BILL NUMBER: AB 2194INTRODUCED BILL TEXT INTRODUCED BY Assembly Member Fletcher FEBRUARY 18, 2010 An act to add and repeal Chapter 2 (commencing with Section 101990) to Part 6 of Division 101 of the Health and Safety Code, relating to health facilities. LEGISLATIVE COUNSEL'S DIGEST AB 2194, as introduced, Fletcher. Health facilities: program flexibility. Existing law requires the State Department of Public Health to administer the licensing of several categories of clinics and health facilities, including general acute care hospitals. Existing law requires the building standards published in the California Building Standards Code and the regulations adopted by the department to prescribe standards for adequacy, safety, and sanitation of the physical plant, of appropriate staffing, and of services, based on the type of health facility and the needs of the persons served. The bill would require the department to establish the Acuity-Adaptable Care Delivery Pilot Program to provide not less than one but not more than 5 general acute care hospitals, as defined, with the ability to use licensed intensive care beds as stepdown and medical surgical beds interchangeably, based on the acuity of the patient, as provided. The bill would require the participating hospitals to measure specified outcomes and to undergo an annual review of the outcomes, including an onsite inspection by the department and independent evaluations. The bill also would require the department, by January 1, 2015, to prepare and submit a report to the Legislature on the pilot program. The bill would allow the department to charge a participating hospital an annual fee that does not exceed the amount of the direct costs to the department of overseeing and evaluating the pilot program and does not exceed $25,000 per year. The bill would make the program inoperative 7 years after the first patient is admitted to the first pilot program hospital and would repeal the program on January 1 of the following year. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Chapter 2 (commencing with Section 101990) is added to Part 6 of Division 101 of the Health and Safety Code, to read: CHAPTER 2. HEALTH FACILITY INNOVATION 101990. (a) The State Department of Public Health shall establish the Acuity-Adaptable Care Delivery Pilot Program to provide general acute care hospitals, as defined in subdivision (a) of Section 1250, the ability to use licensed intensive care beds as stepdown and medical surgical beds interchangeably based upon the acuity of the patient, including the use of technology, equipment, procedures, techniques, and concepts that support this model of care. (b) Utilization of technology, equipment, procedures, techniques, and concepts that supports the acuity-adaptable care delivery model shall be consistent with the provision of safe, therapeutic, effective care that promotes patient safety. Deployment of technology shall not prevent health care providers from following accepted practice standards, including use of clinical judgment in the assessment, evaluation, planning, and implementation of care, nor from acting as a patient advocate. (c) The department shall identify alternate technology, equipment, procedures, techniques, and concepts, giving special consideration to the use of acuity-adaptable nursing units and beds, that will promote innovation and improvement in services and patient care. (d) The department shall solicit and accept proposals from general acute care hospitals to participate in the pilot program to use licensed intensive care beds as stepdown and medical surgical beds interchangeably based upon the acuity of the patient, including the use of technology, equipment, procedures, techniques, and concepts that support this model of care. (e) The department shall, by October 1, 2011, authorize not less than one, but not more than five, general acute care hospitals identified by the department or proposed by a hospital pursuant to subdivision (d) to use licensed intensive care beds as stepdown and medical surgical beds interchangeably based upon the acuity of the patient, including the use of technology, equipment, procedures, techniques, and concepts that support this model of care. At least one authorized general acute care hospital shall be located within the County of San Diego and shall be associated with a two-hospital system operated by a health care district. (f) A general acute care hospital participating in the pilot program shall measure all of the following patient, caregiver, and organizational outcomes: (1) Morbidity. (2) Hospital acquired infections. (3) Adverse events. (4) Patient satisfaction. (5) Cost per discharge. (6) Length of stay. (7) Workplace injuries. (8) Employee satisfaction. (9) Staff turnover, by job category. (g) Measures of program success shall include improvement in any or all of the outcomes listed in subdivision (f) as compared to risk-adjusted and like populations. Outcome data shall be stratified by service line; for example, cardiovascular and neuroscience. (h) A general acute care hospital participating in the pilot program shall comply with the staffing requirements for licensed nurses set forth in Section 1276.4 based on the acuity of the patient and not the licensed bed category and physical location of the patient. (i) (1) Each general acute care hospital, acute psychiatric hospital, and special hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, shall ensure that each direct care registered nurse, including a new hire, casual, per diem, temporary agency, registry, and traveler staff, shall receive and complete orientation to the hospital and patient care unit or clinical care area in which he or she will be working. Each health facility subject to this section shall adopt written policies and procedures for the training and orientation of nursing staff. (2) Each direct care registered nurse shall have current demonstrated and validated competency required for the specific individual needs of the patient population admitted to the unit or clinical area before being assigned to patient care for that unit or clinical area. (j) A general acute care hospital participating in the pilot program 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. (k) A general acute care hospital participating in the pilot program shall be required to undergo an annual review of the outcomes of the pilot program, including an onsite inspection by the department. The department shall also require independent evaluations by experts, subject to conflict-of-interest requirements, on an annual basis to evaluate the outcomes in terms of quality and patient safety as well as worker safety. (l) The department may charge a general acute care hospital participating in the pilot program an annual fee that does not exceed the amount of the direct costs to the department of overseeing and evaluating the pilot program and does not exceed twenty-five thousand dollars ($25,000) per year. The moneys collected from this fee shall be deposited in the State Department of Public Health Licensing and Certification Program Fund. (m) As appropriate, a general acute care hospital participating in the pilot program shall consult with the Office of Statewide Health Planning and Development if the hospital's physical building is involved in the use of technology, equipment, procedures, techniques, and concepts that support the acuity-adaptable care delivery model. (n) On or before January 1, 2015, the department shall prepare and submit a report to the Legislature on the results of the pilot program and its impact upon the quality of service and patient care. 101991. This chapter shall become inoperative seven years after the first patient is admitted to the first pilot program hospital and shall be repealed on January 1 of the following year.