an existing conforming Structural Performance Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or Structural Performance Category-5 (SPC-5) and Non-Structural Performance Category-4 (NPC-4) or Non-Structural Performance Category-5 (NPC-5) building.

(B)Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5 building.

(C)Continued in the building if the building is retrofitted to an SPC-5 and NPC-4 or NPC-5 building.

(4)A five-year extension is also provided to a post-1973 building if the hospital owner informs the Office of Statewide Health Planning and Development that the building is classified as SPC-1, SPC-3, or SPC-4 and will be closed to general acute care inpatient service use by January 1, 2013. The basic services in the building shall be relocated into an SPC-5 and NPC-4 or NPC-5 building by January 1, 2013.

(5)SPC-1 buildings, other than the building identified in paragraph (3) or (4), in the contiguous grouping of hospital buildings shall also be exempt from the requirement in subdivision (a) until January 1, 2013. However, on or before January 1, 2013, at a minimum, each of these buildings shall be retrofitted to an SPC-2 and NPC-3 building, or no longer be used for general acute care hospital inpatient services.

(c)On or before March 1, 2001, the office shall establish a schedule of interim work progress deadlines that hospitals shall be required to meet to be eligible for the extension specified in subdivision (b). To receive this extension, the hospital building or buildings shall meet the year 2002 nonstructural requirements.

(d)A hospital building that is eligible for an extension pursuant to this section shall meet the January 1, 2030, nonstructural and structural deadline requirements if the building is to be used for general acute care inpatient services after January 1, 2030.

(e)Upon compliance with subdivision (b), the hospital shall be issued a written notice of compliance by the office. The office shall send a written notice of violation to hospital owners that fail to comply with this section. The office shall make copies of these notices available on its Internet Web site.

(f)(1)A hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) may request an additional extension of up to two years for a hospital building that it owns or operates and that meets the criteria specified in paragraph (2), (3), or (5).

(2)The office may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A)The hospital building is under construction at the time of the request for extension under this subdivision and the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b).

(B)The hospital building plans were submitted to the office and were deemed ready for review by the office at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C)The hospital received a building permit for the construction described in subparagraph (A) at least two years prior to the applicable deadline for the building.

(D)The hospital submitted a construction timeline at least two years prior to the applicable deadline for the building demonstrating the hospital’s intent to meet the applicable deadline. The timeline shall include all of the following:

(i)The projected construction start date.

(ii)The projected construction completion date.

(iii)Identification of the contractor.

(E)The hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D), but factors beyond the hospital’s control make it impossible for the hospital to meet the deadline.

(3)The office may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A)The hospital building is owned by a health care district that has, as owner, received the extension of the January 1, 2008, deadline, but if the hospital is operated by an unaffiliated third-party lessee pursuant to a facility lease that extends at least through December 31, 2009. The district shall file a declaration with the office with a request for an extension stating that, as of the date of the filing, the district has lacked, and continues to lack, unrestricted access to the subject hospital building for seismic planning purposes during the term of the lease, and that the district is under contract with the county to maintain hospital services when the hospital comes under district control. The office shall not grant the extension if an unaffiliated third-party lessee will operate the hospital beyond December 31, 2010.

(B)The hospital building plans were submitted to the office and were deemed ready for review by the office at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C)The hospital received a building permit for the construction described in subparagraph (B) by December 31, 2011.

(D)The hospital submitted, by December 31, 2011, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the deadline of December 31, 2014. The timeline shall include all of the following:

(i)The projected construction start date.

(ii)The projected construction completion date.

(iii)Identification of the contractor.

(E)The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).

(F)The hospital granted an extension pursuant to this paragraph shall submit an additional status report to the office, equivalent to that required by subdivision (c) of Section 130061, no later than June 30, 2013.

(4)An extension granted pursuant to paragraph (3) shall be applicable only to the health care district applicant and its affiliated hospital while the hospital is operated by the district or an entity under the control of the district.

(5)The office may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A)The hospital owner submitted to the office, prior to June 30, 2009, a request for review using current computer modeling utilized by the office and based upon software developed by the Federal Emergency Management Agency (FEMA), referred to as Hazards US, and the building was deemed SPC-1 after that review.

(B)The hospital building plans for the building are submitted to the office and deemed ready for review by the office prior to July 1, 2010. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that shall be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C)The hospital receives a building permit from the office for the construction described in subparagraph (B) prior to January 1, 2012.

(D)The hospital submits, prior to January 1, 2012, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the applicable deadline. The timeline shall include all of the following:

(i)The projected construction start date.

(ii)The projected construction completion date.

(iii)Identification of the contractor.

(E)The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).

(F)The hospital owner completes construction so that the hospital meets all criteria to enable the office to issue a certificate of occupancy by the applicable deadline for the building.

(6)A hospital located in the County of Sacramento, San Mateo, or Santa Barbara or the City of San Jose or the City of Willits that has received an additional extension pursuant to paragraph (2) or (5) may request an additional extension until September 1, 2015, to obtain either a certificate of occupancy from the office for a replacement building, or a construction final from the office for a building on which a retrofit has been performed.

(7)A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.

(8)The office may revoke an extension granted pursuant to this subdivision for a hospital building if the work of construction is abandoned or suspended for a period of at least one year, unless the hospital demonstrates in a public document that the abandonment or suspension was caused by factors beyond its control.

(g)(1)Notwithstanding subdivisions (a), (b), (c), and (f), and Sections 130061.5 and 130064, a hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) also may request an additional extension of up to seven years for a hospital building that it owns or operates. The office may grant the extension subject to the hospital meeting the milestones set forth in paragraph (2).

(2)The hospital building subject to the extension shall meet all of the following milestones, unless the hospital building is reclassified as SPC-2 or higher as a result of its Hazards US score:

(A)The hospital owner submits to the office, no later than September 30, 2012, a letter of intent stating whether it intends to rebuild, replace, or retrofit the building, or remove all general acute care beds and services from the building, and the amount of time necessary to complete the construction.

(B)The hospital owner submits to the office, no later than September 30, 2012, a schedule detailing why the requested extension is necessary, and specifically how the hospital intends to meet the requested deadline.

(C)The hospital owner submits to the office, no later than September 30, 2012, an application ready for review seeking structural reassessment of each of its SPC-1 buildings using current computer modeling based upon software developed by FEMA, referred to as Hazards US.

(D)The hospital owner submits to the office, no later than January 1, 2015, plans ready for review consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B).

(E)The hospital owner submits a financial report to the office at the time the plans are submitted pursuant to subparagraph (D). The report shall demonstrate the hospital owner’s financial capacity to implement the construction plans submitted pursuant to subparagraph (D).

(F)The hospital owner receives a building permit consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B), no later than July 1, 2018.

(3)To evaluate public safety and determine whether to grant an extension of the deadline, the office shall consider the structural integrity of the hospital’s SPC-1 buildings based on its Hazards US scores, community access to essential hospital services, and the hospital owner’s financial capacity to meet the deadline as determined by either a bond rating of BBB or below or the financial report on the hospital owner’s financial capacity submitted pursuant to subparagraph (E) of paragraph (2). The criteria contained in this paragraph shall be considered by the office in its determination of the length of an extension or whether an extension should be granted.

(4)The extension or subsequent adjustments granted pursuant to this subdivision may not exceed the amount of time that is reasonably necessary to complete the construction specified in paragraph (2).

(5)If the circumstances underlying the request for extension submitted to the office pursuant to paragraph (2) change, the hospital owner shall notify the office as soon as practicable, but in no event later than six months after the hospital owner discovered the change of circumstances. The office may adjust the length of the extension granted pursuant to paragraphs (2) and (3) as necessary, but in no event longer than the period specified in paragraph (1).

(6)A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.

(7)(A)The office may revoke an extension granted pursuant to this subdivision for a hospital building if it is determined that any information submitted pursuant to this section was falsified, or if the hospital failed to meet a milestone set forth in paragraph (2), or if the work of construction is abandoned or suspended for a period of at least six months, unless the hospital demonstrates in a publicly available document that the abandonment or suspension was caused by factors beyond its control.

(B)The office shall provide a 30-day notice to the hospital prior to revoking an extension pursuant to subparagraph (A). The office shall provide the hospital with the opportunity to provide evidence and information to challenge the revocation.

(8)Regulatory submissions made by the office to the California Building Standards Commission to implement this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations.

(9)The hospital owner that applies for an extension pursuant to this subdivision shall pay the office an additional fee, to be determined by the office, sufficient to cover the additional reasonable costs incurred by the office for maintaining the additional reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the extension documentation submitted pursuant to this subdivision. This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.

(10)This subdivision shall become operative on the date that the State Department of Health Care Services receives all necessary federal approvals for a 2011–12 fiscal year hospital quality assurance fee program that includes three hundred twenty million dollars ($320,000,000) in fee revenue to pay for health care coverage for children, which is made available as a result of the legislative enactment of a 2011–12 fiscal year hospital quality assurance fee program.

(h)A critical access hospital located in the City of Tehachapi may submit a seismic safety extension application pursuant to subdivision (g), notwithstanding deadlines in that subdivision that are earlier than the effective date of the act that added this subdivision. The submitted application shall include a timetable as required pursuant to subdivision (g).

(i)(1)A hospital located in the Tarzana neighborhood of the City of Los Angeles that has received extensions pursuant to subdivisions (b) and (g) may request an additional extension for a single building until October 1, 2022, in order to obtain a certificate of occupancy from the office for a replacement building.

(2)The hospital owner seeking the extension shall submit a written request that includes a timeline specifying how the hospital intends to meet the new deadline, including the construction document submission dates. The following timeline shall be met for construction document submissions:

(A)No later than January 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the second increment with information including the building core and shell of the hospital. Failure to submit the construction documents by January 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(B)No later than March 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the first increment with information including the structural foundation, frame, and underslab utilities of the hospital. Failure to submit the construction documents by March 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(C)No later than September 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the third increment with information on the build-out of the hospital. Failure to submit the construction documents by September 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(D)No later than November 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the fourth increment with information on the seismic support and anchorage of the hospital. Failure to submit the construction documents by November 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(E)The hospital owner may submit a written request to the office seeking an extension of the deadlines set forth in subparagraphs (A), (B), (C), and (D). The written request shall state with specificity the reason for the request and how the reason preventing compliance with the deadlines was outside of the control of the hospital owner. After review of the request for extension, the office may grant the request for a period of time not to exceed 30 calendar days. If the office grants the request for an extension, no fine shall accrue or be imposed during the extension period.

(3)Notwithstanding any other law, any fines assessed pursuant to paragraph (2) shall be deposited into the General Fund following a determination on appeal, if any. A hospital assessed a fine pursuant to this subdivision may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any fines to be held by the office pending the resolution of the appeal.

(4)The office shall not issue a certificate of occupancy for the single replacement building until all assessed fines accrued pursuant to paragraph (2) have been paid in full, or, if an appeal is pending, have been posted subject to resolution of an appeal. Fines deposited by the hospital pursuant to paragraph (3) shall be considered paid in full for purposes of issuing a certificate of occupancy pursuant to this paragraph. This paragraph is in addition to, and is not intended to supersede, any other requirements that must be met by the hospital for issuance by the office of a certificate of occupancy.

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