California Assembly Bill AB491 Amended / Bill

 BILL NUMBER: AB 491AMENDED BILL TEXT AMENDED IN SENATE AUGUST 30, 2012 AMENDED IN SENATE AUGUST 29, 2012 AMENDED IN SENATE AUGUST 24, 2012 AMENDED IN SENATE JULY 6, 2012 AMENDED IN ASSEMBLY MAY 10, 2011 AMENDED IN ASSEMBLY APRIL 15, 2011 AMENDED IN ASSEMBLY APRIL 5, 2011 INTRODUCED BY Assembly Member Ma (Coauthors: Assembly Members Garrick and Miller) (Coauthor: Senator Wyland) FEBRUARY 15, 2011 An act to amend Section 1255 of the Health and Safety Code, relating to health facilities, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST AB 491, as amended, Ma. General acute care hospitals: cardiac catheterization. Existing law provides for the licensure and regulation of health facilities, including general acute care hospitals, administered by the State Department of Public Health. A violation of these provisions is a crime. Existing law authorizes the department to approve, as prescribed, a general acute care hospital to offer specified special services, including, but not limited to, cardiac catheterization laboratory services, in addition to the basic services offered under the facility's license. This bill would authorize the expansion of a cardiac catheterization laboratory service  under specified circumstances   if specified requirements are   met, to apply to no more than two general acute care hospitals  . Because this bill would expand the definition of a crime, it 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 no reimbursement is required by this act for a specified reason. This bill would declare that it is to take effect immediately as an urgency statute. Vote: 2/3. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1255 of the Health and Safety Code is amended to read: 1255. (a) 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: (1) Radiation therapy department. (2) Burn center. (3) Emergency center. (4) Hemodialysis center (or unit). (5) Psychiatric. (6) Intensive care newborn nursery. (7) Cardiac surgery. (8) Cardiac catheterization laboratory. (9) Renal transplant. (10) Other special services as the department may prescribe by regulation. (b) 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. (c) The department shall adopt standards for special services and other regulations as may be necessary to implement this section. (d) (1) For cardiac catheterization laboratory service, the department shall, at a minimum, adopt standards and regulations that specify that only diagnostic services, and what diagnostic services, may be offered by a general 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. (2) Except as provided in paragraph (3), 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. (3) Commencing March 1, 2013,  a general acute care hospital that has applied for program flexibility on or before July 1, 2012, to expand  cardiac catheterization laboratory services may  be expanded by a general acute care hospital to include   utilize  cardiac catheterization space that is in conformance with applicable building code standards, including those promulgated by the Office of Statewide Health Planning and Development, provided that all of the following  occur   conditions are met  : (A) The expanded laboratory space is located in the building so that the space is connected  to the general acute care hospital  by an enclosed all-weather passageway that is accessible by staff and patients who are accompanied by staff. (B) The service performs  cardiac catheterization services on  no more than 25 percent of  its procedures on hospital inpatients   the hospital's inpatients who need cardiac catheterizations  . (C) The service complies with  all   the same  policies and procedures approved by hospital medical staff  for cardiac catheterization laboratories that are   located within the general acute care hospital  , and  all   the same  standards and regulations prescribed by the department  for cardiac catheterization laboratories located inside general acute care hospitals  , including, but not limited to,  applicable   appropriate  nurse-to-patient ratios under Section 1276.4, and with all standards and regulations prescribed by the Office of Statewide Health Planning and Development. Emergency regulations allowing a general acute care hospital to operate a cardiac catheterization laboratory service shall be adopted by the department and by the Office of Statewide Health Planning and Development by February 28, 2013.  (D) Emergency regulations implementing this paragraph have been adopted by the department and by the Office of Statewide Health Planning and Development by February 28, 2013.   (E) This paragraph shall not apply to more than two general acute care hospitals.   (4) After March 1, 2014, an acute care hospital may only operate a cardiac catheterization laboratory service pursuant to paragraph (3) if the department and the Office of Statewide Health Planning and Development have adopted regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code that provide adequate protection to patient health and safety including, but not limited to, building standards contained in Part 2.5 (commencing with Section 18901) of Division 13.   (4)   (5)  Notwithstanding Section 129885, cardiac catheterization laboratory services expanded in accordance with paragraph (3) shall be subject to all applicable building standards. The Office of Statewide Health Planning and Development shall review the services for compliance with the OSHPD 3 requirements of the most recent version of the California Building Standards Code. (e) 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. (f) Except as provided in this section and 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. SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution. SEC. 3. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to improve access to health care for patients requiring cardiac catheterization services at the earliest possible time, it is necessary that this act take effect immediately.