2010 California Code
Health and Safety Code
Article 1. General

1250.  As used in this chapter, "health facility" means any
facility, place, or building that is organized, maintained, and
operated for the diagnosis, care, prevention, and treatment of human
illness, physical or mental, including convalescence and
rehabilitation and including care during and after pregnancy, or for
any one or more of these purposes, for one or more persons, to which
the persons are admitted for a 24-hour stay or longer, and includes
the following types:
   (a) "General acute care hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental Center
may, until June 30, 2007, provide surgery and anesthesia services
through a contract or agreement with another acute care hospital.
Notwithstanding the requirements of this subdivision, a general acute
care hospital operated by the Department of Corrections and
Rehabilitation or the Department of Veterans Affairs may provide
surgery and anesthesia services during normal weekday working hours,
and not provide these services during other hours of the weekday or
on weekends or holidays, if the general acute care hospital otherwise
meets the requirements of this section.
   A "general acute care hospital" includes a "rural general acute
care hospital." However, a "rural general acute care hospital" shall
not be required by the department to provide surgery and anesthesia
services. A "rural general acute care hospital" shall meet either of
the following conditions:
   (1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982.
   (2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982, and has
no more than 76 acute care beds and is located in a census dwelling
place of 15,000 or less population according to the 1980 federal
census.
   (b) "Acute psychiatric hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care for mentally disordered, incompetent,
or other patients referred to in Division 5 (commencing with Section
5000) or Division 6 (commencing with Section 6000) of the Welfare
and Institutions Code, including the following basic services:
medical, nursing, rehabilitative, pharmacy, and dietary services.
   (c) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
   (d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
   (e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer persons with developmental
disabilities who have intermittent recurring needs for nursing
services, but have been certified by a physician and surgeon as not
requiring availability of continuous skilled nursing care.
   (f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.
   (g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons with
developmental disabilities whose primary need is for developmental
services and who have a recurring but intermittent need for skilled
nursing services.
   (h) "Intermediate care facility/developmentally disabled-nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
   (i) (1) "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than 12 beds, that provides inpatient care, including the following
basic services: medical supervision, 24-hour skilled nursing and
supportive care, pharmacy, dietary, social, recreational, and at
least one type of service specified in paragraph (2). The primary
need of congregate living health facility residents shall be for
availability of skilled nursing care on a recurring, intermittent,
extended, or continuous basis. This care is generally less intense
than that provided in general acute care hospitals but more intense
than that provided in skilled nursing facilities.
   (2) Congregate living health facilities shall provide one of the
following services:
   (A) Services for persons who are mentally alert, persons with
physical disabilities, who may be ventilator dependent.
   (B) Services for persons who have a diagnosis of terminal illness,
a diagnosis of a life-threatening illness, or both. Terminal illness
means the individual has a life expectancy of six months or less as
stated in writing by his or her attending physician and surgeon. A
"life-threatening illness" means the individual has an illness that
can lead to a possibility of a termination of life within five years
or less as stated in writing by his or her attending physician and
surgeon.
   (C) Services for persons who are catastrophically and severely
disabled. A person who is catastrophically and severely disabled
means a person whose origin of disability was acquired through trauma
or nondegenerative neurologic illness, for whom it has been
determined that active rehabilitation would be beneficial and to whom
these services are being provided. Services offered by a congregate
living health facility to a person who is catastrophically disabled
shall include, but not be limited to, speech, physical, and
occupational therapy.
   (3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
   (4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
   (B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons may
have not more than 25 beds for the purpose of serving persons who are
terminally ill.
   (C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving persons who are catastrophically
and severely disabled.
   (5) A congregate living health facility shall have a
noninstitutional, homelike environment.
   (j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the state department, provides
inpatient health services to that portion of the inmate population
who do not require a general acute care level of basic services. This
definition shall not apply to those areas of a law enforcement
facility that houses inmates or wards that may be receiving
outpatient services and are housed separately for reasons of improved
access to health care, security, and protection. The health services
provided by a correctional treatment center shall include, but are
not limited to, all of the following basic services: physician and
surgeon, psychiatrist, psychologist, nursing, pharmacy, and dietary.
A correctional treatment center may provide the following services:
laboratory, radiology, perinatal, and any other services approved by
the state department.
   (2) Outpatient surgical care with anesthesia may be provided, if
the correctional treatment center meets the same requirements as a
surgical clinic licensed pursuant to Section 1204, with the exception
of the requirement that patients remain less than 24 hours.
   (3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.
   (4) Physician and surgeon services shall be readily available in a
correctional treatment center on a 24-hour basis.
   (5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men's Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the Department of Corrections and
Rehabilitation from obtaining a correctional treatment center license
at these sites.
   (k) "Nursing facility" means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of
care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act or as a
nursing facility in the federal Medicaid Program under Title XIX of
the federal Social Security Act, or as both.
   (l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, shall not become effective prior to, or if effective,
shall be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.
   (m) "Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)" means a homelike facility
with a capacity of four to eight, inclusive, beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
continuous needs for skilled nursing care and have been certified by
a physician and surgeon as warranting continuous skilled nursing
care. The facility shall serve medically fragile persons who have
developmental disabilities or demonstrate significant developmental
delay that may lead to a developmental disability if not treated.
ICF/DD-CN facilities shall be subject to licensure under this chapter
upon adoption of licensing regulations in accordance with Section
1275.3. A facility providing continuous skilled nursing services to
persons with developmental disabilities pursuant to Section 14132.20
or 14495.10 of the Welfare and Institutions Code shall apply for
licensure under this subdivision within 90 days after the regulations
become effective, and may continue to operate pursuant to those
sections until its licensure application is either approved or
denied.



1250.02.  Article 9 (commencing with Section 70901) of Chapter 1 of
Division 5 of Title 22 of the California Code of Regulations, as
adopted to implement the requirements of Section 2 of Chapter 67 of
the Statutes of 1988, shall apply to a rural general acute care
hospital as defined in Section 1250. Any reference in those
provisions to the Office of Statewide Health Planning and Development
shall instead refer to the department. Any reference in those
provisions to a small and rural hospital shall instead refer to a
rural general acute care hospital. The department may adopt
regulations to implement or administer this action.



1250.03.  A rural general acute care hospital that does not provide
surgical and anesthesia services shall maintain written transfer
agreements with one or more general acute care hospitals that provide
surgical and anesthesia services.


1250.05.  (a) All general acute care hospitals licensed under this
chapter shall maintain a medical records system, based upon current
standards for medical record retrieval and storage, that organizes
all medical records for each patient under a unique identifier.
   (b) This section shall not require electronic records or require
that all portions of patients' records be stored in a single
location.
   (c) In addition, all general acute care hospitals shall have the
ability to identify the location of all portions of a patient's
medical record that are maintained under the general acute care
hospital's license.
   (d) All general acute care hospitals, including those holding a
consolidated general acute care license pursuant to Section 1250.8,
shall develop and implement policies and procedures to ensure that
relevant portions of patients' medical records can be made available
within a reasonable period of time to respond to the request of a
treating physician, other authorized medical professionals,
authorized representatives of the department, or any other person
authorized by law to make such a request, taking into consideration
the physical location of the records and hours of operation of the
facility where those records are located, as well as the best
interests of the patients.



1250.1.  (a) The state department shall adopt regulations that
define all of the following bed classifications for health
facilities:
   (1) General acute care.
   (2) Skilled nursing.
   (3) Intermediate care-developmental disabilities.
   (4) Intermediate care--other.
   (5) Acute psychiatric.
   (6) Specialized care, with respect to special hospitals only.
   (7) Chemical dependency recovery.
   (8) Intermediate care facility/developmentally disabled
habilitative.
   (9) Intermediate care facility/developmentally disabled nursing.
   (10) Congregate living health facility.
   (11) Pediatric day health and respite care facility, as defined in
Section 1760.2.
   (12) Correctional treatment center. For correctional treatment
centers that provide psychiatric and psychological services provided
by county mental health agencies in local detention facilities, the
State Department of Mental Health shall adopt regulations specifying
acute and nonacute levels of 24-hour care. Licensed inpatient beds in
a correctional treatment center shall be used only for the purpose
of providing health services.
   (b) Except as provided in Section 1253.1, beds classified as
intermediate care beds, on September 27, 1978, shall be reclassified
by the state department as intermediate care--other. This
reclassification shall not constitute a "project" within the meaning
of Section 127170 and shall not be subject to any requirement for a
certificate of need under Chapter 1 (commencing with Section 127125)
of Part 2 of Division 107, and regulations of the state department
governing intermediate care prior to the effective date shall
continue to be applicable to the intermediate care--other
classification unless and until amended or repealed by the state
department.



1250.2.  (a) As defined in Section 1250, "health facility" includes
a "psychiatric health facility," defined to mean a health facility,
licensed by the State Department of Mental Health, that provides
24-hour inpatient care for mentally disordered, incompetent, or other
persons described in Division 5 (commencing with Section 5000) or
Division 6 (commencing with Section 6000) of the Welfare and
Institutions Code. This care shall include, but not be limited to,
the following basic services: psychiatry, clinical psychology,
psychiatric nursing, social work, rehabilitation, drug
administration, and appropriate food services for those persons whose
physical health needs can be met in an affiliated hospital or in
outpatient settings.
   It is the intent of the Legislature that the psychiatric health
facility shall provide a distinct type of service to psychiatric
patients in a 24-hour acute inpatient setting. The State Department
of Mental Health shall require regular utilization reviews of
admission and discharge criteria and lengths of stay in order to
assure that these patients are moved to less restrictive levels of
care as soon as appropriate.
   (b) The State Department of Mental Health may issue a special
permit to a psychiatric health facility for it to provide structured
outpatient services (commonly referred to as SOPS) consisting of
morning, afternoon, or full daytime organized programs, not exceeding
10 hours, for acute daytime care for patients admitted to the
facility. This subdivision shall not be construed as requiring a
psychiatric health facility to apply for a special permit to provide
these alternative levels of care.
   The Legislature recognizes that, with access to structured
outpatient services, as an alternative to 24-hour inpatient care,
certain patients would be provided with effective intervention and
less restrictive levels of care. The Legislature further recognizes
that, for certain patients, the less restrictive levels of care
eliminate the need for inpatient care, enable earlier discharge from
inpatient care by providing a continuum of care with effective
aftercare services, or reduce or prevent the need for a subsequent
readmission to inpatient care.
   (c) Any reference in any statute to Section 1250 of the Health and
Safety Code shall be deemed and construed to also be a reference to
this section.
   (d) Notwithstanding any other provision of law, and to the extent
consistent with federal law, a psychiatric health facility shall be
eligible to participate in the medicare program under Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), and
the medicaid program under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.), if all of the following conditions
are met:
   (1) The facility is a licensed facility.
   (2) The facility is in compliance with all related statutes and
regulations enforced by the State Department of Mental Health,
including regulations contained in Chapter 9 (commencing with Section
77001) of Division 5 of Title 22 of the California Code of
Regulations.
   (3) The facility meets the definitions and requirements contained
in subdivisions (e) and (f) of Section 1861 of the federal Social
Security Act (42 U.S.C. Sec. 1395x (e) and (f)), including the
approval process specified in Section 1861(e)(7)(B) of the Social
Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which requires that the
state agency responsible for licensing hospitals has assured that
the facility meets licensing requirements.
   (4) The facility meets the conditions of participation for
hospitals pursuant to Part 482 of Title 42 of the Code of Federal
Regulations.



1250.3.  (a) As defined in Section 1250, "health facility" includes
the following type: "Chemical dependency recovery hospital" means a
health facility that provides 24-hour inpatient care for persons who
have a dependency on alcohol or other drugs, or both alcohol and
other drugs. This care shall include, but not be limited to, the
following basic services: patient counseling, group therapy, physical
conditioning, family therapy, outpatient services, and dietetic
services. Each facility shall have a medical director who is a
physician and surgeon licensed to practice in this state.
   (b) The Legislature finds and declares that problems related to
the inappropriate use of alcohol or other drugs, or both alcohol and
other drugs, are widespread and adversely affect the general welfare
of the people of the State of California. It is the intent of the
Legislature that the chemical dependency recovery hospital will
provide an innovative inpatient treatment program for persons who
have a dependency on alcohol or drugs, or both alcohol and other
drugs. The Legislature further finds and declares that significant
cost reductions can be achieved by chemical dependency recovery
hospitals when both of the following conditions exist:
   (1) Architectural requirements established by the department
encourage a flexible and open construction approach that
significantly reduces capital construction costs.
   (2) Programs are designed to provide comprehensive inpatient
treatment while permitting substantial flexibility in the use of
qualified personnel to meet the specific needs of the patients of the
facility.
   (c) Beds classified as chemical dependency recovery beds in a
general acute care hospital or acute psychiatric hospital or a
freestanding facility that is owned or leased by the general acute
care hospital or the acute psychiatric hospital, that is located on
the same premises or adjacent premises thereof, not to exceed a
15-mile radius within the same health facility planning area, as
defined January 1, 1981, by the Office of Statewide Health Planning
and Development, and that is under the administrative control of the
general acute care hospital or the acute psychiatric hospital, shall
be used exclusively for alcohol or other drug dependency treatment,
or both alcohol and other drug dependency treatment. No general acute
care hospital or acute psychiatric hospital or a freestanding
facility, as defined in this subdivision, shall, without fulfilling
the requirements of the licensing laws and health planning laws,
convert beds classified as chemical dependency recovery beds to any
other bed classification or provide new chemical dependency recovery
beds by increasing bed capacity.
   (d) (1) Chemical dependency recovery services may be provided as a
supplemental service in existing general acute care beds and acute
psychiatric beds in a general acute care hospital or in existing
acute psychiatric beds in an acute psychiatric hospital or in
existing beds in a freestanding facility, as defined in subdivision
(c). When providing chemical dependency recovery services as a
supplemental service, the general acute care hospital, acute
psychiatric hospital, or freestanding facility, as defined in
subdivision (c), shall provide the supplemental services in a
distinct part of the hospital or freestanding facility, if the
distinct part satisfies the criteria established by law and
regulation for approval as a chemical dependency recovery
supplemental service.
   (2) For purposes of this subdivision, "distinct part" means an
identifiable unit of a hospital or a freestanding facility, as
defined in subdivision (c), accommodating beds, and related services,
including, but not limited to, contiguous rooms, a wing, a floor, or
a building that is approved by the department for a specific
purpose. Notwithstanding any other provisions of this subdivision, an
acute psychiatric hospital that provides all of the basic services
specified in subdivision (b) of Section 1250 may, subject to the
approval of the department, have all of its licensed acute
psychiatric beds approved for chemical dependency recovery services.
Chemical dependency recovery services provided pursuant to this
subdivision shall not require a separate license or reclassification
of beds under the health planning laws.
   (e) If the chemical dependency recovery hospital is not a
supplemental service of a general acute care hospital, it shall have
agreements with one or more general acute care hospitals providing
for 24-hour emergency service and pharmacy, laboratory, and any other
services that the department may require.
   (f) Any reference in any statute to Section 1250 shall be deemed
and construed to also be a reference to this section.



1250.4.  (a) As used in this section:
   (1) "Department" means the Department of Corrections or the
Department of the Youth Authority.
   (2) "Communicable, contagious, or infectious disease" means any
disease that is capable of being transmitted from person to person
with or without contact and as established by the State Department of
Health Services pursuant to Section 120130, and Section 2500 et seq.
of Title 17 of the California Code of Regulations.
   (3) "Inmate or ward" means any person incarcerated within the
jurisdiction of the Department of Corrections or the Department of
the Youth Authority, with the exception of a person on parole.
   (4) "Institution" means any state prison, camp, center, office, or
other facility under the jurisdiction of the Department of
Corrections or the Department of the Youth Authority.
   (5) "Medical director," "chief of medical services," or "chief
medical officer" means the medical officer, acting medical officer,
medical director, or the physician designated by the department to
act in that capacity, who is responsible for directing the medical
treatment programs and medical services for all health services and
services supporting the health services provided in the institution.
   (b) Each health care facility in the Department of Corrections and
in the Department of the Youth Authority shall have a medical
director in charge of the health care services of that facility who
shall be a physician and surgeon licensed to practice in California
and who shall be appointed by the directors of the departments. The
medical director shall direct the medical treatment programs for all
health services and services supporting the health services provided
in the facility.
   (c) The medical director, chief of medical services, chief medical
officer, or the physician designated by the department to act in
that capacity, shall use every available means to ascertain the
existence of, and to immediately investigate, all reported or
suspected cases of any communicable, contagious, or infectious
disease and to ascertain the source or sources of the infections and
prevent the spread of the disease. In carrying out these
investigations, the medical director, chief of medical services,
chief medical officer, or the physician designated by the department
to act in that capacity, is hereby invested with full powers of
inspection, examination, and quarantine or isolation of all inmates
or wards known to be, or reasonably suspected to be, infected with a
communicable, contagious, or infectious disease.
   (d) The medical director, chief of medical services, chief medical
officer, or the physician designated by the department to act in
that capacity, shall order an inmate or ward to receive an
examination or test, or may order an inmate or ward to receive
treatment if the medical director, chief of medical services, chief
medical officer, or the physician designated by the department to act
in that capacity, has reasonable suspicion that the inmate or ward
has, has had, or has been exposed to a communicable, contagious, or
infectious disease and the medical director, chief of medical
services, chief medical officer, or the physician designated by the
department to act in that capacity, has reasonable grounds to believe
that it is necessary for the preservation and protection of staff
and inmates or wards.
   (e) Notwithstanding Section 2600 or 2601 of the Penal Code, or any
other provision of law, any inmate or ward who refuses to submit to
an examination, test, or treatment for any communicable, contagious,
or infectious disease or who refuses treatment for any communicable,
contagious, or infectious disease, or who, after notice, violates, or
refuses or neglects to conform to any rule, order, guideline, or
regulation prescribed by the department with regard to communicable
disease control shall be tested involuntarily and may be treated
involuntarily. This inmate or ward shall be subject to disciplinary
action as described in Title 15 of the California Code of
Regulations.
   (f) This section shall not apply to HIV or AIDS. Testing,
treatment, counseling, prevention, education, or other procedures
dealing with HIV and AIDS shall be conducted as prescribed in Title 8
(commencing with Section 7500) of Part 3 of the Penal Code.
   (g) This section shall not apply to tuberculosis. Tuberculosis
shall be addressed as prescribed in Title 8.7 (commencing with
Section 7570) of the Penal Code.



1250.5.  "Council" means the Advisory Health Council.



1250.6.  Any requirement placed upon, or reference to, a corporation
in this chapter, shall also apply to a limited liability company.



1250.7.  (a) (1) With respect to each hospital designated by the
department as a critical access hospital, and certified as such by
the Secretary of the United States Department of Health and Human
Services under the federal Medicare Rural Hospital Flexibility
Program, the department may develop criteria to waive any
requirements of Division 5 (commencing with Section 70001) of Title
22 of the California Code of Regulations that are in conflict with
the federal requirements for designation in the federal program, if
the department finds that it is in the public interest to do so, and
the department determines that the waiver would not negatively affect
the quality of patient care.
   (2) The criteria established pursuant to this subdivision shall
not be considered regulations within the meaning of Section 11342 of
the Government Code, and shall not be subject to adoption as
regulations pursuant to Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code.
   (b) Nothing in this section shall be construed to mean that a
critical access hospital is not a general acute care hospital. Every
hospital designated by the department as a critical access hospital
and certified as such by the United States Department of Health and
Human Services shall be deemed to be a general acute care hospital,
as defined in subdivision (a) of Section 1250, even if the department
waives regulatory requirements otherwise applicable to general acute
care hospitals pursuant to this section.



1250.8.  (a) Notwithstanding subdivision (a) of Section 127170, the
department, upon application of a general acute care hospital that
meets all the criteria of subdivision (b), and other applicable
requirements of licensure, shall issue a single consolidated license
to a general acute care hospital that includes more than one physical
plant maintained and operated on separate premises or that has
multiple licenses for a single health facility on the same premises.
A single consolidated license shall not be issued where the separate
freestanding physical plant is a skilled nursing facility or an
intermediate care facility, whether or not the location of the
skilled nursing facility or intermediate care facility is contiguous
to the general acute care hospital unless the hospital is exempt from
the requirements of subdivision (b) of Section 1254, or the facility
is part of the physical structure licensed to provide acute care.
   (b) The issuance of a single consolidated license shall be based
on the following criteria:
   (1) There is a single governing body for all the facilities
maintained and operated by the licensee.
   (2) There is a single administration for all the facilities
maintained and operated by the licensee.
   (3) There is a single medical staff for all the facilities
maintained and operated by the licensee, with a single set of bylaws,
rules, and regulations, which prescribe a single committee
structure.
   (4) Except as provided otherwise in this paragraph, the physical
plants maintained and operated by the licensee which are to be
covered by the single consolidated license are located not more than
15 miles apart. If an applicant provides evidence satisfactory to the
department that it can comply with all requirements of licensure and
provide quality care and adequate administrative and professional
supervision, the director may issue a single consolidated license to
a general acute care hospital that operates two or more physical
plants located more than 15 miles apart under any of the following
circumstances:
   (A) One or more of the physical plants is located in a rural area,
as defined by regulations of the director.
   (B) One or more of the physical plants provides only outpatient
services, as defined by the department.
   (C) If Section 14105.986 of the Welfare and Institutions Code is
implemented and the applicant meets all of the following criteria:
   (i) The applicant is a nonprofit corporation.
   (ii) The applicant is a children's hospital listed in Section
10727 of the Welfare and Institutions Code.
   (iii) The applicant is affiliated with a major university medical
school and located adjacent thereto.
   (iv) The applicant operates a regional tertiary care facility.
   (v) One of the physical plants is located in a county that has a
consolidated and county government structure.
   (vi) One of the physical plants is located in a county having a
population between 1,000,000 and 2,000,000.
   (vii) The applicant is located in a city with a population between
50,000 and 100,000.
   (c) In issuing the single consolidated license, the state
department shall specify the location of each supplemental service
and the location of the number and category of beds provided by the
licensee. The single consolidated license shall be renewed annually.
   (d) To the extent required by Chapter 1 (commencing with
Section127125) of Part 2 of Division 107, a general acute care
hospital that has been issued a single consolidated license:
   (1) Shall not transfer from one facility to another a special
service described in Section 1255 without first obtaining a
certificate of need.
   (2) Shall not transfer, in whole or in part, from one facility to
another, a supplemental service, as defined in regulations of the
director pursuant to this chapter, without first obtaining a
certificate of need, unless the licensee, 30 days prior to the
relocation, notifies the Office of Statewide Health Planning and
Development, the applicable health systems agency, and the state
department of the licensee's intent to relocate the supplemental
service, and includes with this notice a cost estimate, certified by
a person qualified by experience or training to render the estimates,
which estimates that the cost of the transfer will not exceed the
capital expenditure threshold established by the Office of Statewide
Health Planning and Development pursuant to Section 127170.
   (3) Shall not transfer beds from one facility to another facility,
without first obtaining a certificate of need unless, 30 days prior
to the relocation, the licensee notifies the Office of Statewide
Health Planning and Development, the applicable health systems
agency, and the state department of the licensee's intent to relocate
health facility beds, and includes with this notice both of the
following:
   (A) A cost estimate, certified by a person qualified by experience
or training to render the estimates, which estimates that the cost
of the relocation will not exceed the capital expenditure threshold
established by the Office of Statewide Health Planning and
Development pursuant to Section 127170.
   (B) The identification of the number, classification, and location
of the health facility beds in the transferor facility and the
proposed number, classification, and location of the health facility
beds in the transferee facility.
   Except as otherwise permitted in Chapter 1 (commencing with
Section 127125) of Part 2 of Division 107, or as authorized in an
approved certificate of need pursuant to that chapter, health
facility beds transferred pursuant to this section shall be used in
the transferee facility in the same bed classification as defined in
Section 1250.1, as the beds were classified in the transferor
facility.
   Health facility beds transferred pursuant to this section shall
not be transferred back to the transferor facility for two years from
the date of the transfer, regardless of cost, without first
obtaining a certificate of need pursuant to Chapter 1 (commencing
with Section 127125) of Part 2 of Division 107.
   (e) Transfers pursuant to subdivision (d) shall satisfy all
applicable requirements of licensure and shall be subject to the
written approval, if required, of the state department. The state
department may adopt regulations that are necessary to implement this
section. These regulations may include a requirement that each
facility of a health facility subject to a single consolidated
license have an onsite full-time or part-time administrator.
   (f) As used in this section, "facility" means a physical plant
operated or maintained by a health facility subject to a single,
consolidated license issued pursuant to this section.
   (g) For purposes of selective provider contracts negotiated under
the Medi-Cal program, the treatment of a health facility with a
single consolidated license issued pursuant to this section shall be
subject to negotiation between the health facility and the California
Medical Assistance Commission. A general acute care hospital that is
issued a single consolidated license pursuant to this section may,
at its option, be enrolled in the Medi-Cal program as a single
business address or as separate business addresses for one or more of
the facilities subject to the single consolidated license.
Irrespective of whether the general acute care hospital is enrolled
at one or more business addresses, the department may require the
hospital to file separate cost reports for each facility pursuant to
Section 14170 of the Welfare and Institutions Code.
   (h) For purposes of the Annual Report of Hospitals required by
regulations adopted by the state department pursuant to this part,
the state department and the Office of Statewide Health Planning and
Development may require reporting of bed and service utilization data
separately by each facility of a general acute care hospital issued
a single consolidated license pursuant to this section.
   (i) The amendments made to this section during the 1985-86 Regular
Session of the Legislature pertaining to the issuance of a single
consolidated license to a general acute care hospital in the case
where the separate physical plant is a skilled nursing facility or
intermediate care facility shall not apply to the following
facilities:
   (1) A facility that obtained a certificate of need after August 1,
1984, and prior to February 14, 1985, as described in this
subdivision. The certificate of need shall be for the construction of
a skilled nursing facility or intermediate care facility that is the
same facility for which the hospital applies for a single
consolidated license, pursuant to subdivision (a).
   (2) A facility for which a single consolidated license has been
issued pursuant to subdivision (a), as described in this subdivision,
prior to the effective date of the amendments made to this section
during the 1985-86 Regular Session of the Legislature.
   A facility that has been issued a single consolidated license
pursuant to subdivision (a), as described in this subdivision, shall
be granted renewal licenses based upon the same criteria used for the
initial consolidated license.
   (j) If the state department issues a single consolidated license
pursuant to this section, the state department may take any action
authorized by this chapter, including, but not limited to, any action
specified in Article 5 (commencing with Section 1294), with respect
to a facility, or a service provided in a facility, that is included
in the consolidated license.
   (k) The eligibility for participation in the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code) of a facility that is included in
a consolidated license issued pursuant to this section, provides
outpatient services, and is located more than 15 miles from the
health facility issued the consolidated license shall be subject to a
determination of eligibility by the state department. This
subdivision shall not apply to a facility that is located in a rural
area and is included in a consolidated license issued pursuant to
subparagraphs (A), (B), and (C) of paragraph (4) of subdivision (b).
Regardless of whether a facility has received or not received a
determination of eligibility pursuant to this subdivision, this
subdivision shall not affect the ability of a licensed professional,
providing services covered by the Medi-Cal program to a person
eligible for Medi-Cal in a facility subject to a determination of
eligibility pursuant to this subdivision, to bill the Medi-Cal
program for those services provided in accordance with applicable
regulations.
   (l) Notwithstanding any other provision of law, the director may
issue a single consolidated license for a general acute care hospital
to Children's Hospital Oakland and San Ramon Regional Medical
Center.
   (m) Notwithstanding any other provision of law, the director may
issue a single consolidated license for a general acute care hospital
to Children's Hospital Oakland and the John Muir Medical Center,
Concord Campus.
   (n) (1) To the extent permitted by federal law, payments made to
Children's Hospital Oakland pursuant to Section 14166.11 of the
Welfare and Institutions Code shall be adjusted as follows:
   (A) The number of Medi-Cal payment days and net revenues
calculated for the John Muir Medical Center, Concord Campus under the
consolidated license shall not be used for eligibility purposes for
the private hospital disproportionate share hospital replacement
funds for Children's Hospital Oakland.
   (B) The number of Medi-Cal payment days calculated for hospital
beds located at John Muir Medical Center, Concord Campus that are
included in the consolidated license beginning in the 2007-08 fiscal
year shall only be used for purposes of calculating disproportionate
share hospital payments authorized under Section 14166.11 of the
Welfare and Institutions Code at Children's Hospital Oakland to the
extent that the inclusion of those days does not exceed the total
Medi-Cal payment days used to calculate Children's Hospital Oakland
payments for the 2006-07 fiscal year disproportionate share
replacement.
   (2) This subdivision shall become inoperative in the event that
the two facilities covered under the consolidated license described
in subdivision (a) are located within a 15-mile radius of each other.



1250.11.  The State Department of Health Services shall develop
written guidelines and regulations as necessary to minimize the risk
of transmission of blood-borne infectious diseases from health care
worker to patient, from patient to patient, and from patient to
health care worker. In so doing, the state department shall consider
the recommendations made by the federal Centers for Disease Control
for preventing transmission of HIV and Hepatitis B. The state
department shall also take into account existing regulations of the
state department as well as standards, guidelines, and regulations
pursuant to the California Occupational Safety and Health Act of 1973
(Part 1 (commencing with Section 6300), Division 5, Labor Code)
regarding infection control to prevent infection or disease as a
result of the transmission of blood-borne pathogens. In so doing, the
state department shall consult with the Medical Board of California,
the Board of Dental Examiners, and the Board of Registered Nursing
as well as associations representing health care professions,
associations of licensed health facilities, organizations which
advocate on behalf of those infected with HIV and organizations
representing consumers of health care. The department shall complete
its review of the need for guidelines and regulations by January 1,
1993.


1251.  "License" means a basic permit to operate a health facility
with an authorized number and classification of beds. A license shall
not be transferable.


1251.3.  A health facility licensed as a general acute care
hospital, providing alcohol recovery services, may convert its
licensure category to an acute psychiatric hospital and it may
reclassify all of its general acute care beds to acute psychiatric
without first obtaining a certificate of need pursuant to Section
127170 if all of the following conditions are met:
   (a) The health facility notifies, in writing, the State Department
and the Office of Statewide Health Planning and Development on or
before September 3, 1982.
   (b) The project would reclassify all of the facility's general
acute care beds to acute psychiatric.
   (c) The total licensed capacity of the facility to be converted
does not exceed 31 beds.



1251.5.  A "special permit" is a permit issued in addition to a
license, authorizing a health facility to offer one or more of the
special services specified in Section 1255 when the state department
has determined that the health facility has met the standards for
quality of care established by state department pursuant to Article 3
(commencing with Section 1275).



1252.  "Special service" means a functional division, department, or
unit of a health facility which is organized, staffed and equipped
to provide a specific type or types of patient care and which has
been identified by regulations of the state department and for which
the state department has established special standards for quality of
care.



1253.  (a) No person, firm, partnership, association, corporation,
or political subdivision of the state, or other governmental agency
within the state shall operate, establish, manage, conduct, or
maintain a health facility in this state, without first obtaining a
license therefor as provided in this chapter, nor provide, after July
1, 1974, special services without approval of the state department.
However, any health facility offering any special service on the
effective date of this section shall be approved by the state
department to continue those services until the state department
evaluates the quality of those services and takes permitted action.
   (b) This section shall not apply to a receiver appointed by the
court to temporarily operate a long-term health care facility
pursuant to Article 8 (commencing with Section 1325).



1253.1.  (a) Any skilled nursing facility or intermediate care
facility that on the effective date of this section is providing care
for the developmentally disabled may utilize beds designated for
that purpose to provide intermediate care for the developmentally
disabled without obtaining a certificate of need, a change in
licensure category, or a change in bed classification pursuant to
subdivision (c) of Section 1250.1, provided the facility meets and
continues to meet the following criteria:
   (1) The facility was surveyed on or before July 18, 1977, by the
State Department of Health for certification under the federal ICF/MR
program pursuant to Section 449.13 of Title 42 of the Code of
Federal Regulations, and the beds designated for intermediate care
for the developmentally disabled were certified by the state
department, either before or after that date, to meet the standards
set forth in Section 449.13 of Title 42 of the Code of Federal
Regulations.
   (2) Not less than 95 percent of the beds so certified for
intermediate care for the developmentally disabled are utilized
exclusively for provision of care to residents with a developmental
disability, as defined in subdivision (a) of Section 4512 of the
Welfare and Institutions Code. Nothing in this paragraph shall
require continuous bed occupancy, but a bed certified for
intermediate care for the developmentally disabled shall be deemed to
be converted to another use if occupied by a resident who is not
developmentally disabled.
   (3) On and after the effective date of regulations implementing
this section, no change of ownership has occurred with respect to the
facility requiring issuance of a new license, except a change
occurring because of a decrease in the number of partners of a
licensed partnership or a reorganization of the governing structure
of a licensee in which there is no change in the relative ownership
interests.
   (b) Any facility receiving an exemption under subdivision (a)
shall, with respect to beds designated for intermediate care for the
developmentally disabled, be subject to regulations of the state
department applicable to that level of care, rather than the level of
care for which the beds are licensed. The state department shall
indicate on the license of any facility receiving an exemption
pursuant to subdivision (a) that the licensee has been determined by
the state department to meet the criteria of subdivision (a).
   (c) The licensee of any facility receiving an exemption under this
section shall notify the state department not less than 30 days
prior to taking action that will cause the facility to cease meeting
the criteria specified in paragraph (2) or (3) of subdivision (a).
   (d) Upon a change of ownership of the facility or change in
ownership interests not meeting the criterion for continued exemption
specified in paragraph (3) of subdivision (a), the applicant for
relicensure shall elect as follows:
   (1) To reclassify all skilled nursing beds that have been exempted
under this section to the intermediate care-developmental
disabilities classification, or to continue the skilled nursing
classification with respect to skilled nursing beds that have
received the exemption.
   (2) To reclassify intermediate care beds that have been exempted
under this section to the intermediate care-developmental
disabilities classification, or to reclassify intermediate care beds
that have received the exemption to the intermediate care-other
classification.
   Reclassification of beds pursuant to this subdivision shall not
constitute a "project" within the meaning of Section 127170 and shall
not be subject to any requirement for a certificate of need under
Chapter 1 (commencing with Section 127125) of Part 2 of Division 107.




1253.5.  (a) The State Department of Public Health, upon issuance
and renewal of a license for a general acute care hospital as defined
in subdivision (a) of Section 1250, an acute psychiatric hospital as
defined in subdivision (b) of Section 1250, or a special hospital as
defined in subdivision (f) of Section 1250, shall separately
identify on the license each supplemental service, including the
address of where each outpatient service is provided and the type of
services provided at each outpatient location.
   (b) On or before July 1, 2010, the department shall post and make
available on its Web site a listing of all outpatient services of
licensed hospitals identified on the hospital's license as a
supplemental service pursuant to subdivision (a). The listing shall
include the name and physical address of where the outpatient service
is provided. The department's Web site shall include a disclaimer
that the information contained in the listing is limited to the
outpatient service information reported to the department by licensed
hospitals.
   (c) The department shall work with stakeholders to review,
streamline, and revise the initial and renewal license application
form prescribed and furnished by the department to any person, firm,
association, partnership, or corporation desiring a license, a change
in licensed beds or services, or renewing a license for a hospital,
acute psychiatric hospital, or special hospital.




1253.6.  (a) This section shall govern applications by general acute
care hospitals for supplemental services approval for outpatient
clinic services.
    (b) Upon receipt of an initial application by a licensed general
acute care hospital to add a new or modify an existing outpatient
service as a supplemental service, the department shall, within 30
days of receipt of the initial application, review the entire
application, determine whether the application is missing information
or has insufficient information, and, on the basis of this
determination, provide the hospital with guidance on how to provide
the missing information.
   (c) Upon determination by the department that an application for
an outpatient clinic service as a supplemental service is complete
pursuant to subdivision (b), the department shall investigate the
facts set forth in the application and, if the department finds that
the statements contained in the application are true, that the
establishment of the operation of the supplemental service are in
conformity with the intent and purpose of this chapter, and that the
applicant is in compliance with this chapter and the rules and
regulations of the department, the department shall approve the
additional or modified outpatient clinic service, add it to the
hospital license, and issue a new license. However, if the department
determines in the course of the investigation that additional
information is needed to determine whether the statements contained
in the application are true or that the establishment or the
continued operation of the supplemental service are in conformity
with the intent and purpose of this chapter, or that the applicant is
in compliance with this chapter and the rules and regulations of the
department, the applicant shall provide the additional information
to the department upon request. If the department finds that the
statements contained in the application are not true, or that the
establishment of the outpatient service as a supplemental service is
not in conformity with the intent and purpose of this chapter, or if
the applicant fails to provide any additional information to the
department within 30 days of the request, the department shall deny
the outpatient clinic services application. The department shall
either grant or deny the application for the outpatient clinic
service as a supplemental service within 100 days of the filing of a
completed application.
   (d) If a licensed general acute care hospital has previously been
approved for an outpatient clinic service within 30 days after
receipt of a completed application for an additional outpatient
clinic service, the department shall approve the additional or
modified outpatient clinic service, add it to the hospital license,
and issue a new license, unless the applicant does not meet the
requirements of this section. Notwithstanding any other law, the
department shall not be required to conduct an onsite inspection
prior to approval of an outpatient clinic service pursuant to this
section. However, nothing shall preclude the department from
conducting an onsite inspection at any time, or denying an
application, in accordance with subdivision (c). If the department
determines that the applicant does not meet the requirements of this
section, the department shall provide the hospital, in writing, the
particular basis for this determination.
   (e) A completed application for purposes of this section shall
include all of the following:
   (1) The appropriate forms, fees, and documentation, as determined
by the department.
   (2) A description of the type of outpatient clinic service to be
operated, the character and scope of the service to be provided, and
a complete description of the building, its location and proximity to
the main hospital building, facilities, equipment, apparatus, and
appliances to be furnished and used in the operation of the
outpatient clinic service and evidence satisfactory to the department
that the hospital owns and will operate the outpatient clinic
service that is the subject of the application.
   (3) Written policies and procedures governing the operation of the
outpatient clinic service and its reporting relationship to the
applicant.
   (4) Evidence of the hospital's compliance with applicable building
standards and possession of a fire clearance for the outpatient
clinic service space.
   (f) The outpatient clinic service that is the subject of the
application shall be limited to providing nonemergency primary health
care services in a clinical environment to patients who remain in
the outpatient clinic for less than 24 hours.
   (g) For purposes of this section "outpatient clinic services"
shall have the same meaning as the services that may be provided by a
primary care clinic in accordance with subdivision (a) of Section
1204. Nothing in this section shall be interpreted to mean that
supplemental outpatient services established by a general acute care
hospital pursuant to this section shall be considered primary care
clinics for licensing, regulatory, or enforcement purposes.



1254.  (a) Except as provided in subdivision (e), the state
department shall inspect and license health facilities. The state
department shall license health facilities to provide their
respective basic services specified in Section 1250. Except as
provided in Section 1253, the state department shall inspect and
approve a general acute care hospital to provide special services as
specified in Section 1255. The state department shall develop and
adopt regulations to implement the provisions contained in this
section.
   (b) Upon approval, the state department shall issue a separate
license for the provision of the basic services enumerated in
subdivision (c) or (d) of Section 1250 whenever these basic services
are to be provided by an acute care hospital, as defined in
subdivision (a), (b), or (f) of that section, where the services
enumerated in subdivision (c) or (d) of Section 1250 are to be
provided in any separate freestanding facility, whether or not the
location of the separate freestanding facility is contiguous to the
acute care hospital. The same requirement shall apply to any new
freestanding facility constructed for the purpose of providing basic
services, as defined in subdivision (c) or (d) of Section 1250, by
any acute care hospital on or after January 1, 1984.
   (c) (1) Those beds licensed to an acute care hospital which, prior
to January 1, 1984, were separate freestanding beds and were not
part of the physical structure licensed to provide acute care, and
which beds were licensed to provide those services enumerated in
subdivision (c) or (d) of Section 1250, are exempt from the
requirements of subdivision (b).
   (2) All beds licensed to an acute care hospital and located within
the physical structure in which acute care is provided are exempt
from the requirements of subdivision (b) irrespective of the date of
original licensure of the beds, or the licensed category of the beds.
   (3) All beds licensed to an acute care hospital owned and operated
by the State of California or any other public agency are exempt
from the requirements of subdivision (b).
   (4) All beds licensed to an acute care hospital in a rural area as
defined by Chapter 1010, of the Statutes of 1982, are exempt from
the requirements of subdivision (b), except where there is a
freestanding skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
   (5) All beds licensed to an acute care hospital which meet the
criteria for designation within peer group six or eight, as defined
in the report entitled Hospital Peer Grouping for Efficiency
Comparison, dated December 20, 1982, and published by the California
Health Facilities Commission, and all beds in hospitals which have
fewer than 76 licensed acute care beds and which are located in a
census designation place of 15,000 or less population, are exempt
from the requirements of subdivision (b), except where there is a
free-standing skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
   (6) All beds licensed to an acute care hospital which has had a
certificate of need approved by a health systems agency on or before
July 1, 1983, are exempt from the requirements of subdivision (b).
   (7) All beds licensed to an acute care hospital are exempt from
the requirements of subdivision (b), if reimbursement from the
Medi-Cal program for beds licensed for the provision of services
enumerated in subdivision (c) or (d) of Section 1250 and not
otherwise exempt does not exceed the reimbursement which would be
received if the beds were in a separately licensed facility.
   (d) Except as provided in Section 1253, the state department shall
inspect and approve a general acute care hospital to provide special
services as specified in Section 1255. The state department shall
develop and adopt regulations to implement subdivisions (a) to (d),
inclusive, of this section.
   (e) The State Department of Mental Health shall inspect and
license psychiatric health facilities. The State Department of Mental
Health shall license psychiatric health facilities to provide their
basic services specified in Section 1250.2. The State Department of
Mental Health shall develop and adopt regulations to implement this
subdivision.



1254.1.  (a) The State Department of Mental Health shall license
psychiatric health facilities to provide their basic services
specified in Section 1250.
   (b) Any reference in any statute to Section 1254 shall be deemed
and construed to also be a reference to this section.



1254.2.  (a) The state department, in addition to the licensing
duties imposed by Section 1254, shall license chemical dependency
recovery hospitals to provide the basic services specified in
subdivision (a) of Section 1250.3.
   (b) Any reference in any statute to Section 1254 shall be deemed
and construed to also be a reference to this section.



1254.4.  (a) A general acute care hospital shall adopt a policy for
providing family or next of kin with a reasonably brief period of
accommodation, as described in subdivision (b), from the time that a
patient is declared dead by reason of irreversible cessation of all
functions of the entire brain, including the brain stem, in
accordance with Section 7180, through discontinuation of
cardiopulmonary support for the patient. During this reasonably brief
period of accommodation, a hospital is required to continue only
previously ordered cardiopulmonary support. No other medical
intervention is required.
   (b) For purposes of this section, a "reasonably brief period"
means an amount of time afforded to gather family or next of kin at
the patient's bedside.
   (c) (1) A hospital subject to this section shall provide the
patient's legally recognized health care decisionmaker, if any, or
the patient's family or next of kin, if available, with a written
statement of the policy described in subdivision (a), upon request,
but no later than shortly after the treating physician has determined
that the potential for brain death is imminent.
   (2) If the patient's legally recognized health care decisionmaker,
family, or next of kin voices any special religious or cultural
practices and concerns of the patient or the patient's family
surrounding the issue of death by reason of irreversible cessation of
all functions of the entire brain of the patient, the hospital shall
make reasonable efforts to accommodate those religious and cultural
practices and concerns.
   (d) For purposes of this section, in determining what is
reasonable, a hospital shall consider the needs of other patients and
prospective patients in urgent need of care.
   (e) There shall be no private right of action to sue pursuant to
this section.


1254.5.  (a) The Legislature finds and declares that the disease of
eating disorders is not simply medical or psychiatric, but involves
biological, sociological, psychological, family, medical, and
spiritual components. In addition, the Legislature finds and declares
that the treatment of eating disorders is multifaceted, and like the
treatment of chemical dependency, does not fall neatly into either
the traditional medical or psychiatric milieu.
   (b) The inpatient treatment of eating disorders shall be provided
only in state licensed hospitals, which may be general acute care
hospitals as defined in subdivision (a) of Section 1250, acute
psychiatric hospitals as defined in subdivision (b) of Section 1250,
or any other licensed health facility designated by the State
Department of Health Services.
   (c) "Eating disorders," for the purposes of this section, means
anorexia nervosa and bulimia as defined by the 1980 Diagnostic and
Statistical Manual of Mental Disorders (DSM-III) published by the
American Psychiatric Association.



1254.6.  (a) A hospital shall provide, free of charge, information
and instructional materials regarding sudden infant death syndrome,
as described in Section 1596.847, explaining the medical effects upon
infants and young children and emphasizing measures that may reduce
the risk.
   (b) The information and materials described in subdivision (a)
shall be provided to parents or guardians of each newborn, upon
discharge from the hospital. In the event of home birth attended by a
licensed midwife, the midwife shall provide the information and
instructional materials to the parents or guardians of the newborn.
   (c) To the maximum extent practicable, the materials provided to
parents or guardians of each newborn shall substantially reflect the
information contained in materials approved by the state department
for public circulation. The state department shall make available to
hospitals, free of charge, information in camera-ready typesetting
format. Nothing in this section prohibits a hospital from obtaining
free and suitable information from any other public or private
agency.


1254.7.  (a) It is the intent of the Legislature that pain be
assessed and treated promptly, effectively, and for as long as pain
persists.
   (b) Every health facility licensed pursuant to this chapter shall,
as a condition of licensure, include pain as an item to be assessed
at the same time as vital signs are taken. The health facility shall
ensure that pain assessment is performed in a consistent manner that
is appropriate to the patient. The pain assessment shall be noted in
the patient's chart in a manner consistent with other vital signs.



1255.  In addition to the basic services offered under the license,
a general acute care hospital may be approved in accordance with
subdivision (c) of Section 1277 to offer special services, including,
but not limited to, the following:
   (a) Radiation therapy department.
   (b) Burn center.
   (c) Emergency center.
   (d) Hemodialysis center (or unit).
   (e) Psychiatric.
   (f) Intensive care newborn nursery.
   (g) Cardiac surgery.
   (h) Cardiac catheterization laboratory.
   (i) Renal transplant.
   (j) Other special services as the department may prescribe by
regulation.
   A general acute care hospital that exclusively provides acute
medical rehabilitation center services may be approved in accordance
with subdivision (b) of Section 1277 to offer special services not
requiring surgical facilities.
   The state department shall adopt standards for special services
and other regulations as may be necessary to implement this section.
For cardiac catheterization laboratory service, the state department
shall, at a minimum, adopt standards and regulations that specify
that only diagnostic services, and what diagnostic services, may be
offered by an acute care hospital or a multispecialty clinic as
defined in subdivision (l) of Section 1206 that is approved to
provide cardiac catheterization laboratory service but is not also
approved to provide cardiac surgery service, together with the
conditions under which the cardiac catheterization laboratory service
may be offered.
   A cardiac catheterization laboratory service shall be located in a
general acute care hospital that is either licensed to perform
cardiovascular procedures requiring extracorporeal coronary artery
bypass that meets all of the applicable licensing requirements
relating to staff, equipment, and space for service, or shall, at a
minimum, have a licensed intensive care service and coronary care
service and maintain a written agreement for the transfer of patients
to a general acute care hospital that is licensed for cardiac
surgery or shall be located in a multispecialty clinic as defined in
subdivision (l) of Section 1206. The transfer agreement shall include
protocols that will minimize the need for duplicative cardiac
catheterizations at the hospital in which the cardiac surgery is to
be performed.
   For purposes of this section, "multispecialty clinic," as defined
in subdivision (l) of Section 1206, includes an entity in which the
multispecialty clinic holds at least a 50-percent general partner
interest and maintains responsibility for the management of the
service, if all of the following requirements are met:
   (1) The multispecialty clinic existed as of March 1, 1983.
   (2) Prior to March 1, 1985, the multispecialty clinic did not
offer cardiac catheterization services, dynamic multiplane imaging,
or other types of coronary or similar angiography.
   (3) The multispecialty clinic creates only one entity that
operates its service at one site.
   (4) These entities shall have the equipment and procedures
necessary for the stabilization of patients in emergency situations
prior to transfer and patient transfer arrangements in emergency
situations that shall be in accordance with the standards established
by the Emergency Medical Services Authority, including the
availability of comprehensive care and the qualifications of any
general acute care hospital expected to provide emergency treatment.
   Except as provided in Sections 128525 and 128530, under no
circumstances shall cardiac catheterizations be performed outside of
a general acute care hospital or a multispecialty clinic, as defined
in subdivision (l) of Section 1206, that qualifies for this
definition as of March 1, 1983.



1255.1.  (a) Any hospital that provides emergency medical services
under Section 1255 shall, as soon as possible, but not later than 90
days prior to a planned reduction or elimination of the level of
emergency medical services, provide notice of the intended change to
the state department, the local government entity in charge of the
provision of health services, and all health care service plans or
other entities under contract with the hospital to provide services
to enrollees of the plan or other entity.
   (b) In addition to the notice required by subdivision (a), the
hospital shall, within the time limits specified in subdivision (a),
provide public notice of the intended change in a manner that is
likely to reach a significant number of residents of the community
serviced by that facility.
   (c) A hospital shall not be subject to this section or Section
1255.2 if the state department does either of the following:
   (1) Determines that the use of resources to keep the emergency
center open substantially threatens the stability of the hospital as
a whole.
   (2) Cites the emergency center for unsafe staffing practices.




1255.2.  A health facility implementing a downgrade or change shall
make reasonable efforts to ensure that the community served by its
facility is informed of the downgrade or closure. Reasonable efforts
may include, but not be limited to, advertising the change in terms
likely to be understood by a layperson, soliciting media coverage
regarding the change, informing patients of the facility of the
impending change, and notifying contracting health care service plans
as required in Section 1255.1.



1255.25.  (a) (1) Not less than 30 days prior to closing a health
facility, as defined in subdivision (a) or (b) of Section 1250, or
eliminating a supplemental service, as defined in Section 70067 of
Chapter 1 of Division 5 of Title 22 of the California Code of
Regulations, the facility shall provide public notice of the proposed
closure or elimination of the supplemental service, including a
notice posted at the entrance to all affected facilities and a notice
to the department and the board of supervisors of the county in
which the health facility is located.
   (2) Not less than 30 days prior to relocating the provision of
supplemental services to a different campus, a health facility, as
defined in subdivision (a) or (b) of Section 1250, shall provide
public notice of the proposed relocation of supplemental services,
including a notice posted at the entrance to all affected facilities
and notice to the department and the board of supervisors of the
county in which the health facility is located.
   (b) The notice required by paragraph (1) or (2) of subdivision (a)
shall include all of the following:
   (1) A description of the proposed closure, elimination, or
relocation. The description shall be limited to publicly available
data, including the number of beds eliminated, if any, the probable
decrease in the number of personnel, and a summary of any service
that is being eliminated, if applicable.
   (2) A description of the three nearest available comparable
services in the community. If the health facility closing these
services serves Medi-Cal or Medicare patients, this health facility
shall specify if the providers of the nearest available comparable
services serve these patients.
   (3) A telephone number and address for each of the following,
where interested parties may offer comments:
   (A) The health facility.
   (B) The parent entity, if any, or contracted company, if any, that
acts as the corporate administrator of the health facility.
   (C) The chief executive officer.
   (c) Notwithstanding subdivisions (a) and (b), this section shall
not apply to county facilities subject to Section 1442.5.



1255.3.  On or before June 30, 1999, with the state department as
the lead agency, the state department and the Emergency Medical
Services Authority, in consultation with hospitals and other health
care providers and local emergency medical services agencies, shall
designate signage requirements for a health facility holding a
special permit for a standby emergency medical service located in an
urban area. The signage shall not include the word "emergency" and
shall reflect the type of emergency services provided by the
facility, and be easily understood by the average person. The
facility shall not post signs, distribute literature, or advertise
that emergency services are available at the facility. Nothing in
this section shall be construed to mean that a facility is no longer
providing emergency services for purposes of billing or
reimbursement. A small and rural hospital, as defined in Section
124840, is not subject to the requirements of this section.




1255.5.  For purposes of Section 1255, the following definitions
apply:
   (a) "Cardiac catheterization" includes an intravascular insertion
of a catheter into the heart for the primary definition and diagnosis
of an anatomic cardiac lesion. For the purposes of this definition,
the insertion of a Swan-Ganz thermodilution cardiac output catheter,
a venous line, and a temporary pacemaking electrode catheter are
excluded.
   (b) "Cardiac surgery" means surgery on the heart or great vessels
requiring a thoracotomy and extracorporeal circulation.
   (c)  "Cardiovascular surgery service" means a program of a general
acute care hospital which has the capability of performing cardiac
catheterizations and cardiac surgery as defined in this section.
Under no circumstances shall there exist in a general acute care
hospital a cardiac surgery service without a cardiac catheterization
laboratory service.
   (d) "Cardiac catheterization laboratory service" means a program
of a general acute care hospital which has the capability of
performing cardiac catheterization. Cardiac catheterization
laboratory service does not include pediatric cardiac catheterization
laboratory service.
   (e) "Pediatric cardiac surgery service" means a program of a
general acute care hospital which has the capability of performing
cardiac catheterization and cardiac surgery, as defined in this
section, for the diagnosis and treatment of congenital defects in
children. Cardiac catheterization for pediatric patients shall be
performed only in a general acute care hospital that has the
capability to perform cardiac surgery on pediatric patients.
   (f) "Intensive care newborn nursery services" means the provision
of comprehensive and intensive care for all contingencies of the
newborn infant, including intensive, intermediate, and continuing
care. Policies, procedures, and space requirements for intensive,
intermediate, and continuing care services shall be based upon the
standards and recommendations of the American Academy of Pediatrics
Guidelines for Perinatal Care, 1983.


1255.6.  During cardiovascular surgery, a perfusionist, as defined
by Chapter 5.67 (commencing with Section 2590) of Division 2 of the
Business and Professions Code, shall operate the extracorporeal
equipment under the immediate supervision of the cardiovascular
surgeon or anesthesiologist. The determination of the qualifications
and competence of a perfusionist, and the awarding of appropriate
privileges, shall be the responsibility of the general acute care
hospital or its medical staff.



1255.7.  (a) (1) For purposes of this section, "safe-surrender site"
means either of the following:
   (A) A location designated by the board of supervisors of a county
or by a local fire agency, upon the approval of the appropriate local
governing body of the agency, to be responsible for accepting
physical custody of a minor child who is 72 hours old or younger from
a parent or individual who has lawful custody of the child and who
surrenders the child pursuant to Section 271.5 of the Penal Code.
Before designating a location as a safe-surrender site pursuant to
this subdivision, the designating entity shall consult with the
governing body of a city, if the site is within the city limits, and
with representatives of a fire department and a child welfare agency
that may provide services to a child who is surrendered at the site,
if that location is selected.
   (B) A location within a public or private hospital that is
designated by that hospital to be responsible for accepting physical
custody of a minor child who is 72 hours old or younger from a parent
or individual who has lawful custody of the child and who surrenders
the child pursuant to Section 271.5 of the Penal Code.
   (2) For purposes of this section, "parent" means a birth parent of
a minor child who is 72 hours old or younger.
   (3) For purposes of this section, "personnel" means a person who
is an officer or employee of a safe-surrender site or who has staff
privileges at the site.
   (4) A hospital and a safe-surrender site designated by the county
board of supervisors or by a local fire agency, upon the approval of
the appropriate local governing body of the agency, shall post a sign
displaying a statewide logo that has been adopted by the State
Department of Social Services that notifies the public of the
location where a minor child 72 hours old or younger may be safely
surrendered pursuant to this section.
   (b) Personnel on duty at a safe-surrender site shall accept
physical custody of a minor child 72 hours old or younger pursuant to
this section if a parent or other individual having lawful custody
of the child voluntarily surrenders physical custody of the child to
personnel who are on duty at the safe-surrender site. Safe-surrender
site personnel shall ensure that a qualified person does all of the
following:
   (1) Places a coded, confidential ankle bracelet on the child.
   (2) Provides, or makes a good faith effort to provide, to the
parent or other individual surrendering the child a copy of a unique,
coded, confidential ankle bracelet identification in order to
facilitate reclaiming the child pursuant to subdivision (f). However,
possession of the ankle bracelet identification, in and of itself,
does not establish parentage or a right to custody of the child.
   (3) Provides, or makes a good faith effort to provide, to the
parent or other individual surrendering the child a medical
information questionnaire, which may be declined, voluntarily filled
out and returned at the time the child is surrendered, or later
filled out and mailed in the envelope provided for this purpose. This
medical information questionnaire shall not require identifying
information about the child or the parent or individual surrendering
the child, other than the identification code provided in the ankle
bracelet placed on the child. Every questionnaire provided pursuant
to this section shall begin with the following notice in no less than
12-point type:
   NOTICE: THE BABY YOU HAVE BROUGHT IN TODAY MAY HAVE SERIOUS
MEDICAL NEEDS IN THE FUTURE THAT WE DON'T KNOW ABOUT TODAY. SOME
ILLNESSES, INCLUDING CANCER, ARE BEST TREATED WHEN WE KNOW ABOUT
FAMILY MEDICAL HISTORIES. IN ADDITION, SOMETIMES RELATIVES ARE NEEDED
FOR LIFE-SAVING TREATMENTS. TO MAKE SURE THIS BABY WILL HAVE A
HEALTHY FUTURE, YOUR ASSISTANCE IN COMPLETING THIS QUESTIONNAIRE
FULLY IS ESSENTIAL. THANK YOU.
   (c) Personnel of a safe-surrender site that has physical custody
of a minor child pursuant to this section shall ensure that a medical
screening examination and any necessary medical care is provided to
the minor child. Notwithstanding any other provision of law, the
consent of the parent or other relative shall not be required to
provide that care to the minor child.
   (d) (1) As soon as possible, but in no event later than 48 hours
after the physical custody of a child has been accepted pursuant to
this section, personnel of the safe-surrender site that has physical
custody of the child shall notify child protective services or a
county agency providing child welfare services pursuant to Section
16501 of the Welfare and Institutions Code, that the safe-surrender
site has physical custody of the child pursuant to this section. In
addition, medical information pertinent to the child's health,
including, but not limited to, information obtained pursuant to the
medical information questionnaire described in paragraph (3) of
subdivision (b) that has been received by or is in the possession of
the safe-surrender site shall be provided to that child protective
services or county agency.
   (2) Any personal identifying information that pertains to a parent
or individual who surrenders a child that is obtained pursuant to
the medical information questionnaire is confidential and shall be
exempt from disclosure by the child protective services or county
agency under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code). Personal identifying information that pertains to a
parent or individual who surrenders a child shall be redacted from
any medical information provided to child protective services or the
county agency providing child welfare services.
   (e) Child protective services or the county agency providing child
welfare services pursuant to Section 16501 of the Welfare and
Institutions Code shall assume temporary custody of the child
pursuant to Section 300 of the Welfare and Institutions Code
immediately upon receipt of notice under subdivision (d). Child
protective services or the county agency providing child welfare
services pursuant to Section 16501 of the Welfare and Institutions
Code shall immediately investigate the circumstances of the case and
file a petition pursuant to Section 311 of the Welfare and
Institutions Code. Child protective services or the county agency
providing child welfare services pursuant to Section 16501 of the
Welfare and Institutions Code shall immediately notify the State
Department of Social Services of each child to whom this subdivision
applies upon taking temporary custody of the child pursuant to
Section 300 of the Welfare and Institutions Code. As soon as
possible, but no later than 24 hours after temporary custody is
assumed, child protective services or the county agency providing
child welfare services pursuant to Section 16501 of the Welfare and
Institutions Code shall report all known identifying information
concerning the child, except personal identifying information
pertaining to the parent or individual who surrendered the child, to
the California Missing Children Clearinghouse and to the National
Crime Information Center.
   (f) If, prior to the filing of a petition under subdivision (e), a
parent or individual who has voluntarily surrendered a child
pursuant to this section requests that the safe-surrender site that
has physical custody of the child pursuant to this section return the
child and the safe-surrender site still has custody of the child,
personnel of the safe-surrender site shall either return the child to
the parent or individual or contact a child protective agency if any
personnel at the safe-surrender site knows or reasonably suspects
that the child has been the victim of child abuse or neglect. The
voluntary surrender of a child pursuant to this section is not in and
of itself a sufficient basis for reporting child abuse or neglect.
The terms "child abuse," "child protective agency," "mandated
reporter," "neglect," and "reasonably suspects" shall be given the
same meanings as in Article 2.5 (commencing with Section 11164) of
Title 1 of Part 4 of the Penal Code.
   (g) Subsequent to the filing of a petition under subdivision (e),
if within 14 days of the voluntary surrender described in this
section, the parent or individual who surrendered custody returns to
claim physical custody of the child, the child welfare agency shall
verify the identity of the parent or individual, conduct an
assessment of his or her circumstances and ability to parent, and
request that the juvenile court dismiss the petition for dependency
and order the release of the child, if the child welfare agency
determines that none of the conditions described in subdivisions (a)
to (d), inclusive, of Section 319 of the Welfare and Institutions
Code currently exist.
   (h) A safe-surrender site, or the personnel of a safe-surrender
site, shall not have liability of any kind for a surrendered child
prior to taking actual physical custody of the child. A
safe-surrender site, or personnel of the safe-surrender site, that
accepts custody of a surrendered child pursuant to this section shall
not be subject to civil, criminal, or administrative liability for
accepting the child and caring for the child in the good faith belief
that action is required or authorized by this section, including,
but not limited to, instances where the child is older than 72 hours
or the parent or individual surrendering the child did not have
lawful physical custody of the child. A safe-surrender site, or the
personnel of a safe-surrender site, shall not be subject to civil,
criminal, or administrative liability for a surrendered child prior
to the time that the site or its personnel know, or should know, that
the child has been surrendered. This subdivision does not confer
immunity from liability for personal injury or wrongful death,
including, but not limited to, injury resulting from medical
malpractice.
   (i) (1) In order to encourage assistance to persons who
voluntarily surrender physical custody of a child pursuant to this
section or Section 271.5 of the Penal Code, no person who, without
compensation and in good faith, provides assistance for the purpose
of effecting the safe surrender of a minor 72 hours old or younger
shall be civilly liable for injury to or death of the minor child as
a result of his or her acts or omissions. This immunity does not
apply to an act or omission constituting gross negligence,
recklessness, or willful misconduct.
   (2) For purposes of this section, "assistance" means transporting
the minor child to the safe-surrender site as a person with lawful
custody, or transporting or accompanying the parent or person with
lawful custody at the request of that parent or person to effect the
safe surrender, or performing any other act in good faith for the
purpose of effecting the safe surrender of the minor.
   (j) For purposes of this section, "lawful custody" means physical
custody of a minor 72 hours old or younger accepted by a person from
a parent of the minor, who the person believes in good faith is the
parent of the minor, with the specific intent and promise of
effecting the safe surrender of the minor.
   (k) Any identifying information that pertains to a parent or
individual who surrenders a child pursuant to this section, that is
obtained as a result of the questionnaire described in paragraph (3)
of subdivision (b) or in any other manner, is confidential, shall be
exempt from disclosure under the California Public Records Act
(Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1
of the Government Code), and shall not be disclosed by any personnel
of a safe-surrender site that accepts custody of a child pursuant to
this section.


1255.8.  (a) For purposes of this section, the following terms have
the following meanings:
   (1) "Colonized" means that a pathogen is present on the patient's
body, but is not causing any signs or symptoms of an infection.
   (2) "Committee" means the Healthcare Associated Infection Advisory
Committee established pursuant to Section 1288.5.
   (3) "Health facility" means a facility as defined in subdivision
(a) of Section 1250.
   (4) "Health-care-associated infection," "health-facility-acquired
infection," or "HAI" means a health-care-associated infection as
defined by the National Healthcare Safety Network of the federal
Centers for Disease Control and Prevention, unless the department
adopts a definition consistent with the recommendations of the
committee or its successor.
   (5) "MRSA" means Methicillin-resistant Staphylococcus aureus.
   (b) (1) Each patient who is admitted to a health facility shall be
tested for MRSA in the following cases, within 24 hours of
admission:
   (A) The patient is scheduled for inpatient surgery and has a
documented medical condition making the patient susceptible to
infection, based either upon federal Centers for Disease Control and
Prevention findings or the recommendations of the committee or its
successor.
   (B) It has been documented that the patient has been previously
discharged from a general acute care hospital within 30 days prior to
the current hospital admission.
   (C) The patient will be admitted to an intensive care unit or burn
unit of the hospital.
   (D) The patient receives inpatient dialysis treatment.
   (E) The patient is being transferred from a skilled nursing
facility.
    (2) The department may interpret this subdivision to take into
account the recommendations of the federal Centers for Disease
Control and Prevention, or recommendations of the committee or its
successor.
   (3) If a patient tests positive for MRSA, the attending physician
shall inform the patient or the patient's representative immediately
or as soon as practically possible.
   (4) A patient who tests positive for MRSA infection shall, prior
to discharge, receive oral and written instruction regarding
aftercare and precautions to prevent the spread of the infection to
others.
   (c) Commencing January 1, 2011, a patient tested in accordance
with subdivision (b) and who shows evidence of increased risk of
invasive MRSA shall again be tested for MRSA immediately prior to
discharge from the facility. This subdivision shall not apply to a
patient who has tested positive for MRSA infection or colonization
upon entering the facility.
   (d) A patient who is tested pursuant to subdivision (c) and who
tests positive for MRSA infection shall receive oral and written
instructions regarding aftercare and precautions to prevent the
spread of the infection to others.
   (e) The infection control policy required pursuant to Section
70739 of Title 22 of the California Code of Regulations, at a
minimum, shall include all of the following:
   (1) Procedures to reduce health care associated infections.
   (2) Regular disinfection of all restrooms, countertops, furniture,
televisions, telephones, bedding, office equipment, and surfaces in
patient rooms, nursing stations, and storage units.
   (3) Regular removal of accumulations of bodily fluids and
intravenous substances, and cleaning and disinfection of all movable
medical equipment, including point-of-care testing devices such as
glucometers, and transportable medical devices.
   (4) Regular cleaning and disinfection of all surfaces in common
areas in the facility such as elevators, meeting rooms, and lounges.
   (f) Each facility shall designate an infection control officer
who, in conjunction with the hospital infection control committee,
shall ensure implementation of the testing and reporting provisions
of this section and other hospital infection control efforts. The
reports shall be presented to the appropriate committee within the
facility for review. The name of the infection control officer shall
be made publicly available, upon request.
   (g) The department shall establish a health care acquired
infection program pursuant to this section.



1256.  (a) The use of the name or title "hospital" by any person or
persons to identify or represent a facility for the diagnosis, care,
and treatment of human illness other than a facility subject to or
specifically exempted from the licensure provisions of this chapter
is prohibited. Notwithstanding any other provisions of the laws of
this state, the name or title "hospital" shall not be used by any
sanitarium, nursing home, convalescent home, or maternity home,
unless preceded by some qualifying descriptive word such as
convalescent, geriatric, rehabilitation, or nursing.
   (b) This section shall not prohibit the use of the word "hospital"
to identify or represent an approved pediatric supplemental service
of a general acute care hospital that is either of the following:
   (1) A children's hospital as defined by Section 10727 of the
Welfare and Institutions Code.
   (2) A University of California children's hospital as defined by
Section 10728 of the Welfare and Institutions Code.



1256.01.  (a) The Elective Percutaneous Coronary Intervention (PCI)
Pilot Program is hereby established in the department. The purpose of
the pilot program is to allow the department to authorize up to six
general acute care hospitals that are licensed to provide cardiac
catheterization laboratory service in California, and that meet the
requirements of this section, to perform scheduled, elective
percutaneous transluminal coronary angioplasty and stent placement
for eligible patients.
   (b) For purposes of this section, the following terms have the
following meanings:
   (1) "Elective Percutaneous Coronary Intervention (elective PCI)"
means scheduled percutaneous transluminal coronary angioplasty and
stent placement. Elective PCI does not include urgent or emergent PCI
that is scheduled on an ad hoc basis.
   (2) "Eligible hospital" means a general acute care hospital that
has a licensed cardiac catheterization laboratory and is in
compliance with all applicable state and federal licensing laws and
regulations.
   (3) "Interventionalist" means a licensed cardiologist who meets
the requirements for performing elective PCI at a pilot hospital.
   (4) "Pilot hospital" means a hospital participating in the
Elective Percutaneous Coronary Intervention (PCI) Pilot Program
established by this section.
   (5) "Primary percutaneous coronary intervention (primary PCI)"
means percutaneous transluminal coronary angioplasty and stent
placement that is emergent in nature for acute myocardial infarction
and that is performed before administration of thrombolytic agents.
   (6) "Receiving hospital" means a licensed general acute care
hospital with cardiac surgery services that has entered into a
transfer agreement with a pilot hospital.
   (7) "STEMI" means ST segment elevation myocardial infarction, a
type of heart attack, or myocardial infarction, that is caused by a
prolonged period of blocked blood supply, which affects a large area
of the heart muscle, and causes changes on an electrocardiogram and
in the blood levels of key chemical markers.
   (8) "Transfer agreement" means an agreement between the eligible
hospital and the receiving hospital that meets all of the
requirements of this section.
   (c) To participate in the pilot program, an eligible hospital
shall demonstrate that it complies with the recommendations of the
SCAI for performance of PCI without onsite cardiac surgery, as those
recommendations may evolve over time, and meets all of the following
criteria:
   (1) Performs at least 36 primary PCI procedures annually, has the
capacity to perform at least 200 primary and elective PCI procedures
annually, and by year two of participation in the pilot program,
actually performs at least 200 primary and elective procedures,
including at least 36 primary PCI procedures.
   (2) Has an on-call schedule with operation of the cardiac
catheterization laboratory 24 hours per day, 365 days per year.
   (3) Performs primary PCI as the treatment of first choice for
STEMI, and has policies and procedures that require the tracking of
door-to-balloon times, with a goal of 90 minutes or less, and
requires that outlier cases be carefully reviewed for process
improvement opportunities.
   (4) Permits only interventionists who meet the following
requirements to perform elective PCI under the pilot program:
   (A) Perform at least 100 total PCI procedures per year, including
at least 18 primary PCI per year.
   (B) Have lifetime experience of at least 500 total PCI procedures
as primary operator.
   (C) Have complication rates and outcomes equivalent or superior to
national benchmarks established by the American College of
Cardiology.
   (D) Hold board certification by the American Board of Internal
Medicine in Interventional Cardiology and Cardiovascular Diseases.
   (E) Actively participate in the eligible hospital's quality
improvement program.
   (5) Employs experienced nursing and technical laboratory staff
with training in interventional laboratories. Cardiac catheterization
laboratory personnel must have demonstrated competency treating
acutely ill patients with hemodynamic and electrical instability.
   (6) Employs experienced intensive care unit nursing staff who have
demonstrated competency with invasive hemodynamic monitoring,
temporary pacemaker operation, and intraaortic balloon pump
management. Nursing personnel must be capable of managing
endotracheal intubation and ventilator management both onsite and
during transfer, if necessary. The eligible hospital shall
demonstrate sufficient staffing capacity in the intensive care unit
to provide posttreatment care for patients undergoing elective PCI.
   (7) Has a well-equipped and maintained cardiac catheterization
laboratory with high resolution digital imaging capability and
intraaortic balloon pump support compatible with transport vehicles.
The ability for the real-time transfer of images and hemodynamic data
via T-1 transmission line as well as audio and video images to
review terminals for consultation at the receiving hospital is ideal.
   (8) Has an appropriate inventory of interventional equipment,
including guide catheters, balloons, and stents in multiple sizes,
throbectomy and distal protection devices, covered stents, temporary
pacemakers, and pericardiocentesis trays. Pressure wire devices and
intravascular ultrasound equipment are optimal, but not mandatory.
   (9) Provides evidence showing the full support from hospital
administration in fulfilling the necessary institutional
requirements, including, but not limited to, appropriate support
services such as respiratory care and blood banking.
   (10) Has a written transfer agreement for the emergency transfer
of patients to a facility with cardiac surgery services. Transport
protocols shall be developed and tested a minimum of twice per year,
and must ensure the immediate and efficient transfer of patients,
within 60 minutes, 24 hours per day, seven days per week, from the
eligible hospital to the receiving hospital. The time for transfer of
patients shall be calculated from the time it is determined that
transfer of a patient for emergency cardiac surgery is necessary at
the eligible hospital, to the time that the patient arrives at the
receiving hospital.
   (11) Has onsite rigorous data collection, outcomes analysis,
benchmarking, quality improvement, and formalized periodic case
review.
   (12) Participates in the American College of Cardiology-National
Cardiovascular Data Registry.
   (13) Provides evidence in its application that demonstrates the
use of rigorous case selection for patients undergoing elective PCI.
Patient selection criteria will meet all of the following
requirements, or otherwise be consistent with the recommendations of
the SCAI, as those recommendations may evolve.
   (A) Patient selection shall be based on the interventionalist's
professional medical judgment, which may include, but is not limited
to, consideration of the patient's risk, the patient's lesion risk,
and the patient's overall health status.
   (B) For purposes of this section, "patient risk" means the
expected clinical risk in case of occlusion or other serious
complication caused by the procedure. "High patient risk" may
include, but is not limited to, patients with any of the following
features: decompensated congestive heart failure (Killip class 3)
without evidence for active ischemia, recent cardiovascular attack,
advanced malignancy, known clotting disorders; left ventricular
ejection fraction less than or equal to 25 percent; left main
stenosis greater than or equal to 50 percent or three-vessel disease
unprotected by prior bypass surgery greater than 70 percent stenosis
in the proximal segment of all major epicardial coronary arteries;
single target lesion that jeopardizes over 50 percent of remaining
viable myocardium.
   (C) For purposes of this section, "lesion risk" means the
probability that the procedure will cause acute vessel occlusion or
other serious complication. "High lesion risk" may include, but is
not limited to, lesions in open vessels with any of the following
characteristics: diffuse disease (greater than 2 cm in length) and
excessive tortuoisty of proximal segments; more than moderate
calcification of a stenosis or proximal segments; location in an
extremely angulated segment (greater than 90 percent); inability to
protect major side branches; degenerated older vein grafts with
friable lesions; substantial thrombus in the vessel or at the lesion
site; and any other feature that may, in the interventionalist's
judgment, impede stent deployment.
   (D) In evaluating patient risk and lesion risk to determine
patient eligibility for inclusion in the pilot program, the
interventionalist shall apply the strategy set forth by the SCAI as
set forth below, or as it may otherwise evolve:
   (i) A high-risk patient with a high-risk lesion shall not be
included in the pilot program.
   (ii) A high-risk patient with a not high-risk lesion may be
included in the pilot program upon confirmation that a cardiac
surgeon and an operating room are immediately available if necessary.
   (iii) A not high-risk patient with a high-risk lesion may be
included in the pilot program.
   (iv) A not high-risk patient with a not high-risk lesion may be
included in the pilot program.
   (14) Will include evidence of institutional review board (IRB)
approval of its participation in the pilot program for as long as
ACC/AHA/SCAI guidelines categorize elective PCI with offsite cardiac
surgery as a Class III indication.
   (15) Shall demonstrate evidence of the process for obtaining
written informed consent from patients prior to undergoing elective
PCI. The application shall include a copy of the eligible hospital's
informed consent form applicable to elective PCI. Evidence of IRB
approval of the informed consent form will also be provided for as
long as ACC/AHA/SCAI guidelines categorize elective PCI with offsite
cardiac surgery a Class III indication.
   (d) Consistent with this section, the department shall invite
eligible hospitals to submit an application to participate in the
Elective PCI Pilot Program. The applications shall include sufficient
information to demonstrate compliance with the standards set forth
in this section, and additionally include the effective date for
initiating elective PCI service, the general service area, a
description of the population to be served, a description of the
services to be provided, a description of backup emergency services,
the availability of comprehensive care, and the qualifications of the
general acute care hospital providing the emergency treatment. The
department may require that additional information be submitted with
the application. Failure to include any required criteria or
additional information shall disqualify the applicant from the
application process and from consideration for participation in the
pilot program. The department may select up to six general acute care
hospitals for participation in the Elective PCI Pilot Program based
on the applicant's ability to meet or exceed the criteria described
in this section.
   (e) An advisory oversight committee comprised of one
interventionalist from each pilot hospital, an equal number of
cardiologists from nonpilot hospitals, and a representative of the
department shall be created to oversee, monitor, and make
recommendations to the department concerning the pilot program. In
designating the cardiologists from nonpilot hospitals to the
committee, the department shall consider the recommendations of the
California Chapter of the American College of Cardiology. The
advisory oversight committee shall submit at least two reports to the
department during the pilot period. The oversight committee shall
conduct a final report at the conclusion of the pilot program,
including recommendations for the continuation or termination of the
pilot program.
   (f) If at any time a pilot hospital fails to meet the criteria set
forth in this section for being a pilot hospital or fails to
safeguard patient safety, as determined by the department, that pilot
hospital shall be removed from participation in the pilot program by
the department.
   (g) Each pilot hospital shall provide quarterly reports to the
department and the oversight committee that include statistical data
and patient information relating to the number of elective PCI
procedures performed, the interventionalists performing elective PCI
procedures, and the outcomes of those procedures. In addition, pilot
hospitals shall include in the report recommendations, if any, for
modifications to the pilot program and any other information the
pilot hospitals deem relevant for evaluating the success of the pilot
program in delivering improved patient care. The department and the
oversight committee may make site visits to any pilot hospital at any
time.
   (h) The department shall prepare and submit a report to the
Legislature on the results of the Elective PCI Pilot Program. The
report shall be submitted no later than 90 days after termination of
the pilot program. The report shall include, but not be limited to,
an evaluation of the pilot program's cost, safety, and quality of
care. The report shall also include a comparison of elective PCI
performed in connection with the Elective PCI Pilot Program, and
elective PCI performed in hospitals with onsite cardiac surgery
services. The report shall further recommend whether elective PCI
without onsite cardiac surgery should be continued in California, and
if so, under what conditions.
   (i) The department may charge pilot hospitals a supplemental
licensing fee, the amount of which shall not exceed the cost to the
department of overseeing the pilot program.
   (j) The department may contract with a professional entity with
medical program knowledge to meet the requirements of this section.
   (k) This section shall remain in effect only until January 1,
2014, allowing up to two years for implementation and at least three
years during which the pilot program will be operational. As of
January 1, 2014, this section is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.



1256.1.  No general acute care hospital shall hold itself out
directly or indirectly by any sign, brochure, or advertisement as
providing any service or services which require a supplemental or
special service unless that general acute care hospital has first
obtained a supplemental or special service approval from the State
Department of Health Services to operate such a service.



1256.2.  (a) (1) No general acute care hospital may promulgate
policies or implement practices that determine differing standards of
obstetrical care based upon a patient's source of payment or ability
to pay for medical services.
   (2) Each hospital holding an obstetrical services permit shall
provide the licensing and certification division of the department
with a written policy statement reflecting paragraph (1) and shall
post written notices of this policy in the obstetrical admitting
areas of the hospital by July 1, 1999. Notices posted pursuant to
this section shall be posted in the predominant language or languages
spoken in the hospital's service area.
   (b) It shall constitute unprofessional conduct within the meaning
of the Medical Practice Act, Chapter 5 (commencing with Section 2000)
of Division 2 of the Business and Professions Code, for a physician
or surgeon to deny, or threaten to withhold pain management services
from a woman in active labor, based upon that patient's source of
payment, or ability to pay for medical services.



1257.  The state department may delegate to local health departments
the authority to verify compliance with the licensing and approval
provisions of this chapter, to provide consultation, and to recommend
disciplinary action by the department against those licensed or
approved under the provisions of this chapter. In exercising the
authority so delegated, the local health department shall conform to
the requirements of this chapter and to the rules and regulations of
the state department. Payment to the local health departments for
services performed pursuant to this section shall be in accordance
with a budget submitted by the local health department and approved
by the state department. Such expenditures shall not exceed amounts
appropriated by the Legislature for the purpose of such inspection
and enforcement.



1257.5.  (a) All registered nurses, certified nurse assistants,
licensed vocational nurses, and physicians working in skilled nursing
facilities, as defined in subdivision (c) of Section 1250, or
congregate living health facilities, as defined in subdivision (i) of
Section 1250, shall participate in a training program, to be
prescribed by the department, that focuses on preventing and
eliminating discrimination based on sexual orientation and gender
identity.
   (b) The department may incorporate the training prescribed in
subdivision (a) into any existing training program that is designed
to prevent or eliminate discrimination in senior care facilities.
   (c) The department may charge each licensee who is subject to
subdivision (a) a fee associated with determining compliance. The fee
shall not exceed the department's costs for the enforcement of this
section.
   (d) "Sexual orientation" and "gender identity" have the same
meanings as those terms are used in Section 422.56 of the Penal Code.



1257.7.  (a) After July 1, 2010, all hospitals licensed pursuant to
subdivisions (a), (b), and (f) of Section 1250 shall conduct, not
less than annually, a security and safety assessment and, using the
assessment, develop, and annually update based on the assessment, a
security plan with measures to protect personnel, patients, and
visitors from aggressive or violent behavior. The security and safety
assessment shall examine trends of aggressive or violent behavior at
the facility. These hospitals shall track incidents of aggressive or
violent behavior as part of the quality assessment and improvement
program and for the purposes of developing a security plan to deter
and manage further aggressive or violent acts of a similar nature.
The plan may include, but shall not be limited to, security
considerations relating to all of the following:
   (1) Physical layout.
   (2) Staffing.
   (3) Security personnel availability.
   (4) Policy and training related to appropriate responses to
violent acts.
   (5) Efforts to cooperate with local law enforcement regarding
violent acts in the facility.
   In developing this plan, the hospital shall consider guidelines or
standards on violence in health care facilities issued by the
department, the Division of Occupational Safety and Health, and the
federal Occupational Safety and Health Administration. As part of the
security plan, a hospital shall adopt security policies including,
but not limited to, personnel training policies designed to protect
personnel, patients, and visitors from aggressive or violent
behavior. In developing the plan and the assessment, the hospital
shall consult with affected employees, including the recognized
collective bargaining agent or agents, if any, and members of the
hospital medical staff organized pursuant to Section 2282 of the
Business and Professions Code. This consultation may occur through
hospital committees.
   (b) The individual or members of a hospital committee responsible
for developing the security plan shall be familiar with all of the
following:
   (1) The role of security in hospital operations.
   (2) Hospital organization.
   (3) Protective measures, including alarms and access control.
   (4) The handling of disturbed patients, visitors, and employees.
   (5) Identification of aggressive and violent predicting factors.
   (6) Hospital safety and emergency preparedness.
   (7) The rudiments of documenting and reporting crimes, including,
by way of example, not disturbing a crime scene.
   (c) The hospital shall have sufficient personnel to provide
security pursuant to the security plan developed pursuant to
subdivision (a). Persons regularly assigned to provide security in a
hospital setting shall be trained regarding the role of security in
hospital operations, including the identification of aggressive and
violent predicting factors and management of violent disturbances.
   (d) Any act of assault, as defined in Section 240 of the Penal
Code, or battery, as defined in Section 242 of the Penal Code, that
results in injury or involves the use of a firearm or other dangerous
weapon, against any on-duty hospital personnel shall be reported to
the local law enforcement agency within 72 hours of the incident. Any
other act of assault, as defined in Section 240 of the Penal Code,
or battery, as defined in Section 242 of the Penal Code, against any
on-duty hospital personnel may be reported to the local law
enforcement agency within 72 hours of the incident. No health
facility or employee of a health facility who reports a known or
suspected instance of assault or battery pursuant to this section
shall be civilly or criminally liable for any report required by this
section. No health facility or employee of a health facility who
reports a known or suspected instance of assault or battery that is
authorized, but not required, by this section, shall be civilly or
criminally liable for the report authorized by this section unless it
can be proven that a false report was made and the health facility
or its employee knew that the report was false or was made with
reckless disregard of the truth or falsity of the report, and any
health facility or employee of a health facility who makes a report
known to be false or with reckless disregard of the truth or falsity
of the report shall be liable for any damages caused. Any individual
knowingly interfering with or obstructing the lawful reporting
process shall be guilty of a misdemeanor. "Dangerous weapon," as used
in this section, means any weapon the possession or concealed
carrying of which is prohibited by Section 12020 of the Penal Code.




1257.7.  (a) After July 1, 2010, all hospitals licensed pursuant to
subdivisions (a), (b), and (f) of Section 1250 shall conduct, not
less than annually, a security and safety assessment and, using the
assessment, develop, and annually update based on the assessment, a
security plan with measures to protect personnel, patients, and
visitors from aggressive or violent behavior. The security and safety
assessment shall examine trends of aggressive or violent behavior at
the facility. These hospitals shall track incidents of aggressive or
violent behavior as part of the quality assessment and improvement
program and for the purposes of developing a security plan to deter
and manage further aggressive or violent acts of a similar nature.
The plan may include, but shall not be limited to, security
considerations relating to all of the following:
   (1) Physical layout.
   (2) Staffing.
   (3) Security personnel availability.
   (4) Policy and training related to appropriate responses to
violent acts.
   (5) Efforts to cooperate with local law enforcement regarding
violent acts in the facility.
   In developing this plan, the hospital shall consider guidelines or
standards on violence in health care facilities issued by the
department, the Division of Occupational Safety and Health, and the
federal Occupational Safety and Health Administration. As part of the
security plan, a hospital shall adopt security policies including,
but not limited to, personnel training policies designed to protect
personnel, patients, and visitors from aggressive or violent
behavior. In developing the plan and the assessment, the hospital
shall consult with affected employees, including the recognized
collective bargaining agent or agents, if any, and members of the
hospital medical staff organized pursuant to Section 2282 of the
Business and Professions Code. This consultation may occur through
hospital committees.
   (b) The individual or members of a hospital committee responsible
for developing the security plan shall be familiar with all of the
following:
   (1) The role of security in hospital operations.
   (2) Hospital organization.
   (3) Protective measures, including alarms and access control.
   (4) The handling of disturbed patients, visitors, and employees.
   (5) Identification of aggressive and violent predicting factors.
   (6) Hospital safety and emergency preparedness.
   (7) The rudiments of documenting and reporting crimes, including,
by way of example, not disturbing a crime scene.
   (c) The hospital shall have sufficient personnel to provide
security pursuant to the security plan developed pursuant to
subdivision (a). Persons regularly assigned to provide security in a
hospital setting shall be trained regarding the role of security in
hospital operations, including the identification of aggressive and
violent predicting factors and management of violent disturbances.
   (d) Any act of assault, as defined in Section 240 of the Penal
Code, or battery, as defined in Section 242 of the Penal Code, that
results in injury or involves the use of a firearm or other dangerous
weapon, against any on-duty hospital personnel shall be reported to
the local law enforcement agency within 72 hours of the incident. Any
other act of assault, as defined in Section 240 of the Penal Code,
or battery, as defined in Section 242 of the Penal Code, against any
on-duty hospital personnel may be reported to the local law
enforcement agency within 72 hours of the incident. No health
facility or employee of a health facility who reports a known or
suspected instance of assault or battery pursuant to this section
shall be civilly or criminally liable for any report required by this
section. No health facility or employee of a health facility who
reports a known or suspected instance of assault or battery that is
authorized, but not required, by this section, shall be civilly or
criminally liable for the report authorized by this section unless it
can be proven that a false report was made and the health facility
or its employee knew that the report was false or was made with
reckless disregard of the truth or falsity of the report, and any
health facility or employee of a health facility who makes a report
known to be false or with reckless disregard of the truth or falsity
of the report shall be liable for any damages caused. Any individual
knowingly interfering with or obstructing the lawful reporting
process shall be guilty of a misdemeanor. "Dangerous weapon," as used
in this section, means any weapon the possession or concealed
carrying of which is prohibited by any provision listed in Section
16590 of the Penal Code.



1257.8.  (a) All hospital employees regularly assigned to the
emergency department shall receive, by July 1, 1995, and thereafter,
on a continuing basis as provided for in the security plan developed
pursuant to Section 1257.7, security education and training relating
to the following topics:
   (1) General safety measures.
   (2) Personal safety measures.
   (3) The assault cycle.
   (4) Aggression and violence predicting factors.
   (5) Obtaining patient history from a patient with violent
behavior.
   (6) Characteristics of aggressive and violent patients and
victims.
   (7) Verbal and physical maneuvers to diffuse and avoid violent
behavior.
   (8) Strategies to avoid physical harm.
   (9) Restraining techniques.
   (10) Appropriate use of medications as chemical restraints.
   (11) Any resources available to employees for coping with
incidents of violence, including, by way of example, critical
incident stress debriefing or employee assistance programs.
   (b) As provided in the security plan developed pursuant to Section
1257.7, members of the medical staff of each hospital and all other
practitioners, including, but not limited to, nurse practitioners,
physician assistants, and other personnel, who are regularly assigned
to the emergency department or other departments identified in the
security plan shall receive the same training as that provided to
hospital employees or, at a minimum, training determined to be
sufficient pursuant to the security plan.
   (c) Temporary personnel shall be oriented as required pursuant to
the security plan. This section shall not be construed to preempt
state law or regulations generally affecting temporary personnel in
hospitals.



1257.9.  (a) (1) The department shall recommend training for general
acute care hospitals, as defined in subdivision (a) of Section 1250,
and special hospitals, as defined in subdivision (f) of Section
1250, that is intended to improve breast-feeding rates among mothers
and infants. This recommended training should be designed for general
acute care hospitals that provide maternity care and have exclusive
patient breast-feeding rates in the lowest 25 percent, according to
the data published yearly by the State Department of Public Health,
when ranked from highest to lowest rates. The training offered shall
include a minimum of eight hours of training provided to appropriate
administrative and supervisory staff on hospital policies and
recommendations that promote exclusive breast-feeding. Hospitals that
meet the minimum criteria for exclusive breast-feeding rates
prescribed in the most current Healthy People Guidelines of the
United States Department of Health and Human Services shall be
excluded from the training requirements recommended by this
paragraph.
   (2) The department shall notify the hospital director or other
person in charge of a hospital to which paragraph (1) applies, that
the eight-hour model training course developed pursuant to
subdivision (b) of Section 123360, is available, upon request, to the
hospital.
   (b) The recommendations provided for in this section are advisory
only. Nothing in this section shall require a hospital to comply with
the training recommended by this section. Section 1290 shall not
apply to this section, nor shall meeting the recommendations of this
section be a condition of licensure.



1258.  No health facility which permits sterilization operations for
contraceptive purposes to be performed therein, nor the medical
staff of such health facility, shall require the individual upon whom
such a sterilization operation is to be performed to meet any
special nonmedical qualifications, which are not imposed on
individuals seeking other types of operations in the health facility.
Such prohibited nonmedical qualifications shall include, but not be
limited to, age, marital status, and number of natural children.
   Nothing in this section shall prohibit requirements relating to
the physical or mental condition of the individual or affect the
right of the attending physician to counsel or advise his patient as
to whether or not sterilization is appropriate. This section shall
not affect existing law with respect to individuals below the age of
majority.


1259.  (a) The Legislature finds and declares that California is
becoming a land of people whose languages and cultures give the state
a global quality. The Legislature further finds and declares that
access to basic health care services is the right of every resident
of the state, and that access to information regarding basic health
care services is an essential element of that right.
   Therefore, it is the intent of the Legislature that where language
or communication barriers exist between patients and the staff of
any general acute care hospital, arrangements shall be made for
interpreters or bilingual professional staff to ensure adequate and
speedy communication between patients and staff.
   (b) As used in this section:
   (1) "Interpreter" means a person fluent in English and in the
necessary second language, who can accurately speak, read, and
readily interpret the necessary second language, or a person who can
accurately sign and read sign language. Interpreters shall have the
ability to translate the names of body parts and to describe
competently symptoms and injuries in both languages. Interpreters may
include members of the medical or professional staff.
   (2) "Language or communication barriers" means:
   (A) With respect to spoken language, barriers which are
experienced by individuals who are limited-English-speaking or
non-English-speaking individuals who speak the same primary language
and who comprise at least 5 percent of the population of the
geographical area served by the hospital or of the actual patient
population of the hospital. In cases of dispute, the state department
shall determine, based on objective data, whether the 5 percent
population standard applies to a given hospital.
   (B) With respect to sign language, barriers which are experienced
by individuals who are deaf and whose primary language is sign
language.
   (c) To ensure access to health care information and services for
limited-English-speaking or non-English-speaking residents and deaf
residents, licensed general acute care hospitals shall:
   (1) Review existing policies regarding interpreters for patients
with limited-English proficiency and for patients who are deaf,
including the availability of staff to act as interpreters.
   (2) Adopt and review annually a policy for providing language
assistance services to patients with language or communication
barriers. The policy shall include procedures for providing, to the
extent possible, as determined by the hospital, the use of an
interpreter whenever a language or communication barrier exists,
except where the patient, after being informed of the availability of
the interpreter service, chooses to use a family member or friend
who volunteers to interpret. The procedures shall be designed to
maximize efficient use of interpreters and minimize delays in
providing interpreters to patients. The procedures shall ensure, to
the extent possible, as determined by the hospital, that interpreters
are available, either on the premises or accessible by telephone, 24
hours a day. The hospital shall annually transmit to the state
department a copy of the updated policy and shall include a
description of its efforts to ensure adequate and speedy
communication between patients with language or communication
barriers and staff.
   (3) Develop, and post in conspicuous locations, notices that
advise patients and their families of the availability of
interpreters, the procedure for obtaining an interpreter and the
telephone numbers where complaints may be filed concerning
interpreter service problems, including, but not limited to, a T.D.D.
number for the hearing impaired. The notices shall be posted, at a
minimum, in the emergency room, the admitting area, the entrance, and
in outpatient areas. Notices shall inform patients that interpreter
services are available upon request, shall list the languages for
which interpreter services are available, shall instruct patients to
direct complaints regarding interpreter services to the state
department, and shall provide the local address and telephone number
of the state department, including, but not limited to, a T.D.D.
number for the hearing impaired.
   (4) Identify and record a patient's primary language and dialect
on one or more of the following: patient medical chart, hospital
bracelet, bedside notice, or nursing card.
   (5) Prepare and maintain as needed a list of interpreters who have
been identified as proficient in sign language and in the languages
of the population of the geographical area serviced who have the
ability to translate the names of body parts, injuries, and symptoms.
   (6) Notify employees of the hospital's commitment to provide
interpreters to all patients who request them.
   (7) Review all standardized written forms, waivers, documents, and
informational materials available to patients upon admission to
determine which to translate into languages other than English.
   (8) Consider providing its nonbilingual staff with standardized
picture and phrase sheets for use in routine communications with
patients who have language or communication barriers.
   (9) Consider developing community liaison groups to enable the
hospital and the limited-English-speaking and deaf communities to
ensure the adequacy of the interpreter services.
   (d) Noncompliance with this section shall be reportable to
licensing authorities.
   (e) Section 1290 shall not apply to this section.



1259.5.  By January 1, 1995, each general acute care hospital, acute
psychiatric hospital, special hospital, psychiatric health facility,
and chemical dependency recovery hospital shall establish written
policies and procedures to screen patients routinely for the purpose
of detecting spousal or partner abuse. The policies shall include
guidelines on all of the following:
   (a) Identifying, through routine screening, spousal or partner
abuse among patients.
   (b) Documenting patient injuries or illnesses attributable to
spousal or partner abuse.
   (c) Educating appropriate hospital staff about the criteria for
identifying, and the procedures for handling, patients whose injuries
or illnesses are attributable to spousal or partner abuse.
   (d) Advising patients exhibiting signs of spousal or partner abuse
of crisis intervention services that are available either through
the hospital facility or through community-based crisis intervention
and counseling services.
   (e) Providing to patients who exhibit signs of spousal or partner
abuse information on domestic violence and a referral list, to be
updated periodically, of private and public community agencies that
provide, or arrange for, evaluation of and care for persons
experiencing spousal or partner abuse, including, but not limited to,
hot lines, local battered women's shelters, legal services, and
information about temporary restraining orders.



1260.  (a) Except as provided in subdivision (b), any member of the
board of directors of a nonprofit corporation that is subject to
Section 5914 of the Corporations Code, who negotiates the terms and
conditions of a sale or transfer of assets, as described in Section
5914 of the Corporations Code, is prohibited from receiving, directly
or indirectly, any salary, compensation, payment, or other form of
remuneration from the for-profit corporation or entity or mutual
benefit corporation following the close of the sale or other transfer
of assets. This prohibition shall not apply to any reimbursement or
payment made to a member of the board of directors, who is a
physician or other health care provider, for direct patient care
services provided to patients covered by a health insurer, health
care service plan, employer, or other entity that provides health
care coverage, and that is owned, operated, or affiliated with the
purchasing for-profit corporation or entity, provided that the
amounts payable for the services rendered are no greater than the
amounts payable to other physicians or health care providers
providing the same or similar services.
   For the purpose of this section, "direct patient care services"
mean health care services provided directly to a patient, and do not
include services provided through an intermediary. Further, in order
to qualify for the exemption in this subdivision, the direct patient
care services must be health care services that are regularly
provided by other physicians or other health care providers in the
community who are also receiving reimbursements or payments from the
same health insurer, health care service plan, employer, or other
entity that is owned or operated by, or affiliated with, the
purchasing for-profit corporation or entity.
   (b) After a period of two years following the close of the sale or
other transfer of assets, a person who was a member of the board of
directors of the nonprofit corporation who is prohibited from
receiving any remuneration from the for-profit corporation or entity
or mutual benefit corporation under subdivision (a) may enter into
usual and customary business transactions with the for-profit
corporation or entity or mutual benefit corporation so long as the
following facts are established:
   (1) Prior to authorizing or approving the transaction, the
representative of the for-profit corporation or entity or mutual
benefit corporation considered and in good faith determined after
reasonable investigation under the circumstances that the corporation
could not have obtained a more advantageous arrangement with
reasonable effort under the circumstances.
   (2) The for-profit corporation or entity or mutual benefit
corporation, in fact could not have obtained a more advantageous
arrangement with reasonable effort under the circumstances.
   (c) Any person who is a member of management of the nonprofit
corporation and who presents information or opinions to the board
regarding the sale or other transfer of assets as described in
subdivision (a) that are relied upon, or considered by, any of the
board members in making decisions regarding the sale or transfer, may
make a written affirmative declaration that he or she will not work
for, or receive any form of remuneration from, the for-profit
corporation or entity or the mutual benefit corporation in the
future.
   (d) In making any decision regarding the sale or other transfer of
the nonprofit corporation's assets, as described in Section 5914 of
the Corporations Code, the board of the nonprofit corporation is
prohibited from substantially relying on any information presented by
any person to whom subdivision (c) applies who has not made a
written affirmative declaration pursuant to subdivision (c). This
subdivision shall not apply to any person whose only role in the sale
or transfer is to provide to the nonprofit corporation exclusively
factual information about the nonprofit corporation, community,
financial status, or other similar data.
   (e) In performing those duties of a director set forth in
subdivision (d), the board of directors may contract with independent
counsel, accountants, financial analysts, or other professionals
whom the board believes to be reliable and competent in the matters
presented, to review and evaluate information and advice presented by
an employee who has not signed an affirmative declaration pursuant
to subdivision (c). Any director who substantially relies on
information and advice presented by such an independent professional
shall be deemed to have not violated subdivision (d).



1260.1.  (a) Except as provided in subdivision (b), any member of
the board of directors of a nonprofit corporation that is subject to
Section 5920 of the Corporations Code, who negotiates the terms and
conditions of a sale or transfer of assets, as described in Section
5920 of the Corporations Code, is prohibited from receiving, directly
or indirectly, any salary, compensation, payment, or other form of
remuneration from the purchasing public benefit corporation or entity
following the close of the sale or other transfer of assets. This
prohibition shall not apply to any reimbursement or payment made to a
member of the board of directors, who is a physician or other health
care provider, for direct patient care services provided to patients
covered by a health insurer, health care service plan, employer, or
other entity that provides health care coverage, and that is owned,
operated, or affiliated with the purchasing public benefit
corporation or entity, provided that the amounts payable for the
services rendered are no greater than the amounts payable to other
physicians or health care providers providing the same or similar
services.
   For the purpose of this section, "direct patient care services"
means health care services provided directly to a patient, and does
not include services provided through an intermediary. Further, in
order to qualify for the exemption in this subdivision, the direct
patient care services must be health care services that are regularly
provided by other physicians or other health care providers in the
community who are also receiving reimbursements or payments from the
same health insurer, health care service plan, employer, or other
entity that is owned or operated by, or affiliated with, the
purchasing public benefit corporation or entity.
   (b) After a period of two years following the close of the sale or
other transfer of assets, a person who was a member of the board of
directors of the selling nonprofit corporation who is prohibited from
receiving any remuneration from the purchasing public benefit
corporation or entity under subdivision (a) may enter into usual and
customary business transactions with the purchasing public benefit
corporation or entity so long as the following facts are established:
   (1) Prior to authorizing or approving the transaction, the
representative of the purchasing public benefit corporation or entity
considered and in good faith determined after reasonable
investigation under the circumstances that the purchasing public
benefit corporation could not have obtained a more advantageous
arrangement with reasonable effort under the circumstances.
   (2) The purchasing public benefit corporation or entity, in fact,
could not have obtained a more advantageous arrangement with
reasonable effort under the circumstances.
   (c) Any person who is a member of management of the selling
nonprofit corporation and who presents information or opinions to the
board regarding the sale or other transfer of assets as described in
subdivision (a) that are relied upon, or considered by, any of the
board members in making decisions regarding the sale or transfer, may
make a written affirmative declaration that he or she will not work
for, or receive any form of remuneration from, the purchasing public
benefit corporation or entity in the future.
   (d) In making any decision regarding the sale or other transfer of
the nonprofit corporation's assets, as described in Section 5920 of
the Corporations Code, the board of the selling nonprofit corporation
is prohibited from substantially relying on any information
presented by any person to whom subdivision (c) applies who has not
made a written affirmative declaration pursuant to subdivision (c).
This subdivision shall not apply to any person whose only role in the
sale or transfer is to provide to the selling nonprofit corporation
exclusively factual information about the selling nonprofit
corporation, community, financial status, or other similar data.
   (e) In performing those duties of a director set forth in
subdivision (d), the board of directors may contract with independent
counsel, accountants, financial analysts, or other professionals
whom the board believes to be reliable and competent in the matters
presented, to review and evaluate information and advice presented by
an employee who has not signed an affirmative declaration pursuant
to subdivision (c). Any director who substantially relies on
information and advice presented by the independent professional
shall be deemed to have not violated subdivision (d).



1261.  (a) A health facility shall allow a patient's domestic
partner, the children of the patient's domestic partner, and the
domestic partner of the patient's parent or child to visit, unless
one of the following is met:
   (1) No visitors are allowed.
   (2) The facility reasonably determines that the presence of a
particular visitor would endanger the health or safety of a patient,
member of the health facility staff, or other visitor to the health
facility, or would significantly disrupt the operations of a
facility.
   (3) The patient has indicated to health facility staff that the
patient does not want this person to visit.
   (b) This section may not be construed to prohibit a health
facility from otherwise establishing reasonable restrictions upon
visitation, including restrictions upon the hours of visitation and
number of visitors.
   (c) For purposes of this section, "domestic partner" has the same
meaning as that term is used in Section 297 of the Family Code.



1261.3.  (a) Notwithstanding any other provision of law, for a
patient aged 50 years or older, a registered nurse or licensed
pharmacist may administer in a skilled nursing facility, as defined
in subdivision (c) of Section 1250, influenza and pneumococcal
immunizations pursuant to standing orders and without
patient-specific orders if all of the following criteria are met:
   (1) The skilled nursing facility medical director, as defined in
Section 72305 of Title 22 of the California Code of Regulations, has
approved the immunization standing orders established by the
facility.
   (2) The standing orders meet the recommendations of the Advisory
Committee on Immunization Practices (ACIP) of the federal Centers for
Disease Control and Prevention.
   (b) Nothing in this section amends, alters, or restricts the scope
of registered nurse practice including, but not limited to, the
scope of practice set forth in Article 2 (commencing with Section
2725) of Chapter 6 of Division 2 of the Business and Professions
Code, the implementing regulations, and interpretative bulletins or
practice advisories issued by the Board of Registered Nursing.



1261.5.  (a) The number of oral dosage form or suppository form
drugs provided by a pharmacy to a health facility licensed pursuant
to subdivision (c) or (d), or both subdivisions (c) and (d), of
Section 1250 of this code for storage in a secured emergency supplies
container, pursuant to Section 4119 of the Business and Professions
Code, shall be limited to 48. The State Department of Public Health
may limit the number of doses of each drug available to not more than
16 doses of any separate drug dosage form in each emergency supply.
   (b) Not more than four of the 48 oral form or suppository form
drugs secured for storage in the emergency supplies container shall
be psychotherapeutic drugs, except that the department may grant a
program flexibility request to the facility to increase the number of
psychotherapeutic drugs in the emergency supplies container to not
more than 10 if the facility can demonstrate the necessity for an
increased number of drugs based on the needs of the patient
population at the facility. In addition, the four oral form or
suppository form psychotherapeutic drug limit shall not apply to a
special treatment program service unit distinct part, as defined in
Section 1276.9. The department shall limit the number of doses of
psychotherapeutic drugs available to not more than four doses in each
emergency supply. Nothing in this section shall alter or diminish
informed consent requirements, including, but not limited to, the
requirements of Section 1418.9.
   (c) Any limitations established pursuant to subdivisions (a) and
(b) on the number and quantity of oral dosage or suppository form
drugs provided by a pharmacy to a health facility licensed pursuant
to subdivision (c) or (d), or both subdivisions (c) and (d), of
Section 1250 for storage in a secured emergency supplies container
shall not apply to an automated drug delivery system, as defined in
Section 1261.6, when a pharmacist controls access to the drugs.



1261.6.  (a) (1) For purposes of this section and Section 1261.5, an
"automated drug delivery system" means a mechanical system that
performs operations or activities, other than compounding or
administration, relative to the storage, dispensing, or distribution
of drugs. An automated drug delivery system shall collect, control,
and maintain all transaction information to accurately track the
movement of drugs into and out of the system for security, accuracy,
and accountability.
   (2) For purposes of this section, "facility" means a health
facility licensed pursuant to subdivision (c), (d), or (k), of
Section 1250 that has an automated drug delivery system provided by a
pharmacy.
   (3) For purposes of this section, "pharmacy services" means the
provision of both routine and emergency drugs and biologicals to meet
the needs of the patient, as prescribed by a physician.
   (b) Transaction information shall be made readily available in a
written format for review and inspection by individuals authorized by
law. These records shall be maintained in the facility for a minimum
of three years.
   (c) Individualized and specific access to automated drug delivery
systems shall be limited to facility and contract personnel
authorized by law to administer drugs.
   (d) (1) The facility and the pharmacy shall develop and implement
written policies and procedures to ensure safety, accuracy,
accountability, security, patient confidentiality, and maintenance of
the quality, potency, and purity of stored drugs. Policies and
procedures shall define access to the automated drug delivery system
and limits to access to equipment and drugs.
   (2) All policies and procedures shall be maintained at the
pharmacy operating the automated drug delivery system and the
location where the automated drug delivery system is being used.
   (e) When used as an emergency pharmaceutical supplies container,
drugs removed from the automated drug delivery system shall be
limited to the following:
   (1) A new drug order given by a prescriber for a patient of the
facility for administration prior to the next scheduled delivery from
the pharmacy, or 72 hours, whichever is less. The drugs shall be
retrieved only upon authorization by a pharmacist and after the
pharmacist has reviewed the prescriber's order and the patient's
profile for potential contraindications and adverse drug reactions.
   (2) Drugs that a prescriber has ordered for a patient on an
as-needed basis, if the utilization and retrieval of those drugs are
subject to ongoing review by a pharmacist.
   (3) Drugs designed by the patient care policy committee or
pharmaceutical service committee of the facility as emergency drugs
or acute onset drugs. These drugs may be retrieved from an automated
drug delivery system pursuant to the order of a prescriber for
emergency or immediate administration to a patient of the facility.
Within 48 hours after retrieval under this paragraph, the case shall
be reviewed by a pharmacist.
   (f) When used to provide pharmacy services pursuant to Section
4119.1 of the Business and Professions Code, the automated drug
delivery system shall be subject to all of the following
requirements:
   (1) Drugs removed from the automated drug delivery system for
administration to a patient shall be in properly labeled units of
administration containers or packages.
   (2) A pharmacist shall review and approve all orders prior to a
drug being removed from the automated drug delivery system for
administration to a patient. The pharmacist shall review the
prescriber's order and the patient's profile for potential
contraindications and adverse drug reactions.
   (3) The pharmacy providing services to the facility pursuant to
Section 4119.1 of the Business and Professions Code shall control
access to the drugs stored in the automated drug delivery system.
   (4) Access to the automated drug delivery system shall be
controlled and tracked using an identification or password system or
biosensor.
   (5) The automated drug delivery system shall make a complete and
accurate record of all transactions that will include all users
accessing the system and all drugs added to, or removed from, the
system.
   (6) After the pharmacist reviews the prescriber's order, access by
licensed personnel to the automated drug delivery system shall be
limited only to drugs ordered by the prescriber and reviewed by the
pharmacist and that are specific to the patient. When the prescriber'
s order requires a dosage variation of the same drug, licensed
personnel shall have access to the drug ordered for that scheduled
time of administration.
   (7) (A) Systems that allow licensed personnel to have access to
multiple drugs and are not patient specific in their design, shall be
allowed under this subdivision if those systems have electronic and
mechanical safeguards in place to ensure that the drugs delivered to
the patient are specific to that patient. Each facility using such an
automated drug system shall notify the department in writing prior
to the utilization of the system. The notification submitted to the
department pursuant to this paragraph shall include, but is not
limited to, information regarding system design, personnel with
system access, and policies and procedures covering staff training,
storage, and security, and the facility's administration of these
types of systems.
   (B) As part of its routine oversight of these facilities, the
department shall review a facility's medication training, storage,
and security, and its administration procedures related to its use of
an automated drug delivery system to ensure that adequate staff
training and safeguards are in place to make sure that the drugs
delivered are appropriate for the patient. If the department
determines that a facility is not in compliance with this section,
the department may revoke its authorization to use automated drug
delivery systems granted under subparagraph (A).
   (C) This paragraph shall remain in effect only until January 1,
2012, unless a later enacted statute is enacted on or before January
1, 2012, deletes or extends that date.
   (g) The stocking of an automated drug delivery system shall be
performed by a pharmacist. If the automated drug delivery system
utilizes removable pockets, cards, drawers, or similar technology,
the stocking system may be done outside of the facility and be
delivered to the facility if all of the following conditions are met:
   (1) The task of placing drugs into the removable pockets, cards,
or drawers is performed by a pharmacist or by an intern pharmacist or
a pharmacy technician working under the direct supervision of a
pharmacist.
   (2) The removable pockets, cards, or drawers are transported
between the pharmacy and the facility in a secure tamper-evident
container.
   (3) The facility, in conjunction with the pharmacy, has developed
policies and procedures to ensure that the pockets, cards, or drawers
are properly placed into the automated drug delivery system.
   (h) Review of the drugs contained within, and the operation and
maintenance of, the automated drug delivery system shall be done in
accordance with law and shall be the responsibility of the pharmacy.
The review shall be conducted on a monthly basis by a pharmacist and
shall include a physical inspection of the drugs in the automated
drug delivery system, an inspection of the automated drug delivery
system machine for cleanliness, and a review of all transaction
records in order to verify the security and accountability of the
system.
   (i) Drugs dispensed from an automated drug delivery system that
meets the requirements of this section shall not be subject to the
labeling requirements of Section 4076 of the Business and Professions
Code or Section 111480 of this code if the drugs to be placed into
the automated drug delivery system are in unit dose packaging or unit
of use and if the information required by Section 4076 of the
Business and Professions Code and Section 111480 of this code is
readily available at the time of drug administration. For purposes of
this section, unit dose packaging includes blister pack cards.




1262.  (a) When a mental health patient is being discharged from one
of the facilities specified in subdivision (c), the patient and the
patient's conservator, guardian, or other legally authorized
representative shall be given a written aftercare plan prior to the
patient's discharge from the facility. The written aftercare plan
shall include, to the extent known, all of the following components:
   (1) The nature of the illness and followup required.
   (2) Medications including side effects and dosage schedules. If
the patient was given an informed consent form with his or her
medications, the form shall satisfy the requirement for information
on side effects of the medications.
   (3) Expected course of recovery.
   (4) Recommendations regarding treatment that are relevant to the
patient's care.
   (5) Referrals to providers of medical and mental health services.
   (6) Other relevant information.
   (b) The patient shall be advised by facility personnel that he or
she may designate another person to receive a copy of the aftercare
plan. A copy of the aftercare plan shall be given to any person
designated by the patient.
   (c) Subdivision (a) applies to all of the following facilities:
   (1) A state mental hospital.
   (2) A general acute care hospital as described in subdivision (a)
of Section 1250.
   (3) An acute psychiatric hospital as described in subdivision (b)
of Section 1250.
   (4) A psychiatric health facility as described in Section 1250.2.
   (5) A mental health rehabilitation center as described in Section
5675 of the Welfare and Institutions Code.
   (6) A skilled nursing facility with a special treatment program,
as described in Section 51335 and Sections 72443 to 72475, inclusive,
of Title 22 of the California Code of Regulations.
   (d) For purposes of this section, "mental health patient" means a
person who is admitted to the facility primarily for the diagnosis or
treatment of a mental disorder.



1262.4.  (a) No hospital, as defined in subdivisions (a), (b), and
(f) of Section 1250, may cause the transfer of homeless patients from
one county to another county for the purpose of receiving supportive
services from a social services agency, health care service
provider, or nonprofit social services provider within the other
county, without prior notification to, and authorization from, the
social services agency, health care service provider, or nonprofit
social services provider.
   (b) For purposes of this section, "homeless patient" means an
individual who lacks a fixed and regular nighttime residence, or who
has a primary nighttime residence that is a supervised publicly or
privately operated shelter designed to provide temporary living
accommodations, or who is residing in a public or private place that
was not designed to provide temporary living accommodations or to be
used as a sleeping accommodation for human beings.



1262.5.  (a) Each hospital shall have a written discharge planning
policy and process.
   (b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to discharge for those
patients who are likely to suffer adverse health consequences upon
discharge if there is no adequate discharge planning. If the hospital
determines that the patient and family members or interested persons
need to be counseled to prepare them for posthospital care, the
hospital shall provide for that counseling.
   (c) The process required by subdivision (a) shall require that the
patient be informed, orally or in writing, of the continuing health
care requirements following discharge from the hospital. The right to
information regarding continuing health care requirements following
discharge shall apply to the person who has legal responsibility to
make decisions regarding medical care on behalf of the patient, if
the patient is unable to make those decisions for himself or herself.
In addition, a patient may request that friends or family members be
given this information, even if the patient is able to make his or
her own decisions regarding medical care.
   (d) (1) A transfer summary shall accompany the patient upon
transfer to a skilled nursing or intermediate care facility or to the
distinct part-skilled nursing or intermediate care service unit of
the hospital. The transfer summary shall include essential
information relative to the patient's diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.
   (2) A copy of the transfer summary shall be given to the patient
and the patient's legal representative, if any, prior to transfer to
a skilled nursing or intermediate care facility.
   (e) A hospital shall establish and implement a written policy to
ensure that each patient receives, at the time of discharge,
information regarding each medication dispensed, pursuant to Section
4074 of the Business and Professions Code.
   (f) A hospital shall provide every patient anticipated to be in
need of long-term care at the time of discharge with contact
information for at least one public or nonprofit agency or
organization dedicated to providing information or referral services
relating to community-based long-term care options in the patient's
county of residence and appropriate to the needs and characteristics
of the patient. At a minimum, this information shall include contact
information for the area agency on aging serving the patient's county
of residence, local independent living centers, or other information
appropriate to the needs and characteristics of the patient.
   (g) A contract between a general acute care hospital and a health
care service plan that is issued, amended, renewed, or delivered on
or after January 1, 2002, may not contain a provision that prohibits
or restricts any health care facility's compliance with the
requirements of this section.



1262.6.  (a) Each hospital shall provide each patient, upon
admission or as soon thereafter as reasonably practical, written
information regarding the patient's right to the following:
   (1) To be informed of continuing health care requirements
following discharge from the hospital.
   (2) To be informed that, if the patient so authorizes, that a
friend or family member may be provided information about the patient'
s continuing health care requirements following discharge from the
hospital.
   (3) Participate actively in decisions regarding medical care. To
the extent permitted by law, participation shall include the right to
refuse treatment.
   (4) Appropriate pain assessment and treatment consistent with
Sections 124960 and 124961.
   (b) A hospital may include the information required by this
section with other notices to the patient regarding patient rights.
If a hospital chooses to include this information along with existing
notices to the patient regarding patient rights, this information
shall be provided when the hospital exhausts its existing inventory
of written materials and prints new written materials.




1262.7.  (a) A skilled nursing facility, as defined in subdivision
(c) of Section 1250, shall admit a patient only upon a physician's
order and only if the facility is able to provide necessary care for
the patient.
   (b) The administrator or designee of a skilled nursing facility
shall be responsible for screening patients for admission to the
facility to ensure that the facility admits only those patients for
whom it can provide necessary care. The administrator, or his or her
designee, shall conduct preadmission personal interviews as
appropriate with the patient's physician, the patient, the patient's
next of kin or sponsor, or the representative of the facility from
which the patient is being transferred. A telephone interview may be
conducted when a personal interview is not feasible.




1262.8.  (a) A noncontracting hospital shall not bill a patient who
is an enrollee of a health care service plan for poststabilization
care, except for applicable copayments, coinsurance, and deductibles,
unless one of the following conditions are met:
   (1) The patient or the patient's spouse or legal guardian refuses
to consent, pursuant to subdivision (f), for the patient to be
transferred to the contracting hospital as requested and arranged for
by the patient's health care service plan.
   (2) The hospital is unable to obtain the name and contact
information of the patient's health care service plan as provided in
subdivision (c).
   (b) If a patient with an emergency medical condition, as defined
by Section 1317.1, is covered by a health care service plan that
requires prior authorization for poststabilization care, a
noncontracting hospital, except as provided in subdivision (n),
shall, prior to providing poststabilization care, do all of the
following once the emergency medical condition has been stabilized,
as defined by Section 1317.1:
   (1) Seek to obtain the name and contact information of the patient'
s health care service plan. The hospital shall document its attempt
to ascertain this information in the patient's medical record, which
shall include requesting the patient's health care service plan
member card or asking the patient, or a family member or other person
accompanying the patient, if he or she can identify the patient's
health care service plan, or any other means known to the hospital
for accurately identifying the patient's health care service plan.
   (2) Contact the patient's health care service plan, or the health
plan's contracting medical provider, for authorization to provide
poststabilization care, if identification of the plan was obtained
pursuant to paragraph (1).
   (A) The hospital shall make the contact described in this
subparagraph by either following the instructions on the patient's
health care service plan member card or using the contact information
provided by the patient's health care service plan pursuant to
subdivision (j) or (k).
   (B) A representative of the hospital shall not be required to make
more than one telephone call to the health care service plan, or its
contracting medical provider, provided that in all cases the health
care service plan, or its contracting medical provider, shall be able
to reach a representative of the hospital upon returning the call,
should the plan, or its contracting medical provider, need to call
back. The representative of the hospital who makes the telephone call
may be, but is not required to be, a physician and surgeon.
   (3) Upon request of the patient's health care service plan, or the
health plan's contracting medical provider, provide to the plan, or
its contracting medical provider, the treating physician and surgeon'
s diagnosis and any other relevant information reasonably necessary
for the health care service plan or the plan's contracting medical
provider to make a decision to authorize poststabilization care or to
assume management of the patient's care by prompt transfer.
   (c) A noncontracting hospital that is not able to obtain the name
and contact information of the patient's health care service plan
pursuant to subdivision (b) is not subject to the requirements of
this section.
   (d) (1) A health care service plan, or its contracting medical
provider, that is contacted by a noncontracting hospital pursuant to
paragraph (2) of subdivision (b), shall, within 30 minutes from the
time the noncontracting hospital makes the initial contact, do either
of the following:
   (A) Authorize poststabilization care.
   (B) Inform the noncontracting hospital that it will arrange for
the prompt transfer of the enrollee to another hospital.
   (2) If the health care service plan, or its contracting medical
provider, does not notify the noncontracting hospital of its decision
pursuant to paragraph (1) within 30 minutes, the poststabilization
care shall be deemed authorized, and the health care service plan, or
its contracting medical provider, shall pay charges for the care, in
accordance with the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2) and any
regulation adopted thereunder.
   (3) If the health care service plan, or its contracting medical
provider, notified the noncontracting hospital that it would assume
management of the patient's care by prompt transfer, but either the
health care service plan or its contracting medical provider fails to
transfer the patient within a reasonable time, the poststabilization
care shall be deemed authorized, and the health care service plan,
or its contracting medical provider, shall pay charges, in accordance
with the Knox-Keene Health Care Service Plan Act of 1975 (Chapter
2.2 (commencing with Section 1340) of Division 2 of the Health and
Safety Code) and any regulation adopted thereunder, for the care
until the enrollee is transferred.
   (4) If the health care service plan, or its contracting medical
provider, provides authorization to the noncontracting hospital for
specified poststabilization care and services, the health care
service plan, or its contracting medical provider, shall be
responsible to pay for that authorized care.
   (e) If a health care service plan, or its contracting medical
provider, decides to assume management of the patient's care by
prompt transfer, the health care service plan, or its contracting
medical provider, shall do all of the following:
   (1) Arrange and pay the reasonable charges associated with the
transfer of the patient.
   (2) Pay for all of the immediately required medically necessary
care rendered to the patient prior to the transfer in order to
maintain the patient's clinical stability.
   (3) Be responsible for making all arrangements for the patient's
transfer, including, but not limited to, finding a contracted
facility available for the transfer of the patient.
   (f) (1) If the patient, or the patient's spouse or legal guardian
refuses to consent to the patient's transfer under subdivision (e),
the noncontracting hospital shall promptly provide a written notice
to the patient or the patient's spouse or legal guardian indicating
that the patient will be financially responsible for any further
poststabilization care provided by the hospital.
   (2) For patients whose primary language is one of the Medi-Cal
threshold languages, the notice shall be delivered to them in their
primary language.
   (3) The Department of Managed Health Care shall translate the
notice required by this subdivision in all Medi-Cal threshold
languages and make the translations available to the hospitals
subject to this section.
   (4) The written notice provided pursuant to this subdivision shall
include the following statement:

   THIS NOTICE MUST BE PROVIDED TO YOU UNDER CALIFORNIA LAW

   "You have received emergency care at a hospital that is not a part
of your health plan's provider network. Under state law, emergency
care must be paid by your health plan no matter where you get that
care. The doctor who is caring for you has decided that you may be
safely moved to another hospital for the additional care you need.
Because you no longer need emergency care, your health plan has not
authorized further care at this hospital. Your health plan has
arranged for you to be moved to a hospital that is in your health
plan's provider network.
   If you agree to be moved, your health plan will pay for your care
at that hospital. You will only have to pay for your deductible,
copayments, or coinsurance for care. You will not have to pay for
your deductible, copayments, or coinsurance for transportation costs
to another hospital that is covered by your health plan.
   IF YOU CHOOSE TO STAY AT THIS HOSPITAL FOR YOUR ADDITIONAL CARE,
YOU WILL HAVE TO PAY THE FULL COST OF CARE NOW THAT YOU NO LONGER
NEED EMERGENCY CARE. This cost may include the cost of the doctor or
doctors, the hospital, and any laboratory, radiology, or other
services that you receive.
   If you do not think you can be safely moved, talk to the doctor
about your concerns. If you would like additional help, you may
contact:
   Your health plan member services department. Look on your health
plan member card for that phone number. You can file a grievance with
your plan.
   The HMO Helpline at 888-HMO-2219. The HMO Helpline is available 24
hours a day, 7 days a week. The HMO Helpline can work with your
health plan to address your concerns, but you may still have to pay
the full cost of care at this hospital if you stay."

   (5) The hospital shall give one copy of the written notice
required by this subdivision to the patient, or the patient's spouse
or legal guardian, for signature and may retain a copy in the patient'
s medical record.
   (6) The hospital shall ensure prompt delivery of the notice to the
patient or his or her spouse or legal guardian. The hospital shall
obtain signed acceptance of the written notice required by this
subdivision, and signed acceptance of any other documents the
hospital requires for any further poststabilization care, from the
patient or the patient's spouse or legal guardian, and shall provide
the health care service plan, or its contracting medical provider,
with confirmation of the patient's, or his or her spouse or legal
guardian's, receipt of the written notice.
   (7) If the noncontracting hospital fails to meet the requirements
of this subdivision, the hospital shall not bill the patient or the
patient's health care service plan, or its contracting medical
provider, for poststabilization care provided to the patient.
   (8) If the patient, or the patient's spouse or legal guardian,
refuses to sign the notice, the noncontracting hospital shall
document in the patient's medical record that the notice was provided
and signature was refused. Upon the patient's refusal to sign, the
patient shall assume financial responsibility for any further
poststabilization care provided by the hospital.
   (9) The Department of Managed Health Care may, by regulation,
modify the wording of the notice required under this subdivision for
clarity, readability, and accuracy of the information provided.
   (10) The Department of Managed Health Care may, in conjunction
with consumer groups, health care service plans, and hospitals,
modify the wording of the notice to include language regarding
Medicare beneficiaries, if appropriate under Medicare rules. The
initial modification shall not be subject to the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340, et. seq.)
of Part 1 of Division 3 of Title 2 of the Government Code).
   (g) If poststabilization care has been authorized by the health
care service plan, the noncontracting hospital shall request the
patient's medical record from the patient's health care service plan
or its contracting medical provider.
   (h) The health care service plan, or its contracting medical
provider, shall, upon conferring with the noncontracting hospital,
transmit any appropriate portion of the patient's medical record, if
the records are in the plan's possession, via facsimile transmission
or electronic mail, whichever method is requested by the
noncontracting hospital's representative or the noncontracting
physician and surgeon. The health care service plan, or its
contracting medical provider, shall transmit the patient's medical
record in a manner that complies with all legal requirements to
protect the patient's privacy.
   (i) A health care service plan, or its contracting medical
provider, that requires prior authorization for poststabilization
care shall provide 24-hour access for patients and providers,
including noncontracting hospitals, to obtain timely authorization
for medically necessary poststabilization care.
   (j) A health care service plan shall provide all noncontracting
hospitals in the state with specific contact information needed to
make the contact required by this section. The contact information
provided to hospitals shall be updated as necessary, but no less than
once a year.
   (k) In addition to meeting the requirements of subdivision (j), a
health care service plan shall provide the contact information
described in subdivision (j) to the Department of Managed Health
Care. The contact information provided pursuant to this subdivision
shall be updated as necessary, but no less than once a year. The
receiving department shall post this contact information on its
Internet Web site no later than January 1 of each calendar year.
   (l) This section shall only apply to a noncontracting hospital.
   (m) For purposes of this section, the following definitions shall
apply:
   (1) "Health care service plan" means a health care service plan
licensed pursuant to Chapter 2.2 (commencing with Section 1340) of
Division 2 that covers hospital, medical, or surgical expenses.
   (2) "Noncontracting hospital" means a general acute care hospital,
as defined in subdivision (a) of Section 1250 or an acute
psychiatric hospital, as defined in subdivision (b) of Section 1250,
that does not have a written contract with the patient's health care
service plan to provide health care services to the patient.
   (3) "Poststabilization care" means medically necessary care
provided after an emergency medical condition has been stabilized, as
defined by subdivision (j) of Section 1317.1.
   (4) "Contracting medical provider" means a medical group,
independent practice association, or any other similar organization
that, pursuant to a signed written contract, has agreed to accept
responsibility for provision or reimbursement of a noncontracting
hospital for emergency and poststabilization services provided to a
health plan's enrollees.
   (n) Subdivisions (b) to (h), inclusive, shall not apply to minor
treatment procedures, if all of the following apply:
   (1) The procedure is provided in the treatment area of the
emergency department.
   (2) The procedure concludes the treatment of the presenting
emergency medical condition of a patient and is related to that
condition, even though the treatment may not resolve the underlying
medical condition.
   (3) The procedure is performed according to accepted standards of
practice.
   (4) The procedure would result in the direct discharge or release
of the patient from the emergency department following this care.
   (o) Nothing in this section is intended to prevent a health care
service plan or its contracting medical provider from assuming
management of the patient's care at any time after the initial
provision of poststabilization care by the noncontracting hospital
before the patient has been discharged. Upon the request of the
health care service plan or its contracting medical provider, the
noncontracting hospital shall provide the health care service plan or
its contracting medical provider with any information specified in
paragraph (3) of subdivision (b).
   (p) Nothing in this section shall authorize a provider of health
care services to bill a Medi-Cal beneficiary enrolled in a Medi-Cal
managed care plan or otherwise alter the provisions of subdivision
(a) of Section 14019.3 of the Welfare and Institutions Code.




1263.  (a) This section shall be known and may be cited as the
Dementia Training Standards Act of 2001.
   (b) (1) Any certified nurse assistant employed by a skilled
nursing facility or intermediate care facility shall have completed
at least two hours of initial dementia-specific training as part of
the facility's orientation program. The training shall be completed
within the first 40 hours of employment.
   (2) The facility shall develop a dementia-specific training
component within the existing orientation program, to be implemented
no later than July 1, 2002.
   (3) The facility's modified orientation program shall be reviewed
by the department in a phasein schedule that begins no later than
July 1, 2002, and is completed no later than July 1, 2005.
   (c) Any certified nursing assistant employed by a skilled nursing
facility or intermediate care facility shall participate in a minimum
of five hours of dementia-specific in-service training per year, as
part of the facility's in-service training.
   (d) Freestanding and hospital-based pediatric skilled nursing
facilities with exclusively pediatric occupancy shall be exempt from
the requirements set forth in this section.


1264.  (a) Any health facility licensed under Section 1250 that
provides prenatal screening ultrasound to detect congenital heart
defects shall require that the ultrasound be performed by a
sonographer who is nationally certified in obstetrical ultrasound by
the American Registry for Diagnostic Medical Sonography (ARDMS),
nationally certified in cardiac sonography by Cardiovascular
Credentialing International (CCI), or credentialed in sonography by
the American Registry of Radiologic Technologists (ARRT).
   (b) For purposes of this section, the following shall apply:
   (1) A sonographer is also known as an "ultrasound technologist" or
"sonologist."
   (2) "Sonographer" means any nonphysician who is qualified by
national certification or academic or clinical experience to perform
diagnostic medical ultrasound, with a subspecialty in obstetrical
ultrasound.
   (c) (1) Any sonographer who is certified as required in
subdivision (a) or otherwise meets the requirements of this section,
shall, in performing a prenatal ultrasound to detect congenital heart
defects, perform the work under the supervision of a licensed
physician and surgeon.
   (2) For purposes of this section, licensed physician and surgeon
means any physician and surgeon, licensed pursuant to Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code.
   (d) Any person with a minimum of two years of full-time work
experience in this state as a sonographer in prenatal ultrasound and
has obtained, or is in the process of obtaining, 30 continuing
medical education credits over a three-year period in ultrasound
shall be deemed to be in compliance with the requirements of this
section.
   (e) A health facility shall develop policies and procedures to
implement the requirements of this section.
   (f) This section and policies and procedures adopted pursuant to
this section shall not prohibit any physician and surgeon licensed
pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of
the Business and Professions Code from performing a prenatal
ultrasound nor in any other way limit the ability of a licensed
physician and surgeon to practice medicine in a manner consistent
with that license.
   (g) This section and policies and procedures adopted pursuant to
this section shall not apply to any physician and surgeon,
sonologist, certified nurse-midwife, or nurse practitioner who
performs limited prenatal ultrasounds for the purpose of obtaining an
amniotic fluid index, fetal position, a biophysical profile or
dating a pregnancy prior to 20 weeks gestation.
   (h) Article 4 (commencing with Section 1235) and any other
provision relating to criminal sanctions for violations of this
chapter shall not apply to any person who violates this section or
any regulation adopted pursuant to this section.
   (i) This section shall become operative on July 1, 2006.