Bill Text: CA AB822 | 2009-2010 | Regular Session | Amended
Bill Title: Health facilities: program flexibility.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2010-02-01 - From committee without further action pursuant to Joint Rule 62(a). [AB822 Detail]
Download: California-2009-AB822-Amended.html
BILL NUMBER: AB 822 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 4, 2010
AMENDED IN ASSEMBLY APRIL 13, 2009
AMENDED IN ASSEMBLY MARCH 25, 2009
INTRODUCED BY Assembly Member Fletcher
(Coauthor: Senator Wyland)
FEBRUARY 26, 2009
An act to amend Section 1276 of , and
to add Chapter 2 (commencing with Section 101990) to Part 6
of Division 101 of the Heath and Safety Code, relating to health
facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 822, as amended, Fletcher. Health facilities: program
flexibility.
Under existing law, the State Department of Public Health has
licensing authority over several categories of clinics and health
facilities, including hospital general acute
care hospitals . Existing law requires the building standards
published in the California Building Standards Code and the
regulations adopted by the department to prescribe standards for
adequacy, safety, and sanitation of the physical plant, of
appropriate staffing, and of services, based on the type of health
facility and the needs of the persons served. These
regulations are required to permit program flexibility in various
contexts, as long as statutory requirements are met, and the use has
the prior written approval of the department or of the Office of
Statewide Health Planning and Development.
Existing law requires the department to 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 is required to approve, approve with conditions or
modifications, or deny the application within 60 days. Denials and
approvals with conditions or modifications are required to be
accompanied by an analysis and a detailed justification for any
conditions or modifications imposed.
This bill would require the department to approve or approve with
conditions or modifications a complete application requesting program
flexibility for the use of alternate concepts, methods, procedures,
techniques, or equipment by a general acute care hospital whenever
the hospital demonstrates to the department that this use meets or
exceeds the quality of care and patient safety in effect on January
1, 2010.
The bill would also require the department to
establish the Innovative Technology
Acuity-Adaptable Care Delivery Pilot Program to gather
clinical data on, and provide general acute care hospitals
experience with, the ability to use alternate concepts, methods,
procedures, techniques, equipment, and care in addition to what is
authorized pursuant to specified regulations, but meet certain
statutory requirements provide at least 2 but not more
than 10 general acute care hospitals with the ability to use
licensed intensive care beds as step-down and medical
surgical beds interchangeably, base d on the acuity of the
patient, as provided . It would require, by January 1,
2014 2015 , the department to prepare
and submit a report to the Legislature on the pilot
program.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature hereby finds and declares all of
the following:
(1) The provision of health care in general acute care hospitals
has improved dramatically in recent years, due in part to innovative
technological and methodological advances in health care that have
greatly improved patient outcomes.
(2) California's hospital licensing regulations, found in Division
5 of Title 22 of the California Code of Regulations, were adopted in
1976. Although there have been limited revisions over the past
decades, the regulations have not kept pace with state-of-the-art
technology, equipment, and practices now available to provide optimum
patient care.
(3) Due to these outdated regulations, California hospitals are
not able to provide patients with some of the cutting-edge
technology, equipment, procedures, and care that are available
elsewhere.
(4) It is appropriate to gather clinical data and experience in
California regarding the state-of-the-art technology, equipment,
procedures, and care now available.
(b) It is the intent of the Legislature that the State Department
of Public Health develop and implement the Innovative
Technology Acuity-Adaptable Care Delivery Pilot
Program for the purposes specified in subdivision (a) of Section
101990 of the Health and Safety Code .
SEC. 2. Chapter 2 (commencing with Section 101990)
is added to Part 6 of Division 101 of the Health and
Safety Code , to read:
CHAPTER 2. HEALTH FACILITY INNOVATION
101990. (a) The State Department of Public Health shall establish
the Acuity-Adaptable Care Delivery Pilot Program to provide a
general acute care hospital, as defined in subdivision (a) of Section
1250, the ability to use licensed intensive care beds as step-down
and medical surgical beds interchangeably based upon the acuity of
the patient, including the use of technology, equipment, procedures,
techniques, and concepts that support this model of care.
(b) Utilization of technology, equipment, procedures, techniques,
and concepts that support the acuity-adaptable care delivery model
shall be consistent with safe, therapeutic, and effective care that
promotes patient safety. Deployment of technology shall not prevent a
health care provider from following accepted practice standards,
including, but not limited to, the use of clinical judgment in the
assessment, evaluation, planning, and implementation of care, or from
acting as a patient advocate.
(c) The department shall identify alternate technology, equipment,
procedures, techniques, and concepts, giving special consideration
to the use of acuity-adaptable nursing units and beds that will
promote innovation and improvement in service and patient care.
(d) The department shall solicit and accept proposals from general
acute care hospitals to participate in the pilot program.
(e) The department shall, by October 1, 2011, authorize at least
two, but not more than 10, general acute care hospitals identified by
the department or proposed by a hospital pursuant to subdivision (d)
to use licensed intensive care beds as step-down and medical
surgical beds interchangeably based on the acuity of the patient,
including the use of technology, equipment, procedures, techniques,
and concepts that support this model of care. At least one authorized
general acute care hospital shall be located within the County of
San Diego and shall be associated with a two-hospital system operated
by a health care district.
(f) A general acute care hospital participating in the pilot
program shall comply with the staffing requirements for licensed
nurses set forth in Section 1276.4 based on the acuity of the patient
and not the licensed bed category and physical location of the
patient.
(g) The department may charge a participating general acute care
hospital an annual fee that does not exceed the amount of the direct
costs to the department of overseeing and evaluating the pilot
program. The money collected from this fee shall be deposited in the
State Department of Public Health Licensing and Certification Program
Fund.
(h) A participating general acute care hospital shall consult with
the Office of Statewide Health Planning and Development if the
hospital's physical building is involved in the use of technology,
equipment, procedures, techniques, and concepts that support the
acuity-adaptable care delivery model.
(i) A general acute care hospital participating in the pilot
program may be required to undergo an annual review of the outcome of
the pilot program, including, but not limited to, an onsite
inspection by the department. The department may require an
independent evaluation by an expert, subject to conflict of interest
requirements, on an annual basis to evaluate the clinical outcome in
terms of quality and patient safety, as well as worker safety.
(j) By January 1, 2015, the department shall prepare and submit a
report to the Legislature on the results of the pilot program and its
impact upon the quality of service and patient care.
SEC. 2. 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 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) (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) Notwithstanding paragraph (1), the department shall approve or
approve with conditions or modifications a complete application
requesting program flexibility for the use of alternate concepts,
methods, procedures, techniques, or equipment by a general acute care
hospital whenever the hospital demonstrates to the department that
this use meets or exceeds the quality of care and patient safety in
effect on January 1, 2010.
(e) Notwithstanding any other provision of 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.
SEC. 3. Chapter 2 (commencing with Section
101990) is added to Part 6 of Division 101 of the Health and Safety
Code, to read:
CHAPTER 2. HEALTH FACILITY INNOVATION
101990. (a) The State Department of Public Health shall establish
the Innovative Technology Pilot Program to gather clinical data on,
and provide general acute care hospitals, as defined in subdivision
(a) of Section 1250, experience with, the ability to use alternate
concepts, methods, procedures, techniques, equipment, and care in
addition to what is authorized pursuant to regulations adopted
pursuant to Chapter 2 (commencing with Section 1250) of Division 2 in
effect on January 1, 2010, but otherwise meet the statutory
requirements of that chapter.
(b) The department shall identify alternate concepts, methods,
procedures, techniques, equipment giving special consideration to the
use of acuity-adaptable nursing units and beds, or care that the
department determines will promote innovation and improvements in
services and patient care. The department shall also solicit and
receive proposals from general acute care hospitals to use alternate
concepts, methods, procedures, techniques, equipment, and care that
will promote innovation and improvements in services and patient
care.
(c) The department shall, by July 1, 2011, authorize at least two,
but not more than 10, general acute care hospitals to use an
alternate concept, method, procedure, technique, equipment, or care
that was identified by the department or proposed by a hospital
pursuant to subdivision (b). At least one general acute care hospital
shall be located within the County of San Diego and shall be
associated with a two-hospital system operated by a health care
district. A general acute care hospital participating in the pilot
program shall staff the alternate concepts, methods, procedures,
techniques, equipment, and care with licensed nurses pursuant to the
requirements of Section 1276.4.
(d) The department may charge a general acute care hospital
authorized to participate in the program an annual fee to participate
in the pilot program that does not exceed the amount of the direct
costs to the department of overseeing and evaluating the pilot
program. The moneys collected from this fee shall be deposited in the
State Department of Public Health Licensing and Certification
Program Fund.
(e) By January 1, 2014, the department shall prepare and submit a
report to the Legislature on the results of the pilot program and its
impact upon the quality of service and patient care.
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CORRECTIONS Title--Page 1.
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