California Assembly Bill AB1862 Latest Draft

 BILL NUMBER: AB 1862AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 17, 2012 INTRODUCED BY Assembly Member Logue FEBRUARY 22, 2012 An act to add  Section   and repeal Sections  1250.9  to   and 1797.134 of  the Health and Safety Code, relating to health facilities. LEGISLATIVE COUNSEL'S DIGEST AB 1862, as amended, Logue. Health facilities: licensure. Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, by the State Department of Public Health. Existing law requires the department, when an applicant for a general acute care hospital license meets the applicable requirements of licensure, to issue a single consolidated general acute care hospital license 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, if any of certain criteria are met. One of these criteria is that the physical plants maintained and operated by the licensee that are to be covered by the single consolidated license are located not more than 15 miles apart. This bill would  ,   until January 1, 2015,  require the department to issue a single consolidated license to certain general acute care hospitals that include more than one physical plant maintained and operated on separate premises, if one of the physical plants is used as  an  a freestanding  emergency  center   department  that provides service 24 hours a day, 7 days a week, and other specified conditions are met. The bill would authorize the transfer of ownership of a freestanding emergency  center   department  if specified conditions are met.  The bill would require, on or before May 1, 2014, the department to prepare and provide a report to the Legislature on the implementation of this bill and its effect upon the quality of emergency health care services provided to the community served by the freestanding emergency departments.  It would also require the department to establish a committee to evaluate the quality and efficiency of services and improvement in patient access provided by freestanding emergency  centers   departments  and provide a specified report to the Legislature and the Governor.  Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, which governs local emergency medical service systems, establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state agencies concerning emergency medical services.   This bill would, until January 1, 2015, require the authority, in conjunction with the department and local emergency medical services (EMS) agencies, to develop and adopt triage criteria for the transportation of patients to freestanding emergency departments, as specified, and would require each local EMS agency to prepare and submit to the authority triage protocols to ensure that the use of a freestanding emergency department is in the best interests of patient care, consistent with the local plan. By increasing the duties of local officials, this bill would impose a state-mandated local program.   The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.   This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.  Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  no   yes  . THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. The Legislature hereby finds and declares all of the following: (a) There are  currently 241   approximately 222  freestanding emergency departments  (FSEDS)  in  the United States   16 states  . (b)  FSEDS   Freestanding emergency departments  are regulated by state licensing requirements and federal certification requirements. (c) Many emergency departments in the state are overcrowded  , as evidenced by the increased number of high severity cases admitted and the increased number of emergency visits resulting in admission  . (d) Eighteen hospitals in the state and their respective emergency departments have closed in the last 10 years. (e) FSEDS   Freestanding   emergency departments  have the ability to provide services to patients who may not otherwise have  timely  access to emergency services.  (f) Historically, freestanding emergency departments filled a need in rural or underserved regions where emergency departments were separated by long distances. More recently, freestanding emergency departments are serving highly congested urban areas that are 15-20 miles from the nearest hospital for easier access and prompt care delivery.   (g) Present freestanding emergency departments report faster throughput times as a majority of the higher acuity patients who might require admission are diverted. Some freestanding emergency departments report a door-to-doctor time of 30 minutes or less compared with a hospital emergency department door-to-doctor time of 55.8 minutes. In addition, freestanding emergency departments report door-to-discharge times of less than 90 minutes in contrast to 180 minutes for hospital emergency departments.   (h) Freestanding emergency departments have reported an average hospital admission rate of 5%, which is much lower than the average hospital emergency department admission rate of 12.8%. In addition, freestanding emergency departments can reduce the time it takes for patients to be placed in inpatient beds because of faster door-to-doctor times equating to faster stabilization and triage combined with the ability to immediately transfer patients to hospitals with available beds.  SEC. 2. Section 1250.9 is added to the Health and Safety Code, to read: 1250.9. (a) Notwithstanding Section 1250.8  OR   or  any other law, upon application of a general acute care hospital that meets all the criteria of paragraphs (1) to (3), inclusive, of subdivision (b) of Section 1250.8, other applicable requirements of licensure, and is approved to provide emergency center special services, the department shall issue a single consolidated license where that hospital includes more than one physical plant maintained and operated on separate  , non   contiguous  premises if one of the physical plants is used as  an   a freestanding  emergency  center   department  that provides service 24 hours a day, seven days a week, and  either   all  of the following conditions  is   are  met: (1) The general acute care hospital  meets either one of the following geographic requirements:   is   (A)    Is  a rural general acute care hospital and the  freestanding  emergency  center   department  is located within  the same county as, and within  30 miles of  ,  the primary physical plant of the hospital and at least 20 miles from an emergency center owned or operated by another general acute care hospital.  (2) The general acute care hospital is   (B)     Is  not a rural general acute care hospital and the  freestanding  emergency  center   department  is located within  the same county as, and within  15 miles of  , the primary physical plant of the hospital and at least seven miles from an emergency center owned or operated by another general acute care hospital.  (2) The freestanding emergency department otherwise meets the requirements for providing basic emergency service, except for the requirements that the emergency department be located within the primary physical plant of the hospital and that the emergency department provide on-site surgical or postanesthesia recovery service immediately available for life-threatening situations. The requirements for providing basic emergency service shall include all of the following:   (A) A laboratory service capable of performing blood gas analysis and electrolyte determinations.   (B) A radiological service capable of providing necessary radiology services.   (C) Licensed physicians and surgeons on staff who have medical staff privileges at the primary physical plant of the hospital and access to the hospital's on-call panel.   (D) Licensed nurses on staff in compliance with Section 1276.4.   (E) The capability of transferring patients in need of a higher level of care to an appropriate general acute care hospital, including standby critical care transport at all times.   (3) The freestanding emergency department publishes and posts the schedule of charges for medical services offered by the emergency department. This schedule shall include charges for the 25 most frequently provided medical services and shall be posted in a conspicuous place in the reception area by signage or through an electronic messaging board. The freestanding emergency department shall also provide a patient with notice that the patient may receive a separate bill for a facility charge in addition to the fee for medical services.   (4) The local emergency medical services agency that has jurisdiction over the area in which the hospital is located prepares a letter of support for the consolidated license and this letter is attached to the application.  (b) The department shall issue not more than  12   four  consolidated licenses pursuant to this section  and   , of which  not more than  six   two  consolidated licenses  may be issued  to rural general acute care hospitals.  Not more than two freestanding emergency departments located i   n the northern portion of the state and not   more than two freestanding emergency departments located in the southern part of the state may operate pursuant to a consolidated license issued pursuant to this section.   (c) Subject to any other state or federal requirements, a freestanding emergency department that operates pursuant to a single, consolidated general acute care hospital license shall be considered the equivalent of an emergency department that is within the primary physical plant of the general acute care hospital.   (c)   (d)  A general acute care hospital, including a rural general acute care hospital, that continuously operates for at least three years an approved  freestanding  emergency  center   department  at a physical plant that is separate from the primary physical plant of the hospital may transfer ownership of the emergency center to another general acute care hospital that is approved to provide emergency center special services, if the conditions of subdivisions (a) and (b) will be met subsequent to the transfer  and the appropriate suppleme   ntal or change   -of   -ownership filings are made  .  (e) This section shall not be construed to authorize the transfer of a health facility license.   (f) (1) The department, in cooperation with the Emergency Medical Services Authority, shall measure the success of the freestanding hospital departments by collecting data on all of the following:   (A) The acuity levels of patients.   (B) Patient transfer times to higher levels of care, as measured by the time of the decision to transfer a patient to the time when the patient is in route to the receiving hospital.   (C) The number of higher level of care transfers conducted through the 911 system.   (D) The number of patient visits per location.   (2) The department shall, on or before May 1, 2014, prepare and provide a report to the Legislature in accordance with Section 9795 of the Government Code on the implementation of this section and its effect upon the quality of emergency health care services provided to the community served by the freestanding emergency departments.   (g) This section shall remain in effect only until January 1, 2015, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2015, deletes or extends that date.   SEC. 3.   Section 1797.134 is added to the   Health and Safety Code   , to read:   1797.134. (a) The authority, in conjunction with the State Department of Public Health and local EMS agencies, shall develop and adopt triage criteria for the transportation of patients to freestanding emergency departments licensed pursuant to Section 1250.9 that considers all essential variables to ensuring safe patient care, including the patient's condition, the necessary equipment and services, and distance and travel times. The triage criteria shall provide that patients in need of emergency medical services, including trauma, stroke, and cardiac patients bypass a freestanding emergency department for the nearest specialty facility, unless immediate stabilization of the patient is necessary for lifesaving measures before transfer. (b) Subject to the triage criteria adopted pursuant to subdivision (a), each local EMS agency shall prepare and submit to the authority triage protocols to ensure that the use of a freestanding emergency department is in the best interests of patient care, consistent with the local plan. (c) This section shall remain in effect only until January 1, 2015, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2015, deletes or extends that date.   SEC. 3.   SEC. 4.   (a)    The State Department of Public Health shall establish a committee to evaluate the quality and efficiency of services and improvement in patient access provided by freestanding emergency  centers   departments  established pursuant to a consolidated license issued pursuant to Section 1250.9 of the Health and Safety Code. The membership of the committee shall include a physician and surgeon who has experience providing medical services within a rural freestanding emergency department, a physician and surgeon who has experience providing medical services within an urban freestanding emergency department, a nurse who has experience working within a rural freestanding emergency department, a nurse who has experience working within an urban freestanding emergency department, a patient who was treated within an urban freestanding emergency department, a patient who was treated within a rural freestanding emergency department, a representative from a rural general acute care hospital with a freestanding emergency center, and a representative from an urban general acute care hospital with a freestanding emergency  center. The   department.   (b)     The  committee shall be established within five years after the first  freestanding  emergency  center   department  is established pursuant to a consolidated license issued pursuant to Section 1250.9 of the Health and Safety Code. The committee shall prepare and submit its evaluation to the Legislature and the Governor  in accordance with Section 9795 of the Government Code  within six months of the first meeting of the committee.  SEC. 5.   If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.