Existing law imposes various limitations on emissions of air contaminants for the control of air pollution from vehicular and nonvehicular sources. Existing law generally designates the State Air Resources Board as the state agency with the primary responsibility for the control of vehicular air pollution, and air pollution control and air quality management districts with the primary responsibility for the control of air pollution from all sources other than vehicular sources.

This bill would require a health facility, as defined, to conduct specified tests and maintenance of its diesel backup generators and standby systems. By adding to the duties of air districts, 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 no reimbursement is required by this act for a specified reason.

Existing law imposes various limitations on emissions of air contaminants for the control of air pollution from vehicular and nonvehicular sources. Existing law generally designates the State Air Resources Board as the state agency with the primary responsibility for the control of vehicular air pollution, and air pollution control and air quality management districts with the primary responsibility for the control of air pollution from all sources other than vehicular sources.

This bill would require a health facility, as defined, to conduct specified tests and maintenance of its diesel backup generators and standby systems. By adding to the duties of air districts, 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 no reimbursement is required by this act for a specified reason.

Existing law imposes various limitations on emissions of air contaminants for the control of air pollution from vehicular and nonvehicular sources. Existing law generally designates the State Air Resources Board as the state agency with the primary responsibility for the control of vehicular air pollution, and air pollution control and air quality management districts with the primary responsibility for the control of air pollution from all sources other than vehicular sources.

This bill would require a health facility, as defined, to conduct specified tests and maintenance of its diesel backup generators and standby systems. By adding to the duties of air districts, 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 no reimbursement is required by this act for a specified reason.

Existing law imposes various limitations on emissions of air contaminants for the control of air pollution from vehicular and nonvehicular sources. Existing law generally designates the State Air Resources Board as the state agency with the primary responsibility for the control of vehicular air pollution, and air pollution control and air quality management districts with the primary responsibility for the control of air pollution from all sources other than vehicular sources.

This bill would require a health facility, as defined, to conduct specified tests and maintenance of its diesel backup generators. generators and standby systems. By adding to the duties of air districts, 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 no reimbursement is required by this act for a specified reason.

Existing law imposes various limitations on emissions of air contaminants for the control of air pollution from vehicular and nonvehicular sources. Existing law generally designates the State Air Resources Board as the state agency with the primary responsibility for the control of vehicular air pollution, and air pollution control and air quality management districts with the primary responsibility for the control of air pollution from all sources other than vehicular sources.

This bill would require a health facility, as defined, to conduct specified tests of its diesel backup generators. By adding to the duties of air districts, 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 no reimbursement is required by this act for a specified reason.

 CONSENT  

Bill No: AB 1014

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 9-0, 6/14/17

AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth

SENATE ENVIRONMENTAL QUALITY COMMITTEE: 6-0, 6/21/17

AYES: Wieckowski, Stone, Hill, Lara, Skinner, Stern

NO VOTE RECORDED: Gaines

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 77-0, 5/11/17 (Consent) - See last page for vote

SUBJECT:

SOURCE: California Hospital Association

DIGEST:

This bill requires a health facility to test and maintain each of its diesel backup generators in conformance with a specified standard adopted by the Centers for Medicare and Medicaid Services (CMS).

ANALYSIS:

Existing law:

1. Licenses and regulates health care facilities by the Department of Public Health (DPH), including general acute care hospitals, special hospitals, skilled nursing facilities, and intermediate care facilities.
2. Establishes the California Air Resources Board (CARB) as the state agency charged with coordinating efforts to attain and maintain ambient air quality standards, to conduct research into the causes of and solution to air pollution, and to systematically attack the serious problem caused by motor vehicles. Specifies that the control of emissions from motor vehicles is the responsibility of CARB, while regional air quality management districts have primary responsibility for regulating air pollution from all other sources.
3. Requires, up until January 1, 2016, that a licensed health facility test each of its diesel backup generators, as specified, 12 times per year, at intervals of between 20 and 40 days. Specified that nothing in this provision of law affected the authority of CARB or local air districts to regulate diesel backup generators owned by a health facility. This provision of law was repealed pursuant to a sunset date as of January 1, 2016.
4. Requires, pursuant to Title 22 regulations, that diesel back-up generators installed in hospitals be tested as required in a specified provision of law, described in 3) above, that was repealed on January 1, 2016, due to a sunset date.

This bill:

1. Requires a health facility, as defined, to test and maintain each of its diesel backup generators and standby systems in conformance with the edition of the National Fire Protection Association’s (NFPA’s) Standard for Emergency and Standby Power Systems adopted by the Life Safety Code and the federal CMS.
2. Defines a health facility, for purposes of this bill, as only including general acute care hospitals, acute psychiatric hospitals, special hospitals, skilled nursing facilities, and intermediate care facilities.
3. Specifies that nothing in this bill affects the authority of CARB or an air quality management district to regulate diesel backup generators owned by a health facility.

Comments

1. Author’s statement. According to the author, it is critical that hospitals and health facilities regularly test their diesel generators to ensure they are fully functional in the event of an emergency. This bill will codify the necessary requirements for testing these generators. These minimum testing requirements also recognize the continued effort to reduce emissions from diesel generators.
2. NFPA standards and CMS. The NFPA is a trade association that creates and maintains private, copyrighted standards and codes for use and adoption by local, state, and national governments. The NFPA is responsible for hundreds of codes and standards, including model building codes, which are designed to minimize the risk and effects of fire by establishing criteria for building, processing, design, service, and installation.

According to NFPA, since 1970, CMS has mandated compliance with various editions of NFPA 101 Life Safety Code, which is intended to protect people based on building construction, protection, and occupancy features that minimizes the effects of fire and related hazards. In 2016, CMS issued a new rule dealing with emergency preparedness. This rule requires hospitals and certain other facilities to comply with NFPA 110, the Standard for Emergency and Standby Power Systems. This standard, which is the standard required under this bill, contains requirements covering the performance of emergency and standby power systems in the event that the primary power source fails. The NFPA 110 standard also includes maintenance, operation and testing requirements as they pertain to the performance of the emergency power supply system.

1. Legislative and regulatory history. In 2003, the California Hospital Association (CHA), which is sponsoring this bill, sponsored AB 390 (Montanez, Chapter 676, Statutes of 2003) to revise diesel generator testing requirements. At the time, Title 22 regulations that had been in effect for many years required weekly 30-minute tests, while standards adopted by the largest hospital accrediting organization only required monthly tests. In 1998, CARB had identified diesel particulate matter as a toxic air contaminant based on its potential to cause cancer and other adverse health effects, and, according to CHA, hospitals were being fined by local air quality management districts for emitting excess diesel particulate matter. AB 390 required hospitals to test their generators based on national accrediting standards (once per month), and to start the generator in those weeks it was not being tested. AB 390 included a sunset date of January 1, 2009, that was intended to allow DPH to consider the issue and revise the Title 22 regulations as necessary. AB 2216 (Gaines, Chapter 232, Statutes of 2008) extended this sunset date to January 1, 2011, and deleted the requirement that generators be started during weeks when the generator is not being tested. Finally, AB 1863 (Gaines, Chapter 164, Statutes of 2010), extended the sunset date to January 1, 2016. In 2013, regulations were adopted to revise the Title 22 requirements pertaining to the testing of emergency generators. However, instead of adopting a new standard, the regulations simply required that the diesel generators be “tested as required by Health and Safety Code, Section 41514.1.” Unfortunately, this is the statute that sunset on January 1, 2016. The standard proposed in this bill uses the same code section, so the regulation would not have to be modified again.

Related/Prior Legislation

AB 1863 (Gaines, Chapter 164, Statutes of 2010) extended the sunset date of provisions of law relating to the testing of backup diesel generators in health facilities to January 1, 2016.

AB 2216 (Gaines, Chapter 232, Statutes of 2008) extended the sunset date of provisions of law relating to the testing of backup diesel generators in health facilities to January 1, 2011, and deleted the requirement that generators be started during weeks when the generator is not being tested.

AB 390 (Montanez, Chapter 676, Statutes of 2003) reduced the testing frequency for testing diesel backup generators of health facilities by requiring health facilities to meet the most recent standards set by the Joint Commission on the Accreditation of Healthcare Organizations, and sunset on January 1, 2009.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 7/10/17)

California Hospital Association (source)

Bay Area Air Quality Management District

California Air Pollution Control Officers Association

California Association of Health Facilities

Sacramento Air Quality Management District

OPPOSITION: (Verified 7/10/17)

None received

ARGUMENTS IN SUPPORT: CHA is sponsoring this bill, and states in support that more than 10 years ago, it sponsored legislation that originally addressed concerns that hospitals were over-testing their diesel backup generators as compared to manufacturer’s requirements, resulting in unnecessary pollution. CHA states that the testing requirements were mandated under 25-year-old regulations, and included a weekly half-hour test of the generator. CHA then sponsored two additional pieces of legislation to extend the sunset date to 2016, and since that time, DPH has updated the regulations to refer back to the statute. However, because the statute sunset in 2016, the regulation is referring to a statute that does not exist. CHA states that this bill replaces the statute, and requires the hospitals follow the NFPA standard which is also required by CMS, as well as for hospital accreditation. This includes a requirement that hospitals test their diesel generators once a month for a half-hour. This bill is supported by the Sacramento Air Quality Management District, the Bay Area Air Quality Management District, and the California Air Pollution Control Officers Association, which state that reliable power supply at hospitals is critical and testing of backup diesel generators is necessary to ensure they function properly during a power outage. However, diesel generators emit toxic diesel particulate matter which is harmful to public health, and supports efforts to require monthly, rather than weekly testing of these generators. The California Association of Health Facilities states in support that this bill will fix conflicting regulations between state and federal guidelines when health facilities need to perform specific tests and maintenance to diesel backup generators.

ASSEMBLY FLOOR: 77-0, 5/11/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Dahle, O'Donnell, Patterson

Prepared by:

7/12/17 11:59:26

**** END ****

SENATE COMMITTEE ON ENVIRONMENTAL QUALITY

Senator Wieckowski, Chair

2017 - 2018 Regular

Bill No: AB 1014

SUBJECT: Diesel backup generators: health facility.

ANALYSIS:

Existing federal law:

1. The Federal Clean Air Act (FCAA) and its implementing regulations set National Ambient Air Quality Standards (NAAQS) for six criteria pollutants, designate air basins that do not achieve NAAQS as nonattainment, allow only California to set vehicular emissions standards stricter than the federal government, and allow other states to adopt either the federal or California vehicular emissions standards. (42 U.S.C. §7401 et seq.)
   

Existing state law:

1. Establishes the Air Resources Board (ARB) as the air pollution control agency in California and requires the ARB, among other things, to control emissions from a wide array of mobile sources and coordinate with local air districts to control emissions from stationary sources in order to implement the FCAA. (Health and Safety Code (HSC) §39500 et seq.)
   
2. Provides shared authority over toxic air contaminant emissions between ARB and local air districts. (HSC §39650 et seq.)
   
3. Requires, subject to the powers and duties of the ARB, the local air districts to adopt and enforce rules and regulations to achieve and maintain the state and federal ambient air quality standards in all areas affected by emission sources under their jurisdiction, and to enforce all applicable provisions of state and federal law. (HSC §40001)
   
4. Prohibits, generally, discharging contaminants into the air, including:
   
   1. Constructing or operating any article, machine, equipment, or other contrivance without a permit, or of any order, rule, or regulation prohibiting or limiting the discharge of air contaminants into the air. (HSC §42450)
      
   2. Discharging from any source whatsoever quantities of air contaminants or other material that cause injury, detriment, nuisance, or annoyance to any considerable number of persons or to the public, or that endanger the comfort, repose, health, or safety of any of those persons or the public, or that cause, or have a natural tendency to cause, injury or damage to business or property. (HSC §41700)
      
   3. Discharging into the atmosphere from any source whatsoever any air contaminant, other than uncombined water vapor, for a period or periods aggregating more than three minutes in any one hour which has opacity sufficient to obscure an observer’s view, as specified. (HSC §41701)
      
5. Establishes the Office of Statewide Health Planning and development (OSHPD) to, among other things, enforce building standards as they relate to health facilities construction. (HSC §127000 et seq.)
   
6. Establishes the California Department of Public Health (CDPH), which contains a Licensing and Certification Division (L&C) to ensure that health care facilities comply with state laws and regulations, to, among other things, oversee public health issues in the state. (HSC §131000 et seq.)
   
7. Defines, among other things, the following health facilities:
   
   1. “General acute care hospital” means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
      
   2. “Acute psychiatric hospital” means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders.
      
   3. “Skilled nursing facility” means a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis.
      
   4. “Intermediate care facility” means a health facility that provides inpatient care to ambulatory or nonambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability of continuous skilled nursing care.
      
   5. “Special hospital” means a health facility 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.
      
   6. “Intermediate care facility/developmentally disabled” means a facility that provides 24-hour personal care, habilitation, developmental, and supportive health services to persons with developmental disabilities whose primary need is for developmental services and who have a recurring but intermittent need for skilled nursing services.
      
   7. “Nursing facility” means a health facility licensed pursuant to this chapter that is certified to participate as a provider of care either as a skilled nursing facility in the federal Medicare Program under Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal Medicaid Program under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.), or as both. (HSC §1250)
      

This bill:

1. Requires the health facilities listed above to test and maintain each of its diesel backup generators and standby systems in conformance with the edition of the National Fire Protection Association 110: Standard for Emergency and Standby Power Systems adopted by the Life Safety Code and the federal Centers for Medicare and Medicaid Services.
   
2. States that nothing in this legislation affects the authority of the state board or a district to regulate diesel backup generators owned by a health facility.
   

Background

1. Health Impacts of Air Pollution. When not adequately controlled, air pollution has dire consequences on the health and safety of both people and the environment. Poor air quality causes the lungs to constrict, resulting in wheezing, shortness of breath and chest tightness, especially during exercise or physical activity.
   
   It is well known that air pollution causes asthma. According to the Centers for Disease Control and Prevention, nationwide 7.4% of adults and 8.6% of children have been diagnosed with asthma. In California, the numbers are significantly higher: 13.1% of adults and 12.5% of children have been diagnosed with asthma. Lower income and minority groups are disproportionately affected by asthma due to their increased exposure to air pollution.
   
   Depending on exposure, air pollution alone can cause an increased risk of cardiovascular and respiratory illness, lung disease, cancerous tumors, birth defects, premature births, developmental disorders, central nervous system damage, intellectual disability, persistent memory impairments, epilepsy, dementia, and premature death.
   
2. Air Quality Standards. The Federal Clean Air Act (FCAA) passed in 1963 and has been revised many times thereafter. The FCAA and its implementing regulations are intended to protect public health and environmental quality by limiting and reducing pollution from various sources. Under the FCAA, the US EPA establishes National Ambient Air Quality Standards (NAAQS) that apply to outdoor air throughout the country.
   
   In 1969 and 1971, ARB set the first air quality standards for ozone, Particulate Matter (PM), oxides of nitrogen (NOx), oxides of sulfur (SOx), and carbon monoxide due to their negative impacts on public health above specified concentrations.
   
   The federal government followed suit and set NAAQS for six “criteria pollutants.” These included ground-level ozone, PM, NOx, SOx, and carbon monoxide, and added lead. Now, the US EPA reviews each NAAQS at five-year intervals to ensure that the standards are based on the most recent scientific information.
   
   Regions that do not meet the national standards for any one of the standards are designated “nonattainment areas.” The FCAA sets deadlines for attainment based on the severity of nonattainment and requires states to develop comprehensive plans, known as the state implementation plan (SIP), to attain and maintain air-quality standards for each area designated nonattainment for an NAAQS.
   
3. Health Effects of Diesel Exhaust.
   
   Diesel exhaust is produced when an engine burns diesel fuel. It is a complex mixture of thousands of gases and fine particles (commonly known as soot) that contains more than 40 toxic air contaminants. These include many known or suspected cancer-causing substances, such as benzene, arsenic and formaldehyde. It also contains other harmful pollutants, including nitrogen oxides (a component of smog).
   
   In 1998, the California Environmental Protection Agency’s (Cal/EPA) Office of Environmental Health Hazard Assessment (OEHHA) completed a comprehensive health assessment of diesel exhaust. This assessment formed the basis for a decision by ARB to formally identify particles in diesel exhaust as a toxic air contaminant that may pose a threat to human health.
   
   Diesel engines are a major source PM. The elderly and people with emphysema, asthma, and chronic heart and lung disease are especially sensitive to PM. Numerous studies have linked elevated particle levels in the air to increased hospital admissions, emergency room visits, asthma attacks and premature deaths among those suffering from respiratory problems. Because children’s lungs and respiratory systems are still developing, they are also more susceptible than healthy adults to fine particles. Exposure to PM is associated with increased frequency of childhood illnesses and can also reduce lung function in children.
   
   Diesel exhaust and many individual substances contained in it have the potential to contribute to mutations in cells that can lead to cancer. In fact, long-term exposure to diesel exhaust particles poses the highest cancer risk of any toxic air contaminant evaluated by OEHHA.
   
4. Diesel generators at health facilities. Health facilities are required to maintain backup generators to provide emergency lighting and power supplies in case of a power failure. Hospitals are currently required by regulation and accreditation to follow the National Fire Protection Association (NFPA) guidelines, which require monthly testing of the generators to full capacity to ensure functionality.
   
   The NFPA is a nonprofit, volunteer-run organization, established in 1896, devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. The NFPA develops standards to minimize the risk and effects of fire by establishing criteria for building, processing, design, service, and installation. The NFPA standards development process encourages public participation in the development of its standards. All NFPA standards are revised and updated every three to five years, in revision cycles that begin twice each year. Normally, a standard’s cycle takes approximately two years to complete.
   
   Since 1970, Centers for Medicare and Medicaid (CMS) has mandated compliance with various editions of NFPA Life Safety Code. In 2016, the CMS issued a new rule requiring the use of an updated edition of NFPA standards to measure life safety compliance in hospitals, long-term care facilities, and certain residential board and care facilities.
   
   Fourteen years ago the California Hospital Association (CHA) sponsored AB 390 (Montañez, Chapter 676, Statutes of 2003), which originally addressed concerns that hospitals were over-testing their diesel backup generators as compared to national standards, resulting in unnecessary pollution. The testing requirements at the time were mandated under 25 year old Title 22 regulations and included a weekly half-hour test of the generator.
   
   According to CHA, the L&C Division of CDPH (Department of Health Services at that time) had not updated these regulations to reflect current national standards and hospitals were being fined for emitting excess diesel particulate matter by their local air districts. AB 390 included a 2009 sunset date to give L&C additional time to evaluate this issue. CHA sponsored two additional bills to extend the deadline, anticipating permanent regulations from CDPH. CDPH filed an updated regulation on January 9, 2013. However, the enabling statute of the regulations, HSC §41514.1, sunset in 2016.

Comments

1. Purpose of Bill. According to the author, “it is critical hospitals and health facilities regularly test their diesel generators to ensure they are fully functional in the event of an emergency. AB 1014 will codify the necessary requirements for testing these generators. These minimum testing requirements specified also recognize the continued effort to reduce emissions from diesel generators.”
   

Related/Prior Legislation

AB 1863 (Gaines, Chapter 164, Statutes of 2010) extends, until January 1, 2016, provisions of law related to testing diesel back-up generators in hospitals, and extends provisions according to national testing standards. 


AB 2216 (Gaines, Chapter 232, Statutes of 2008) extends, until January 1, 2011, a requirement that health care facilities meet the most recent standards set by the Joint Commission on the Accreditation of Healthcare Organizations for testing of backup diesel generators. Deletes a requirement that health facility diesel backup generators be started during weeks when the generator is not being tested. 


AB 390 (Montanez, Chapter 676, Statutes of 2003) reduced the testing frequency for testing diesel back-up generators of health facilities and aligned California law with the joint commission standards governing this type of testing.

DOUBLE REFERRAL:

This measure was heard in Senate Health Committee on June 14, 2017, and passed out of committee with a vote of 9-0.

SOURCE:

California Hospital Association

SUPPORT:

Bay Area Air Quality Management District

California Air Pollution Control Officers Association

California Association of Health Facilities

Sacramento Air Quality Management District

OPPOSITION:

None received

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1014

SUBJECT: Diesel backup generators: health facility

SUMMARY:

Requires a health facility to test and maintain each of its diesel backup generators in conformance with a specified standard adopted by CMS.

Existing law:

1. Licenses and regulates health care facilities by the Department of Public Health (DPH), including general acute care hospitals, special hospitals, skilled nursing facilities, and intermediate care facilities.
2. Establishes the California Air Resources Board (CARB) as the state agency charged with coordinating efforts to attain and maintain ambient air quality standards, to conduct research into the causes of and solution to air pollution, and to systematically attack the serious problem caused by motor vehicles. Specifies that the control of emissions from motor vehicles is the responsibility of CARB, while regional air quality management districts have primary responsibility for regulating air pollution from all other sources.
3. Required, up until January 1, 2016, that a licensed health facility test each of its diesel backup generators, as specified, 12 times per year, at intervals of between 20 and 40 days. Specified that nothing in this provision of law affected the authority of CARB or local air districts to regulate diesel backup generators owned by a health facility. This provision of law was repealed pursuant to a sunset date as of January 1, 2016.
4. Requires, pursuant to Title 22 regulations, that diesel back-up generators installed in hospitals be tested as required in a specified provision of law, described in 3) above, that was repealed on January 1, 2016 due to a sunset date.

This bill:

1. Requires a health facility, as defined, to test and maintain each of its diesel backup generators and standby systems in conformance with the edition of the National Fire Protection Association’s (NFPA’s) Standard for Emergency and Standby Power Systems adopted by the Life Safety Code and the federal Centers for Medicare and Medicaid Services (CMS).
2. Defines a health facility, for purposes of this bill, as only including general acute care hospitals, acute psychiatric hospitals, special hospitals, skilled nursing facilities, and intermediate care facilities.
3. Specifies that nothing in this bill affects the authority of CARB or an air quality management district to regulate diesel backup generators owned by a health facility.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill would have negligible state fiscal effect.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, it is critical hospitals and health facilities regularly test their diesel generators to ensure they are fully functional in the event of an emergency. This bill will codify the necessary requirements for testing these generators. These minimum testing requirements also recognize the continued effort to reduce emissions from diesel generators.
2. National Fire Protection Association standards and CMS. The National Fire Protection Association (NFPA) is a trade association that creates and maintains private, copyrighted standards and codes for use and adoption by local, state, and national governments. The NFPA is responsible for hundreds of codes and standards, including model building codes, which are designed to minimize the risk and effects of fire by establishing criteria for building, processing, design, service, and installation.
   
   According to NFPA, since 1970, CMS has mandated compliance with various editions of NFPA 101 Life Safety Code, which is intended to protect people based on building construction, protection, and occupancy features that minimizes the effects of fire and related hazards. In 2016, CMS issued a new rule dealing with emergency preparedness. This rule requires hospitals and certain other facilities to comply with NFPA 110, the Standard for Emergency and Standby Power Systems. This standard, which is the standard required under this bill, contains requirements covering the performance of emergency and standby power systems in the event that the primary power source fails. The NFPA 110 standard also includes maintenance, operation and testing requirements as they pertain to the performance of the emergency power supply system.
3. Legislative and regulatory history. In 2003, the California Hospital Association (CHA), which is sponsoring this bill, sponsored AB 390 (Montanez, Chapter 676, Statutes of 2003), to revise diesel generator testing requirements. At the time, Title 22 regulations that had been in effect for many years required weekly 30-minute tests, while standards adopted by the largest hospital accrediting organization only required monthly tests. In 1998, CARB had identified diesel particulate matter as a toxic air contaminant based on its potential to cause cancer and other adverse health effects, and according to CHA, hospitals were being fined by local air quality management districts for emitting excess diesel particulate matter. AB 390 required hospitals to test their generators based on national accrediting standards (once per month), and to start the generator in those weeks it was not being tested. AB 390 included a sunset date of January 1, 2009 that was intended to allow DPH to consider the issue and revise the Title 22 regulations as necessary. SB 2216 (Gaines, Chapter 232, Statutes of 2008) extended this sunset date to January 1, 2011, and deleted the requirement that generators be started during weeks when the generator is not being tested. Finally, AB 1863 (Gaines, Chapter 164, Statutes of 2010), extended the sunset date to January 1, 2016. In 2013, regulations were adopted to revise the Title 22 requirements pertaining to the testing of emergency generators. However, instead of adopting a new standard, the regulations simply required that the diesel generators be “tested as required by Health and Safety Code, Section 41514.1.” Unfortunately, this is the statute that sunset on January 1, 2016. The standard proposed in this bill uses the same code section, so the regulation would not have to be modified again.
4. Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Environmental Quality Committee.
5. Prior legislation. AB 390 (Montanez, Chapter 676, Statutes of 2003) reduced the testing frequency for testing diesel backup generators of health facilities by requiring health facilities to meet the most recent standards set by the Joint Commission on the Accreditation of Healthcare Organizations, and sunset on January 1, 2009.
   
   SB 2216 (Gaines, Chapter 232, Statutes of 2008) extended the sunset date of provisions of law relating to the testing of backup diesel generators in health facilities to January 1, 2011, and deleted the requirement that generators be started during weeks when the generator is not being tested.
   
   AB 1863 (Gaines, Chapter 164, Statutes of 2010) extended the sunset date of provisions of law relating to the testing of backup diesel generators in health facilities to January 1, 2016.
6. Support. CHA is sponsoring this bill, and states in support that more than 10 years ago, it sponsored legislation that originally addressed concerns that hospitals were over-testing their diesel backup generators as compared to manufacturer’s requirements, resulting in unnecessary pollution. CHA states that the testing requirements were mandated under 25-year-old regulations, and included a weekly half-hour test of the generator. CHA then sponsored two additional pieces of legislation to extend the sunset date to 2016, and since that time, DPH has updated the regulations to refer back to the statute. However, because the statute sunset in 2016, the regulation is referring to a statute that does not exist. CHA states that this bill replaces the statute, and requires the hospitals follow the NFPA standard which is also required by CMS, as well as for hospital accreditation. This includes a requirement that hospitals test their diesel generators once a month for a half-hour. This bill is supported by the Sacramento Air Quality Management District, the Bay Area Air Quality Management District, and the California Air Pollution Control Officers Association, which state that reliable power supply at hospitals is critical and testing of backup diesel generators is necessary to ensure they function properly during a power outage. However, diesel generators emit toxic diesel particulate matter which is harmful to public health, and supports efforts to require monthly, rather than weekly testing of these generators. The California Association of Health Facilities states in support that this bill will fix conflicting regulations between state and federal guidelines when health facilities need to perform specific tests and maintenance to diesel backup generators.

SUPPORT AND OPPOSITION:

Support: California Hospital Association (sponsor)

California Air Pollution Control Officers Association

California Association of Health Facilities

Bay Area Air Quality Management District

Sacramento Air Quality Management District

Oppose: None received

-- END --

Date of Hearing: May 3, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1014

Author:(Cooper) – As Amended Ver:April 17, 2017

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill reenacts a code section that is referenced in a California Department of Public Health facility licensing regulation, which establishes standards related to testing of diesel backup generators in hospitals.

FISCAL EFFECT:

Negligible state fiscal effect.

COMMENTS:

Purpose and Background. This bill reenacts a statute that inadvertently sunset in 2016. Hospitals are required to test backup generators in order to maintain power in the case of an outage. The code describing the testing protocol originally included a sunset which was extended twice as hospitals waited for CDPH to issue regulations. The regulations were issued in 2013, but the code section referenced in the regulation, which contained the standards, was repealed due to the application of the sunset.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 24, 2017

ASSEMBLY COMMITTEE ON NATURAL RESOURCES

Cristina Garcia, Chair

ABPCA Bill Id:AB 1014 (

Author:Cooper) – As Amended Ver:April 17, 2017

SUBJECT: Diesel backup generators: health facility

SUMMARY: Requires a health facility to test and maintain each of its diesel backup generators and standby systems in conformance with specified National Fire Protection Association (NFPA) standards. Provides that the bill does not affect the authority of the Air Resources Board (ARB) or air districts to regulate diesel backup generators owned by a health facility.

EXISTING LAW:

1. Establishes ARB to regulate motor vehicle emissions, coordinate activities of air districts for the purposes of the federal Clean Air Act, and implement the California Global Warming Solutions Act (AB 32).
   
2. Subject to the powers of the ARB, requires air districts to adopt and enforce rules and regulations to achieve and maintain the state and federal ambient air quality standards in all areas affected by non-vehicular emission sources under their jurisdiction.
3. Generally prohibits a person, except as specified, from discharging air contaminants or other material that cause injury, detriment, nuisance, or annoyance or endanger the comfort, repose, health or safety to any considerable number of persons, or to the public, or that cause, or have a tendency to cause, injury or damage to a business or property.
4. Establishes the Office of Statewide Health Planning and Development to, among other functions, enforce building standards per the California Building Standards Code, as they relate to health facilities construction.
5. Establishes the Department of Public Health (DPH) Licensing and Certification Division (L&C) which is responsible for ensuring health care facilities comply with state laws and regulations.

FISCAL EFFECT: Unknown

COMMENTS:

Health facilities are required to maintain backup generators to provide emergency lighting and power supplies in case of a power failure. Hospitals are currently required by regulation and accreditation to follow the NFPA guidelines, which require monthly testing of the generators to full capacity to ensure functionality. The NFPA is a nonprofit, volunteer-run organization, established in 1896, devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. The NFPA develops standards to minimize the risk and effects of fire by establishing criteria for building, processing, design, service, and installation. The NFPA standards development process encourages public participation in the development of its standards. All NFPA standards are revised and updated every three to five years, in revision cycles that begin twice each year. Normally, a standard’s cycle takes approximately two years to complete. Since 1970, Centers for Medicare and Medicaid (CMS) has mandated compliance with various editions of NFPA Life Safety Code. In 2016, the CMS issued a new rule requiring the use of an updated edition of NFPA standards to measure life safety compliance in hospitals, long-term care facilities, and certain residential board and care facilities.

Fourteen years ago the California Hospital Association (CHA) sponsored AB 390 (Montañez), Chapter 676, Statutes of 2003, which originally addressed concerns that hospitals were over-testing their diesel backup generators as compared to national standards, resulting in unnecessary pollution.  The testing requirements at the time were mandated under 25 year old Title 22 regulations and included a weekly half-hour test of the generator. According to CHA, the L&C division of DPH (Department of Health Services at that time) had not updated these regulations to reflect current national standards and hospitals were being fined for emitting excess diesel particulate matter by their local air districts. AB 390 included a 2009 sunset date to give L&C additional time to evaluate this issue. CHA sponsored two additional bills to extend the deadline, anticipating permanent regulations from DPH. DPH filed an updated regulation on January 9, 2013. However, the enabling statute of the regulations, Health and Safety Code Section 41514.1, sunseted in 2016. This bill reenacts Section 41514.1.

REGISTERED SUPPORT / OPPOSITION:

Support

California Hospital Association (Sponsor)

Bay Area Air Quality Management District

California Air Pollution Control Officers Association

California Association of Health Facilities

Sacramento Air Quality Management District

Opposition

None on file

Analysis Prepared by: Lawrence Lingbloom / NAT. RES. /

Date of Hearing: April 4, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1014

Author:(Cooper) – As Amended Ver:March 21, 2017

SUBJECT: Diesel backup generators: health facility.

SUMMARY: Requires a health facility, as defined, to test and maintain each of its diesel backup generators and standby systems in conformance with the edition of the National Fire Protection Association (NFPA) 110: Standard for Emergency and Standby Power Systems adopted by the Life Safety Code and the Center's for Medicare and Medicaid (CMS). Applies the provisions of this bill to: general acute care hospitals (GACHs); acute psychiatric hospitals (APHs); skilled nursing facilities (SNFs); intermediate care facilities (ICFs); ICF/Developmentally Disabled (ICF/DD); special hospitals (SHs); and, nursing facilities (NF).

EXISTING LAW:

1. Establishes the Air Resources Board (ARB) to, among other functions, coordinate state, regional, and local efforts to protect and enhance the ambient air quality of the state and provide local and regional authorities with the primary responsibility for control of air pollution from all sources other than vehicular sources.
2. Establishes the Office of Statewide Health Planning and Development (OSHPD) to, among other functions, enforce building standards per the California Building Standards Code, as they relate to health facilities construction.
3. Establishes the Department of Public Health (DPH) Licensing and Certification Division (L&C) which is responsible for ensuring health care facilities comply with state laws and regulations. In addition, L&C cooperates with CMS to ensure that facilities accepting Medicare and Medicaid (Medi-Cal in California) payments meet federal requirements.
4. Defines a health facility as all of the following:
   1. GACH means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing; surgical; anesthesia; laboratory; radiology; pharmacy; and, dietary services. A GACH includes a rural GACH, however a rural GACH is not required by DPH to provide surgery and anesthesia services;
      
   2. APH means a facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders;
      
   3. SNF means a facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis;
      
   4. ICF means a facility that provides inpatient care to ambulatory or non-ambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability of continuous skilled nursing care;
   5. SH means a facility 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;
   6. ICF/DD means a facility that provides 24-hour personal care, habilitation, developmental, and supportive health services to persons with developmental disabilities; and,
   7. NF means a facility that is certified to participate as a provider of care as a skilled nursing facility in the federal Medicare or Medicaid Programs.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, it is critical for hospitals and health facilities to regularly test their diesel generators to ensure they are fully functional in the event of an emergency. The author states that this bill will codify the necessary requirements for testing these generators, and that these minimum testing requirements also recognize the continued effort to reduce emissions from diesel generators.
2. BACKGROUND.
   
   1. Legislative and regulatory history. Health facilities are required to maintain backup generators to provide emergency lighting and power supplies in case of a power failure. Fourteen years ago the California Hospital Association (CHA) sponsored AB 390 (Montañez), Chapter 676, Statutes of 2003, which originally addressed concerns that hospitals were over-testing their diesel backup generators as compared to national standards, resulting in unnecessary pollution.  The testing requirements at the time were mandated under 25 year old Title 22 regulations and included a weekly half-hour test of the generator. According to CHA, the L&C division of DPH (Department of Health Services at that time), had not updated these regulations to reflect current national standards and hospitals were being fined for emitting excess diesel particulate matter by their local air quality management districts. AB 390 included a 2009 sunset date to give L&C additional time to evaluate this issue. CHA sponsored two additional bills to extend the deadline, anticipating permanent regulations from DPH. DPH filed an updated regulation on January 9, 2013. However, the enabling statute of the regulations was Health and Safety Code section 41514.1, which sunset in 2016.
      
   2. Testing of diesel generators. Existing law relating to the testing of diesel generators sunset in 2016. Those provisions were as follows:
      
      1. Required a health facility to test each of its diesel backup generators 12 times a year with testing intervals of not less than 20 days and not more than 40 days. Required that tests be conducted for at least 30 continuous minutes pursuant to either of the following:
         
         1. A dynamic load that is at least 30% of the nameplate rating (initial capability as stated on the nameplate) of the generator; or,
            
         2. A test conducted at less than 30% of the nameplate rating of the generator, if the health facility revises its existing documented management plan to conform with the NFPA 110: Standard for Emergency and Standby Power Systems, 2005 edition, testing and maintenance activities. Requires these activities to include inspection procedures for assessing the prime mover’s exhaust gas temperature against the minimum temperature recommended by the manufacturer.
            
      2. Required, if a diesel backup generator could not be tested pursuant to the requirements in 1) above, to be tested for 30 continuous minutes at intervals of not less than 20 days and not more than 40 days with available Emergency Power Supply Systems load and tested annually with supplemental loads of all of the following in the following order for a total of two continuous hours:
         
         1. Twenty-five percent of nameplate rating for 30 minutes;
            
         2. Fifty percent of nameplate rating for 30 minutes; and,
            
         3. Seventy-five percent of nameplate rating for 60 minutes.
            
      3. Required health facilities to submit all data collected about diesel backup generator operation to DPH, upon request.
         
      4. Sunset the requirements on January 1, 2016.
         
   3. NFPA standards. The NFPA is a nonprofit, volunteer-run organization, established in 1896, devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. The NFPA develops standards to minimize the risk and effects of fire by establishing criteria for building, processing, design, service, and installation. The NFPA standards development process encourages public participation in the development of its standards. All NFPA standards are revised and updated every three to five years, in revision cycles that begin twice each year. Normally, a standard’s cycle takes approximately two years to complete. Since 1970, CMS has mandated compliance with various editions of NFPA Life Safety Code. In 2016, CMS issued a new rule requiring the use of an updated edition of NFPA 101 to measure life safety compliance in hospitals, long-term care facilities, and certain residential board and care facilities.
      
3. SUPPORT. CHA is the sponsor of this bill and states that this bill will replace the statute related to the testing requirements for diesel back-up generators in health facilities, requiring health facilities to follow the National Fire Protection Agency guidelines, which is also required by CMS. NFPA guidelines require monthly testing of the generators to full capacity to ensure functionality. CHA notes that this bill also clarifies when alternative testing may be used, and will reduce diesel particular matter in the environment.
   
   
4. PREVIOUS LEGISLATION.
   1. AB 1863 (Gaines), Chapter 164, Statutes of 2010, extends, until January 1, 2016, provisions of law related to testing diesel back-up generators in hospitals, and extends provision according to national testing standards.
   2. SB 2216 (Gaines), Chapter 232, Statutes of 2008, extends, until January 1, 2011, a requirement that health care facilities meet the most recent standards set by the Joint Commission on the Accreditation of Healthcare Organizations for testing of backup diesel generators. Deletes a requirement that health facility diesel backup generators be started during weeks when the generator is not being tested.
5. DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Natural Resources Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California Hospital Association (sponsor)

California Association of Health Facilities

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097