1250-1264
HEALTH AND SAFETY CODE
SECTION 1250-1264
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 Legislatu