As used in this chapter, “health facility” means a 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:

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:

medical staff that provides 24-hour inpatient care for persons with mental health disorders 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.

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.

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.

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.

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.

health facility license shall specify which of the types of persons described in paragraph (2) to whom a facility is licensed to provide services.

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 department.

correctional treatment center.

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.

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.

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.

hospice services. Hospice services include, but are not limited to, routine care, continuous care, inpatient respite care, and inpatient hospice care as defined in subdivision (d) of Section 1339.40, and is operated by a provider of hospice services that is licensed pursuant to Section 1751 and certified as a hospice pursuant to Part 418 of Title 42 of the Code of Federal Regulations.

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.

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.

A licensed general acute care hospital, as defined pursuant to subdivision (a) of Section 1250, or an acute psychiatric hospital, as defined pursuant to subdivision (b) of Section 1250, shall adopt policies and procedures regarding the responsibility for ensuring proper methods of repackaging and labeling of bulk cleaning agents, solvents, chemicals, and nondrug hazardous substances used throughout the hospital. The hospital is not required to consult a pharmacist regarding the repackaging and labeling of

these substances, except for areas where sterile compounding is performed.

requirements.

in amount, duration, and scope to reasonably achieve the purpose for which services are provided. The statewide bed limit shall comply with state and federal Medicaid requirements. The department shall notify the Legislature when the total number of beds in licensed psychiatric residential treatment facilities in the state reaches 250 beds, 500 beds, and 750 beds.

psychiatric services to Medicaid-eligible individuals under 21 years of age in accordance with the requirements and standards developed by the State Department of Health Care Services pursuant to the authority in Section 1905(a)(16) and (h) (42 U.S.C. Sec. 1396d(a)(16) and (h)), Section 1902(a)(9)(A) (42 U.S.C. Sec. 1396a(a)(9)(A)), which

authorizes the State Department of Health Care Services to establish and maintain health standards for institutions in which Medicaid beneficiaries may receive services, and Section 1902(a)(33)(B) (42 U.S.C. Sec. 1396a (a)(33)(B)) of the federal Social Security Act and the Medicaid State Plan.

Medicaid program and maintains compliance with the conditions of participation for psychiatric residential treatment facilities pursuant to Subpart D of Part 441 and Subpart G of Part 483 of Title 42 of the Code of Federal Regulations.

time needed to stabilize, treat, and transition the patient to a less restrictive setting consistent with the patient individual plan of care.

(ii) Designed to achieve the patient’s discharge from inpatient status, step-down service, at the earliest possible time or as a diversion to admittance to a psychiatric hospital.

(iii) The individual plan of care shall be based on a diagnostic evaluation that is developed by a treatment team in consultation with the patient and their parents, legal guardians, or others into whose care they will be released after discharge, and include discharge plans and after-care resources such as community services to ensure continuity of care with the patient’s family, school, and community upon discharge.

data:

patient prior to address the patient’s crisis needs, if any, and the number of prior hospitalizations, if any.

provided upon discharge.

with a report summarizing the information provided under subdivision (c) including, at a minimum:

(ii) The total number of patients admitted to psychiatric residential facilities, including the number of Medi-Cal beneficiaries and the number of patients under the jurisdiction of the juvenile court, from each county. For purposes of this clause, “from each county” refers to the county where the patient resided prior to admission to the facility.

or ethnicity, and gender of patients served, and, if available, the gender expression of patients served.

(ii) The age, race or ethnicity, and gender of patients served, and, if available, sexual orientation and gender identity or expression of patients served from each county. For purposes of this clause, “from each county” refers to the county where the patient resided prior to admission to the facility.

(ii) For the purposes of this data collection, “family-based treatment setting” means a licensed home-like setting to serve a child’s, minor’s, or youth’s behavioral health needs. These family-based treatment settings may utilize a range of applicable license types, so long as they provide enhanced care and supervision in a home-like setting, meet all requirements

pursuant to their respective license type, and provide an integrated behavioral health treatment as an alternative to, or stepdown from, psychiatric residential facilities and short-term residential therapeutic programs.

(A) Therapeutic programming shall be provided seven days per week, including weekends and holidays,

with sufficient mental health professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual client’s needs.

(B) The established number of beds in the facility shall be consistent with the individual treatment needs of the clients served at the facility and shall meet the requirements developed pursuant to subdivision (u) of Section 4081 of the Welfare and Institutions Code. At least 50 percent of the beds shall be in single-occupancy rooms.

(C) (i) The length of stay shall be consistent with the individual plan of care developed by the interdisciplinary team.

(ii) In the case of non-Medi-Cal beneficiaries, reauthorizations for admission

shall be obtained using the process established by the entity providing coverage.

(D) The length of stay shall be consistent with the individual plan of care developed by the interdisciplinary team. If a determination is made by a health care professional that a psychiatric residential treatment facility is medically necessary and is the appropriate level of care, reauthorization for admission shall be obtained using the process established by the entity providing coverage.

(E) For voluntary admission of any minor patient subject to the jurisdiction of the juvenile court, the facility shall obtain court authorization for the admission pursuant to Section 361.23 or 727.13, as applicable, and Section 6552 of the Welfare and Institutions Code. Whenever consent for admission of a

patient who is subject to the jurisdiction of the juvenile court is revoked, the facility shall immediately contact the county child welfare agency or probation department, as applicable, to arrange for the patient’s discharge.

(F) Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical support to each client and for integrating family members into the day-to-day care of the youth. The facility shall provide patients with at least one hour per day of outdoor exercise or other time spent outside, weather permitting.

(G) The facility shall collaborate with each client’s existing mental health team, if applicable, child and family team, as defined by paragraph (4) of subdivision (a) of Section 16501 of the Welfare and

Institutions Code, if the patient is an Indian child, as defined in subdivisions (a) and (b) of Section 224.1 of the Welfare and Institutions Code, who is under the jurisdiction of the juvenile court, the child’s tribe, if applicable, and other support persons or providers identified by the child or parents within three business days of intake and throughout the course of care and treatment, as appropriate.

(H) The facility shall provide information, upon request, to the county child welfare agency or county probation department to assist the county with its implementation of the patient’s aftercare plan for transitioning each admitted child from the program.

(I) The patient’s rights provisions contained in Sections 5325, 5325.1, 5325.2, and 5326 of the Welfare and Institutions Code shall

be available to any patient admitted to, or eligible for admission to, the facility. Every patient shall have a right to a hearing by writ of habeas corpus, within two judicial days of the filing of a petition for the writ of habeas corpus with the superior court of the county in which the facility is located, for their release. Regulations adopted pursuant to this section shall specify the procedures by which this right shall be ensured. These regulations shall generally be consistent with the procedures contained in Article 5 (commencing with Section 5275) of Chapter 2 of Part 1 of Division 5 of the Welfare and Institutions Code concerning habeas corpus for individuals, including children, subject to various involuntary holds.

(J) The facility shall establish and implement an individual plan of care within 72 hours of the patient’s

admission that is designed to achieve the patient’s discharge from inpatient status, step-down service, at the earliest possible time. The individual plan of care shall be based on a diagnostic evaluation that is developed by a treatment team in consultation with the patient and their parents, legal guardians, or others in whose care they will be released after discharge and include discharge plans and after-care resources such as community services to ensure continuity of care with the patient’s family, school, and community upon discharge. The plan of care shall be updated at least every 10 days, or more frequently if warranted by the patient’s change in acuity. For patients who are under the jurisdiction of the juvenile court, the patient’s social worker or probation officer and, for Indian children, as defined by subdivisions (a) and (b) of Section 224.1 of the Welfare and Institutions Code,

the child’s tribe shall be included in the consultation by the treatment team.

(K) Guidelines for the use of physical restraints and seclusion providing protections and safeguards in addition to the requirements in Subpart G (commencing with Section 483.350) of Title 42 of the Code of Federal Regulations. If a patient under the jurisdiction of the juvenile court under Section 300 or 602 of the Welfare and Institutions Code has been restrained or secluded, the facility shall notify the patient’s counsel, social worker, or probation officer, as applicable, the patient’s tribe if the patient is an Indian child, as defined in subdivisions (a) and (b) of Section 224.1 of the Welfare and Institutions Code, and, except in cases in which parental rights or a legal guardianship has been terminated, the patient’s parent, legal guardian, or Indian

custodian.

Social Services, shall report to the Legislature on the use of psychiatric residential treatment facilities in the state. The report shall include evaluation metrics assessing the efficacy of facilities in treating the mental health of individuals under 21 years of age, including analyses of individuals under 21 years of age within and without the jurisdiction of the juvenile court and by age, race or ethnicity, and sexual orientation and gender identity, and shall be submitted in compliance with Section 9795 of the Government Code.

Data published by the department shall be deidentified in compliance with Section 164.514(a) and (b) of Title 45 of the Code of Federal Regulations.

The State Department of Public Health 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 department shall consider the recommendations made by the federal Centers for Disease Control and Prevention for preventing transmission of HIV and Hepatitis B. The department shall also take into account existing regulations of the 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) of Division 5 of the Labor Code) regarding infection control to prevent infection or disease as a result of the transmission of

blood-borne pathogens. In so doing, the department shall consult with the Medical Board of California, the Dental Board of California, and the Board of Registered Nursing as well as associations representing health care professions, associations of licensed health facilities, organizations that 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.

social work, rehabilitation, drug administration, food services, and substance use disorder services, as medically necessary and appropriate. Psychiatric health facilities shall only admit persons whose physical health needs can be met in an affiliated hospital or in outpatient settings and shall only admit people with stand-alone severe substance use disorders involuntarily pursuant to Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code.

reviews of admission and discharge criteria and lengths of stay in order to ensure that these patients are moved to less restrictive levels of care as soon as appropriate.

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.

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:

(f)), including the approval process specified in Section 1861(e)(7)(B) of the federal Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which requires that the state agency responsible for licensing hospitals has ensured that the facility meets licensing requirements.

voluntary inpatient detoxification, patient counseling, group therapy, physical conditioning, family therapy, outpatient services, and dietetic services, but does not include emergency department services or medical inpatient admission for treatment of severe, potentially life-threatening, intoxication and withdrawal syndromes.

Legislature to expand access to chemical dependency recovery services, and to support persons receiving those services, while ensuring the safety and quality of care for all patients in a health facility. It is also the intent of the Legislature that the chemical dependency recovery hospital will provide an innovative inpatient treatment with medications, as well as a 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:

approach that significantly reduces capital construction costs and allows for the use of nonfreestanding facilities.

for chemical dependency recovery services. Chemical dependency recovery beds shall be used exclusively for alcohol or other drug dependency treatment, or both alcohol and other drug dependency treatment.

of the California Building Code.

them, for chemical dependency recovery hospitals in Chapter 11 (commencing with Section 79001) of Division 5 of Title 22 of the California Code of Regulations.

part 2 program, as defined in Section 2.11 of Title 42 of the Code of Federal Regulations, the general acute care hospital, acute psychiatric hospital, or distinct unit thereof shall provide the confidentiality protections required by Part 2 (commencing with Section 2.1) of Subchapter A of Chapter I of Title 42 of the Code of Federal Regulations to the hospital’s or unit’s patients with a substance use disorder.

may be colocated with other services of its parent general acute care hospital or acute psychiatric hospital.

“Council” means the Advisory Health Council.

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

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.

(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.

(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.

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.

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.

(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.

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

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:

inspection is required for this change of license category.

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).

makes sense at this point.

Legislature that this is a temporary approach, intended to provide a period of time to assess whether and to what extent the town of Paradise will return and make the construction of a new hospital viable.

to the applicant hospital, including serving as an emergency medical services receiving site if authorized to do so by the medical director of the local emergency medical services agency pursuant to Section 1798.101, if the hospital provides satisfactory evidence to the department that the hospital has a written transfer agreement with the hospital closest to the location where emergency stabilization services will be provided pursuant to this section, and any other hospital necessary to ensure the safe and effective transfer of patients needing services outside the capacity of the closest hospital, and if the applicant hospital submits and has received approval for an

application pursuant to subdivision (c) and meets all of the following requirements:

days a week.

SERVICES, PHYSICIAN ON DUTY.”

requiring surgery, trauma care, or an inpatient bed will be transported to the nearest hospital.

(A) A plan of operation that shall, at a minimum, address the location’s plan

for patient care, infection control, waste disposal, and linen services.

(B) The policy and procedure that the location will implement for the emergency transportation of patients that cannot be served by the facility. The policy and procedure shall comply with the standards of practice and shall include all of the following:

(ii) The timeframe for transfer to the nearest general acute care hospital with an emergency department.

(iii) How the location will ensure patient safety during the transfer.

(C) A written transfer agreement with the nearest hospital with an emergency

department.

(D) A community outreach and education plan to ensure the community is informed of the types of services that the facility is capable of providing. The plan shall include instructions identifying the care that the facility is capable of providing and indicating the types of injuries or conditions for which a patient should be transported directly to the nearest general acute care hospital emergency department.

(E) A triage algorithm that the location developed and will implement in collaboration with the local emergency medical services agency to determine appropriate patients for transport to the location.

issued pursuant to this section shall expire two years from the date of its issuance, and may be renewed every two years, for a combined period not to exceed six years from the initial date of issuance.

permit pursuant to Article 5 (commencing with Section 1294).

purposes of the Annual Report of Hospitals required by regulations adopted pursuant to Section 1250.8, report bed and service utilization data separately by each facility issued a single consolidated license pursuant to this section.