Article 10. Primary Health Service Hospitals of California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 10.
The Legislature hereby finds and declares that:
(a) In many areas, small, rural general acute care hospitals are
experiencing financial difficulties brought upon partially because of
governmental regulations and underutilization of acute care beds.
(b) Closure of such facilities, in most cases, would represent a
direct threat to the health and well-being of both the resident and
tourist populations served by these facilities.
(c) Availability and accessibility to primary and preventive
health care services could be greatly improved through coordination
with existing resources in the area.
(d) Because of the special attributes of the small, rural general
acute care hospital, such as longevity, focus of community support,
critical geographic location, and availability of services, such
facilities could serve as the major focal point for the promotion of
health and the delivery of health care services within the rural
(e) There is a lack of systematic study and evaluation of the
economics of efficiently operating small rural hospitals and the ways
in which these hospitals might more effectively meet the health
needs of their communities.
It is, therefore, the intent of the Legislature to
designate certain general acute care hospitals as primary health
service hospitals, which will facilitate the diversification of the
small rural hospital. The designation shall apply only to those
general acute care hospitals that meet the criteria set forth in this
article and which are designated by the state department.
As used in this article, unless otherwise indicated:
(a) "Health systems agency" means a health systems agency
established pursuant to Public Law 93-641.
(b) "Primary care mid-level health practitioner" means a physician
assistant certified pursuant to Chapter 7.7 (commencing with Section
3500) of Division 2 of the Business and Professions Code and also
means a registered nurse who meets the standards for a nurse
practitioner adopted pursuant to Article 8 (commencing with Section
2834) of Chapter 6 of Division 2 of the Business and Professions
Code, and also means a nurse midwife certified pursuant to Article
2.5 (commencing with Section 2746) of Chapter 6 of Division 2 of the
Business and Professions Code.
(c) "Swing bed" means beds licensed for general acute care
pursuant to Section 1250.1 that may, subject to this article, be used
as skilled nursing beds, as classified in Section 1250.1. Swing beds
shall retain the general acute care bed classification, for the
purposes of Chapter 1 (commencing with Section 127125) of Part 2 of
The state department shall administer the program
authorized in this article. In administering the program, the state
department shall do all of the following:
(a) Verify hospital eligibility, pursuant to Section 1339.9, and
designate those hospitals as primary health service hospitals.
(b) Establish criteria for the health service plans pursuant to
(c) Review a general acute care hospital's health service plan
based upon recommendations of the local health systems agency, input
from local public meetings, recommendations of the medical advisory
panel, as appropriate, and the adequacy of the plan in meeting the
criteria established pursuant to this section. The state department
shall approve, deny, or defer the plan in whole or in part and shall
notify the hospital of its findings, in writing, within 120 days
after receipt of the plan. The plan shall be deemed approved if the
hospital has not received notification from the state department
within the 120-day period.
(d) Negotiate and grant exceptions to the licensure requirements
for general acute care hospitals that are necessary to serve the
purposes of this article when the granting of such exceptions do not
jeopardize the health and welfare of the patients. Exceptions that
are granted shall be consistent with the primary health service
hospital's plan and any amendments thereto.
(e) Convene an advisory panel to review the medical-surgical and
obstetrical services proposed as part of the primary hospital service
plan and make recommendations to the state department on the medical
appropriateness of those services according to the primary health
service hospital's proposed plan. The panel shall include, but not be
limited to, a rural hospital administrator, a rural family practice
physician and surgeon, a rural hospital nurse administrator, an
internist, a primary care mid-level practitioner, and a physician and
surgeon from a hospital which serves as a referral center for rural
(f) Issue evidence of primary health service hospital designation
and evidence of the number of acute care beds approved as swing beds
pursuant to paragraph (4) of subdivision (b) of Section 1339.15.
(g) Monitor the performance of the primary health service hospital
to assure compliance with such hospital's plan and licensure
requirements from which such hospitals are not exempt.
(h) Immediately upon the denial of a primary health service
hospital's health service plan, or a portion thereof, notify the
hospital in writing. Within 20 days after the state department mails
the notice, the hospital may present a written petition for a hearing
to the state department. Upon receipt by the state department of the
petition in proper form, the petition shall be set for hearing. The
proceedings shall be conducted in accordance with Chapter 5
(commencing with Section 11500) of Part 1 of Division 3 of Title 2 of
the Government Code, and the state department has all the powers
(i) Compile and make available to health systems agencies and
primary health service hospitals, information regarding state and
federal funding programs for which the primary health service
hospital may be eligible, the procedures necessary to apply for
funding, and a description of how such requests may be incorporated
into a primary health service hospital's plan and opportunities for
diversification of services, the requirements and feasibility, and
the procedures for development of such services.
(j) On behalf of primary health service hospitals, seek
appropriate federal waivers consistent with the intent of this act.
(k) Contract with one or more health systems agencies to perform
the functions specified in subdivision (c) of Section 1339.11.
(l) Develop or assist hospitals submitting a primary health
service plan pursuant to Section 1339.15 to develop the following:
(1) Alternative methods of filing claims which reduce
(2) Alternative methods of Medi-Cal payment to hospitals.
(3) Other methods of filing claims which reduce administrative
(4) Simplified and abbreviated procedures required by the
department of Medi-Cal costs reports.
(5) An abbreviated medical and social review process and other
(m) Provide technical assistance to primary health service
hospitals in development of their health service plan.
The Office of Statewide Health Planning and Development
shall review and approve the number of swing beds that may be
designated pursuant to paragraph (4) of subdivision (b) of Section
1339.15, based upon community need and projected utilization and
issue a certificate of need pursuant to the review and approval.
Except as provided herein, a primary health service hospital shall be
subject to the requirements pertaining to approval of projects, as
defined in Section 127170, that are set forth in Chapter 1
(commencing with Section 127125) of Part 2 of Division 107.
In order to be eligible for designation as a primary health
service hospital, a hospital shall be licensed pursuant to
subdivision (a) of Section 1250 and meet one of the following
(a) Be located outside of a standard metropolitan statistical
area, be located at least 15 miles from another licensed acute care
hospital, and have 60 or fewer acute care beds.
(b) Be located at least 20 miles from any other licensed acute
care hospital and have 60 or fewer acute care beds.
(c) Be the only licensed acute care hospital in the county and
have fewer than 100 acute care beds.
(a) The department may request and maintain employment
information for nurse assistants and direct care staff of
intermediate care facilities/developmentally disabled, other than
state-operated intermediate care facilities/developmentally disabled
that secure criminal record clearances for employees through another
method, intermediate care facilities/developmentally
disabled-habilitative, or intermediate care
(b) Within five working days of receipt of a criminal record or
information from the Department of Justice pursuant to Section
1338.5, the department shall notify the licensee and applicant of any
(c) The department shall conduct a feasibility study to assess the
additional technology requirements necessary to include previous and
current employment information on its registry and to make that
information available to potential employers. The department shall
report to the Legislature by July 1, 2000, as to the results of the
Health systems agencies shall do all of the following:
(a) Verify information in the health service plan received from
hospitals in their respective health service area.
(b) Within 45 days make a recommendation, including findings, to
the state department regarding the need for, and ability of the
hospital to implement its health services plan for hospitals in their
respective health service area.
(c) Upon contracting with the state department, provide technical
assistance to primary health service hospitals in the preparation of
health services pursuant to Section 1339.15.
(d) In the event a health systems agency is unable to perform the
functions, the state department shall perform those functions.
Any primary health service hospital, or any group thereof,
may submit a health service plan to the state department when a
public meeting, which satisfies the following criteria, has been
conducted in the community by the hospital with respect to such
hospital's health service plan for the community, or when more than
one hospital is involved, in the communities for which the hospitals
propose to provide primary health service hospital services:
(a) The plan is made available for public review at least two
weeks prior to the public meeting.
(b) Notices announcing the public meeting are posted in publicly
visible places in the community and at the hospital at least 10 days
prior to the public meeting.
(c) A public notice is published in a newspaper of general
circulation not less than 10 or more than 20 days prior to the public
A primary health service hospital may request waivers
pursuant to subdivision (d) of Section 1339.7, and Section 1339.25,
authorization for swing beds pursuant to Section 1339.8 and seek the
benefits pursuant to subdivision (l) of Section 1339.7 by submitting
a health service plan. The health service plan shall be submitted to
the state department and the health systems agency and shall contain
the following as appropriate and dependent on the needs of the
(a) A description of the hospital's current capabilities with
emphasis on the following:
(1) Primary and preventive care services including life saving
(2) Community access to health services.
(3) Cost effectiveness.
(b) Additionally, and as appropriate, the plan shall include:
(1) A description of any services to be deleted from those
authorized by license at the time the plan is submitted with a
description of the impact the deletion of this service will have on
(2) A description of any services to be added to those authorized
by license at the time the plan is submitted, including evidence of
market feasibility, methods and schedule for plan implementation,
evidence of community and medical staff support of the plan, and
evidence of coordination with other health providers and services in
(3) Requests for waivers or exemptions which do not jeopardize the
health, safety, and well-being of patients affected, and which are
needed for increased operational efficiency or to implement the
health service plan.
(4) Identification of the number of acute care beds in the
hospital, if any, requested for use as swing beds, depending upon
community need and projected utilization, including a description of
the way in which medical care will be provided to those patients and
a description of how the facility will provide for the transfer of
long-term care patients when the need for acute care beds develops.
A primary health service hospital may amend its health
service plan. Such amendments shall be subject to the provisions of
subdivision (c) of Section 1337.7 and Section 1339.13. Amendments
shall not be made to such plan solely for the purpose of
circumventing sanctions administered for noncompliance with such
hospital's health service plan.
The primary health service hospital shall operate under
the following requirements:
(a) The primary health service hospital shall be subject to the
regulations contained in Division 5 (commencing with Section 70001)
of Title 22 of the California Administrative Code that are not waived
as a result of the health service plan or subsequent amendments to
(b) Services offered by the primary health service hospital shall
be limited in scope according to its license or authorized by an
approved health service plan, and any subsequent amendments thereto.
(c) All or a portion of the health service plan shall be
implemented, based upon an agreed timetable between the state
department and the hospital, and to the extent that state and federal
requirements are waived.
(d) The hospital shall remain in compliance with its plan in
accordance with subdivision (c).
(a) In accordance with the procedures prescribed in
subdivision (h) of Section 1339.7, the state department shall
terminate a hospital's health service plan or its designation as a
primary health service hospital, or both, when it finds that the
hospital is not in compliance with Section 1339.19 or the welfare or
safety of the patients served by the facility is adversely affected,
(b) A primary health service hospital may terminate its
designation or health service plan, or both, after giving a 30-day
notice to the state department.
(c) Upon termination from the project, as prescribed by this
section, the hospital shall revert to the same status it held
immediately preceding its designation or approval of its plan, or
Implementation of this article shall be consistent with
federal rules and regulations in effect on January 1, 1979, and as
adopted on or after such date. In keeping with the intent in enacting
this article and to the extent permitted by federal law, each
department within the Health and Welfare Agency may waive
requirements, provide exemptions to the enforcement of statutes upon
which the requirements were based, allow flexible enforcement of
regulations and policies, and make resources available which are
necessary for the administration of this article, including technical
assistance to primary health service hospitals in developing their
health service plans.