SB 759: Hospitals: seismic safety.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2023-03-21
Current Status:
Failed
(2024-02-01: Returned to Secretary of Senate pursuant to Joint Rule 56.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
What does this bill do?
This bill gives owners of California acute care inpatient hospitals ten more years—changing the seismic safety deadline from January 1, 2030 to January 1, 2040—to retrofit, replace, demolish, or convert hospital buildings that don’t meet state earthquake-safety rules. It also updates related requirements that hospital boards confirm they know about the deadline, that noncompliant buildings display a public notice in lobbies, and that hospitals send annual status updates to local officials, emergency services, unions, and the state.
The summary is provided by generative AI which can make mistakes. For original language, please view the details in the table below.
Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes, under the jurisdiction of the Department of Health Care Access and Information, a program of seismic safety building standards for certain hospitals constructed on and after March 7, 1973. Existing law requires, by January 1, 2030, owners of all acute care inpatient hospitals to either seismically retrofit all acute care inpatient hospitals, or demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with regulations and standards developed by the department in accordance with the act, as specified.
This bill would extend the deadline to January 1, 2040, and would make conforming changes related to the deadline extension.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care benefits, including substance use disorder services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) and authorizes the department to enter into a Drug Medi-Cal contract with each county for the provision of alcohol and drug use services within the county service area. Existing law authorizes the department to enter into contracts for the procurement of services to assist the department in administering Drug Medi-Cal.This bill would make a technical, nonsubstantive change to one of those provisions.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care benefits, including substance use disorder services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) and authorizes the department to enter into a Drug Medi-Cal contract with each county for the provision of alcohol and drug use services within the county service area. Existing law authorizes the department to enter into contracts for the procurement of services to assist the department in administering Drug Medi-Cal.
This bill would make a technical, nonsubstantive change to one of those provisions.
(a)(1)After January 1, 2008, a general acute care hospital building that is determined to be a potential risk of collapse or pose significant loss of life shall only be used for nonacute care hospital purposes, unless an extension of this deadline has been granted and either of the following occurs before the end of the extension:
(A)A replacement building has been constructed and a certificate of occupancy has been granted by the department for the replacement building.
(B)A retrofit has been performed on the building and a construction final has been obtained by the department.
(2)An extension of the deadline may be granted by the department upon a demonstration by the owner that compliance will result in a loss of health care capacity that may not be provided by other general acute care hospitals within a reasonable proximity. In its request for an extension of the deadline, a hospital shall state why the hospital is unable to comply with the January 1, 2008, deadline requirement.
(3)Prior to granting an extension of the January 1, 2008, deadline pursuant to this section, the department shall do all of the following:
(A)Provide public notice of a hospitals request for an extension of the deadline. The notice, at a minimum, shall be posted on the departments internet website, and shall include the facilitys name and identification number, the status of the request, and the beginning and ending dates of the comment period, and shall advise the public of the opportunity to submit public comments pursuant to subparagraph (C). The department shall also provide notice of all requests for the deadline extension directly to interested parties upon request of the interested parties.
(B)Provide copies of extension requests to interested parties within 10 working days to allow interested parties to review and provide comment within the 45-day comment period. The copies shall include those records that are available to the public pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(C)Allow the public to submit written comments on the extension proposal for a period of not less than 45 days from the date of the public notice.
(b)(1)It is the intent of the Legislature, in enacting this subdivision, to facilitate the process of having more hospital buildings in substantial compliance with this chapter and to take nonconforming general acute care hospital inpatient buildings out of service more quickly.
(2)The functional contiguous grouping of hospital buildings of a general acute care hospital, each of which provides, as the primary source, one or more of the hospitals eight basic services as specified in subdivision (a) of Section 1250, may receive a five-year extension of the January 1, 2008, deadline specified in subdivision (a) of this section pursuant to this subdivision for both structural and nonstructural requirements. A functional contiguous grouping refers to buildings containing one or more basic hospital services that are either attached or connected in a way that is acceptable to the State Department of Health Care Services. These buildings may be either on the existing site or a new site.
(3)To receive the five-year extension, a single building containing all of the basic services or at least one building within the contiguous grouping of hospital buildings shall have obtained a building permit prior to 1973 and this building shall be evaluated and classified as a nonconforming, Structural Performance Category-1 (SPC-1) building. The classification shall be submitted to and accepted by the Department of Health Care Access and Information. The identified hospital building shall be exempt from the requirement in subdivision (a) until January 1, 2013, if the hospital agrees that the basic service or services that were provided in that building shall be provided, on or before January 1, 2013, as follows:
(A)Moved into an existing conforming Structural Performance Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or Structural Performance Category-5 (SPC-5) and Non-Structural Performance Category-4 (NPC-4) or Non-Structural Performance Category-5 (NPC-5) building.
(B)Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5 building.
(C)Continued in the building if the building is retrofitted to an SPC-5 and NPC-4 or NPC-5 building.
(4)A five-year extension is also provided to a post-1973 building if the hospital owner informs the Department of Health Care Access and Information that the building is classified as SPC-1, SPC-3, or SPC-4 and will be closed to general acute care inpatient service use by January 1, 2013. The basic services in the building shall be relocated into an SPC-5 and NPC-4 or NPC-5 building by January 1, 2013.
(5)SPC-1 buildings, other than the building identified in paragraph (3) or (4), in the contiguous grouping of hospital buildings shall also be exempt from the requirement in subdivision (a) until January 1, 2013. However, on or before January 1, 2013, at a minimum, each of these buildings shall be retrofitted to an SPC-2 and NPC-3 building, or no longer be used for general acute care hospital inpatient services.
(c)On or before March 1, 2001, the department shall establish a schedule of interim work progress deadlines that hospitals shall be required to meet to be eligible for the extension specified in subdivision (b). To receive this extension, the hospital building or buildings shall meet the year 2002 nonstructural requirements.
(d)A hospital building that is eligible for an extension pursuant to this section shall meet the January 1, 2030, 2040, nonstructural and structural deadline requirements if the building is to be used for general acute care inpatient services after January 1, 2030. 2040.
(e)Upon compliance with subdivision (b), the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section. The department shall make copies of these notices available on its internet website.
(f)(1)A hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) may request an additional extension of up to two years for a hospital building that it owns or operates and that meets the criteria specified in paragraph (2), (3), or (5).
(2)The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A)The hospital building is under construction at the time of the request for extension under this subdivision and the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b).
(B)The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C)The hospital received a building permit for the construction described in subparagraph (A) at least two years prior to the applicable deadline for the building.
(D)The hospital submitted a construction timeline at least two years prior to the applicable deadline for the building demonstrating the hospitals intent to meet the applicable deadline. The timeline shall include all of the following:
(i)The projected construction start date.
(ii)The projected construction completion date.
(iii)Identification of the contractor.
(E)The hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D), but factors beyond the hospitals control make it impossible for the hospital to meet the deadline.
(3)The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A)The hospital building is owned by a health care district that has, as owner, received the extension of the January 1, 2008, deadline, but where the hospital is operated by an unaffiliated third-party lessee pursuant to a facility lease that extends at least through December 31, 2009. The district shall file a declaration with the department with a request for an extension stating that, as of the date of the filing, the district has lacked, and continues to lack, unrestricted access to the subject hospital building for seismic planning purposes during the term of the lease, and that the district is under contract with the county to maintain hospital services when the hospital comes under district control. The department shall not grant the extension if an unaffiliated third-party lessee will operate the hospital beyond December 31, 2010.
(B)The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C)The hospital received a building permit for the construction described in subparagraph (B) by December 31, 2011.
(D)The hospital submitted, by December 31, 2011, a construction timeline for the building demonstrating the hospitals intent and ability to meet the deadline of December 31, 2014. The timeline shall include all of the following:
(i)The projected construction start date.
(ii)The projected construction completion date.
(iii)Identification of the contractor.
(E)The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).
(F)The hospital granted an extension pursuant to this paragraph shall submit an additional status report to the department, equivalent to that required by subdivision (c) of Section 130061, no later than June 30, 2013.
(4)An extension granted pursuant to paragraph (3) shall be applicable only to the health care district applicant and its affiliated hospital while the hospital is operated by the district or an entity under the control of the district.
(5)The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:
(A)The hospital owner submitted to the department, prior to June 30, 2009, a request for review using current computer modeling utilized by the department and based upon software developed by the Federal Emergency Management Agency (FEMA), referred to as Hazards US, and the building was deemed SPC-1 after that review.
(B)The hospital building plans for the building are submitted to the department and deemed ready for review by the department prior to July 1, 2010. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that shall be retrofitted or replaced to meet the requirements of this section as a result of the project.
(C)The hospital receives a building permit from the department for the construction described in subparagraph (B) prior to January 1, 2012.
(D)The hospital submits, prior to January 1, 2012, a construction timeline for the building demonstrating the hospitals intent and ability to meet the applicable deadline. The timeline shall include all of the following:
(i)The projected construction start date.
(ii)The projected construction completion date.
(iii)Identification of the contractor.
(E)The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).
(F)The hospital owner completes construction such that the hospital meets all criteria to enable the department to issue a certificate of occupancy by the applicable deadline for the building.
(6)A hospital located in the County of Sacramento, San Mateo, or Santa Barbara or the City of San Jose or the City of Willits that has received an additional extension pursuant to paragraph (2) or (5) may request an additional extension until September 1, 2015, to obtain either a certificate of occupancy from the department for a replacement building, or a construction final from the department for a building on which a retrofit has been performed.
(7)A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.
(8)The department may revoke an extension granted pursuant to this subdivision for any hospital building where the work of construction is abandoned or suspended for a period of at least one year, unless the hospital demonstrates in a public document that the abandonment or suspension was caused by factors beyond its control.
(g)(1)Notwithstanding subdivisions (a), (b), (c), and (f), and Sections 130061.5 and 130064, a hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) also may request an additional extension of up to seven years for a hospital building that it owns or operates. The department may grant the extension subject to the hospital meeting the milestones set forth in paragraph (2).
(2)The hospital building subject to the extension shall meet all of the following milestones, unless the hospital building is reclassified as SPC-2 or higher as a result of its Hazards US score:
(A)The hospital owner submits to the department, no later than September 30, 2012, a letter of intent stating whether it intends to rebuild, replace, or retrofit the building, or remove all general acute care beds and services from the building, and the amount of time necessary to complete the construction.
(B)The hospital owner submits to the department, no later than September 30, 2012, a schedule detailing why the requested extension is necessary, and specifically how the hospital intends to meet the requested deadline.
(C)The hospital owner submits to the department, no later than September 30, 2012, an application ready for review seeking structural reassessment of each of its SPC-1 buildings using current computer modeling based upon software developed by FEMA, referred to as Hazards US.
(D)The hospital owner submits to the department, no later than January 1, 2015, plans ready for review consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B).
(E)The hospital owner submits a financial report to the department at the time the plans are submitted pursuant to subparagraph (D). The report shall demonstrate the hospital owners financial capacity to implement the construction plans submitted pursuant to subparagraph (D).
(F)The hospital owner receives a building permit consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B), no later than July 1, 2018.
(3)To evaluate public safety and determine whether to grant an extension of the deadline, the department shall consider the structural integrity of the hospitals SPC-1 buildings based on its Hazards US scores, community access to essential hospital services, and the hospital owners financial capacity to meet the deadline as determined by either a bond rating of BBB or below or the financial report on the hospital owners financial capacity submitted pursuant to subparagraph (E) of paragraph (2). The criteria contained in this paragraph shall be considered by the department in its determination of the length of an extension or whether an extension should be granted.
(4)The extension or subsequent adjustments granted pursuant to this subdivision may not exceed the amount of time that is reasonably necessary to complete the construction specified in paragraph (2).
(5)If the circumstances underlying the request for extension submitted to the department pursuant to paragraph (2) change, the hospital owner shall notify the department as soon as practicable, but in no event later than six months after the hospital owner discovered the change of circumstances. The department may adjust the length of the extension granted pursuant to paragraphs (2) and (3) as necessary, but in no event longer than the period specified in paragraph (1).
(6)A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.
(7)The department may revoke an extension granted pursuant to this subdivision for any hospital building when it is determined that any information submitted pursuant to this section was falsified, or if the hospital failed to meet a milestone set forth in paragraph (2), or where the work of construction is abandoned or suspended for a period of at least six months, unless the hospital demonstrates in a publicly available document that the abandonment or suspension was caused by factors beyond its control.
(8)Regulatory submissions made by the department to the California Building Standards Commission to implement this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations.
(9)The hospital owner that applies for an extension pursuant to this subdivision shall pay the office an additional fee, to be determined by the department, sufficient to cover the additional reasonable costs incurred by the department for maintaining the additional reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the extension documentation submitted pursuant to this subdivision. This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.
(10)This subdivision shall become operative on the date that the State Department of Health Care Services receives all necessary federal approvals for a 201112 fiscal year hospital quality assurance fee program that includes three hundred twenty million dollars ($320,000,000) in fee revenue to pay for health care coverage for children, which is made available as a result of the legislative enactment of a 201112 fiscal year hospital quality assurance fee program.
(h)A critical access hospital located in the City of Tehachapi may submit a seismic safety extension application pursuant to subdivision (g), notwithstanding deadlines in that subdivision that are earlier than the effective date of the act that added this subdivision. The submitted application shall include a timetable as required pursuant to subdivision (g).
(i)(1)A hospital located in the Tarzana neighborhood of the City of Los Angeles that has received extensions pursuant to subdivisions (b) and (g) may request an additional extension for a single building until October 1, 2022, in order to obtain a certificate of occupancy from the department for a replacement building.
(2)The hospital owner seeking the extension shall submit a written request that includes a timeline specifying how the hospital intends to meet the new deadline, including the construction document submission dates. The following timeline shall be met for construction document submissions:
(A)No later than January 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the second increment with information including the building core and shell of the hospital. Failure to submit the construction documents by January 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(B)No later than March 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the first increment with information including the structural foundation, frame, and underslab utilities of the hospital. Failure to submit the construction documents by March 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(C)No later than September 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the third increment with information on the build-out of the hospital. Failure to submit the construction documents by September 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(D)No later than November 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the fourth increment with information on the seismic support and anchorage of the hospital. Failure to submit the construction documents by November 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.
(E)The hospital owner may submit a written request to the department seeking an extension of the deadlines set forth in subparagraphs (A), (B), (C), and (D). The written request shall state with specificity the reason for the request and how the reason preventing compliance with the deadlines was outside of the control of the hospital owner. After review of the request for extension, the department may grant the request for a period of time not to exceed 30 calendar days. If the department grants the request for an extension, no fine shall accrue or be imposed during the extension period.
(3)Notwithstanding any other law, any fines assessed pursuant to paragraph (2) shall be deposited into the General Fund following a determination on appeal, if any. A hospital assessed a fine pursuant to this subdivision may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any fines to be held by the department pending the resolution of the appeal.
(4)The department shall not issue a certificate of occupancy for the single replacement building until all assessed fines accrued pursuant to paragraph (2) have been paid in full, or, if an appeal is pending, have been posted subject to resolution of an appeal. Fines deposited by the hospital pursuant to paragraph (3) shall be considered paid in full for purposes of issuing a certificate of occupancy pursuant to this paragraph. This paragraph is in addition to, and is not intended to supersede, any other requirements that must be met by the hospital for issuance by the department of a certificate of occupancy.
SEC. 2.Section 130063 of the Health and Safety Code is amended to read:130063.(a)With regard to a general acute care hospital building located in Seismic Zone 3 as indicated in the 1995 edition of the California Building Standards Code, any hospital may request an exemption from Non-Structural Performance Category-3 requirements in Title 24 of the California Code of Regulations if the hospital building complies with the year 2002 nonstructural requirements.
(b)The department shall determine the maximum allowable level of earthquake ground shaking potential for purposes of this section.
(c)To qualify for an exemption under this section, a hospital shall provide a site-specific engineering geologic report that demonstrates an earthquake ground shaking potential below the maximum allowable level of earthquake ground shaking potential determined by the department pursuant to subdivision (b).
(d)(1)To demonstrate an earthquake ground shaking potential as provided in subdivision (c), a hospital shall submit a site-specific engineering geologic report to the department.
(2)The department shall forward the report received from a hospital to the Division of Mines and Geology in the Department of Conservation for purposes of a review.
(3)If, after review of the analysis, the Division of Mines and Geology concurs with the findings of the report, it shall return the report with a statement of concurrence to the office. Upon the receipt of the statement, if the ground shaking potential is below that established pursuant to subdivision (b), the department shall grant the exemption requested.
(e)A hospital building that is eligible for an exemption under this section shall meet the January 1, 2030, 2040, nonstructural requirement deadline if the building is to be used for general acute care inpatient services after January 1, 2030. 2040.
(f)A hospital requesting an exemption pursuant to this section shall pay the actual expenses incurred by the department and the Division of Mines and Geology.
(g)All regulatory submissions to the California Building Standards Commission made by the department for purposes of this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations. This emergency regulation authority shall remain in effect until January 1, 2004.
SEC. 3.Section 130065 of the Health and Safety Code is amended to read:130065.(a)In accordance with the compliance schedule approved by the department, but in any case no later than January 1, 2030, 2040, owners of all acute care inpatient hospitals shall either:
(a)(1)Demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.
(b)(2)Seismically retrofit all acute care inpatient hospital buildings so that they are in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.
Upon(b)Upon compliance with this section, the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section.
SEC. 4.Section 130066 of the Health and Safety Code is amended to read:130066.Before January 1, 2020, the owner of an acute care inpatient hospital whose building does not substantially comply with the seismic safety regulations or standards described in Section 130065 shall submit to the department an attestation that the board of directors of that hospital is aware that the hospital building is required to meet the January 1, 2030, 2040, deadline for substantial compliance with those regulations and standards.
SEC. 5.Section 130066.5 of the Health and Safety Code is amended to read:130066.5.(a)Before January 1, 2024, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065 shall post in any lobby or waiting area generally accessible to patients or the public a notice provided by the department that the hospital is not in compliance with the seismic safety requirements that the hospital is required to meet by January 1, 2030. 2040. The notice shall be posted until the time the owner receives notification from the department that it meets the requirements described in Section 130065.
(b)On or before January 1, 2024, and annually thereafter, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065 shall provide an annual status update on the Structural Performance Category ratings of the buildings and the services provided in each hospital building on the hospital campus to all of the following entities until each of the hospital buildings owned by that hospital building owner is compliant with Section 130065:
(1)The county board of supervisors in whose jurisdiction the hospital building is located.
(2)The city council in whose jurisdiction the hospital building is located, if applicable.
(3)Any labor union representing workers who work in a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065.
(4)The board of directors of the special district or joint powers agency that provides fire and emergency medical services in the jurisdiction in which the hospital building is located, if applicable.
(5)The department.
(6)The board of directors of the hospital.
(7)The local office of emergency services or the equivalent agency.
(8)The Office of Emergency Services.
(9)The medical health operational area coordinator.
(c)Before July 1, 2023, the department shall develop the notice required in subdivision (a) with the intent that the notice will clearly convey to patients and the public that the hospital building does not meet seismic safety standards intended to ensure that the hospital will be capable of continued operation following an earthquake. For SPC-2 buildings, the notice shall clearly state, The State of California has determined that this building does not significantly jeopardize life, but may not be repairable or functional following an earthquake. For other buildings that are not compliant with the seismic safety regulations or standards described in Section 130065, the notice shall state, The State of California has determined that the hospital building is at risk of not being functional to provide care to its patients or the community after an earthquake. In its discretion, the department may develop multiple notices in order to provide a more detailed description of different hospital buildings failure to meet the seismic safety regulations or standards described in Section 130065.
SECTION 1.Section 14124.23 of the Welfare and Institutions Code is amended to read:14124.23.The department may enter into contracts for procuring services to assist the department in administering the Drug Medi-Cal Treatment Program.The department may enter into contracts for the procurement of procuring services to assist the department in administering the Drug Medi-Cal Treatment Program.
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Date
|
Status
|
|---|---|
| Feb 1, 2024 | Returned to Secretary of Senate pursuant to Joint Rule 56. |
| Jan 10, 2024 | January 10 set for second hearing canceled at the request of author. |
| Jan 3, 2024 | Set for hearing January 10. |
| Apr 24, 2023 | April 26 set for first hearing canceled at the request of author. |
| Apr 12, 2023 | Set for hearing April 26. |
| Mar 29, 2023 | Re-referred to Com. on HEALTH. |
| Mar 21, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Mar 1, 2023 | Referred to Com. on RLS. |
| Feb 21, 2023 | From printer. May be acted upon on or after March 20. |
| Feb 17, 2023 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Adventist Health | ** Support | |
| Alliance Of Catholic Health Care | ** Support | |
| American Federation of State, County and Municipal Employees | ** Against | |
| California Hospital Association | ** Support | |
| California Labor Federation | ** Against | |
| California Nurses Association | ** Against | |
| California Professional Firefighters | ** Against | |
| California Teamsters Public Affairs Council | ** Against | |
| Community Health Systems | ** Support | |
| Dignity Health | ** Support | |
| Engineers and Scientists of California | ** Against | |
| Kern Health Systems | ** Support | |
| Professional Engineers In California Government | ** Against | |
| Ridgecrest Regional Hospital | ** Support | |
| Rural County Representatives of California | ** Support | |
| Saint Agnes Medical Center | ** Support | |
| Scripps Health | ** Support | |
| SEIU California | ** Against | |
| State Building and Construction Trades Council | ** Against | |
| Tenet Healthcare | ** Support | |
| Unite Here | ** Against | |
| United Hospital Association | ** Support | |
| United Nurses Associations Of California/Union Of Health Care Professionals | ** Against | |
| Valley Children's Healthcare | ** Support |
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: SB 759
AUTHOR: | Grove | ||
VERSION: | March 21, 2023 | ||
HEARING DATE: | January 10, 2024 | ||
CONSULTANT: | Vincent D. Marchand | ||
SUBJECT: Hospitals: seismic safety
SUMMARY:
Extends the seismic safety deadline for hospitals to be capable of continued operations following an earthquake by ten years, to January 1, 2040.
Existing law:
- Licenses and regulates health facilities, including general acute care hospitals, by the California Department of Public Health (CDPH). [HSC §1250, et seq.]
- Establishes the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Seismic Safety Act), to ensure that hospital buildings are designed and constructed to resist the forces generated by earthquakes and requires the Department of Health Care Access and Information (HCAI), formerly the Office of Statewide Health Planning and Development (OSHPD), to propose building standards for earthquake resistance and to provide independent review of the design and construction of hospital buildings. [HSC §129675, et seq.]
- Establishes timelines for hospital compliance with seismic safety standards, including a requirement that buildings posing a significant risk of collapse and a danger to the public (referred to as SPC -1 buildings) be rebuilt or retrofitted to be capable of withstanding an earthquake, or removed from acute care service, by January 1, 2008 (which has since been extended for various hospitals to various dates), and a requirement that hospitals must also be capable of continued operation by January 1, 2030. [HSC §130060, §130065]
- Permits HCAI to grant an extension of up to five years to the 2008 deadline, which would be January 1, 2013, for hospitals for which compliance will result in a loss of health care capacity, as defined. Allows HCAI to grant various further extensions beyond this, including up to seven years to January 1, 2020, in part based on the loss of essential hospital services to the community if the hospital closed, and financial hardship. [HSC §130060, §130061.5]
- Permits HCAI, under legislation enacted in 2018, to provide for an extension of the January 1, 2020 deadline in 4) above, for up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to meet the 2020 standard, and up to five years (January 1, 2025) for hospitals that plan to rebuild to a standard that meets the 2030 requirement. [HSC §130062]
- Requires the owner of an acute care inpatient hospital whose building does not substantially comply with the January 1, 2030 seismic safety requirement described in 3) above, to submit to HCAI, by January 1, 2020, an attestation that the board of directors of that hospital is aware that the hospital building is required to meet this requirement. [HSC §130066]
- Establishes the Small and Rural Hospital Relief Program within HCAI for the purpose of funding seismic safety compliance with respect to small hospitals, rural hospitals, and critical access hospitals. Requires HCAI to provide grants to small, rural, and critical access hospital applicants that meet certain criteria, including that seismic safety compliance, as defined, imposes a financial burden on the applicant that may result in hospital closure. [HSC §130075, §130076, §130078]
This bill: Extends the January 1, 2030 deadline, under the Seismic Safety Act, by which hospitals are required to be capable of continued operations following a major earthquake, by ten years, so that the new deadline is January 1, 2040.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, this bill provides hospitals a delay in meeting compliance standards until there are resources available to assist them with compliance. The bill will keep these hospitals open as they work to meet these standards. This extension will also give hospitals time to begin recovering from the financial devastation of the pandemic without sacrificing patient care, especially in our most challenged communities.
- Background on hospital seismic safety requirements. The original Seismic Safety Act was passed in 1973, following the 1971 San Fernando Valley (also known as Sylmar) earthquake, and required all new hospital construction to meet seismic safety standards. The Seismic Safety Act did not apply to existing buildings with the expectation that older buildings would be replaced with conforming buildings over time. By the time of the Northridge earthquake in 1994, however, 80% of hospital beds were still in pre-1973 non-conforming buildings. The Northridge earthquake caused significant structural damage to a number of hospitals, with at least two hospitals needing to be evacuated. What also became apparent in the Northridge earthquake was that nonstructural damage was also a threat to patient safety, with damage to heating and ventilation systems and sprinklers, forcing evacuations. Following the Northridge earthquake, the Legislature updated the Seismic Safety Act with SB 1953 (Alquist, Chapter 740, Statutes of 1994), which required HCAI (at that time OSHPD) to establish earthquake performance categories for hospitals. SB 1953 also established a January 1, 2008 deadline by which general acute care hospitals must be retrofitted or replaced so that they do not pose a risk of collapse in the event of an earthquake (which has been repeatedly extended by subsequent legislation for most hospitals), and a January 1, 2030, deadline by which they must be capable of remaining operational following an earthquake.
Specifically, SB 1953 required HCAI to create structural performance categories (SPCs), as well as nonstructural performance categories (NPCs) for “nonstructural systems that are critical to providing basic services to hospital inpatients and the public after a disaster.” Each hospital building receives both an SPC and an NPC rating. According to HCAI, the SPC requirements can be thought of as protecting the skeleton, while NPC requirements ensure the organs and other tissues that are necessary for a human body to function will remain safely attached to the skeleton. It is important to note that a licensed facility, or hospital, is often made up of several buildings on its campus. Many hospitals may have one or more buildings that are 2030 compliant, while other buildings still need to be retrofitted or replaced. - Description of SPC ratings. Following the enactment of SB 1953, HCAI adopted regulations that initially created five SPC ratings, with a sixth category (SPC-4D) added more recently. The SPC ratings are as follows:
- SPC 1 – These are pre-1973 buildings (built prior to the adoption of the Seismic Safety Act standards) that are at significant risk of collapse and that represent a danger to the public. These buildings were originally required to be brought up to SPC 2 level or removed from service by 2008, but there have been a number of extensions. Most recently, AB 2190 (Reyes, Chapter 673, Statutes of 2018), provided for an extension until July 1, 2022 for hospitals that plan to replace or retrofit to SPC 2, and up to January 1, 2025 for hospitals that plan to retrofit to SPC 4D or replace with a new SPC 5 building.
- SPC 2 – These are also pre-1973 buildings, but were in substantial compliance with pre-1973 California Building Standards Codes, and while they may not be repairable or functional following an earthquake, they will not significantly jeopardize life. These buildings are permitted to remain in service only until January 1, 2030, at which point they need to have been replaced by an SPC 5 building, have the acute care services relocated to a conforming building (SPC 3, 4, or 5), or be retrofitted to SPC 4D.
The following categories are 2030 compliant, and can continue operating indefinitely:
- SPC 3 – These buildings are in compliance with the original 1973 Seismic Safety Act, but were constructed under a permit issued prior to October 25, 1994, and utilized steel movement-resisting frames. These buildings may experience structural damage during an earthquake, which does not significantly jeopardize life, but may not be repairable or functional following strong ground motion.
- SPC 4 – These are buildings constructed in compliance with the Seismic Safety Act under building permits issued between 1973 and 1989, but may experience structural damage, which may inhibit the ability to provide services to the public following strong ground motion.
- SPC 4D – This is a new category created to allow SPC 2 buildings to be retrofitted to a standard that is 2030 compliant. Because SPC 2 buildings were constructed prior to 1973, they can never reach SPC 3, 4 or 5, since these categories required construction to have started after the adoption of the 1973 standards. SPC 4D became effective on January 1, 2017.
- SPC 5 – These are buildings constructed after 1989, and are considered reasonably capable of providing services to the public following strong ground motion.
- Description of NPC ratings. The NPC requirements, unlike SPC requirements, are cumulative, and not different options. For example, a hospital is first required to achieve NPC 2, which ensures that the nonstructural components that are necessary for a safe evacuation are braced and anchored. Next, a hospital is required to achieve NPC 3 status, which ensures that at least the critical care areas are able to continue to function following an earthquake, and so on. The NPC standards are as follows:
- NPC 1 – The building does not meet any bracing and anchorage requirements.
- NPC 2 – The following systems in the building are braced or anchored according to the California Building Standards Code: communications systems, emergency power supply, bulk medical gas systems, fire alarm systems, and emergency lighting equipment and signs in the means of egress. Hospitals had to meet at least the NPC 2 standard by January 1, 2002.
- NPC 3 – This standard requires NPC 2 compliance, plus specified additional bracing and anchorage requirements in critical care areas, clinical laboratory services spaces, pharmaceutical service spaces, radiological service spaces, and central and sterile supply areas. Hospitals had to meet this standard by January 1, 2008, unless an extension or exemption was approved. Extensions generally tracked the extensions given to SPC 1 buildings, so some buildings are not required to achieve NPC 3 until January 1, 2024.
- NPC 4 – This standard requires NPC 3 compliance, plus all architectural, mechanical, electrical systems, components and equipment, and hospital equipment to meet bracing and anchorage requirements. Hospitals are required to meet this standard by January 1, 2024 or 2030 depending on the building’s seismic risk category and extension request requirements.
- NPC 4D – This is a new category assigned to existing hospital buildings that are in compliance with NPC 3 requirements, and have additionally achieved one of three levels with regards to emergency preparedness. NPC 4D became effective on January 1, 2017. Hospitals are required to meet this standard by January 1, 2030.
- NPC 5 – This final standard requires the hospital building to meet NPC 4 or NPC 4D, plus have onsite supplies of water and holding tanks for sewage and liquid waste, sufficient to support 72 hours of emergency operations, which are required to be integrated into the plumbing systems. Additionally, an onsite emergency system, as defined in the California Electrical Code, must be incorporated in the building electrical system for critical care areas, and the system is required to provide for radiological service and onsite fuel supply for 72 hours of acute care operation. Hospitals are required to meet this standard by January 1, 2030.
- Building code requirements account for regional variation of seismic risk. According to HCAI, compared to rest of the nation, California, in general, has high seismicity throughout the state. Parts of the state have very high seismicity in areas of close proximity to the major earthquake faults. Other areas of the state still have high seismicity. Additionally, each facility has a seismicity value based on their location. This location-specific seismic value is used to evaluate and design buildings at that site. Therefore, the evaluation for a building located in an area with a very high seismicity value will require a stronger building that can resist stronger earthquakes when compared to the evaluation for a building in a high seismicity value area. The evaluation based on location-specific seismicity values addresses the narrow differences in seismicity levels in California. Therefore, an SPC 2 building near a fault will need to be stronger to be life-safe than an SPC 2 building located significantly farther away from a fault line.
- Status of hospital seismic safety compliance. According to HCAI, as of October of 2023, there are a total of 3,323 buildings at 413 licensed hospital facilities that are subject to the seismic safety standards. All have achieved at least the SPC-2 standard that allows them to remain in service until 2030 except for 45 buildings spread across 22 hospital facilities. In some cases, there are no plans to retrofit or rebuild, and the hospital has either already taken them out of service but it is not reflected in the data yet, or there are plans to take them out of service prior to the January 1, 2025 deadline. It is unclear how many of the remaining out-of-compliance buildings are expected to remain in service, but are in jeopardy of missing the January 1, 2025 deadline for retrofit or replacement projects.
Regarding the 2030 deadline for buildings to achieve SPC-3, 4, 4D or 5, there are still 667 buildings, spread across 251 licensed hospitals, that have an SPC-2 rating and will need to either be retrofitted to SPC-4D, replaced with an SPC-5 building, or removed from acute care service. Four of the 45 remaining SPC-1 buildings are being brought up to SPC-2, and eight of the 45 are being brought up to SPC-4D. There are currently 11 SPC-4D rated buildings. Of the 667 SPC-2 buildings, 151 have SPC-4D upgrade projects submitted. It is unclear how many of these 151 SPC 2 building upgrade projects will be in construction. The SPC 4D option has only been available since 2017; it is not known whether that will be utilized for the remaining buildings, or whether hospitals choose to construct new replacement buildings.
Regarding NPC compliance, the vast majority of buildings have not yet met 2030 standards. More than half of all hospital buildings are still NPC 2. Only about 6% of all hospital buildings have achieved NPC 5 and are fully 2030 compliant. Another 33% have met NPC 4 requirements. The deadline to submit NPC construction projects is January 1, 2026, followed by an NPC construction permit deadline of January 1, 2028. - RAND report on costs of seismic compliance. The California Hospital Association (which supports this bill) commissioned the RAND Corporation to update its prior estimates of the cost of future seismic safety compliance with a particular focus on the 2030 deadline. RAND published its report in 2019, and estimated that collectively, California hospitals faced (at that time) a range of $34 billion to $143 billion in compliance costs, depending on assumptions regarding retrofit versus new construction and future cost escalation. RAND stated that a significant proportion of hospitals were already experiencing some degree of financial distress, and the burden of future compliance is likely to exacerbate this stress. RAND suggested that there are a variety of options to provide regulatory relief or flexibility to hospitals, including providing public subsidies, offering additional flexibility in the timing of compliance, rethinking what it means for hospitals to remain operational after an earthquake, and streamlining the administrative processes associated with seismic compliance projects.
- Small and Rural Hospital Relief Program. The Small and Rural Hospital Relief Program (SRHRP) was established by SB 395 (Caballero, Chapter 489, Statutes of 2021), with funding coming from 10% of the excise tax revenue from electronic cigarettes. The SRHRP provides grants to qualified small and rural hospitals for the purpose of funding seismic safety compliance projects. It is projected that this program will have approximately $2 to $3 million annually available for disbursement. Additionally, the health trailer bill for the Budget Act of 2023-2024 [AB 118 (Committee on Budget), Chapter 42, Statutes of 2023] provided an additional $50 million in one-time funds for this program. According to HCAI, which administers the program, as of November 2023, 30 of the potentially eligible 102 hospitals have initiated applications for program participation, and 22 have submitted updated seismic compliance plans to fulfill application requirements. Once a participating hospital has submitted updated seismic compliance plans, HCAI meets with executive leadership for each participating facility to review their proposed compliance plan details, describe available technical assistance to their project teams, and prepare them for their subsequent grant applications. Grant awards may partially or fully cover the grant request as allowed by availability of funds. So far, ten hospitals have submitted grant applications, and three of those have grant approvals pending.
- California Hospital Association proposal to focus on emergency services. In the summer of 2021, the Newsom Administration released budget trailer bill language, with the support of the California Hospital Association and the hospital community, to delay the 2030 deadline to 2037, and to only require that it apply to buildings that house the emergency department, and those areas and services necessary to support emergency medical services following a disaster, as specified. The Legislature did not adopt this budget trailer language.
- Related legislation. AB 869 (Wood) creates a grant program for small and rural hospitals to fund assessments for complying with 2030 seismic safety requirements, including estimating the costs of compliance. Additionally permits qualifying small and rural, as well as financially distressed district hospitals, as defined, to apply for grants for complying with the 2030 seismic safety deadline. Extends the January 1, 2030 deadline for seismic compliance to January 1, 2035, for hospitals that apply, and qualify for, seismic compliance grants under this bill. Exempts eligible small and rural and financially distressed district hospitals from the January 1, 2030 seismic safety requirements if the estimated cost of compliance is more than $1 million or 2% of the hospital’s revenue, whichever is greater, if HCAI determines that the cost of compliance results in a financial hardship for the hospital, and state or grant funding is not available to assist with the cost of compliance. AB 869 is pending in this Committee.
AB 412 (Soria) requires the California Health Facilities Financing Authority (CHFFA) to establish the Hospital Emergency Loan Program (HELP) for the purpose of providing loans to prevent the closure of a hospital or facilitating the reopening of a closed hospital, as defined. Grants CHFFA the authority to adopt guidelines, rather than regulations, to implement HELP, and other programs. AB 412 is pending in this Committee. - Prior legislation. SB 1339 (Pan of 2022) would have required general acute care hospital buildings with specific seismic ratings to submit estimated costs to comply with the 2030 seismic requirements to HCAI. SB 1339 would have required HCAI to provide a report to the Legislature with an assessment of the projected costs to retrofit each hospital building to meet the 2030 seismic requirements. SB 1339 was held on the Assembly Appropriations suspense file.
AB 1882 (Robert Rivas, Chapter 584, Statutes of 2022) requires owners of general acute care hospital buildings that are not compliant with the January 1, 2030 seismic safety requirement to remain operational following a major earthquake, to submit annual status updates to various entities, including the county board of supervisors, any labor union that represents workers in a building that is not January 1, 2030 compliant, the local office of emergency services, and the medical health operational area coordinator; and, requires hospitals to post in any lobby or waiting area of a hospital building that is not compliant with the January 1, 2030 seismic requirement a notice that the hospital is not in compliance.
AB 2904 (Bonta of 2022) would have extended the January 1, 2030 seismic safety requirement for Alameda Hospital until January 1, 2032. AB 2904 was vetoed by the Governor, who stated that any consideration of an extension must be contemplated across all communities and across all types of facilities in a holistic manner.
SB 758 (Portantino of 2020), among other provisions, would have extended the 2030 hospital seismic compliance deadline to January 1, 2032. SB 758 was not taken up on the Assembly Floor.
AB 2190 (Reyes, Chapter 673, Statutes of 2018) provides for an extension of the January 1, 2020 hospital seismic safety deadline of up to 30 months (until July 1, 2022) for hospitals that plan to replace or retrofit a building to at least the 2020 standard of SPC-2, and up to five years (January 1, 2025) for hospitals that plan to rebuild to SPC-4D or SPC-5 standards that meet 2030 standards. Additionally, required OSHPD to provide the Legislature with an inventory of the SPC category of each hospital building before June 1, 2019, and required hospitals that do not comply with the January 1, 2030 deadline to submit an attestation to OSHPD that it is aware of the deadline.
SB 90 (Steinberg, Chapter 19, Statutes of 2011) allows a hospital to seek an extension for seismic compliance for its SPC-1 buildings of up to seven years based on the following elements: the structural integrity of the building, the loss of essential hospital services to the community if the hospital closed, and financial hardship.
SB 499 (Ducheny, Chapter 601, Statutes of 2009) required all general acute care hospitals that have SPC-1 buildings to report to OSHPD by November 1, 2010, and annually thereafter, on the status of their compliance with the seismic safety deadlines.
SB 306 (Ducheny, Chapter 642, Statutes of 2007) amends the Alquist Act to permit hospitals to delay compliance with the July 1, 2008 seismic retro deadline, and the 2013 extension, to the year 2020, by filing a declaration with OSHPD that the owner lacks financial capacity to comply with the law. - Support. The California Hospital Association (CHA) states in support that California hospitals have spent the last decade retrofitting their buildings to prevent collapse after a major earthquake to ensure they will remain standing. By contrast, the need for relief from the 2030 fully operational mandate is widespread and critical. CHA states that given the financial losses spurred by the pandemic, unprecedented inflation in the cost of delivering health care, and the workforce shortage, many hospitals will not make it to 2030 or beyond unless the law changes. Hospitals that do not meet this deadline will have to close. CHA states that while extending the deadline is an important first step, it will be critical for the Legislature to also consider what type of care is most needed post-earthquake; otherwise, we will only delay the inevitable for many communities. A number of hospitals and health systems make similar arguments in support. Community Health System, which operates Community Regional Medical Center (CRMC) in Fresno, states that it is struggling to identify a viable path toward compliance with the 2030 mandate. Community Health System states that CRMC sits in downtown Fresno, which is in one of California’s lowest seismic risk areas, and that in order to meet the 2030 mandate; it would have to invest $2 to $3 billion, a monumental investment that will not result in a net gain in hospital beds nor improve access.
- Opposition. Numerous labor organizations submitted a coalition letter opposing this bill. According to the labor coalition, almost all hospital buildings are no longer at risk of collapsing in an earthquake. However, in the decades since the higher standard was imposed, it has become clear that as many as one in four hospital buildings that meet this standard would need to be evacuated and closed after a major quake. The existing requirements for hospitals to be operational after a major earthquake include such basic safety protections as electricity, elevators, water, sewage, oxygen, and other requirements for a functional modern hospital. California hospitals have known for 30 years that they face the requirement to be fully operational after a major seismic event. California’s working families expect their hospitals to take care of them after an earthquake, and the labor coalition oppose the unrelenting efforts of hospital management to put the safety of patients and workers at risk.
SUPPORT AND OPPOSITION:
Support: Adventist Health
Alliance of Catholic Health Care
California Hospital Association
Community Health System
Dignity Health
Kern Health Systems
Ridgecrest Regional Hospital
Rural County Representatives of California
Saint Agnes Medical Center
Scripps Health
Tenet Healthcare
United Hospital Association
Valley Children's Healthcare
Two Individuals
Oppose: American Federation of State, County and Municipal Employees
California Labor Federation
California Nurses Association
California Professional Firefighters
SEIU California
California Teamsters Public Affairs Council
Engineers and Scientists of California
Professional Engineers in California Government
State Building and Construction Trades Council
UNITE HERE
United Nurses Associations of California/Union of Health Care Professionals
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Bill Author
Bill Co-Author(s):