Health and Safety Code — Part 28 | HSC — United States — California law | Esheria

Health and Safety Code

Part 28 of 87 · provisions 5,401–5,600

This section says the act is to be known as the Health and Safety Code.

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About this statute

The Legislature states findings supporting a unified, single-payer-style health care financing system for all Californians. The State Department of Health Services is renamed the State Department of Health Care Services, and its retained functions continue with the renamed department. The Director of Health Care Services is appointed by the Governor with Senate confirmation, the director receives a salary set by law, and the Governor may appoint up to two chief deputies on the director’s recommendation. The director has the powers of a department head under the cited Government Code chapter. The Department of Health Services has a Division of Rural Health, and that division must administer specified chapters and sections.

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Provisions of Health and Safety Code

Showing 200 of 17,333

  1. 12642.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    The permit’s effective period must be set in the permit and cannot exceed the license’s valid period. The issuing authority may revoke the permit for just cause if there is a fire nuisance or possible personal injury.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12642. The effective period of the permit shall be defined in the permit and in no case shall the period of the permit exceed the valid period of the license. This section shall not prohibit the revocation of the permit by the issuing authority for just cause where a fire nuisance exists or where personal injury may occur. (Added by Stats. 1973, Ch. 1109.)
  2. 12643.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    A licensee must apply in writing for a permit before doing an act covered by Section 12640, and the application must be filed at least 10 days before the proposed act.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12643. Any licensee desiring to do any act specified in Section 12640 shall first make written application for a permit to the chief of the fire department or the chief fire prevention officer of the city or county, or to such other issuing authority which may be designated by the governing body of the city or county. In the event there is no such officer or person appointed within the area, application shall be made to the State Fire Marshal or his deputy. Applications for permits shall be made in writing at least 10 days prior to the proposed act. (Added by Stats. 1973, Ch. 1109.)
  3. 12644.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    The issuing authority must not accept a permit application unless the applicant presents evidence of a valid license for the acts listed on the application. If no license is required for those acts, the issuing authority may set reasonable conditions for permit qualification and public safety.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12644. The issuing authority shall not accept an application for a permit from any person who does not possess, and present at the time of application, evidence of a valid license to perform those acts specified on the application for the permit. When a license is not required for specific acts, the issuing authority may prescribe such reasonable conditions to qualify the applicant to receive a permit and provide for the public safety. (Added by Stats. 1973, Ch. 1109.)
  4. 12645.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    The officer handling a permit application must investigate it and report findings, recommendations, and reasons to the city or county governing body. A public display permit applicant must file a certificate showing a valid public display license with that officer.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12645. The officer to whom the application for a permit is made shall undertake an investigation and submit a report of his findings and his recommendation concerning the issuance of the permit, together with his reasons therefor, to the governing body of the city or county. The applicant for a permit to conduct a public display shall file a certificate evidencing the possession of a valid public display license with the officer making the investigation. (Added by Stats. 1973, Ch. 1109.)
  5. 12646.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    The governing body may grant or deny the permit and may attach reasonable conditions.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12646. The governing body may grant or deny the permit, subject to such reasonable conditions, if any, as it shall prescribe. (Added by Stats. 1973, Ch. 1109.)
  6. 12647.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    The governing body may delegate permit-granting or denial power to the issuing authority, but if it does, it must also provide a hearing so an applicant can appeal a denial.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12647. The governing body may delegate the power to grant or deny the permit to the issuing authority to whom the application is made. In such case, the governing body shall also provide for a hearing by the governing body by which an applicant may appeal a denial of the permit. The governing body may, after such a hearing, reverse, modify, or sustain the denial. (Added by Stats. 1973, Ch. 1109.)
  7. 12648.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    When someone applies for a permit for a public fireworks display, the officer must investigate the proposed display and may recommend granting or denying the permit, with conditions.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12648. The officer to whom the application for a permit for a public display of fireworks is made shall make an investigation to determine whether such a display as proposed will be of such character or so located that it may be hazardous to property or dangerous to any person. He shall, in the exercise of reasonable discretion, recommend granting or denying the permit, subject to such conditions as he may prescribe. (Added by Stats. 1973, Ch. 1109.)
  8. 12649.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    A fireworks display permit applicant must submit their license for inspection and provide proof of employee compensation insurance when applying.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12649. The applicant for a permit for any public display of fireworks shall, at the time of application, submit his license for inspection and furnish proof that he carries compensation insurance for his employees as provided by the laws of this state. (Added by Stats. 1973, Ch. 1109.)
  9. 1265.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Applicants for certain health-facility licenses or approvals must file a verified application with the department and include specified information.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265. A person, political subdivision of the state, or governmental agency desiring a license for a health facility, approval for a special service under this chapter, or approval to manage a health facility currently licensed as a health facility, as defined in subdivision (a), (b), (c), (d), or (f) of Section 1250, that has not filed an application for a license to operate that facility shall file with the department a verified application on forms prescribed and furnished by the department, containing all of the following: (a) The name of the applicant and, if an individual, whether the applicant has attained 18 years of age. (b) The type of facility or health facility. (c) The location thereof. (d) The name of the person in charge thereof. (e) Evidence satisfactory to the department that the applicant is of reputable and responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation, or company, like evidence shall be submitted as to the members or shareholders thereof, and the person in charge of the health facility for which application for license is made. If the applicant is a political subdivision of the state or other governmental agency, like evidence shall be submitted as to the person in charge of the health facility for which application for license is made. (f) Evidence satisfactory to the department of the ability of the applicant to comply with this chapter and of rules and regulations promulgated under this chapter and Chapter 2.4 (commencing with Section 1417) by the department. (g) Evidence satisfactory to the department that the applicant to operate a skilled nursing facility or intermediate care facility possesses financial resources sufficient to operate the facility for a period of at least 90 days. A management company shall not be required to submit this information. (h) An applicant for a license to operate a skilled nursing facility or intermediate care facility shall disclose to the department evidence of the right to possession of the facility at the time the application will be granted, which may be satisfied by the submission of a copy of applicable portions of a lease agreement or deed of trust. The names and addresses of any persons or organizations listed as owner of record in the real estate, including the buildings and the grounds appurtenant to the buildings, shall be disclosed to the department. (i) Any other information as may be required by the department for the proper administration and enforcement of this chapter. (j) Upon submission of an application to the department by an intermediate care facility/developmentally disabled habilitative or an intermediate care facility/developmentally disabled-nursing, the application shall include a statement of need signed by the chairperson of the area board pursuant to Chapter 4 (commencing with Section 4570) of Division 4.5 of the Welfare and Institutions Code. In the event the area board has not provided the statement of need within 30 days of receipt of the request from the applicant, the department may process the application for license without the statement. (k) The information required pursuant to this section, other than individuals’ social security numbers, shall be made available to the public upon request, and shall be included in the department’s public file regarding the facility. (l) With respect to a facility licensed as a health facility, as defined in subdivision (a), (b), or (f) of Section 1250, for purposes of this section, “manage” means to assume operational control of the facility. (m) With respect to a skilled nursing facility, as defined in subdivision (c) of Section 1250, excluding skilled nursing facilities that are operated as a distinct part of an acute care hospital, for purposes of this section, “manage” means to assume operational control of the facility, to make financial decisions for the facility, to direct or control aspects of patient care and quality within the facility, or to be involved in the hiring, firing, supervision, and direction of direct care staff when these actions are completed by a management company hired, retained, or authorized to act on behalf of a licensee. (Amended by Stats. 2022, Ch. 578, Sec. 5. (AB 1502) Effective January 1, 2023.)
  10. 1265.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The state department may deny a health facility licensure application if the applicant was convicted of a crime or knowingly made a false statement in the application.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.1. (a) An application for licensure under this chapter may be denied by the state department if the applicant for a license has been convicted of a crime, as defined in Section 1265.2, or on the ground of knowingly making a false statement of fact required to be revealed in an application for such licensure. (b) If the applicant is a firm, partnership, association, or corporation, the conviction of any officer, director, shareholder with a beneficial ownership interest in the applicant exceeding 10 percent, or the person in charge of the health facility may serve as the basis for denial of the license by the state department. If the applicant is a political subdivision of the state or other governmental agency, the conviction of such a crime by the person in charge of the health facility may serve as the basis for denial of the license by the state department. (c) The record of conviction or a certified copy thereof certified by the clerk of the court or by the judge in whose court the conviction is had, shall be conclusive evidence thereof. (Added by Stats. 1980, Ch. 708.)
  11. 1265.10.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Licensed health facilities must provide wholesome plant-based meals that meet patients’ needs and follow physicians’ orders.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.10. (a) A licensed health facility, as defined in subdivision (a), (b), (c), (d), (f), or (k) of Section 1250, shall make available wholesome, plant-based meals of such variety as to meet the needs of patients in accordance with their physicians’ orders. (b) Notwithstanding any other law, including, but not limited to, Section 1290, a violation of this section shall not constitute a crime. (c) For the purposes of this section, “plant-based meals” shall mean entire meals that contain no animal products or byproducts, including meat, poultry, fish, dairy, or eggs. (Added by Stats. 2018, Ch. 512, Sec. 2. (SB 1138) Effective January 1, 2019.)
  12. 1265.11.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Licensure may not be denied or a license limited because of certain out-of-state judgments or discipline when they are based only on another state’s law interfering with access to sensitive services that would be lawful in California.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.11. (a) An application for licensure made pursuant to this chapter shall not be denied, nor shall any license issued pursuant to this chapter be suspended, revoked, or otherwise limited, on the basis of a civil judgment, criminal conviction, or disciplinary action imposed by another state if that judgment, conviction, or disciplinary action is based solely on the application of another state’s law that interferes with a person’s right to receive sensitive services that would be lawful if provided in this state. (b) This section does not apply to a civil judgment, criminal conviction, or disciplinary action imposed by another state based upon conduct in another state that would subject an applicant, licensee, or health care practitioner subject to this division to a similar claim, charge, or action under the laws of this state. (c) For purposes of this section, “sensitive services” has the same meaning as in Section 56.05 of the Civil Code. (Added by Stats. 2023, Ch. 258, Sec. 4. (AB 1707) Effective January 1, 2024.)
  13. 1265.12.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section bars certain state and local actors from taking criminal, civil, professional discipline, licensing, suspension, revocation, or other disciplinary action against a licensee for lawful mifepristone or medication-abortion-related conduct.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.12. (a) Notwithstanding any other state law, and consistent with Sections 1 and 1.1 of Article I of the California Constitution, an individual or state or local officer shall not commence a criminal, civil, professional discipline, or licensing action against a licensee concerning the transport, distribution, delivery, receipt, acquisition, sale, possession, furnishment, dispensation, repackaging, or storage of brand name or generic mifepristone or any drug used for medication abortion that is lawful under the laws of the state. (b) The department shall not suspend a license, revoke a license, or otherwise take disciplinary action against a licensee solely on the basis that the licensee transported, distributed, delivered, received, acquired, sold, possessed, furnished, dispensed, repackaged, or stored brand name or generic mifepristone or any drug used for medication abortion that is lawful under the laws of the state. (c) The department shall not deny an application for licensure, or suspend a license, revoke a license, or otherwise impose discipline upon a licensee solely because the licensee is licensed in another state and was convicted or disciplined in that state solely for an activity related to brand name or generic mifepristone or any drug used for medication abortion that, if performed in this state, would not be grounds for denial, suspension, revocation, or other discipline. (Added by Stats. 2025, Ch. 136, Sec. 14. (AB 260) Effective September 26, 2025.)
  14. 1265.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section defines “crime” and “conviction” for the chapter, and limits license denial, suspension, or revocation based only on a crime conviction when the director finds the person has been rehabilitated.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.2. A “crime,” within the meaning of this chapter, means a violation of a law or regulation which is substantially related to the qualifications or duties of the applicant or licensee or which is substantially related to the functions of the business for which the license was, or is to be, issued. A “conviction,” within the meaning of this chapter, means a plea or verdict of guilty or a conviction following a plea of nolo contendere. Any action which the state department is permitted to take following the establishment of a conviction may be taken when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, notwithstanding a subsequent order pursuant to the provisions of Section 1203.4 of the Penal Code permitting such person to withdraw his plea of guilty and to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation, information, or indictment. Evidence of conviction of a misdemeanor following a plea of nolo contendere pursuant to the provisions of Section 1290 shall not be admissible in any hearing conducted under Section 1269 or 1295. No application for licensure shall be denied nor shall a license be suspended or revoked solely on the basis of the conviction of a crime if the director determines that the person has been rehabilitated in accordance with standards for rehabilitation developed by the director. The director shall take into account all competent evidence of rehabilitation furnished by the applicant or licensee. (Amended by Stats. 1980, Ch. 1285.)
  15. 1265.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    When reviewing certain health facility approval applications, the department must consider specific character and compliance evidence, and it may require additional information or documents.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.3. (a) For any individual or entity that seeks approval to operate or manage a health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250 and is subject to Section 1265, the department shall consider the following: (1) To determine whether the applicant is of reputable and responsible character, the department shall consider any available information that the applicant has demonstrated a pattern and practice of violations of state or federal laws and regulations. The department shall give particular consideration to those violations that affect the applicant’s ability to deliver safe patient care. (2) To determine whether the applicant has the ability to comply with this chapter and the rules and regulations adopted under this chapter, the department shall consider evidence that shall include all of the following: (A) If any, prior history of operating in this state any other facility licensed pursuant to Section 1250, and the applicant’s history of substantial compliance with the requirements imposed under that license, applicable federal laws and regulations, and requirements governing the operators of those facilities. (B) If any, prior history of operating in any other state any facility authorized to receive Medicare Program reimbursement or Medicaid Program reimbursement, and the applicant’s history of substantial compliance with that state’s requirements, and applicable federal laws, regulations, and requirements. (C) If any, prior history of providing health services as a licensed health professional or an individual or entity contracting with a health care service plan or insurer, and the applicant’s history of substantial compliance with state requirements, and applicable federal law, regulations, and requirements. (b) The department may also require the entity described in subdivision (a) to furnish other information or documents for the proper administration and enforcement of the licensing laws. (Added by Stats. 2005, Ch. 507, Sec. 2. Effective January 1, 2006.)
  16. 1265.4.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Licensed health facilities must employ dietitian staffing, and certain facilities must also employ a full-time dietetic services supervisor with specified qualifications.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.4. (a) A licensed health facility, as defined in subdivision (a), (b), (c), (d), (f), or (k) of Section 1250, shall employ a full-time, part-time, or consulting dietitian. A health facility that employs a registered dietitian less than full time, shall also employ a full-time dietetic services supervisor who meets the requirements of subdivision (b) to supervise dietetic service operations. The dietetic services supervisor shall receive frequently scheduled consultation from a qualified dietitian. (b) The dietetic services supervisor shall have completed at least one of the following educational requirements: (1) A baccalaureate degree with major studies in food and nutrition, dietetics, or food management and has one year of experience in the dietetic service of a licensed health facility. (2) A graduate of a dietetic technician training program approved by the American Dietetic Association, accredited by the Commission on Accreditation for Dietetics Education, or currently registered by the Commission on Dietetic Registration. (3) A graduate of a dietetic assistant training program approved by the American Dietetic Association. (4) Is a graduate of a dietetic services training program approved by the Dietary Managers Association and is a certified dietary manager credentialed by the Certifying Board of the Dietary Managers Association, maintains this certification, and has received at least six hours of in-service training on the specific California dietary service requirements contained in Title 22 of the California Code of Regulations prior to assuming full-time duties as a dietetic services supervisor at the health facility. (5) Is a graduate of a college degree program with major studies in food and nutrition, dietetics, food management, culinary arts, or hotel and restaurant management and is a certified dietary manager credentialed by the Certifying Board of the Dietary Managers Association, maintains this certification, and has received at least six hours of in-service training on the specific California dietary service requirements contained in Title 22 of the California Code of Regulations prior to assuming full-time duties as a dietetic services supervisor at the health facility. (6) A graduate of a state approved program that provides 90 or more hours of classroom instruction in dietetic service supervision, or 90 hours or more of combined classroom instruction and instructor led interactive Web-based instruction in dietetic service supervision. (7) Received training experience in food service supervision and management in the military equivalent in content to paragraph (2), (3), or (6). (c) Pursuant to Section 1276, the State Department of Public Health may grant a program flexibility request to the facility to modify the requirements in subdivision (b) for any individual who has at least five years experience prior to January 1, 2009, as a dietetic services supervisor in a health facility specified in subdivision (a) to allow that individual to function as a dietetic services supervisor for a period not to exceed 18 months, as long as the individual is enrolled in a program that meets the requirements listed in subdivision (b). The department may extend the program flexibility request for a period not to exceed six months if the individual can demonstrate to the department that the coursework could not otherwise be completed within the original 18-month period. Program flexibility requests shall be submitted not later than December 31, 2009. (Added by Stats. 2008, Ch. 225, Sec. 1. Effective January 1, 2009.)
  17. 1265.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section requires criminal background clearance steps for certain intermediate care facility licensing and hiring, including fingerprint submission, DOJ record checks, and restrictions on contact with residents until clearance is complete.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.5. (a) (1) Prior to the initial licensure or renewal of a license of any person or persons to operate or manage an intermediate care facility/developmentally disabled habilitative, an intermediate care facility/developmentally disabled-nursing, an intermediate care facility/developmentally disabled-continuous nursing, or an intermediate care facility/developmentally disabled, other than an intermediate care facility/developmentally disabled operated by the state, that secures criminal record clearances for its employees through a method other than as specified in this section or upon the hiring of direct care staff by any of these facilities, the department shall secure from the Department of Justice criminal offender record information to determine whether the applicant, facility administrator or manager, any direct care staff, or any other adult living in the same location, has ever been convicted of a crime other than a minor traffic violation. (2) (A) The criminal record clearance shall require the applicant to submit electronic fingerprint images and related information of the facility administrator or manager, and any direct care staff, or any other adult living in the same location, to the Department of Justice. Applicants shall be responsible for any cost associated with capturing or transmitting the fingerprint images and related information. (B) The criminal record clearance shall be completed prior to direct staff contact with residents of the facility. A criminal record clearance shall be complete when the department has obtained the person’s criminal record information from the Department of Justice and has determined that he or she is not disqualified from engaging in the activity for which clearance is required. (3) (A) The Licensing and Certification Program shall issue an All Facilities Letter (AFL) to facility licensees when it determines that both of the following criteria have been met for a period of 30 days: (i) The program receives, within three business days, 95 percent of its total responses indicating no evidence of recorded criminal information from the Department of Justice. (ii) The program processes 95 percent of its total responses requiring disqualification in accordance with subdivision (b), with notices mailed to the facility no later than 45 days after the date that the criminal offender record information report is received from the Department of Justice. (B) After the AFL is issued, facilities shall not allow newly hired facility administrators, managers, direct care staff, or any other adult living in the same location to have direct contact with clients or residents of the facility prior to completion of the criminal record clearance. A criminal record clearance shall be complete when the department has obtained the person’s criminal offender record information search response from the Department of Justice and has determined that the person is not disqualified from engaging in the activity for which clearance is required. (C) An applicant or certificate holder who may be disqualified on the basis of a criminal conviction shall provide the department with a certified copy of the judgment of each conviction. In addition, the individual may, during a period of two years after the department receives the criminal record report, provide the department with evidence of good character and rehabilitation in accordance with subdivision (c). Upon receipt of a new application for certification of the individual, the department may receive and consider the evidence during the two-year period without requiring additional fingerprint imaging to clear the individual. (D) The department’s Licensing and Certification Program shall explore and implement methods for maximizing its efficiency in processing criminal record clearances within the requirements of law, including a streamlined clearance process for persons that have been disqualified on the basis of criminal convictions that do not require automatic denial pursuant to subdivision (b). (4) An applicant and any other person specified in this subdivision, as part of the background clearance process, shall provide information as to whether or not the person has any prior criminal convictions, has had any arrests within the past 12-month period, or has any active arrests, and shall certify that, to the best of his or her knowledge, the information provided is true. This requirement is not intended to duplicate existing requirements for individuals who are required to submit fingerprint images as part of a criminal background clearance process. Every applicant shall provide information on any prior administrative action taken against him or her by any federal, state, or local governmental agency and shall certify that, to the best of his or her knowledge, the information provided is true. An applicant or other person required to provide information pursuant to this section that knowingly or willfully makes false statements, representations, or omissions may be subject to administrative action, including, but not limited to, denial of his or her application or exemption or revocation of any exemption previously granted. (b) (1) The application for licensure or renewal shall be denied if the criminal record indicates that the person seeking initial licensure or renewal of a license referred to in subdivision (a) has been convicted of a violation or attempted violation of any one or more of the following Penal Code provisions: Section 187, subdivision (a) of Section 192, Section 203, 205, 206, 207, 209, 210, 210.5, 211, 220, 222, 243.4, 245, 261, 262, or 264.1, Sections 265 to 267, inclusive, Section 273a, 273d, 273.5, or 285, subdivisions (c), (d), (f), and (g) of Section 286, Section 288, subdivisions (c), (d), (f), and (g) of Section 287 or of former Section 288a, Section 288.5, 289, 289.5, 368, 451, 459, 470, 475, 484, or 484b, Sections 484d to 484j, inclusive, Section 487, subdivision (a) of Section 487a, or Section 488, 496, 503, 518, or 666, unless any of the following applies: (A) The person was convicted of a felony and has obtained a certificate of rehabilitation under Chapter 3.5 (commencing with Section 4852.01) of Title 6 of Part 3 of the Penal Code and the information or accusation against the person has been dismissed pursuant to Section 1203.4 of the Penal Code with regard to that felony. (B) The person was convicted of a misdemeanor and the information or accusation against the person has been dismissed pursuant to Section 1203.4 or 1203.4a of the Penal Code. (C) The person was convicted of a felony or a misdemeanor, but has previously disclosed the fact of each conviction to the department and the department has made a determination in accordance with law that the conviction does not disqualify the person. (2) The application for licensure or renewal shall be denied if the criminal record of the person includes a conviction in another state for an offense that, if committed or attempted in this state, would have been punishable as one or more of the offenses set forth in paragraph (1), unless evidence of rehabilitation comparable to the dismissal of a misdemeanor or a certificate of rehabilitation as set forth in subparagraph (A) or (B) of paragraph (1) is provided to the department. (c) If the criminal record of a person described in subdivision (a) indicates any conviction other than a minor traffic violation or other than a conviction listed in subdivision (b), the department may deny the application for licensure or renewal. In determining whether or not to deny the application for licensure or renewal pursuant to this subdivision, the department shall take into consideration the following factors as evidence of good character and rehabilitation: (1) The nature and seriousness of the offense under consideration and its relationship to their employment duties and responsibilities. (2) Activities since conviction, including employment or participation in therapy or education, that would indicate changed behavior. (3) The time that has elapsed since the commission of the conduct or offense referred to in paragraph (1) or (2) and the number of offenses. (4) The extent to which the person has complied with any terms of parole, probation, restitution, or any other sanction lawfully imposed against the person. (5) Any rehabilitation evidence, including character references, submitted by the person. (6) Employment history and current employer recommendations. (7) Circumstances surrounding the commission of the offense that would demonstrate the unlikelihood of repetition. (8) The granting by the Governor of a full and unconditional pardon. (9) A certificate of rehabilitation from a superior court. (d) Nothing in this section shall be construed to require a criminal record check of a person receiving services in an intermediate care facility/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, intermediate care facility/developmentally disabled-continuous nursing, or intermediate care facility/developmentally disabled. (e) For purposes of this section, “direct care staff” means all facility staff who are trained and experienced in the care of persons with developmental disabilities and who directly provide program and nursing services to clients. Administrative and licensed personnel shall be considered direct care staff when directly providing program and nursing services to clients. Persons employed as consultants and acting as direct care staff shall be subject to the same requirements for a criminal record clearance as other direct care staff. However, the employing facility shall not be required to pay any costs associated with that criminal record clearance. (f) Upon the employment of any person specified in subdivision (a), and prior to any contact with clients or residents, the facility shall ensure that electronic fingerprint images are submitted to the Department of Justice for the purpose of obtaining a criminal record check. (g) The department shall develop procedures to ensure that any licensee, direct care staff, or certificate holder for whom a criminal record has been obtained pursuant to this section or Section 1338.5 or 1736 shall not be required to obtain multiple criminal record clearances. (h) In addition to the persons who are not required to obtain multiple criminal record clearances pursuant to subdivision (g), a person shall not be required to obtain a separate criminal record clearance if the person meets all of the following criteria: (1) The person is employed as a consultant and acts as direct care staff. (2) The person is a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, or speech-language pathologist. (3) The person has obtained a criminal record clearance as a prerequisite to holding a license or certificate to provide direct care services. (4) The person has a license or certificate to provide direct care service that is in good standing with the appropriate licensing or certification board. (5) The person is providing time-limited specialized clinical care or services. (6) The person is not left alone with the client. (i) If, at any time, the department determines that it does not meet the standards specified in clauses (i) and (ii) of subparagraph (A) of paragraph (3) of subdivision (a), for a period of 90 consecutive days, the requirements in paragraph (3) of subdivision (a) shall be suspended until the department determines that it has met those standards for a period of 90 consecutive days. (j) During any period of time in which paragraph (3) of subdivision (a) is inoperative, facilities may allow newly hired facility administrators, managers, direct care staff, or any other adult living in the same location to have direct contact with clients or residents of the facility after those persons have submitted live-scan fingerprint images to the Department of Justice, and the department shall issue an AFL advising of this change in the statutory requirement. (k) Notwithstanding any other provision of law, the department is authorized to provide an individual with a copy of his or her state or federal level criminal offender record information search response as provided to that department by the Department of Justice if the department has denied a criminal background clearance based on this information and the individual makes a written request to the department for a copy specifying an address to which it is to be sent. The state or federal level criminal offender record information search response shall not be modified or altered from its form or content as provided by the Department of Justice and shall be provided to the address specified by the individual in his or her written request. The department shall retain a copy of the individual’s written request and the response and date provided. (Amended by Stats. 2018, Ch. 423, Sec. 32. (SB 1494) Effective January 1, 2019.)
  18. 1265.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A registered nurse may direct trained direct care staff in certain intermediate care facilities to perform blood glucose testing for eligible residents, if the section’s training, supervision, documentation, and waiver requirements are met.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.6. Notwithstanding any other provision of law, a registered nurse within his or her scope of practice may require direct care staff in an intermediate care facility/developmentally disabled habilitative or an intermediate care facility/developmentally disabled-nursing to administer blood glucose testing for a person with developmental disabilities who resides at the facility and who has diabetes, if all of the following criteria are met: (a) The blood glucose testing is specifically ordered by a physician. The results of the testing shall be reported to a registered nurse as specified in the physician’s order. (b) Prior to performing the blood glucose testing, the direct care staff shall be trained by the registered nurse to perform the testing and shall demonstrate proficiency in performing the testing while under the immediate supervision of the registered nurse. (c) Training of direct care staff to perform blood glucose testing shall include, but not be limited to, an overview of the basic disease process of type I and type II diabetes, recognition of the signs and symptoms of hypoglycemia and hyperglycemia, the role of nutrition management in diabetes, diabetes and blood sugar control, long-term complications of diabetes, specific instruction in utilizing and the use of a specific over-the-counter glucose monitoring device that is approved by the FDA, including the cleaning and maintaining the accuracy of the client-specific glucose monitoring device, proper infection control practices related to the use of the device, including the handling and disposal of infectious waste, and recording accurate records of blood glucose readings in the client medical record. Records of blood glucose readings shall be reviewed by the facility registered nurse at least monthly. (d) A signed written statement shall be prepared by the registered nurse that includes a certification of the direct care staff’s competence to perform the testing and that identifies the clients residing at the facility for whom the certification is applicable. This certification shall be placed and maintained in the direct care staff’s training record. (e) The certification of competence to perform the blood glucose testing shall be procedure and client specific, and shall not be transferred between clients residing at the facility or other facilities. (f) The registered nurse shall be responsible for monitoring and implementing the direct care staff blood glucose testing. At least once every three months, the registered nurse shall observe and confirm the direct care staff person’s proficiency in performing the approved testing and shall update the certification. The proficiency determination shall include a determination by the registered nurse that the direct care staff remains proficient in demonstrating the specified method for cleaning and recalibration of the glucose monitoring device. (g) A registered nurse shall provide continuing in-service education on the management of diabetes and the use of blood glucose monitoring devices not less than once per year and include documentation of the content of the training and the staff who were in attendance. (h) A facility shall develop a written policy and procedure governing blood glucose testing for clients residing at the facility that shall include procedures for the training and competency assessment of direct care staff as required by this section. (i) A facility shall have received a certificate of waiver pursuant to subdivision (n) of Section 483.460 of Title 42 of the Code of Federal Regulations prior to the implementation of blood glucose testing and shall retain a copy of the CLIA waiver for inspection by the department. (Amended by Stats. 2007, Ch. 130, Sec. 154. Effective January 1, 2008.)
  19. 1265.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The state department must adopt licensing regulations for congregate living health facilities, and it must license qualifying entities under the stated conditions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.7. (a) (1) The state department shall adopt regulations for the licensure of congregate living health facilities. The regulations shall include minimum standards of adequacy, safety, and sanitation of the physical plant and equipment, minimum standards for staffing with duly qualified personnel, and training of the staff, and minimum standards for providing the services offered. (2) Regulations for facilities approved to provide services for persons who may be ventilator dependent shall ensure that residents of these facilities are assured appropriate supportive health services in the most normal, least restrictive physical and rehabilitative environment appropriate to individual resident needs. (3) Regulations for facilities approved to provide services for persons who are terminally ill, who have a diagnosis of a life-threatening illness, who are catastrophically and severely disabled, or any combination of those persons, shall ensure that residents of these facilities receive supportive health services, based on individual resident acuity levels in the most normal, least restrictive physical environment for individual resident needs. (b) Pending adoption of the regulations pursuant to paragraphs (2) and (3) of subdivision (a), an entity shall be licensed as a congregate living health facility serving persons who are terminally ill, persons who are catastrophically and severely disabled, persons who are mentally alert but physically disabled, or any combination of these persons, by the state department beginning July 1, 1988, if it meets the requirements identified in subdivision (i) of Section 1250 and in Section 1267.13. (Amended by Stats. 1992, Ch. 494, Sec. 1. Effective January 1, 1993.)
  20. 1265.8.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Anyone seeking a health facility license must file a verified statement with the state department, and the state department cannot issue the license until that requirement is met.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.8. In addition to the requirements of this chapter, any person, political subdivision of the state, or governmental agency desiring a license for a health facility shall file with the state department a verified statement that it has complied with the requirements of Chapter 1 (commencing with Section 15000) of Division 12.5, and it has received approval pursuant to that chapter. The state department shall not issue any license until such requirement has been met. (Added by Stats. 1973, Ch. 1202.)
  21. 1265.9.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section allows certain state-operated acute psychiatric hospitals to offer an Enhanced Treatment Program if approved, and sets operating rules for those programs.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1265.9. (a) On and after July 1, 2015, any acute psychiatric hospital that submits a completed application and is operated by the State Department of State Hospitals may be approved by the State Department of Public Health to offer, as a supplemental service, an Enhanced Treatment Program (ETP) that meets the requirements of this section, Section 4144 of the Welfare and Institutions Code, and applicable regulations. (b) (1) Prior to the admission of the first patient into the last pilot ETP, the State Department of Public Health may adopt emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) to implement this section. The adoption of an emergency regulation under this paragraph is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the State Department of Public Health is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code. (2) As an alternative to paragraph (1) and notwithstanding the rulemaking provisions of Administrative Procedures Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director of the State Department of Public Health may implement this section, in whole or in part, by means of an all facility letter or other similar instruction. (c) An ETP shall meet all of the following requirements: (1) Maintain a staff-to-patient ratio of one to five. (2) Limit each room to one patient. (3) Each patient room shall allow visual access by staff 24 hours per day. (4) Each patient room shall have a toilet and sink in the room. (5) Each patient room door shall have the capacity to be locked externally. The door may be locked when clinically indicated and determined to be the least restrictive treatment environment for the patient’s care and treatment pursuant to Section 4144 of the Welfare and Institutions Code, but shall not be considered seclusion, as defined in subdivision (e) of Section 1180.1, for purposes of Division 1.5 (commencing with Section 1180). (6) Provide emergency egress for ETP patients. (7) In the event that seclusion or restraints, as defined in Section 1180.1, are used in an ETP, all state licensing and regulations shall be followed. (8) A full-time independent patients’ rights advocate who provides patients’ rights advocacy services shall be assigned to each ETP. (d) The ETPs shall adopt and implement policies and procedures necessary to encourage patient improvement, recovery, and a return to a standard treatment environment, and to create identifiable facility requirements and benchmarks. The policies and procedures shall also provide all of the following: (1) Criteria and process for admission into an ETP pursuant to Section 4144 of the Welfare and Institutions Code. (2) Clinical assessment and review focused on behavior, history, high risk of most dangerous behavior, and clinical need for patients to receive treatment in an ETP as the least restrictive treatment environment. (3) A process for identifying an ETP along a continuum of care that will best meet the patient’s needs, including least restrictive treatment environment. (4) A process for creating and implementing a treatment plan with regular clinical review and reevaluation of placement back into a standard treatment environment and discharge and reintegration planning as specified in subdivision (e) of Section 4144 of the Welfare and Institutions Code. (e) Patients who have been admitted to an ETP shall have the same rights guaranteed to patients not in an ETP with the exception set forth in paragraph (5) of subdivision (c). (f) For purposes of paragraph (1) of subdivision (c), “staff” means licensed nurses and psychiatric technicians providing direct patient care. (g) This section shall remain in effect only until January 1, 2030, and as of that date is repealed, unless a later enacted statute that is enacted before January 1, 2030, deletes or extends that date. (Amended by Stats. 2025, Ch. 21, Sec. 1. (AB 116) Effective June 30, 2025. Repealed as of January 1, 2030, by its own provisions.)
  22. 12650.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    If a public fireworks display permit is granted, fireworks may be sold, possessed, transported, and used for that display only.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12650. When a permit for the public display of fireworks is granted, the sale, possession, transportation, and use of fireworks for the public display is lawful for that purpose only. The permit to hold a public display shall authorize the transportation of public display fireworks between the approved routes, as specified in Section 12651, and the public display site. (Repealed and added by Stats. 1973, Ch. 1109.)
  23. 12651.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    Some license holders may transport fireworks, but others may not, and transporting licensees must follow specified Vehicle Code rules.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12651. Any person holding a valid license for the manufacture, wholesale, or import and export of dangerous fireworks or pyrotechnic devices may transport any class of fireworks or pyrotechnic devices authorized by such license. Persons holding a special effects pyrotechnic operators license may transport special effects fireworks, but the transportation of fireworks by all other pyrotechnic operator licensees shall not be permitted. The authority granted to the licensee to transport fireworks is limited to traveling upon the approved routes for the transportation of explosives designated as provided in Section 31616 of the Vehicle Code. The licensee shall also comply with Section 27903 of the Vehicle Code and equip and maintain any vehicle used to transport fireworks as required by Section 31610 of the Vehicle Code. It is the intent of the Legislature by this section to require the maximum use of the approved routes in the delivery of fireworks to the point of destination. (Amended by Stats. 1986, Ch. 248, Sec. 146.)
  24. 12652.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    A licensee traveling off the approved routes to the destination must have a transportation permit from the local fire authority, unless the fireworks are public display fireworks under Section 12650.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12652. When traveling between the approved routes, as specified in Section 12651, and the point of destination the licensee shall possess a transportation permit from the local fire authority having jurisdiction over the boundaries in which the off-route travel occurs. A transportation permit is not required for public display fireworks as provided in Section 12650. (Repealed and added by Stats. 1973, Ch. 1109.)
  25. 12653.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    A transportation permit application for fireworks must be submitted to the State Fire Marshal, and it must also be approved by the local issuing authority where the shipment starts before the permit is issued.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12653. The application for a transportation permit shall be submitted to the State Fire Marshal for the transportation of any quantity of fireworks where such transportation is outside the boundaries of the issuing authority having jurisdiction at the point of origin or such shipment originates within this state and is transported out of this state. The application for a transportation permit as required by this section shall be approved by the issuing authority having jurisdiction at the place where the shipment originates before the State Fire Marshal shall issue such transportation permit. No further permits shall be required by issuing authorities other than the authority at the point of origin where the State Fire Marshal has issued a permit pursuant to this section. (Repealed and added by Stats. 1973, Ch. 1109.)
  26. 12654.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. )

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    Public carriers and private carriers with a valid qualifying license or permit do not need a transportation permit under this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 6. Permits [12640 - 12654] ( Chapter 6 added by Stats. 1973, Ch. 1109. ) ## 12654. A transportation permit shall not be required by this part for public carriers or private carriers who each hold a valid license or permit issued pursuant to the provisions of Division 14 (commencing with Section 31600) of the Vehicle Code or Division 11 (commencing with Section 12000) of the Health and Safety Code. (Repealed and added by Stats. 1973, Ch. 1109.)
  27. 1266.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The Licensing and Certification Program must publish estimated fees, prepare annual reports, and update fee lists on set dates; it may also charge a Los Angeles County supplemental fee and change renewal dates, subject to conditions and notice rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266. (a) The Licensing and Certification Program shall be supported entirely by federal funds and special funds by no earlier than the beginning of the 2009–10 fiscal year unless otherwise specified in statute, or unless funds are specifically appropriated from the General Fund in the annual Budget Act or other enacted legislation. (b) Commencing February 1, 2007, and every February 1 thereafter, the Licensing and Certification Program shall publish a list of estimated program fees, including, but not limited to, annual licensing, report of change application, and written notification fees pursuant to this section. The calculation of estimated fees and the publication of the report and list of estimated fees shall not be subject to the rulemaking requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (c) Notwithstanding Section 10231.5 of the Government Code, by February 1 of each year, the department shall prepare the following reports and shall make those reports, and the list of estimated fees required to be published pursuant to subdivision (b), available to the public by submitting them to the Legislature and posting them on the department’s internet website: (1) A report of all costs for activities of the Licensing and Certification Program. At a minimum, this report shall include a narrative of all baseline adjustments and their calculations, a description of how each category of facility was calculated, descriptions of assumptions used in any calculations, and shall recommend Licensing and Certification Program fees in accordance with the following: (A) Projected workload and costs shall be grouped for each fee category, including workload costs for facility categories that have been established by statute and for which licensing regulations and procedures are under development. (B) Cost estimates, and the estimated fees, shall be based on the appropriation amounts in the Governor’s proposed budget for the next fiscal year, with and without policy adjustments to the fee methodology. (C) The allocation of program, operational, and administrative overhead, and indirect costs to fee categories shall be based on generally accepted cost allocation methods. Significant items of costs shall be directly charged to fee categories if the expenses can be reasonably identified to the fee category that caused them. Indirect and overhead costs shall be allocated to all fee categories using a generally accepted cost allocation method. (D) The amount of federal funds and General Fund moneys to be received in the budget year shall be estimated and allocated to each fee category based upon an appropriate metric. (E) The fee for each category shall be determined by dividing the aggregate state share of all costs for the Licensing and Certification Program by the appropriate metric for the category of licensure. Amounts received for new licensure applications, including change of ownership applications, and late payment penalties, pursuant to Section 1266.5, during each fiscal year shall be calculated and 95 percent shall be applied to the appropriate fee categories in determining Licensing and Certification Program fees for the second fiscal year following receipt of those funds. The remaining 5 percent shall be retained in the fund as a reserve until appropriated. (2) (A) A staffing and systems analysis to ensure efficient and effective utilization of fees collected, proper allocation of departmental resources to licensing and certification activities, survey schedules, complaint investigations, enforcement and appeal activities, data collection and dissemination, surveyor training, and policy development. (B) The analysis under this paragraph shall be made available to interested persons and shall include all of the following: (i) The number of surveyors and administrative support personnel devoted to the licensing and certification of health care facilities. (ii) The percentage of time devoted to licensing and certification activities for the various types of health facilities. (iii) The number of facilities receiving full surveys and the frequency and number of followup visits. (iv) The number and timeliness of complaint investigations, including data on the department’s compliance with the requirements of paragraphs (3), (4), and (5) of subdivision (a) of Section 1420. (v) Data on deficiencies and citations issued, and numbers of arbitration hearings. (vi) Other applicable activities of the Licensing and Certification Program. (3) The annual program fee report described in subdivision (d) of Section 1416.36. (d) The reports required pursuant to subdivision (c) shall be submitted in compliance with Section 9795 of the Government Code. (e) Commencing in the 2015–16 fiscal year, the fees for skilled nursing facilities shall be increased so as to generate four hundred thousand dollars ($400,000) for the California Department of Aging’s Long-Term Care Ombudsman Program for its work related to investigating complaints made against skilled nursing facilities and increasing visits to those facilities. (f) Commencing in the 2018–19 fiscal year, the Licensing and Certification Program may assess a supplemental program fee on facilities located in the County of Los Angeles for all facility types set forth in this section. This supplemental program fee shall be in addition to the program fees set forth in the estimated program fee list described in subdivision (b). The Licensing and Certification Program shall calculate the supplemental program fee based upon the difference between the estimated costs of regulating facility types licensed in the County of Los Angeles, including, but not limited to, the costs associated with the Licensing and Certification Program’s contract for licensing and certification activities with the County of Los Angeles and the costs of the Licensing and Certification Program conducting the licensing and certification activities for facilities located in the County of Los Angeles. The supplemental program fees shall be used to cover the costs to administer and enforce state licensure standards and other federal compliance activities for facilities located in the County of Los Angeles, as described in the annual report. The supplemental program fee shall be based upon the fee methodology published in the annual report described in subdivision (b). (g) (1) The Licensing and Certification Program shall adjust the list of estimated fees published pursuant to subdivision (b) if the annual Budget Act or other enacted legislation includes an appropriation that differs from those proposed in the Governor’s proposed budget for that fiscal year. (2) The Licensing and Certification Program shall publish a final fee list, with an explanation of any adjustment, by the issuance of an all facilities letter, by posting the list on the department’s internet website, and by including the final fee list as part of the licensing application package, within 14 days of the enactment of the annual Budget Act. The adjustment of fees and the publication of the final fee list shall not be subject to the rulemaking requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (h) Fees shall not be assessed or collected pursuant to this section from any state department, authority, bureau, commission, or officer, unless federal financial participation would become available by doing so and an appropriation is included in the annual Budget Act for that state department, authority, bureau, commission, or officer for this purpose. Fees shall not be assessed or collected pursuant to this section from any clinic that is certified only by the federal government and is exempt from licensure under Section 1206, unless federal financial participation would become available by doing so. (i) The Licensing and Certification Program may change annual license expiration renewal dates to provide for efficiencies in operational processes or to provide for sufficient cashflow to pay for expenditures. If an annual license expiration date is changed, the annual license fee shall be prorated accordingly. Facilities shall be provided with a 60-day notice of any change in their annual license renewal date. If a licensee voluntarily surrenders its license, they shall not be entitled to a refund for the remainder of the license period. (j) Commencing with the 2018–19 November Program estimate, the Licensing and Certification Program shall evaluate the feasibility of reducing investigation timelines based on experience with implementing paragraphs (3), (4), and (5) of subdivision (a) of Section 1420. (Amended by Stats. 2024, Ch. 40, Sec. 9. (SB 159) Effective June 29, 2024.)
  28. 1266.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Applicants for psychiatric health facility licenses must include a fee, and special permit applicants must apply with the license application and may owe an additional fee unless exempt.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.1. (a) Each new or renewal application for a license for a psychiatric health facility shall be accompanied by a fee credited to the State Department of Health Care Services for its costs incurred in the review of psychiatric health facility programs, in connection with the licensing of these facilities. The amount of the fees shall be determined and collected by the State Department of Health Care Services, but the total amount of the fees collected shall not exceed the actual costs of licensure and review of psychiatric health facility programs, including, but not limited to, the costs of processing the application, inspection costs, and other related costs. (b) New or renewal licensure application fees for psychiatric health facilities shall be collected by the State Department of Health Care Services. (c) The annual fees shall be waived for any psychiatric health facility conducted, maintained, or operated by this state or any state department, authority, bureau, commission, or officer, or by the Regents of the University of California, or by a local hospital district, city, county, or city and county. (d) If additional private psychiatric health facilities seek new licensure on or after January 1, 1991, the State Department of Health Care Services may increase the fees for all private psychiatric health facilities with more than nine beds sufficient to accommodate the increased level of workload and costs. (e) (1) Any licensee desiring to obtain a special permit to offer and provide structured outpatient services shall file an application with the State Department of Health Care Services. (2) The application for a special permit, if any, shall be submitted with each new or renewal application for a license for a psychiatric health facility, and shall be accompanied by a reasonable fee, as determined by the State Department of Health Care Services, not to exceed the actual costs of administration related to the special permit. An application for a special permit submitted by a psychiatric health facility operated by a public entity shall be exempt from the fee required pursuant to this section for the issuance of the special permit. (3) The State Department of Health Care Services shall not issue a special permit unless the applicant furnishes all of the following: (A) Its annual licensing fee required pursuant to subdivision (a). (B) A completed application submitted on forms furnished by the department. (C) A written agreement ensuring that the facility will have additional staffing for the services to be provided under the special permit, that the additional staffing will meet the same professional standards as required by regulation for inpatient services, and that a coordinator of these services will be appointed. (D) Any other information or documentation as may be required by the department for its proper and efficient administration and enforcement of special permit services. (4) The provision of structured outpatient services pursuant to a special permit may be as an alternative to admission to inpatient services, as aftercare services following discharge from inpatient care, or as both. (Amended by Stats. 2013, Ch. 23, Sec. 10. (AB 82) Effective June 27, 2013.)
  29. 1266.10.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section appropriates $3,204,370 from the General Fund to the State Department of Health Services for a loan to support the Licensing and Certification Program, and requires repayment from Section 1266 fee proceeds in three equal annual installments.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.10. The amount of three million two hundred four thousand three hundred seventy dollars ($3,204,370) is appropriated from the General Fund to the State Department of Health Services, for a loan for use to support the operations of the Licensing and Certification Program. Repayment of this loan shall be made with proceeds from fees collected pursuant to Section 1266, in three equal annual installments of one million sixty-eight thousand one hundred twenty-three dollars ($1,068,123), commencing on July 1, 2007, or upon the enactment of the Budget Act of 2007, whichever is later. (Added by Stats. 2006, Ch. 74, Sec. 10. Effective July 12, 2006.)
  30. 1266.12.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The department must prioritize initial licensing surveys for certain developmental disability intermediate care facilities, and after licensure plus notice, must schedule and start a certification survey within 60 days.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.12. (a) The annual Licensing and Certification Program fee for a skilled nursing facility, intermediate care facility, general acute care hospital, acute psychiatric hospital, special hospital, chemical dependency recovery hospital, correctional treatment center, intermediate care facility/developmentally disabled, intermediate care facility/developmentally disabled nursing, and intermediate care facility/developmentally disabled habilitative shall be set in accordance with Section 1266. (b) Commencing January 1, 2007, the department shall give priority in conducting initial licensing surveys to each intermediate care facility/developmentally disabled, intermediate care facility/developmentally disabled habilitative, and intermediate care facility/developmentally disabled nursing. Upon successful completion of licensure, and upon notification by the facility that it is ready for an initial certification survey, the department shall schedule and initiate a certification survey within 60 days. (Added by Stats. 2006, Ch. 74, Sec. 11. Effective July 12, 2006.)
  31. 1266.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Late fees become delinquent after the license or required filing deadline, and the Licensing and Certification Program may add a penalty and offset payments to collect unpaid fees.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.5. (a) Whenever any entity required to pay fees pursuant to Section 1266 continues to operate beyond its license expiration date, without the Licensing and Certification Program annual license fees first having been paid as required by this division, those fees are delinquent. (b) A late payment penalty shall be added to any delinquent annual license fees made later than midnight of the license expiration date. The late payment penalty shall be computed as follows: (1) For a delinquency period of 30 days or less, the penalty shall be 10 percent of the fee. (2) For a delinquency period of more than 30 days to and including 60 days, the penalty shall be 20 percent of the fee. (3) For a delinquency period of more than 60 days, the penalty shall be 60 percent of the fee. (c) A license may not be renewed without payment of the Licensing and Certification Program annual license fee plus any late payment penalty. (d) Whenever any entity required to pay a report of change or written notification fee pursuant to Section 1266 fails to both submit a timely report of change or written notification and pay the applicable fee, those fees are delinquent. (e) A late payment penalty shall be added to any delinquent fees due with a report of change or written notification made later than midnight of the required submission date. The late payment penalty shall be computed as follows: (1) For a delinquency period of 30 days or less, the penalty shall be 10 percent of the fee. (2) For a delinquency period of more than 30 days to and including 60 days, the penalty shall be 20 percent of the fee. (3) For a delinquency period of more than 60 days, the penalty shall be 60 percent of the fee. (f) The Licensing and Certification Program may, upon written notification to the licensee, offset any moneys owed to the licensee by the Medi-Cal program or any other payment program administered by the department to recoup any annual license, report of change, or written notification fee along with any associated late payment penalties. (Amended by Stats. 2024, Ch. 40, Sec. 10. (SB 159) Effective June 29, 2024.)
  32. 1266.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The annual Licensing and Certification Program fee for a congregate living health facility must be set under Section 1266.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.7. The annual Licensing and Certification Program fee for a congregate living health facility shall be set in accordance with Section 1266. (Added by Stats. 2006, Ch. 74, Sec. 8. Effective July 12, 2006.)
  33. 1266.9.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A state fund is created in the State Treasury, and revenue collected under Section 1266 must be deposited into it.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1266.9. There is hereby created in the State Treasury the State Department of Public Health Licensing and Certification Program Fund. The revenue collected in accordance with Section 1266 shall be deposited in the State Department of Public Health Licensing and Certification Program Fund and shall be available for expenditure, upon appropriation by the Legislature, to support the department’s Licensing and Certification Program’s operation. Interest earned on the moneys in the fund shall be deposited as revenue into the fund to support the department’s Licensing and Certification Program’s operation. (Amended by Stats. 2007, Ch. 483, Sec. 15. Effective January 1, 2008.)
  34. 1267.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Licenses and special permits under this chapter expire after 12 months, and renewal applications with the fee must be filed at least 30 days before expiration.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267. (a) (1) Each license issued pursuant to this chapter shall expire 12 months from the date of its issuance and each special permit shall expire on the expiration date of the license. Application for renewal of a license or special permit accompanied by the necessary fee shall be filed with the state department not less than 30 days prior to the expiration date. Failure to make a timely renewal shall result in expiration of the license or special permit. (2) Notwithstanding paragraph (1), the license of a facility operated by a receiver appointed pursuant to Article 8 (commencing with Section 1325) shall not expire during the period of the receivership, and for 30 days thereafter. (b) A renewal license or special permit may be issued for a period not to exceed two years if the holder of the license or special permit has been found in substantial compliance with any statutory requirements, regulations, or standards during the preceding license period. However, for a health facility specified in subdivision (a) or (b) of Section 1250, a renewal license or special permit may be issued for a period not to exceed three years, if the holder of the license or special permit has been found in substantial compliance with statutory requirements, regulations, or standards during the preceding license period. (c) Notwithstanding the length of the period for which a renewal license is issued, a license fee shall be due and payable annually. (Amended by Stats. 2000, Ch. 451, Sec. 5. Effective January 1, 2001.)
  35. 1267.11.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    An intermediate care facility/developmentally disabled-habilitative must assign direct care staff to supervise clients for at least 56 hours per week, and those supervisory staff must meet one of three qualification options.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.11. Each intermediate care facility/developmentally disabled-habilitative shall designate direct care staff persons to supervise the direct care services to clients for at least 56 hours per week. The hours of these supervisory staff persons shall be applied against the total number of direct care hours required in regulations developed by the department pursuant to Section 1267.7. These supervisory staff persons shall, at a minimum, meet one of the following criteria: (a) Possession of a valid vocational nurse or psychiatric technician license issued by the Board of Vocational Nurse and Psychiatric Technician Examiners. (b) Completion of at least 30 college or university units in education, social services, behavioral sciences, health sciences, or related fields, and six months experience providing direct services to developmentally disabled persons. (c) Eighteen months experience providing direct services to developmentally disabled persons while under the supervision of a person who meets the requirements of a professional as defined in regulations promulgated pursuant to Section 1267.7. (Amended by Stats. 2023, Ch. 797, Sec. 4. (AB 248) Effective January 1, 2024.)
  36. 1267.12.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A congregate living health facility may admit, accept for care, or discharge a person only on a physician and surgeon’s order.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.12. No person shall be admitted, or accepted for care, or discharged, by a congregate living health facility except upon the order of a physician and surgeon. Admission criteria shall be subject to review and approval by the state department. All persons admitted or accepted for care by the congregate living health facility shall remain under the care of a physician and surgeon who shall see the resident at least every 30 calendar days or more frequently if required by the resident’s medical condition. (Added by Stats. 1988, Ch. 1478, Sec. 8. Effective September 28, 1988.)
  37. 1267.13.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section sets interim operating standards for certain congregate living health facilities, including fire clearance, staffing, room setup, hygiene, and resident safety requirements.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.13. Pursuant to paragraph (3) of subdivision (a) and subdivision (b) of Section 1265.7, this section shall be effective until the adoption of permanent regulations. Notwithstanding, the state department has authority to make reasonable accommodation for exceptions to the standards in this section, providing the health, safety, and quality of patient care is not compromised. No exceptions shall be made for building standards. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. Applicants shall request the exception in writing accompanied by detailed, supporting documentation. Congregate living health facilities serving persons who are terminally ill, persons who are catastrophically and severely disabled, persons who are mentally alert but physically disabled, or any combination of these persons, shall conform to the following: (a) Facilities shall obtain and maintain a valid fire clearance from the appropriate authority having jurisdiction over the facility, based on compliance with state regulations concerning fire and life safety, as adopted by the State Fire Marshal. (b) The State Fire Marshal, with the advice of the State Board of Fire Services, shall adopt regulations on or before January 1, 1991, following a public hearing, establishing minimum requirements for the protection of life and property for congregate living health facilities serving terminally ill persons, catastrophically and severely disabled persons, persons who are mentally alert but physically disabled, or any combination of these persons. These minimum requirements shall recognize the residential and noninstitutional setting of congregate living health facilities serving terminally ill persons, catastrophically and severely disabled persons, persons who are mentally alert but physically disabled, or any combination of these persons. (c) Facilities shall be in a homelike residential setting. Living accommodations and grounds shall be related to the facility’s function and clientele. Facilities shall provide sufficient space for comfortable living accommodations and privacy for residents, staff, and others who may reside in the facility. (d) Common rooms, including, but not limited to, living rooms, dining rooms, and dens or other recreation or activity rooms, shall be provided and shall have sufficient space, separation, or both to promote and facilitate the program of activities and to prevent these activities from interfering with other functions. Accommodations shall ensure adequate space for residents to have visitors and for privacy during visits, if desired. (e) Resident bedrooms shall have adequate space to allow easy passage throughout; permit comfortable usage of furnishings; promote ease of nursing care; and accommodate use of assistive devices, including, but not limited to, wheelchairs, walkers, and patient lifts, when needed. (f) No room commonly used for other purposes, including, but not limited to, a hall, stairway, attic, garage, storage area, shed, or similar detached building, shall be used as a sleeping room for any resident. (g) No resident bedroom shall be used as a passageway to another room, bath, or toilet. (h) Not more than two residents shall share a bedroom. (i) Equipment and supplies necessary for personal care and maintenance of adequate hygiene shall be readily available to all residents. (j) Toilets and bathrooms shall be conveniently located. At least one toilet and washbasin shall be provided per six residents. At least one bathtub or shower shall be provided per 10 residents. Individual privacy shall be provided in all toilet, bath and shower areas. Separate toilet, washbasin, and bathtub or shower accommodations shall be provided for staff. (k) Sufficient room shall be available throughout the facility to accommodate and serve all persons in comfort and safety. The premises shall be maintained in good repair and shall provide a safe, clean, and healthful environment. ( l) Facilities shall have equipment and supplies appropriate to meet the routine and specialized needs of all residents. (m) All persons shall be protected from hazards throughout the premises: (1) Stairways, inclines, ramps, open porches, and other areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible unless well lighted and equipped with sturdy hand railings. (2) Night lights shall be maintained in hallways and passages to nonprivate bathrooms. (3) All indoor and outdoor passageways and stairways shall be kept free of obstructions. (4) Fireplaces, woodstoves, and open-faced heaters shall be adequately screened. (5) Facilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools, or similar bodies of water or other areas of potential hazard when not in active use. (n) Facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, shall, in addition to the requirements of this chapter and until specific regulations governing their operation are filed, conform to regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations of April 1, 1988, with the exception of the following sections or portions of sections: 72007, 72053, 72073, subdivision (a) of Section 72077, 72097, 72099, 72103, 72203, subdivision (a) of Section 72205, 72301, 72305, subdivision (a) of Section 72325, 72327, 72329, 72331, 72337, subdivisions (b), (g), and (h) of Section 72351, 72353, subdivision (a) of Section 72367, 72373, subdivision (b) of Section 72375, 72401, 72403, 72405, 72407, 72409, 72411, 72413, 72415, 72417, 72419, 72421, 72423, 72425, 72427, 72429, 72431, 72433, 72435, 72437, 72439, 72441, 72443, 72445, 72447, 72449, 72451, 72453, 72455, 72457, 72459, 72461, 72463, 72465, 72467, 72469, 72471, 72473, 72475, 72503, paragraph (2) of subdivision (a) of Section 72513, 72520, 72535, 72555, 72557, subdivisions (a) and (b) of Section 72601, subdivision (d) of Section 72607, subdivisions (a) and (d) of Section 72609, 72611, 72615, 72617, 72629, 72631, 72633, 72635, subdivisions (b), (c), and (d) of Section 72639, 72641, and 72665. (o) (1) Facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, shall have an administrator who is responsible for the day-to-day operation of the facility. The administrator may be either a licensed registered nurse, a nursing home administrator, or the licensee. The administrator shall be present at the facility a sufficient number of hours to ensure the smooth operation of the facility. If the administrator is also the registered nurse fulfilling the duties specified in paragraph (2), the administrator shall not be responsible for more than one facility. In all other circumstances, the administrator shall not be responsible for more than three facilities with an aggregate total of 75 beds and these facilities shall be within one hour’s surface travel time of each other. (2) (A) For each congregate living health facility of more than six beds serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, there shall be, at a minimum, a registered nurse or licensed vocational nurse awake and on duty at all times. A registered nurse shall be awake and on duty eight hours a day, five days a week. (B) For each congregate living health facility of six or fewer beds serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, a registered nurse shall visit each patient at least twice a week for approximately two hours, or more as patient care requires. (C) For all congregate living health facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, a registered nurse shall be available for consultation and able to come into the facility within 30 minutes, if necessary, when no registered nurse is on duty. In addition, certified nurse assistants, or persons with similar training and experience as determined by the department, shall be awake and on duty in the facility in at least the following ratios: facilities with six beds or less, one per shift; facilities with 7 to 12 beds, two per shift; facilities with 13 to 25 beds, three per day and evening shifts and two per nocturnal shift. No nursing services personnel shall be assigned housekeeping or dietary duties. (3) Notwithstanding the provisions of this subdivision, the facility shall provide appropriately qualified staff in sufficient numbers to meet patient care needs. (4) Nursing service personnel shall be employed and on duty in at least the number and with the qualifications determined by the department to provide the necessary nursing services for patients admitted for care. The department may require a facility to provide additional professional, administrative, or supportive personnel whenever the state department determines through a written evaluation, that additional personnel are needed to provide for the health and safety of patients. (5) All staff members shall receive orientation regarding care appropriate for the patients’ diagnoses and individual resident needs. Orientation shall include a minimum of 16 hours during the first 40 hours of employment. (6) Nothing in this chapter shall prevent the use of volunteers; however, volunteers shall not be used as substitutes for the personnel required in the above sections. Volunteers providing patient care services shall: (A) Be provided clearly defined roles and written job descriptions. (B) Receive orientation and training equivalent to that provided paid staff. (C) Possess education and experience equal to that required of paid staff performing similar functions. (D) Conform to the facility’s policies and procedures. (E) Receive periodic performance evaluations. (p) The interim standards prescribed by this section shall become inoperative upon the filing of the regulations with the Secretary of State. (Amended by Stats. 1993, Ch. 1020, Sec. 1. Effective January 1, 1994.)
  38. 1267.15.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Congregate living health facilities must be freestanding and separately licensed, with a limited rule allowing multiple facilities in one multifloor building if stated conditions are met.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.15. (a) Congregate living health facilities shall be freestanding, but this does not preclude their location on the premises of a hospital. Congregate living health facilities shall be separately licensed. (b) Notwithstanding subdivision (a), multiple congregate living health facilities may exist in one multifloor building if all of the following requirements are satisfied: (1) Each facility meets other applicable building standards not related to multiple floors. (2) Each facility is separated by a wall, floor, or other permanent partition but may share an elevator, stairs, or stairwell, and need not be freestanding. (3) Proposals to develop proximate congregate living health facilities are supported by the county health department and the board of supervisors in the county in which the facilities are to be located. (4) The congregate living health facilities are proposed for one of the following locations: (A) McClellan Air Force Base Building No. 522, located at 3201 James Way, McClellan, California. (B) McClellan Air Force Base Building No. 523, located at 3207 James Way, McClellan, California. (C) McClellan Air Force Base Building No. 524, located at 5621 Dudley Blvd., McClellan, California. (D) McClellan Air Force Base Building No. 525, located at 5327 Dudley Blvd., McClellan, California. (Amended by Stats. 2013, Ch. 722, Sec. 3. (SB 534) Effective January 1, 2014.)
  39. 1267.16.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Certain congregate living health facilities are treated as residential property uses, and some local zoning and ordinance limits still apply, including conditional use permits for larger facilities unless an exception applies.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.16. (a) A congregate living health facility which serves six or fewer persons shall be considered a residential use of property for purposes of any zoning ordinance or law related to the residential use of property. This article does not forbid any city, county, or local public entity from placing restrictions on building heights, setback, lot dimensions, or placement of signs of a congregate living health facility as long as these restrictions are identical to those applied to single-family residences. (b) This article does not forbid the application to a congregate living health facility of any local ordinance which deals with health and safety, building standards, environmental impact standards, or any other matter within the jurisdiction of a local public entity, except as provided in subdivisions (a) and (b) of Section 1267.9 and this section. (c) Any congregate living health facility of more than six beds for persons who are terminally ill and any congregate living health facility of more than six beds for persons who are catastrophically and severely disabled shall be subject to the conditional use permit requirements of the city or county in which it is located unless those requirements are waived by the city or county. However, any facility that, on the effective date of this section, is performing the functions of a congregate living health facility for persons who are terminally ill and that is subsequently licensed as a congregate living health facility within 18 months of the effective date of this section shall not be subject to the conditional use permit requirements of the city or county in which it is located, unless the number of beds is increased. (Amended by Stats. 1989, Ch. 1393, Sec. 7. Effective October 2, 1989.)
  40. 1267.17.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A congregate living health facility must conspicuously post its license, or a true copy, where the public can see it.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.17. Each congregate living health facility shall conspicuously post the license, or a true copy thereof in a location accessible to public view. (Added by Stats. 1988, Ch. 1478, Sec. 12. Effective September 28, 1988.)
  41. 1267.19.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Congregate living health facilities are exempt from architectural plan review, and applicants must show local building code compliance and provide an adequate physical environment.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.19. Congregate living health facilities shall not be subject to architectural plan review by the Office of Statewide Health Planning and Development. As part of the application for licensure, the prospective licensee shall submit evidence of compliance with local building code requirements. In addition, the physical environment shall be adequate to provide for the level of care and service required by the residents of the facility, as determined by the department. (Amended by Stats. 2006, Ch. 538, Sec. 350. Effective January 1, 2007.)
  42. 1267.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Applicants for skilled nursing or intermediate care facility licenses must disclose ownership and related control information to the state department, and certain ownership changes need prior written approval.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.5. (a) (1) Each applicant for a license to operate a skilled nursing facility or intermediate care facility shall disclose to the state department the name and business address of each general partner if the applicant is a partnership, or each director and officer if the applicant is a corporation, and each person having a beneficial ownership interest of 5 percent or more in the applicant corporation or partnership. (2) If any person described in paragraph (1) has served or currently serves as an administrator, general partner, trustee or trust applicant, sole proprietor of any applicant or licensee who is a sole proprietorship, executor, or corporate officer or director of, or has held a beneficial ownership interest of 5 percent or more in, any other skilled nursing facility or intermediate care facility or in any community care facility licensed pursuant to Chapter 3 (commencing with Section 1500) of this division, the applicant shall disclose the relationship to the state department, including the name and current or last address of the health facility or community care facility and the date the relationship commenced and, if applicable, the date it was terminated. (3) (A) If the facility is operated by, or is proposed to be operated in whole or part under, a management contract, the names and addresses of any person or organization, or both, having an ownership or control interest of 5 percent or more in the management company shall be disclosed to the state department. This provision shall not apply if the management company has submitted an application for licensure or a change of ownership pursuant to this chapter with the state department and has complied with paragraph (1). (B) If the management company is a subsidiary of one or more other organizations, the information shall include the names and addresses of the parent organizations of the management company and the names and addresses of any officer or director of the parent organizations. The failure to comply with this subparagraph may result in action to revoke or deny a license. However, once the information that is required under this subparagraph is provided, the action to revoke the license shall terminate. (4) If the applicant or licensee is a subsidiary of one or more other organizations, the information shall include the names and addresses of the parent organizations of the subsidiary and the names and addresses of any officer or director of the parent organizations. (5) The information required by this subdivision shall be provided to the state department upon initial application for licensure, and any change in the information shall be provided to the state department 30 calendar days prior to that change, except as provided in Section 1253.3. (6) The information required by this subdivision and by Section 1253.3 shall be provided to the department upon application for a change of ownership or change of management in compliance with the time requirements of Section 1253.3. (7) Except as provided in subparagraph (B) of paragraph (3), the failure to comply with this section may result in action to revoke or deny a license. (8) The information required by this section shall be made available to the public upon request, shall be included in the public file of the facility, and by July 1, 2002, shall be included in the department’s automated certification licensing administration information management system. (b) (1) On and after January 1, 1990, no person may acquire a beneficial interest of 5 percent or more in any corporation or partnership licensed to operate a skilled nursing facility or intermediate care facility, or in any management company under contract with a licensee of a skilled nursing facility or intermediate care facility, nor may any person become an officer or director of, or general partner in, a corporation, partnership, or management company of this type without the prior written approval of the state department. Each application for departmental approval pursuant to this subdivision shall include the information specified in subdivision (a) as regards the person for whom the application is made. (2) The state department shall approve or disapprove the application, other than an application submitted pursuant to Section 1253.3, within 30 days after receipt thereof, unless the state department, with just cause, extends the application review period beyond 30 days. (c) The state department may deny approval of a license application or of an application for approval under subdivision (b) if a person named in the application, as required by this section, was an officer, director, general partner, or owner of a 5-percent or greater beneficial interest in a licensee of, or in a management company under contract with a licensee of, a skilled nursing facility, intermediate care facility, community care facility, or residential care facility for the elderly at a time when one or more violations of law were committed therein that resulted in suspension or revocation of its license, or at a time when a court-ordered receiver was appointed pursuant to Section 1327, or at a time when a final Medi-Cal decertification action was taken under federal law. However, the prior suspension, revocation, or court-ordered receivership of a license shall not be grounds for denial of the application if the applicant shows to the satisfaction of the state department (1) that the person in question took every reasonably available action to prevent the violation or violations that resulted in the disciplinary action and (2) that they took every reasonably available action to correct the violation or violations once they knew, or with the exercise of reasonable diligence should have known of, the violation or violations. (d) No application shall be denied pursuant to this section until the state department first (1) provides the applicant with notice in writing of grounds for the proposed denial of application, and (2) affords the applicant an opportunity to submit additional documentary evidence in opposition to the proposed denial. (e) Nothing in this section shall cause any individual to be personally liable for any civil penalty assessed pursuant to Chapter 2.4 (commencing with Section 1417) or create any new criminal or civil liability contrary to general laws limiting that liability. (f) This section shall not apply to a bank, trust company, financial institution, title insurer, controlled escrow company, or underwritten title company to which a license is issued in a fiduciary capacity. (g) As used in this section, “person” has the same meaning as specified in Section 19. (h) This section shall not apply to the directors of a nonprofit corporation exempt from taxation under Section 23701d of the Revenue and Taxation Code that operates a skilled nursing facility or intermediate care facility in conjunction with a licensed residential facility, where the directors serve without financial compensation and are not compensated by the nonprofit corporation in any other capacity. (Amended by Stats. 2022, Ch. 578, Sec. 6. (AB 1502) Effective January 1, 2023.)
  43. 1267.61.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A facility licensee must give residents and their representatives written notice at least 90 days before certain sales, transfers, leases, management changes, or ownership changes, post the notice on entrance and exit doors, and make the information available on request and in the department’s database/website.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.61. (a) At least 90 days prior to a finalization of the sale, transfer of operation, including management changes, assignment, lease, or other change or transfer of ownership interests, the licensee of a facility defined in subdivision (c) of Section 1250, excluding skilled nursing facilities that are operated as a distinct part of an acute care hospital, shall give a written notice of the proposed change in licensee or management company to all residents of the facility and their representatives that contains all of the following information applicable to the proposed change: (1) The name and address of the prospective licensee, transferee, assignee, lessee, property owner, or the licensee’s parent company and management company, if applicable. (2) A list of all prospective licensee or prospective management company’s owners or shareholders and their ownership percentages. (3) A list of directors, officers, board members, and property owners of the prospective licensee and, if existing, a list of directors, officers, and board members of the prospective licensee’s parent company and proposed management company. (4) The expected date of sale, assignment, lease, or other change. (b) The licensee shall post a copy of the notice required pursuant to this section on all entrance and exit doors of the facility. (c) The information required by this section shall be made available to the public by the facility upon request and shall be included in the department’s licensing database and consumer information website. (d) A licensee that fails to comply with the notification requirements of this section is liable for a civil penalty in the amount of of one hundred dollars ($100) per day for each day the notice is delayed. (e) This section applies only to license applications submitted after July 1, 2020. (Added by Stats. 2019, Ch. 832, Sec. 1. (AB 1695) Effective January 1, 2020.)
  44. 1267.62.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    When a facility is sold or otherwise transferred, the prospective licensee must keep most employees for 60 days and give each employee a written job offer, with at least 10 days to accept.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.62. (a) In the event of the sale, transfer of operation, including management changes, assignment, lease, or other change or transfer of ownership of a facility defined in subdivision (c) of Section 1250, excluding skilled nursing facilities that are operated as a distinct part of an acute care hospital, a prospective transferee, in the capacity of a prospective licensee, shall retain, for a 60-day transition employment period, all employees who are employed by the licensee, except for the nursing home administrator and the director of nursing. (b) The prospective licensee shall make a written offer of employment to each employee for the 60-day transition period in the employee’s primary language or another language in which the employee is literate. That offer shall state the time within which the employee shall accept the offer, but that time period may not be fewer than 10 days. (c) During the 60-day transition period, the prospective licensee shall not discharge without cause an employee retained pursuant to this section. Cause shall be based only on the performance or conduct of the particular employee. (d) Except as provided in subdivision (c), during the 60-day transition period, an employee shall not suffer any reduction in wages, benefits, or other terms and conditions of employment, economic or otherwise, as a result of the transfer or change of ownership. (e) This section does not make the department responsible for adjudicating a labor dispute or wrongful termination complaint. (f) This section applies only to license applications submitted after January 1, 2020. (Added by Stats. 2019, Ch. 832, Sec. 2. (AB 1695) Effective January 1, 2020.)
  45. 1267.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Two state health agencies must jointly create and carry out licensing and Medi-Cal regulations for certain intermediate care facilities.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.7. The State Department of Health Services and the State Department of Developmental Services shall jointly develop and implement licensing and Medi-Cal regulations appropriate to intermediate care facility/developmentally disabled-habilitative facilities. These regulations shall ensure that residents of these facilities are assured appropriate developmental and supportive health services in the most normal, least restrictive physical and programmatic environments appropriate to individual resident needs. Regulations adopted pursuant to this section shall include provision for maximum utilization of generic community resources in the provision of services to residents and participation of the residents in community activities. (Repealed and added by Stats. 1987, Ch. 1456, Sec. 2.5.)
  46. 1267.75.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section lets certain licensed small intermediate care facilities use delayed egress devices with secured perimeters, but only for qualifying residents and subject to staffing, training, approval, and bed-limit rules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.75. (a) A licensee of an intermediate care facility/developmentally disabled habilitative, as defined in subdivision (e) of Section 1250, or of an intermediate care facility/developmentally disabled, as defined in subdivision (g) of Section 1250, for no more than six residents, except for the larger facilities provided for in paragraph (1) of subdivision (k), may install and utilize delayed egress devices of the time delay type in combination with secured perimeters in accordance with the provisions of this section. (b) For purposes of this section, the following definitions shall apply: (1) “Delayed egress device” means a device that precludes the use of exits for a predetermined period of time. These devices shall not delay any resident’s departure from the facility for longer than 30 seconds. (2) “Secured perimeters” means fences that meet the requirements prescribed by this section. (c) Only individuals meeting all of the following conditions may be admitted to or reside in a facility described in subdivision (a) utilizing delayed egress devices of the time delay type in combination with secured perimeters: (1) The person shall have a developmental disability as defined in Section 4512 of the Welfare and Institutions Code. (2) The person shall be receiving services and case management from a regional center under the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code). (3) (A) The person shall be 14 years of age or older. (B) Notwithstanding subparagraph (A), a child who is at least 10 years of age and less than 14 years of age may be placed in a licensed facility described in subdivision (a) using delayed egress devices of the time delay type in combination with secured perimeters only if both of the following occur: (i) A comprehensive assessment is conducted and an individual program plan meeting is convened to determine the services and supports needed for the child to receive services in a less restrictive, unlocked residential setting in California, and the regional center requests assistance from the State Department of Developmental Services’ statewide specialized resource service to identify options to serve the child in a less restrictive, unlocked residential setting in California. (ii) The regional center requests placement of the child in a facility described in subdivision (a) using delayed egress devices of the time delay type in combination with secured perimeters on the basis that the placement is necessary to prevent out-of-state placement or placement in a more restrictive, locked residential setting such as a developmental center, institution for mental disease, or psychiatric facility, and the State Department of Developmental Services approves the request. (4) (A) An interdisciplinary team, through the individual program plan (IPP) process pursuant to Section 4646.5 of the Welfare and Institutions Code, shall have determined that the person lacks hazard awareness or impulse control and, for the person’s safety and security, requires the level of supervision afforded by a facility equipped with delayed egress devices of the time delay type in combination with secured perimeters and that, but for this placement, the person would be at risk of admission to, or would have no option but to remain in, a more restrictive placement. The individual program planning team shall convene every 90 days after admission to determine and document the continued appropriateness of the current placement and progress in implementing the transition plan. (B) The clients’ rights advocate for the regional center shall be notified of the proposed admission and the individual program plan meeting and may participate in the individual program plan meeting, unless the consumer objects on their own behalf. (d) The licensee shall be subject to all applicable fire and building codes, regulations, and standards, and shall receive approval by the county or city fire department, the local fire prevention district, or the State Fire Marshal for the installed devices and secured perimeters. (e) The licensee shall provide staff training regarding the use and operation of the delayed egress devices of the time delay type and secured perimeters, protection of residents’ personal rights, lack of hazard awareness and impulse control behavior, and emergency evacuation procedures. (f) The licensee shall revise its facility plan of operation. These revisions shall first be approved by the State Department of Developmental Services. The plan of operation shall not be approved by the State Department of Public Health unless the licensee provides certification that the plan was approved by the State Department of Developmental Services. The plan shall include, but not be limited to, all of the following: (1) A description of how the facility is to be equipped with secured perimeters that are consistent with regulations adopted by the State Fire Marshal pursuant to Section 13143.6. (2) A description of how the facility will provide training for staff. (3) A description of how the facility will ensure the protection of the residents’ personal rights consistent with Sections 4502, 4503, and 4504 of the Welfare and Institutions Code, and any applicable personal rights provided in Title 22 of the California Code of Regulations. (4) A description of how the facility will manage residents’ lack of hazard awareness and impulse control behavior, which shall emphasize positive behavioral supports and techniques that are alternatives to physical, chemical, or mechanical restraints, or seclusion. (5) A description of the facility’s emergency evacuation procedures. (6) A description of how the facility will comply with applicable health and safety standards. (g) Delayed egress devices of the time delay type in combination with secured perimeters shall not substitute for adequate staff. (h) Emergency fire and earthquake drills shall be conducted on each shift in accordance with existing licensing requirements, and shall include all facility staff providing resident care and supervision on each shift. (i) Interior and exterior space shall be available on the facility premises to permit clients to move freely and safely. (j) For the purposes of using secured perimeters, the licensee shall not be required to obtain a waiver or exception to a regulation that would otherwise prohibit the locking of a perimeter fence or gate. (k) The state shall not authorize or fund more than a combined total of 174 beds statewide in facilities with secured perimeters under this section and under Section 1531.15. The department shall notify the appropriate fiscal and policy committees of the Legislature through the January and May budget estimates prior to authorizing an increase above a combined total of 100 beds statewide in facilities with secured perimeters under this section and under Section 1531.15. (1) A minimum of 50 beds shall be available within programs designed for individuals who are designated incompetent to stand trial pursuant to Section 1370.1 of the Penal Code. These beds shall be within facilities that are exclusively used to provide care for individuals who are placed and participating in forensic competency training pursuant to Section 1370.1 of the Penal Code, except as provided in paragraph (2). No more than half of these facilities may have more than 6 beds and no facility may have more than 15 beds. (2) When, in the joint determination of the regional center and the facility administrator, an individual would be most appropriately served in a specific program, regardless of whether the facility meets the criteria established in paragraph (1), individuals who are not similarly designated may be placed in the same facility. That placement may occur only when the individual’s planning team determines that the placement and the facility plan of operation meet the individual’s needs and that placement is not incompatible with the needs and safety of other facility residents. (l) This section shall become operative only upon the filing of emergency regulations by the State Department of Developmental Services. These regulations shall be developed with stakeholders, including the State Department of Public Health, consumer advocates, and regional centers. The regulations shall establish program standards for homes that include delayed egress devices of the time delay type in combination with secured perimeters, including requirements and timelines for the completion and updating of a comprehensive assessment of the consumer’s needs, including the identification through the individual program plan process of the services and supports needed to transition the consumer to a less restrictive living arrangement, and a timeline for identifying or developing those services and supports. The regulations shall establish a statewide limit on the total number of beds in homes with delayed egress devices of the time delay type in combination with secured perimeters. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. (m) This section shall not apply to developmental centers and state-operated community facilities. (Amended by Stats. 2020, Ch. 11, Sec. 5. (AB 79) Effective June 29, 2020.)
  47. 1267.8.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Certain intermediate care and congregate living health facilities must follow the same fire and seismic safety standards as comparable community care facilities, and they get some zoning and local-use protections.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.8. (a) An intermediate care facility/developmentally disabled habilitative or an intermediate care facility/developmentally disabled—nursing or a congregate living health facility shall meet the same fire safety standards adopted by the State Fire Marshal pursuant to Sections 13113, 13113.5, 13143, and 13143.6 that apply to community care facilities, as defined in Section 1502, of similar size and with residents of similar age and ambulatory status. No other state or local regulations relating to fire safety shall apply to these facilities and the requirements specified in this section shall be uniformly enforced by state and local fire authorities. (b) An intermediate care facility/developmentally disabled habilitative or an intermediate care facility/developmentally disabled—nursing or a congregate living health facility shall meet the same seismic safety requirements applied to community care facilities of similar size with residents of similar age and ambulatory status. No additional requirements relating to seismic safety shall apply to such facilities. (c) Whether or not unrelated persons are living together, an intermediate care facility/developmentally disabled habilitative which serves six or fewer persons or an intermediate care facility/developmentally disabled—nursing which serves six or fewer persons or a congregate living health facility shall be considered a residential use of property for the purposes of this article. In addition, the residents and operators of the facility shall be considered a family for the purposes of any law or zoning ordinance that is related to the residential use of property pursuant to this article. (d) For the purposes of all local ordinances, an intermediate care facility/developmentally disabled habilitative that serves six or fewer persons or an intermediate care facility/developmentally disabled—nursing that serves six or fewer persons or a congregate living health facility shall not be included within the definition of a boarding house, rooming house, institution or home for the care of minors, the aged, or persons with mental health disorders, foster care home, guest home, rest home, community residence, or other similar term that implies that the intermediate care facility/developmentally disabled habilitative or intermediate care facility/developmentally disabled—nursing or a congregate living health facility is a business run for profit or differs in any other way from a single-family residence. (e) This section does not forbid a city, county, or other local public entity from placing restrictions on building heights, setback, lot dimensions, or placement of signs of an intermediate care facility/developmentally disabled habilitative that serves six or fewer persons or an intermediate care facility/developmentally disabled—nursing that serves six or fewer persons or a congregate living health facility as long as those restrictions are identical to those applied to other single-family residences. (f) This section does not forbid the application to an intermediate care facility/developmentally disabled habilitative or an intermediate care facility/developmentally disabled—nursing or a congregate living health facility of any local ordinance that deals with health and safety, building standards, environmental impact standards, or any other matter within the jurisdiction of a local public entity, as long as that ordinance does not distinguish intermediate care facility/developmentally disabled habilitative that serves six or fewer persons or an intermediate care facility/developmentally disabled—nursing or a congregate living health facility from other single-family dwellings and that the ordinance does not distinguish residents of the intermediate care facility/developmentally disabled habilitative or intermediate care facility/developmentally disabled—nursing that serves six or fewer persons or a congregate living health facility from persons who reside in other single-family dwellings. (g) No conditional use permit, zoning variance, or other zoning clearance shall be required of an intermediate care facility/developmentally disabled habilitative that serves six or fewer persons or an intermediate care facility/developmentally disabled—nursing that serves six or fewer persons or a congregate living health facility that is not required of a single-family residence in the same zone. (h) Use of a single-family dwelling for purposes of an intermediate care facility/developmentally disabled habilitative serving six or fewer persons or an intermediate care facility/developmentally disabled—nursing that serves six or fewer persons or a congregate living health facility shall not constitute a change of occupancy for purposes of Part 1.5 (commencing with Section 17910) of Division 13 or local building codes. However, nothing in this section supersedes Section 13143 to the extent these provisions are applicable to intermediate care facility/developmentally disabled habilitative providing care for six or fewer residents or an intermediate care facility/developmentally disabled—nursing serving six or fewer persons or a congregate living health facility. (Amended by Stats. 2014, Ch. 144, Sec. 27. (AB 1847) Effective January 1, 2015.)
  48. 1267.9.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The director must deny certain new facility license applications if the site would create overconcentration, but may allow shorter separations with local approval and special local needs.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1267.9. (a) The Legislature hereby declares it to be the policy of the state to prevent overconcentrations of intermediate care facilities/development ally disabled habilitative, intermediate care facilities/developmentally disabled-nursing, congregate living health facilities, or pediatric day health and respite care facilities, as defined in Section 1760.2, which impair the integrity of residential neighborhoods. Therefore, the director shall deny an application for a new intermediate care facility/developmentally disabled habilitative license, a new intermediate care facility/developmentally disabled-nursing license, a congregate living health facility, or a pediatric day health and respite care facility license if the director determines that the location is in such proximity to an existing intermediate care facility/developmentally disabled habilitative, an intermediate care facility/developmentally disabled-nursing, a congregate living health facility, or a pediatric day health and respite care facility as would result in overconcentration. (b) As used in this section, “overconcentration” means that if a new license is issued, either of the following will occur: (1) There will be intermediate care facilities/developmentally disabled habilitative, intermediate care facilities/developmentally disabled-nursing, residential care facilities, as defined in Section 1502, or pediatric day health and respite care facilities which are separated by a distance of less than 300 feet, as measured from any point upon the outside walls of the structures housing the facilities. (2) There will be congregate living health facilities serving persons who are terminally ill, diagnosed with a life-threatening illness, or catastrophically and severely disabled, as defined in Section 1250, which are separated by a distance of less than 1,000 feet, as measured from any point upon the outside walls of the structures housing the facilities. Based on special local needs and conditions, the director may approve a separation distance of less than 300 feet or 1,000 feet, whichever is applicable, with the approval of the city or county in which the proposed facility will be located. (c) At least 45 days prior to approving any application for a new intermediate care facility/developmentally disabled habilitative, a new intermediate care facility/developmentally disabled-nursing, a congregate living health facility, or a pediatric day health and respite care facility, the director shall notify, in writing, the city or county planning authority in which the facility will be located, of the proposed location of the facility. (d) Any city or county may request denial of the license applied for on the basis of overconcentration of intermediate care facilities/developmentally disabled habilitative, intermediate care facilities/developmentally disabled-nursing, a congregate living health facility, or a pediatric day health and respite care facility. (e) Nothing in this section authorizes the director, on the basis of overconcentration, to refuse to renew an intermediate care facility/development ally disabled habilitative license, an intermediate care facility/developmental ly disabled-nursing license, a congregate living health facility license, or a pediatric day health and respite care facility license, or to refuse to grant a license upon a change of ownership of an existing intermediate care facility/developmentally disabled habilitative, intermediate care facility/developmentally disabled-nursing, a congregate living health facility, or a pediatric day health and respite care facility where there is no change in the location of the facility. (f) Foster family homes and residential care facilities for the elderly shall not be considered in determining overconcentration of intermediate care facilities/developmentally disabled-habilitative, intermediate care facilities/developmentally disabled-nursing, residential care facilities, as defined in Section 1502, congregate living health facilities, or pediatric day health and respite care facilities. (Amended by Stats. 1990, Ch. 1227, Sec. 5. Effective September 24, 1990.)
  49. 12670.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not advertise a fireworks or pyrotechnic-device business, or be listed under a fireworks classification in an ad or directory, unless licensed under this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12670. It is unlawful for any person to advertise that he is in any business or venture involving fireworks or pyrotechnic devices or shall cause his name or business name style to be included in any classified advertisement or directory under a classification which includes the word fireworks, unless he is licensed pursuant to this part. (Added by Stats. 1973, Ch. 1109.)
  50. 12671.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    It is unlawful for any person to handle fireworks in the listed ways within this state unless the State Fire Marshal has classified and registered the fireworks.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12671. It is unlawful for any person to sell, offer for sale, use, discharge, possess, store, or transport any type of fireworks within this state unless the State Fire Marshal has classified and registered such fireworks. (Added by Stats. 1973, Ch. 1109.)
  51. 12672.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    Any person may not sell or offer for sale safe and sane fireworks outside the period allowed by Section 12599.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12672. It is unlawful for any person to sell, or offer for sale, safe and sane fireworks at any time outside of the period specified in Section 12599. (Added by Stats. 1973, Ch. 1109.)
  52. 12673.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person must not store fireworks unless they have a valid permit required by this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12673. It is unlawful for any person to store any fireworks without having in his possession a valid permit as required by this part. (Added by Stats. 1973, Ch. 1109.)
  53. 12674.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not store or possess fireworks that require a license if the license has been revoked, surrendered, or not renewed, and the storage or possession continues beyond the period in Section 12604.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12674. It is unlawful for any person to store or possess any fireworks for which a license is required and which has been revoked or surrendered or any license which has not been renewed and such storage or possession is held beyond the period provided for in Section 12604. (Added by Stats. 1973, Ch. 1109.)
  54. 12675.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    Anyone selling or shipping fireworks must record the license number of both the seller/shipper and the buyer/receiver on each bill of lading, manifest, or invoice, unless the sale or shipment is to nonlicensees under the seller’s license.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12675. It is unlawful for any person to fail to record on each bill of lading, manifest or invoice issued to cover the sale or shipment of fireworks, the license number of both the seller or shipper and the buyer or receiver, unless the sale or shipment is made to nonlicensees in accordance with the provisions of his license. (Added by Stats. 1973, Ch. 1109.)
  55. 12676.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not sell, transfer, give, deliver, or otherwise pass title to dangerous fireworks, including fireworks kits, to someone in this state who does not show a valid permit at the time of transfer.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12676. It is unlawful for any person to sell, transfer, give, deliver, or otherwise convey title of any dangerous fireworks, including fireworks kits, to any person in this state who does not possess and present to the seller or donor for inspection at the time of transfer, a valid permit to receive, use, or transport dangerous fireworks as provided in this part. (Added by Stats. 1973, Ch. 1109.)
  56. 12677.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not possess dangerous fireworks unless they have a valid permit.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12677. It is unlawful for any person to possess dangerous fireworks without holding a valid permit. (Added by Stats. 1973, Ch. 1109.)
  57. 12678.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person must not use or discharge agricultural and wildlife fireworks unless a permit has first been secured under this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12678. It is unlawful for any person to use or discharge agricultural and wildlife fireworks without first securing a permit as provided in this part. (Added by Stats. 1973, Ch. 1109.)
  58. 12679.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    Any person may not store, sell, or discharge fireworks within 100 feet of where gasoline or other flammable liquids are stored or dispensed.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12679. It is unlawful for any person to store, sell, or discharge any type of fireworks in or within 100 feet of a location where gasoline or any other flammable liquids are stored or dispensed. (Amended by Stats. 1978, Ch. 868.)
  59. 1268.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    Licenses or special permits must be issued when an applicant files and complies with the chapter and state rules, but must be denied in specified noncompliance situations. Licensure also requires evidence of a written patient-information policy.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1268. (a) Upon the filing of the application for licensure or for a special permit for special services and full compliance with this chapter and the rules and regulations of the state department, the state department shall issue to the applicant the license or special permit applied for. A license shall not be issued or renewed for beds permanently converted to other than patient use and that do not meet construction and operational requirements. However, if the director finds that the applicant is not in compliance with the laws or regulations of this part, the director shall deny the applicant a license or a special permit for special services. Additionally, the director shall not issue a license covering a project within the meaning of Section 127170 for which there is no valid, subsisting, and unexpired certificate of need issued pursuant to Chapter 1 (commencing with Section 127125) of Part 2 of Division 107. (b) As a condition of licensure, the director shall require evidence that the applicant have a written policy relating to the dissemination of the following information to patients: (1) A summary of current state laws requiring child passenger restraint systems to be used when transporting children in motor vehicles. (2) A listing of child passenger restraint system programs located within the county, as required by Section 27360 or 27362 of the Vehicle Code. (3) Information describing the risks of death or serious injury associated with the failure to utilize a child passenger restraint system. A hospital may satisfy the requirements of this paragraph by reproducing for distribution materials specified in Section 27366 of the Vehicle Code, describing the risks of injury or death as a result of the failure to utilize passenger restraints for infants and children, as provided, without charge, by the Department of the California Highway Patrol. A hospital that does not have these materials, but demonstrates that it has made a written request to the Department of the California Highway Patrol for the materials, is in compliance with this paragraph. (c) The conversion of a general acute care hospital or special hospital to a general acute care hospital that exclusively provides acute medical rehabilitation center services shall not require a certificate of need, as required by Section 127170, if the health facility is rendering the services specified in subdivision (f) of Section 1250 on January 1, 1979. (Amended (as amended by Stats. 1995, Ch. 512) by Stats. 1996, Ch. 1023, Sec. 157. Effective September 29, 1996.)
  60. 1268.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The state department may issue a provisional license to a health facility if specified standards and correction conditions are met, but not for certain facilities, and the license expires within six months and cannot be renewed.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1268.5. (a) Notwithstanding the provisions of Section 1268 requiring full compliance with this chapter and the rules and regulations of the state department as a condition to the issuance of a license or special permit, the state department may issue a provisional license to a health facility except for a health facility defined in subdivisions (a) and (b) of Section 1250, if: (1) The facility and the applicant for licensure substantially meet the standards specified by this chapter and regulations adopted pursuant to this chapter. (2) No violation of this chapter or regulations adopted pursuant to this chapter exists in the facility which jeopardizes the health or safety of patients. (3) The applicant has adopted a plan for correction of any existing violations which is satisfactory to the state department. (b) A provisional license issued under this section shall expire not later than six months after the date of issuance, or at an earlier time as determined by the state department at the time of issuance, and may not be renewed. At the end of the provisional license period under this section or Section 1437 the state department shall assess the facility’s full compliance with licensure requirements. The state department may extend a provisional license for a period of no longer than six months from the time of the extension for one of the following purposes: (1) Requiring the facility’s full compliance with a plan of correction, which includes time frames, as specified by the state department. (2) Allowing the provisional licensee to comply with Section 1336.2. (3) Providing for a change of ownership. (4) Instituting a receivership of the facility. The length of the extension period shall be determined by the state department at the time of the issuance of the extension. (c) The department shall not apply less stringent criteria when issuing a provisional license pursuant to this section than it applies when issuing a license pursuant to Section 1268. It is the intent of the Legislature in enacting this section to additionally provide for continuity of reimbursement under the Medi-Cal Act, Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code, whenever ownership of a skilled nursing facility or intermediate care facility is transferred. (Amended by Stats. 1989, Ch. 811, Sec. 1.)
  61. 1268.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    For initial licensure of certain intermediate care facilities, the applicant or the applicant’s designee must attend a 16-hour orientation program approved by the State Department of Developmental Services.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1268.6. (a) Commencing October 1, 2011, as a requirement of initial licensure of an intermediate care facility/developmentally disabled-habilitative or an intermediate care facility/developmentally disabled-nursing, the applicant or designee of the applicant shall attend a sixteen-hour orientation program approved by the State Department of Developmental Services. (b) The sixteen-hour orientation program shall contain both of the following: (1) Eight hours of the orientation program shall outline the role, requirements, and regulations of each of the following: (A) The scope of responsibility for operation including regulatory requirements and statutes governing the facility type. (B) Local planning. (C) Regional center and other community support services. (D) All federal and state agencies responsible for licensing and certification, and data collection. (E) Government and private agencies responsible for ensuring the rights of the developmentally disabled. (2) Eight hours of the orientation program shall outline the statutory and regulatory requirements related to business management. The program shall include, but need not be limited to, all of the following: (A) Cost reporting. (B) General accounting principles. (C) The State Department of Health Care Services’ audit process. (D) The regional center vendorization process. (c) The orientation shall be conducted by relevant community services and provider organizations. Organizations conducting the orientation class shall be responsible for keeping a record of all attendees and shall provide the department with the information within 15 working days or upon request. Instructors of the orientation shall have knowledge or experience in the subject area to be taught, and shall meet any of the following criteria: (1) Possession of a four-year college degree relevant to the course or courses to be taught. (2) Be a health professional with a valid and current license to practice in California. (3) Have at least two years experience in California as an administrator of a long-term health care facility that provides services to persons with developmental disabilities within the last eight years. (d) If the licensee can demonstrate to the satisfaction of the department that the licensee, or a representative of the licensee, has taken the orientation program any year prior to opening a new facility, the licensee shall not be required to repeat the program to open the facility. (e) This section shall become operative on October 1, 2011. (Repealed (in Sec. 1) and added by Stats. 2010, Ch. 473, Sec. 2. (AB 2675) Effective January 1, 2011. Section operative October 1, 2011, by its own provisions.)
  62. 12680.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person generally must not place, throw, discharge, ignite, or fire dangerous fireworks near people when injury is likely, or do so to create chaos, fear, or panic.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12680. (a) Except as provided in subdivision (b) or (c), it is unlawful for any person to place, throw, discharge or ignite, or fire dangerous fireworks at or near any person or group of persons where there is a likelihood of injury to that person or group of persons or when the person willfully places, throws, discharges, ignites, or fires the fireworks with the intent of creating chaos, fear, or panic. (b) Subdivision (a) does not apply to a person described in Section 12517 who uses special effects. For purposes of this subdivision, “special effects” means articles containing any pyrotechnic composition manufactured and assembled, designed, or discharged in connection with television, theater, or motion picture productions, which may or may not be presented before live audiences, and any other articles containing any pyrotechnic composition used for commercial, industrial, educational, recreational, or entertainment purposes when authorized by the authority having jurisdiction. (c) Subdivision (a) does not apply to a person holding a fireworks license issued pursuant to Chapter 5 (commencing with Section 12570). (Amended by Stats. 2000, Ch. 274, Sec. 1. Effective January 1, 2001.)
  63. 12681.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person must not sell or transfer safe and sane fireworks to a consumer or user except at a retailer’s fixed place of business with a license and permit.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12681. It is unlawful for any person to sell or transfer any safe and sane fireworks to a consumer or user thereof other than at a fixed place of business of a retailer for which a license and permit has been issued. (Added by Stats. 1973, Ch. 1109.)
  64. 12682.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    It is unlawful to let a fire nuisance exist on premises used for fireworks manufacturing, sale, assembly, discharge, packaging, storage, or distribution.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12682. It is unlawful for any person to allow or permit a fire nuisance, as defined in Section 12510, to exist on any premises where any fireworks are manufactured, sold, assembled, discharged, packaged, stored, or distributed. The authority to determine that a fire nuisance exists shall be vested in those officers identified in Section 12721. (Added by Stats. 1973, Ch. 1109.)
  65. 12683.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not sell, use, or discharge an emergency signaling device unless it is registered by the State Fire Marshal.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12683. It is unlawful for any person to sell, use, or discharge any emergency signaling device not registered by the State Fire Marshal. (Added by Stats. 1973, Ch. 1109.)
  66. 12684.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person must not use or discharge a registered emergency signaling device except as permitted by its instructions for use.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12684. It is unlawful for any person to use or discharge any registered emergency signaling device in any manner other than that permitted by the instructions for use. (Added by Stats. 1973, Ch. 1109.)
  67. 12685.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not conduct a public display without a valid permit.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12685. It is unlawful for any person to conduct a public display without possessing a valid permit for this purpose. (Added by Stats. 1973, Ch. 1109.)
  68. 12686.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not use special effects fireworks unless they have a pyrotechnic operator license.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12686. It is unlawful for any person to use any special effects fireworks unless he possesses a pyrotechnic operator license. (Added by Stats. 1973, Ch. 1109.)
  69. 12687.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    Any person may not sell, transfer, give, or deliver special effects fireworks to someone who is not licensed as a pyrotechnic operator.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12687. It is unlawful for any person to sell, transfer, give, or deliver any special effects fireworks to any person not licensed as a pyrotechnic operator. (Added by Stats. 1973, Ch. 1109.)
  70. 12688.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person may not advertise to sell or transfer fireworks unless they have a valid license or permit.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12688. It is unlawful for a person to advertise to sell or transfer any class of fireworks, including agricultural and wildlife fireworks or model rocket motors, unless he or she possesses a valid license or permit. (Amended by Stats. 2015, Ch. 106, Sec. 8. (AB 467) Effective January 1, 2016.)
  71. 12689.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    This section bans selling certain fireworks to minors and limits a minor’s possession of rocket-type explosive or incendiary devices unless a parent or guardian gives written permission or accompanies the minor.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12689. (a) It is unlawful for any person to sell, give, or deliver any dangerous fireworks to any person under 18 years of age. (b) It is unlawful for any person who is a retailer to sell or transfer any safe and sane fireworks to a person who is under 16 years of age. (c) Except as otherwise provided in subdivision (d), it is unlawful for any person who is a retailer to sell or transfer to a person under the age of 18 any rocket, rocket propelled projectile launcher, or similar device containing any explosive or incendiary material whether or not the device is designed for emergency or distance signaling purposes. It is also unlawful for a minor to possess such a device unless he or she has the written permission of, or is accompanied by, his or her parent or guardian while it is in his or her possession. (d) Model rocket products including model rockets, launch systems, and model rocket motors designed, sold, and used for the purpose of propelling recoverable model rockets may be sold or transferred pursuant to regulations, adopted by the State Fire Marshal which the Fire Marshal determines are reasonably necessary to carry out the requirements of this part. (Amended by Stats. 1983, Ch. 56, Sec. 1. Effective May 31, 1983.)
  72. 1269.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    If a license or special permit application is denied, the state department must notify the applicant in writing, and the applicant may file a written petition for a hearing within 20 days after the notice is mailed.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1269. Immediately upon the denial of any application for a license or for a special permit for special services, the state department shall notify the applicant in writing. Within 20 days after the state department mails the notice, the applicant may present his written petition for a hearing to the state department. Upon receipt by the state department of the petition in proper form, such petition shall be set for hearing. The proceedings shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the state department has all the powers granted therein. (Added by Stats. 1973, Ch. 1202.)
  73. 12690.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    A person must not do business or perform an act using an expired license or permit when that license or permit is required.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12690. It is unlawful for any person to perform any act, or transact or attempt to transact any business, with an expired license or an expired permit where a license or permit is required for the performance of such act or transaction. (Added by Stats. 1973, Ch. 1109.)
  74. 12691.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    It is unlawful for any person to violate regulations adopted by the State Fire Marshal under this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12691. It is unlawful for any person to violate any provision of any regulation adopted by the State Fire Marshal pursuant to this part. (Added by Stats. 1973, Ch. 1109.)
  75. 12692.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. )

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    This chapter does not prohibit a licensed pyrotechnic operator with a special effects license from carrying out necessary production-related operations or functions if they are done under a valid permit from the authority having jurisdiction.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 7. Violations [12670 - 12692] ( Chapter 7 added by Stats. 1973, Ch. 1109. ) ## 12692. This chapter shall not prohibit the operations or functions of a licensed pyrotechnic operator holding a special effects license when the operations or functions are a necessary part of the production and are performed pursuant to a valid permit issued by the authority having jurisdiction. (Amended by Stats. 1990, Ch. 233, Sec. 3.)
  76. 1270.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section says the chapter does not apply to several listed kinds of institutions and facilities.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1270. The provisions of this chapter do not apply to the following institutions: (a) Any facility conducted by and for the adherents of any well-recognized church or religious denomination for the purpose of providing facilities for the care or treatment of the sick who depend upon prayer or spiritual means for healing in the practice of the religion of that church or denomination. (b) Hotels or other similar places that furnish only board and room, or either, to their guests. (c) Any house or institution supplying board and room only, or room only, or board only; provided, that no resident thereof requires any element of medical care as determined by the department. For the purpose of this subdivision “medical care” means those services required to be provided by health professionals in accordance with the provisions of Division 2 (commencing with Section 500) of the Business and Professions Code. In addition, medical services means those services provided by health facilities as defined in Sections 1250, 1250.2, and 1250.3 which includes nursing care to patients whose primary need is for the availability of licensed nursing care on an extended, continuous, intermittent, or part-time basis. (d) Any facility as defined in Section 1502. (Amended by Stats. 1988, Ch. 1478, Sec. 14. Effective September 28, 1988.)
  77. 12700.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    Violating this part or its regulations can be a misdemeanor with fines, jail, or both; separate penalties apply for possessing dangerous fireworks in specified weight ranges.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12700. (a) Except as provided in Section 12702 and subdivision (b), a person who violates any provision of this part, or any regulations issued pursuant to this part, is guilty of a misdemeanor, and upon conviction shall be punished by a fine of not less than one thousand dollars ($1,000) or more than two thousand dollars ($2,000), or by imprisonment in the county jail for not exceeding one year, or by both that fine and imprisonment. (b) A person who violates any provision of this part, or any regulations issued pursuant to this part, by possessing dangerous fireworks shall be subject to the following: (1) A person who possesses a gross weight, including packaging, of less than 25 pounds of unaltered dangerous fireworks, as defined in Section 12505, is guilty of a misdemeanor, and upon conviction shall be punished by a fine of not less than one thousand dollars ($1,000) or more than two thousand dollars ($2,000), or by imprisonment in the county jail for not exceeding one year, or both that fine and imprisonment. Upon a second or subsequent conviction, a person shall be punished by a fine of not less than two thousand dollars ($2,000), or by imprisonment in a county jail not exceeding one year or by both that fine and imprisonment. (2) A person who possesses a gross weight, including packaging, of not less than 25 pounds or more than 100 pounds of unaltered dangerous fireworks, as defined in Section 12505, is guilty of a public offense, and upon conviction shall be punished by imprisonment in a county jail for not more than one year, or by a fine of not less than two thousand dollars ($2,000) or more than ten thousand dollars ($10,000), or by both that fine and imprisonment. (3) A person who possesses a gross weight, including packaging, of not less than 100 pounds or more than 5,000 pounds of unaltered dangerous fireworks, as defined in Section 12505, is guilty of a public offense, and upon conviction shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code or a county jail for not more than one year, or by a fine of not less than ten thousand dollars ($10,000) or more than twenty thousand dollars ($20,000), or by both that fine and imprisonment. (4) A person who possesses a gross weight, including packaging, of more than 5,000 pounds of unaltered dangerous fireworks, as defined in Section 12505, is guilty of a public offense, and upon conviction shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or a county jail for not more than one year, or by a fine of not less than twenty thousand dollars ($20,000) or more than one hundred thousand dollars ($100,000), or by both that fine and imprisonment. (c) Subdivision (b) shall not apply to a person who holds and is operating within the scope of a valid license as described in Section 12516 or valid permit as described in Section 12522. (Amended by Stats. 2023, Ch. 368, Sec. 4. (AB 1403) Effective January 1, 2024.)
  78. 127000.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    This section states that the Department of Health Care Access and Information exists in the state government within the Health and Welfare Agency.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127000. There is in the state government, in the Health and Welfare Agency, the Department of Health Care Access and Information. (Amended by Stats. 2021, Ch. 143, Sec. 30. (AB 133) Effective July 27, 2021.)
  79. 127002.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    References to the Office of Statewide Health Planning and Development must be read as references to the Department of Health Care Access and Information.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127002. Any reference to the Office of Statewide Health Planning and Development shall be deemed a reference to the Department of Health Care Access and Information. (Added by Stats. 2021, Ch. 143, Sec. 31. (AB 133) Effective July 27, 2021.)
  80. 127005.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    The Department of Health Care Access and Information is controlled by a Director appointed by the Governor and confirmed by the Senate.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127005. The department is under the control of an executive officer known as the Director of the Department of Health Care Access and Information who shall be appointed by the Governor, subject to confirmation by the Senate, and hold office at the pleasure of the Governor. The Director shall receive the annual salary provided by Article 1 (commencing with Section 11550) of Chapter 6 of Part 1 of Division 3 of Title 2 of the Government Code. (Amended by Stats. 2021, Ch. 143, Sec. 32. (AB 133) Effective July 27, 2021.)
  81. 12701.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    A person commits a separate offense for each day they violate this part or any order or regulation issued under it.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12701. A person is guilty of a separate offense for each day during which he or she commits, continues, or permits a violation of this part, or any order or regulation issued pursuant to this part. (Amended by Stats. 2006, Ch. 538, Sec. 371. Effective January 1, 2007.)
  82. 127010.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    The department’s director has the powers of a department head under the cited Government Code chapter.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127010. The director of the department shall have the powers of a head of the department pursuant to Chapter 2 (commencing with Section 11150) of Part 1 of Division 3 of Title 2 of the Government Code. (Amended by Stats. 2021, Ch. 143, Sec. 33. (AB 133) Effective July 27, 2021.)
  83. 127011.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    The Department of Health Care Access and Information must send fingerprint images and related information to the Department of Justice for covered workers and volunteers, and the Department of Justice must return a state- or federal-level response.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 1. DEPARTMENT OF HEALTH CARE ACCESS AND INFORMATION [127000 - 127011] ( Heading of Part 1 amended by Stats. 2021, Ch. 143, Sec. 29. ) ## CHAPTER 1. General Provisions [127000 - 127011] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127011. (a) Pursuant to subdivision (u) of Section 11105 of the Penal Code, the Department of Health Care Access and Information shall submit to the Department of Justice fingerprint images and related information required by the Department of Justice for all employees, prospective employees, contractors, subcontractors, and volunteers whose duties include, or would include, access to medical information, as defined in Section 56.05 of the Civil Code. (b) The Department of Justice shall provide a state- or federal-level response pursuant to subdivision (p) of Section 11105 of the Penal Code. (Added by Stats. 2024, Ch. 997, Sec. 17. (AB 179) Effective September 30, 2024.)
  84. 12702.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    Selling, giving, or delivering dangerous fireworks to anyone under 18 is a misdemeanor, with harsher penalties for repeat convictions.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12702. Notwithstanding Section 12700: (a) A person who violates this part by selling, giving, or delivering any dangerous fireworks to any person under 18 years of age is guilty of a misdemeanor and upon a first conviction shall be punished as prescribed in subdivision (b) of Section 12700. (b) Upon a second or subsequent conviction of the offense, the person shall be punished by an additional fine of ten thousand dollars ($10,000), or by imprisonment in a county jail for up to one year or by both that fine and imprisonment. The person shall not be granted probation and the execution of the sentence imposed upon the person shall not be suspended by the court. (Amended by Stats. 2023, Ch. 368, Sec. 5. (AB 1403) Effective January 1, 2024.)
  85. 12703.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    The State Fire Marshal and DMV must create rules for temporarily suspending a commercial motor vehicle license in certain fireworks-transport cases, and a driver convicted of the covered conduct may not drive a commercial motor vehicle for three years unless a stated license or permit exception applies.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12703. (a) The State Fire Marshal shall, in conjunction with the Department of Motor Vehicles, develop regulations and procedures to temporarily suspend the commercial motor vehicle license of a person who is operating a commercial motor vehicle while transporting unaltered dangerous fireworks, as defined in Section 12505, having a gross weight, including packaging, of 10,000 pounds or more. (b) A driver of a commercial motor vehicle shall not operate a commercial motor vehicle for three years if the driver is convicted of transporting unaltered dangerous fireworks, as defined in Section 12505, having a gross weight, including packaging, of 10,000 pounds or more, as described in Section 15301 of the Vehicle Code. (c) This section shall not apply to a person who holds and is operating within the scope of a valid license as described in Section 12516 or valid permit as described in Section 12522. (Added by Stats. 2007, Ch. 563, Sec. 7. Effective January 1, 2008.)
  86. 12704.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    The State Fire Marshal must, at least once a year and after consulting the Attorney General, notify fireworks suppliers that unauthorized fireworks shipments into California will be reported to federal authorities for possible prosecution.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12704. The State Fire Marshal, at least once a year and in consultation with the Attorney General, shall serve notice to any individual or business known to supply fireworks that any unauthorized shipments of fireworks into California will result in an immediate report to federal authorities with a request for any relevant federal prosecution. (Added by Stats. 2007, Ch. 563, Sec. 8. Effective January 1, 2008.)
  87. 12706.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. )

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    Courts must send covered fines and forfeitures to the county treasurer, and the county auditor must later split and report the money.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 8. Penalties [12700 - 12706] ( Chapter 8 added by Stats. 1973, Ch. 1109. ) ## 12706. Notwithstanding Section 1463 of the Penal Code, all fines and forfeitures imposed by or collected in any court of this state, except for administrative fines described in Section 12557, as a result of citations issued by a public safety agency, for any violation of subdivision (b) of Section 12700 or of any regulation adopted pursuant to subdivision (b) of Section 12700, shall be deposited, as soon as practicable after the receipt of the fine or forfeiture, with the county treasurer of the county in which the court is situated. Amounts deposited pursuant to this section shall be paid at least once a month as follows: (a) Sixty-five percent to the Treasurer, by warrant of the county auditor drawn upon the requisition of the clerk or judge of the court, for deposit in the State Fire Marshal Fireworks Enforcement and Disposal Fund, as described in Section 12728, on order of the Controller. At the time of the transmittal, the county auditor shall forward to the Controller, on the form or forms prescribed by the Controller, a record of the imposition, collection, and payments of the fines or forfeitures. (b) Thirty-five percent to the local public safety agency in the county in which the offense was committed to reimburse the local public safety agency for expenses, including, but not limited to, the costs for handling, processing, photographing, and storing seized dangerous fireworks. (Added by Stats. 2007, Ch. 563, Sec. 9. Effective January 1, 2008.)
  88. 1271.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    The state department must create and run continuing orientation, in-service training, and program review functions for licensing and certification field offices.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1271. (a) The Legislature finds and declares that uniform orientation and training are fundamental to ensuring a high level of competency of state personnel charged with enforcing state law regulating the licensure, certification, and inspection of long-term health care facilities. (b) The state department shall develop, adopt, and implement comprehensive continuing orientation and in-service training programs. The comprehensive programs shall, at a minimum, include, but not be limited to, both of the following: (1) An orientation program consisting of instruction in basic enforcement, inspection, investigation, and survey skills and techniques, patients’ rights and safety, health facility, clinic, and agency licensing regulations, and supervised on-the-job training in long-term health care facilities. (2) Ongoing in-service training to maintain continuing competency in existing and new inspection, investigation, and enforcement skills, patient care modalities, and to assure statewide uniform interpretation and application of long-term health care facility licensing regulations. (c) The state department shall establish and maintain a program review function responsible for inspecting, monitoring, evaluating, and providing consultative support and assistance to licensing and certification field offices. The program review shall ensure that the licensing and certification field offices implement, enforce, and interpret applicable state statutes, licensing regulations, certification standards, and departmental policies and procedures in an effective and uniform manner statewide. (Added by Stats. 1985, Ch. 11, Sec. 3. Effective March 6, 1985.)
  89. 1271.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A health facility may voluntarily suspend up to half of its licensed beds for up to three years if it gives written notice to the state department and the Office of Statewide Health Planning and Development.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1271.1. (a) A health facility may place up to 50 percent of its licensed bed capacity in voluntary suspension for a period not exceeding three years, upon submitting written notification to the state department and to the Office of Statewide Health Planning and Development. However, this section does not authorize a health facility to deactivate all beds utilized for the provision of a basic service or to deactivate all beds utilized for a special service or other supplemental service for which the health facility holds a special permit or licensure approval. Prior to the expiration of the voluntary suspension, the health facility may request an extension, that may be granted by the director if the director finds, after consultation with the Director of the Office of Statewide Health Planning and Development, that there is no identified need for additional beds (of the category suspended) in the service area of the health facility. If during a period of voluntary suspension under this section the statewide Health Facilities and Services Plan identifies a need for additional beds (of the category suspended) in the health facility’s service area, the Director of the Office of Statewide Health Planning and Development may require the health facility to terminate the voluntary suspension and exercise one of the following options, at the discretion of the health facility: (1) place some or all of the suspended beds in operation, in accordance with the identified need, within one year following his or her order, or (2) alternatively have the beds deemed permanently converted to other than patient use within the meaning of Section 1268. (b) A health facility may remove all or any portion of its voluntarily suspended bed capacity from voluntary suspension by request to the state department, which request shall be granted unless the areas housing the suspended beds fail to meet currently applicable operational requirements or fail to meet construction requirements for the health facility in effect at the time the request for suspension of the beds was received by the state department. (c) While health facility beds are in suspension pursuant to subdivision (a), the beds shall not be deemed to be permanently converted to other than patient use, for purposes of Section 1268. The requirements of this section shall not apply to any temporary deactivation of beds necessitated by the work of construction or other activities required with respect to a project for which a certificate of need or certificate of exemption has been granted pursuant to Chapter 1 (commencing with Section 127125) of Part 2 of Division 107. Nothing in this section shall in any way limit or affect the authority of a health facility to use a portion of its beds in one bed classification in another bed classification as permitted by subdivision (a) of Section 127170, including the use of general acute care beds as skilled nursing beds; provided, however, that when beds in a particular classification are suspended pursuant to this section, the remainder of the health facility’s beds in the same classification may not be used so as to result in elimination of all beds utilized for provision of a basic service or utilized for provision of a special service or other supplemental service for which the health facility holds a special permit or licensure approval. (Amended by Stats. 1996, Ch. 1023, Sec. 158. Effective September 29, 1996.)
  90. 1271.15.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    A health facility may temporarily suspend all or part of its licensed bed capacity to operate as a licensed mental health rehabilitation center, but it must give written notice first.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1271.15. (a) Notwithstanding any provision of law to the contrary, including, but not limited to, Section 1271.1, a health facility may do any of the following: (1) (A) It may place all or a portion of its licensed bed capacity in voluntary suspension for the purposes of using the facility to operate a licensed mental health rehabilitation center pursuant to Section 5675 of the Welfare and Institutions Code after submitting written notification to the State Department of Health Services and to the Office of Statewide Health Planning and Development. During the period of voluntary suspense, the facility shall remain under the jurisdiction of the office. The office shall enforce both the mental health rehabilitation center requirements and the health facility requirements of the California Building Standards Code. (B) A mental health rehabilitation center operating under this paragraph may remove all or any portion of its voluntarily suspended bed capacity from voluntary suspension by submitting a request to the State Department of Health Services. (C) The department shall grant the request under subparagraph (B) to remove bed capacity from voluntary suspension and to reinstatement of the health facility bed capacity, unless the facility fails to meet currently applicable operational requirements for a health facility. (b) This section authorizes the voluntary suspension of bed capacity or surrender of a license by a health facility only for the purpose of converting the facility for use as a licensed mental health rehabilitation center pursuant to Section 5675 of the Welfare and Institutions Code. (Added by Stats. 2004, Ch. 509, Sec. 1. Effective January 1, 2005.)
  91. 1272.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. )

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    This section sets deadlines for the department to review hospital applications and service-expansion requests, and requires licensed hospitals to comply with the laws for the service or program involved.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2. Administration [1265 - 1272] ( Article 2 added by Stats. 1973, Ch. 1202. ) ## 1272. (a) If a general acute care hospital or an acute psychiatric hospital submits a written application to the department’s centralized applications unit, the department shall do both of the following: (1) Complete its evaluation and approve or deny the application within 100 days of receiving it, including completing any activities pursuant to paragraph (2). (2) Once the written application is approved, the district office of the department shall, within 30 business days from the date of approval, complete any additional review, including an onsite visit, if applicable, and submit its findings to the department. If the hospital’s application is approved, the department shall add it to the hospital’s license and issue a new or revised license on the 31st business day following approval of the written application. (b) Notwithstanding subdivision (a), if a general acute care hospital or an acute psychiatric hospital submits a written application to expand a service that it currently provides and that is currently approved by the department, the department shall, within 30 business days of receipt of the completed application, approve the expansion, add it to the hospital license, and issue a revised license, unless the hospital is out of compliance with existing laws governing the service to be expanded. A service approved pursuant to this subdivision shall remain licensed for not more than 18 months, unless the department approves the license for a longer period. The department shall not be required to conduct an onsite inspection of the service to approve the expansion. This subdivision does not preclude the department from conducting an onsite inspection of a hospital at any time or denying an application in accordance with this subdivision. (c) A general acute care hospital or an acute psychiatric hospital that receives a license to modify, add, or expand a service or program pursuant to this section shall comply with all laws related to that service or program. (d) The department shall develop a centralized applications advice program to assist hospitals in identifying and completing the correct paperwork and other requirements necessary to modify, add, or expand a service or program. (e) On or before December 31, 2019, the department shall develop an automated application system to process applications submitted pursuant to this section. (Amended by Stats. 2019, Ch. 38, Sec. 13. (SB 78) Effective June 27, 2019.)
  92. 12720.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    A threatened violation of this part or of a State Fire Marshal order or regulation may be stopped by a civil injunction suit.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12720. Any threatened violation of any provision of this part or of any order or regulation of the State Fire Marshal issued pursuant to this part may be enjoined in a civil action brought in the name of the people of the State of California. Such actions may be instituted by the Attorney General or the district attorney of the county in which the act, practice, or transaction is about to be committed. (Added by Stats. 1973, Ch. 1109.)
  93. 12721.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    Authorized fire officials and certain public agencies may seize fireworks covered by this part and may charge the owner for transport, storage, and handling costs.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12721. The State Fire Marshal, his or her salaried deputies, or any chief of a fire department, or his or her authorized representatives, any fire protection agency, or any other public agency authorized by statute to enforce the State Fire Marshal’s regulations, may seize any fireworks described in this part. The State Fire Marshal, any chief of a fire department, any fire protection agency, or any other public agency authorized to enforce the State Fire Marshal’s regulations may charge any person, firm, or corporation, whose fireworks are seized pursuant to this section, an amount which is sufficient to cover the cost of transporting, storing, and handling the seized fireworks. When the State Fire Marshal, other enforcing officer or agency described in this section, or a court determines that a person's, firm's, or corporation’s fireworks are illegally or erroneously seized, or if legal proceedings do not result in a conviction for violation of any provision of this part, any funds collected pursuant to this section shall be refunded, or if charged but unpaid, canceled. (Amended by Stats. 1984, Ch. 681, Sec. 1.)
  94. 12722.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    Certain fireworks may be seized if they fall within listed prohibited or noncompliant categories, and the State Fire Marshal must approve protective caps for some items.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12722. The following fireworks may be seized pursuant to Section 12721: (a) Those fireworks that are sold, offered for sale, possessed, stored, used, or transported within this state prior to having been examined, classified, and registered by the State Fire Marshal, except those specific items designated as samples pending examination, classification, and registration by the State Fire Marshal where the licensee provides documentary evidence that the action by the State Fire Marshal is pending. (b) All imported fireworks possessed without benefit of the filing of notices as required by this part. (c) Safe and sane fireworks stored in violation of the conditions required by the permit as provided in this part. (d) Safe and sane fireworks sold or offered for sale at retail that do not bear the State Fire Marshal label of registration and firing instructions. (e) Safe and sane fireworks sold or offered for sale at retail that are in unsealed packages or containers that do not bear the State Fire Marshal label of registration and firing instructions. (f) Safe and sane fireworks sold or offered for sale at retail before 12 noon on the 28th day of June or after 12 noon on the sixth day of July of each year. (g) Each safe and sane fireworks item sold or offered for sale at retail that does not have its fuse or other igniting device protected by a cap approved by the State Fire Marshal, or groups of fireworks with exposed fuses that are not enclosed in sealed packages that bear the State Fire Marshal label of registration. The State Fire Marshal shall approve the caps as he or she determines provide reasonable protection from unintentional ignition of the fireworks. (h) Dangerous fireworks, including fireworks kits, used, possessed, stored, manufactured, or transported by a person who does not possess a valid permit authorizing an activity listed in this part. (i) Fireworks stored or sold in a public garage or public oil station, or on any premises where gasoline or any other class 1 flammable liquids are stored or dispensed. (j) Fireworks still possessed by a person who has just thrown any ignited fireworks at a person or group of persons. (k) Model rocket motors or model rockets with motors possessed by a person who does not hold a valid permit. (l) An emergency signaling device sold, offered for sale, or used that does not bear the State Fire Marshal label of registration as required by this part. (m) Fireworks or pyrotechnic device offered for sale by a person violating this part. (Amended by Stats. 2015, Ch. 106, Sec. 9. (AB 467) Effective January 1, 2016.)
  95. 12723.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    Authorities that seize fireworks must notify the State Fire Marshal within three days and report the reason, quantity, type, and location. Most seized fireworks are later disposed of by the State Fire Marshal, while dangerous fireworks follow separate procedures.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12723. (a) The authority seizing fireworks under the provisions of this chapter shall notify the State Fire Marshal not more than three days following the date of seizure and shall state the reason for the seizure and the quantity, type, and location of the fireworks. Fireworks, with the exception of dangerous fireworks, seized pursuant to Section 12721 shall be disposed of by the State Fire Marshal in the manner prescribed by the State Fire Marshal at any time subsequent to 60 days from the seizure or 10 days from the final termination of proceedings under the provisions of Section 12593 or 12724, whichever is later. Dangerous fireworks shall be disposed of according to procedures in Sections 12724 and 12726. Fireworks seized by any authority as defined in this chapter, other than the State Fire Marshal or his or her salaried assistants, shall be held in trust for the State Fire Marshal by that authority. (b) This section shall become operative on January 1, 2016. (Repealed (in Sec. 9) and added by Stats. 2015, Ch. 24, Sec. 10. (SB 83) Effective June 24, 2015. Section operative January 1, 2016, by its own provisions.)
  96. 12724.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    People whose fireworks were seized may ask the State Fire Marshal to return them within 10 days, and the Marshal must decide the petition within 15 days and give the decision in writing.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12724. (a) Any person whose fireworks are seized under the provisions of this chapter may, within 10 days after seizure, petition the State Fire Marshal to return the fireworks seized upon the ground that the fireworks were illegally or erroneously seized. Any petition filed pursuant to this section shall be considered by the State Fire Marshal within 15 days after filing or after a hearing granted to the petitioner, if requested. The State Fire Marshal shall advise the petitioner of his or her decision in writing. The determination of the State Fire Marshal is final unless within 60 days after seizure an action is commenced in a court of competent jurisdiction in the State of California for the recovery of the fireworks seized pursuant to this part, except as provided in subdivision (b). (b) The determination of the State Fire Marshal is final in the case of the seizure of dangerous fireworks, unless within 20 days after the notice of the determination is mailed to the petitioner an action is commenced in a court of competent jurisdiction in the State of California for the recovery of the fireworks seized pursuant to this part. (Amended by Stats. 1985, Ch. 629, Sec. 2.)
  97. 12725.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    Specified fire safety officials may stop or prevent a public fireworks display if its location, discharge, or firing is found to be hazardous to property or dangerous to the public.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12725. The State Fire Marshal, his salaried deputies, or any chief or his authorized representatives as qualified in this chapter may prevent, stop, or cause to be stopped, any public display in progress, or any proposed public display, when the location, discharge, or firing of such public display is determined by him to be hazardous to property or dangerous to the public. (Added by Stats. 1973, Ch. 1109.)
  98. 12726.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    The State Fire Marshal must manage seized dangerous fireworks under prescribed rules, follow hazardous-waste laws for items identified as hazardous waste, and not repurpose, transfer, or sell them for retail sale.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12726. (a) The dangerous fireworks seized pursuant to this part shall be managed by the State Fire Marshal in the manner prescribed by the State Fire Marshal and in accordance with subdivision (b) at any time after the final determination of proceedings under Section 12724, or upon final termination of proceedings under Section 12593, whichever is later. If no proceedings are commenced pursuant to Section 12724, the State Fire Marshal shall manage the dangerous fireworks in a manner prescribed by the State Fire Marshal and in accordance with subdivision (b). (b) (1) The State Fire Marshal shall ensure that any dangerous fireworks seized pursuant to this part that are identified by the State Fire Marshal as hazardous waste are managed in accordance with California and federal hazardous waste laws and regulations. The State Fire Marshal shall ensure that this hazardous waste is shipped only by registered hazardous waste transporters and treated, stored, or disposed of only by authorized hazardous waste facilities. (2) When managing fireworks seized pursuant to this part, the State Fire Marshal shall not repurpose, transfer, or sell the seized fireworks for purposes of retail sale. (3) Management of fireworks seized pursuant to this part shall only involve the following actions: (A) Use by fire and law enforcement agencies for safety, education, training, testing, and enforcement purposes. (B) Use by the Office of the State Fire Marshal and the federal Consumer Product Safety Commission for regulatory compliance testing and comparison. (C) Held for testing, comparison, or disposal in the interest of public safety, if identified and seized pursuant to a recall issued by the federal Consumer Product Safety Commission. (D) Reclassification by the Office of the State Fire Marshal from a consumer product to a hazardous waste, and disposed of in accordance with applicable laws governing hazardous waste. (E) Deconstruction or alteration by the arson and bomb unit of the Office of the State Fire Marshal, local public safety bomb squads, the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or the Federal Bureau of Investigations, for purposes of testing, as it relates to the investigation of criminal, terrorist, or civil disobedience acts. (F) Held for investigation, as it relates to counterfeit or illicit seals of the State Fire Marshal, product packaging, labeling, coding, inspection labeling, manufacturer labeling, or importer or exporter labeling. (G) Held by the Office of the State Fire Marshal as evidence for local, state, or federal criminal prosecution. (H) Use by the arson and bomb unit of the Office of the State Fire Marshal for fireworks education, testing, disposal, enforcement, and investigations not addressed in subparagraphs (A) to (G), inclusive. (c) If dangerous fireworks are seized pursuant to a local ordinance that provides for administrative fines or penalties and these fines or penalties are collected, the local government entity collecting the fines or penalties shall forward 65 percent of the collected moneys to the Controller for deposit in the State Fire Marshal Fireworks Enforcement and Disposal Fund, as described in Section 12728. (Amended by Stats. 2022, Ch. 238, Sec. 1. (SB 277) Effective January 1, 2023.)
  99. 12726.1.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    The State Fire Marshal must train local fire and law enforcement personnel, and must develop and provide guidance and training to certain local agencies, if the Legislature appropriates money.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12726.1. (a) Subject to an appropriation by the Legislature, the State Fire Marshal shall train local fire and law enforcement personnel on the requirements of this chapter. (b) The State Fire Marshal shall, in consultation with relevant state and local public agencies, the fireworks industry, and other relevant stakeholders, develop, publish, and provide necessary guidance and training to local agencies that seize, collect, transport, store, and treat seized fireworks. This training and education may include, but is not limited to, the following specific areas: (1) Standards for the transportation, storage, and handling of fireworks and pyrotechnic articles in accordance with Chapter 6 (commencing with Section 979) of Division 1 of Title 19 of the California Code of Regulations and the National Fire Protection Association 1124: Code for the Manufacture, Transportation, Storage, and Retail Sales of Fireworks and Pyrotechnic Articles of 2013. (2) Recognition of explosive materials and isolation procedures in accordance with Chapter 10 (commencing with Section 1550) of Division 1 of Title 19 of the California Code of Regulations and the National Fire Protection Association 495: Explosive Materials Code of 2013. (3) Recognition of commercial, consumer, and illegal fireworks in accordance with Chapter 6 (commencing with Section 979) of Division 1 of Title 19 of the California Code of Regulations and the National Fire Protection Association 1124: Code for the Manufacture, Transportation, Storage, and Retail Sales of Fireworks and Pyrotechnic Articles of 2013. (Added by Stats. 2023, Ch. 368, Sec. 6. (AB 1403) Effective January 1, 2024.)
  100. 12727.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    The State Fire Marshal must make regulations to assess fees on California fireworks licensees and consult the fireworks industry and licensees when setting the fee amount.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12727. (a) The State Fire Marshal shall establish regulations pursuant to the requirements and procedures established with the Office of Administrative Law to assess fees on all import and export, wholesale, and retail fireworks licensees in California to be deposited in the State Fire Marshal Fireworks Enforcement and Disposal Fund. (b) In determining the appropriate amount of the fees described in subdivision (a), the State Fire Marshal shall consult with the fireworks industry and import and export, wholesale, and retail fireworks licensees. (c) The total amount of the fees collected shall not exceed the reasonable costs of the statewide programs described in subdivision (c) of Section 12728. (Added by Stats. 2007, Ch. 563, Sec. 11. Effective January 1, 2008.)
  101. 12728.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. )

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    This section creates the State Fire Marshal Fireworks Enforcement and Disposal Fund and directs certain fireworks-related money into it for specified public-safety uses.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 2. FIREWORKS AND PYROTECHNIC DEVICES [12500 - 12728] ( Part 2 repealed and added by Stats. 1973, Ch. 1109. ) ## CHAPTER 9. Remedies [12720 - 12728] ( Chapter 9 added by Stats. 1973, Ch. 1109. ) ## 12728. (a) The State Fire Marshal Fireworks Enforcement and Disposal Fund is hereby established in the State Treasury. (b) All of the moneys collected pursuant to Section 12706 shall be deposited in the fund and shall be available, upon appropriation by the Legislature, to the State Fire Marshal for the exclusive use in statewide programs for the enforcement, prosecution related to, disposal, and management of seized dangerous fireworks, and for the education of public safety agencies in the proper handling and management of dangerous fireworks. (c) All of the moneys collected pursuant to Section 12727 shall be deposited in the fund and shall be available, upon appropriation by the Legislature, to the State Fire Marshal for the exclusive use in statewide programs for all of the following: (1) To further assist in statewide programs for the enforcement, prosecution related to, disposal, and management of seized dangerous fireworks. (2) The education of public safety agencies in the proper handling and management of dangerous fireworks as well as safety issues involving all fireworks and explosives. (3) Assist the State Fire Marshal in identifying and evaluating methods to capture more detailed data relating to fires, damages, and injuries caused by both dangerous and safe and sane fireworks, and to assist with funding the eventual development and implementation of those methods. (4) To further assist in public safety and education efforts within the general public as well as public safety agencies on the proper and responsible use of safe and sane fireworks. (Added by Stats. 2007, Ch. 563, Sec. 12. Effective January 1, 2008.)
  102. 127280.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    Certain health facilities must pay annual fees set by the department, and unpaid fees can block license issuance or renewal and lead to revocation.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127280. (a) Every health facility licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2, except a health facility owned and operated by the state, shall each year be charged a fee established by the department consistent with the requirements of this section. (b) Commencing in calendar year 2004, every freestanding ambulatory surgery clinic as defined in Section 128700, shall each year be charged a fee established by the department consistent with the requirements of this section. (c) The fee structure shall be established each year by the department to produce revenues equal to the appropriation made in the annual Budget Act or another statute to pay for the functions required to be performed by the department pursuant to this chapter, Article 2 (commencing with Section 127340) of Chapter 2, or Chapter 1 (commencing with Section 128675) of Part 5, and to pay for any other health-related programs administered by the department. The fee shall be due on July 1 and delinquent on July 31 of each year. (d) The fee for a health facility that is not a hospital, as defined in subdivision (f) of Section 128700, shall be not more than 0.035 percent of the gross operating cost of the facility for the provision of health care services for its last fiscal year that ended on or before June 30 of the preceding calendar year. (e) The fee for a hospital, as defined in subdivision (f) of Section 128700, shall be not more than 0.035 percent of the gross operating cost of the facility for the provision of health care services for its last fiscal year that ended on or before June 30 of the preceding calendar year. (f) (1) The fee for a freestanding ambulatory surgery clinic shall be established at an amount equal to the number of ambulatory surgery data records submitted to the department pursuant to Section 128737 for encounters in the preceding calendar year multiplied by not more than fifty cents ($0.50). (2) (A) For the calendar year 2004 only, a freestanding ambulatory surgery clinic shall estimate the number of records it will file pursuant to Section 128737 for the calendar year 2004 and shall report that number to the department by March 12, 2004. The estimate shall be as accurate as possible. The fee in the calendar year 2004 shall be established initially at an amount equal to the estimated number of records reported multiplied by fifty cents ($0.50) and shall be due on July 1 and delinquent on July 31, 2004. (B) The department shall compare the actual number of records filed by each freestanding clinic for the calendar year 2004 pursuant to Section 128737 with the estimated number of records reported pursuant to subparagraph (A). If the actual number reported is less than the estimated number reported, the department shall reduce the fee of the clinic for calendar year 2005 by the amount of the difference multiplied by fifty cents ($0.50). If the actual number reported exceeds the estimated number reported, the department shall increase the fee of the clinic for calendar year 2005 by the amount of the difference multiplied by fifty cents ($0.50) unless the actual number reported is greater than 120 percent of the estimated number reported, in which case the department shall increase the fee of the clinic for calendar year 2005 by the amount of the difference, up to and including 120 percent of the estimated number, multiplied by fifty cents ($0.50), and by the amount of the difference in excess of 120 percent of the estimated number multiplied by one dollar ($1). (g) There is hereby established the California Health Data and Planning Fund within the department for the purpose of receiving and expending fee revenues collected pursuant to this chapter. (h) Any amounts raised by the collection of the special fees provided for by subdivisions (d), (e), and (f) that are not required to meet appropriations in the Budget Act for the current fiscal year shall remain in the California Health Data and Planning Fund and shall be available to the department in succeeding years when appropriated by the Legislature in the annual Budget Act or another statute, for expenditure under the provisions of this chapter, Article 2 (commencing with Section 127340) of Chapter 2, and Chapter 1 (commencing with Section 128675) of Part 5, or for any other health-related programs administered by the department, and shall reduce the amount of the special fees that the department is authorized to establish and charge. In no event, however, shall those amounts be used for programs administered by the department pursuant to Sections 127676, 127679, 127681, 127683, and 127685, that become effective on or after January 1, 2019. (i) (1) No health facility liable for the payment of fees required by this section shall be issued a license or have an existing license renewed unless the fees are paid. A new, previously unlicensed, health facility shall be charged a pro rata fee to be established by the department during the first year of operation. (2) The license of any health facility, against which the fees required by this section are charged, shall be revoked, after notice and hearing, if it is determined by the department that the fees required were not paid within the time prescribed by subdivision (c). (j) This section shall become operative on January 1, 2002. (Amended by Stats. 2021, Ch. 143, Sec. 73. (AB 133) Effective July 27, 2021.)
  103. 127280.1.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    The State Department of Health Services may use up to $200,000 for data collection, analysis, and reporting on maternal and perinatal outcomes if the Budget Act appropriates funds.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127280.1. Notwithstanding any other provision of law, up to two hundred thousand dollars ($200,000) of the moneys collected pursuant to Section 127280 may be used by the State Department of Health Services for data collection on, analysis of, and reporting on, maternal and perinatal outcomes, if funds are appropriated in the Budget Act. (Amended by Stats. 2003, Ch. 230, Sec. 16. Effective August 11, 2003.)
  104. 127285.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    Most health facilities and clinics must annually report specified inventory, utilization, equipment, and project information to the department.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127285. (a) Health facilities and clinics, except for chronic dialysis clinics as defined in subdivision (b) of Section 1204, shall annually report to the department all of the following information on forms supplied by the department: (1) A current inventory of beds and services. (2) Utilization data by bed type and service. (3) Acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000). (4) Commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000). (b) With respect to chronic dialysis clinics, the department may annually obtain this information to the extent it is available from the Federal End Stage Renal Disease Network. (Amended by Stats. 2021, Ch. 143, Sec. 74. (AB 133) Effective July 27, 2021.)
  105. 127286.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. )

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    Certain health care employers must report annual waiting-period information to the department, and the department must make reporting available and post the information online.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 1. Health Planning [127280 - 127286] ( Chapter 1 added by Stats. 1995, Ch. 415, Sec. 9. ) ## 127286. (a) Commencing on January 1, 2027, health facilities, clinics, home health agencies, and hospices shall annually report to the department, on forms supplied by the department, whether all of their health care employees eligible for employer-sponsored health care coverage are eligible to receive coverage at the commencement of employment without a waiting period. If not all health care employees eligible for employer-sponsored health care coverage are eligible without a waiting period, the health facilities, clinics, home health agencies, and hospices shall additionally report the following on forms supplied by the department: (1) If the same waiting period applies to all eligible health care employees, the length of the waiting period. (2) If different waiting periods apply to different classifications of eligible health care employees, the length of the waiting period for each classification employed by the health facility, clinic, home health agency, or hospice. (b) The information required by paragraph (2) of subdivision (a) shall be collected for the following employee classifications: (1) Physicians. (2) Physician interns, residents, and fellows. (3) Registered nurses. (4) Licensed vocational nurses. (5) Aides and orderlies. (6) Medical assistants. (7) Home health aides. (8) Technicians and specialists. (9) Clerical and other administrative staff. (10) Environmental services and food staff. (11) Management and supervision. (12) All other employee classifications. (c) The department shall provide the health facilities, clinics, home health agencies, and hospices the ability to report the waiting period information required under subdivision (a) in the following date ranges: (1) Zero days. (2) 1 to 14 days. (3) 15 to 30 days. (4) 31 to 60 days. (5) 61 to 90 days. (6) More than 90 days. (d) The department shall, to the extent feasible, integrate the reporting obligation imposed pursuant to this section with existing reports that health facilities, clinics, home health agencies, and hospices are required to submit to the department to minimize any additional burden. Notwithstanding subdivision (a), this section shall not apply to health facilities, clinics, home health agencies, and hospices that are not required to file reports with the department. (e) The department shall post the information reported pursuant to this section on its internet website on at least an annual basis. (f) For purposes of this section, the following definitions apply: (1) “Health facilities, clinics, home health agencies, and hospices” means all of the following: (A) “Health facilities,” as defined by Section 1250, except that “health facilities” does not include facilities within the meaning of subdivisions (e), (h), (j), or (m) of Section 1250. (B) “Clinics,” as defined by Section 1200. (C) “Home health agencies,” as defined by Section 1727. (D) “Hospices,” as defined by Section 1746. (2) “Waiting period” means the number of days between the date of commencement of employment and the start date of employer-sponsored health care coverage eligibility. (Added by Stats. 2025, Ch. 398, Sec. 1. (AB 1418) Effective January 1, 2026.)
  106. 1273.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2.5. Health Care Advisory Committee [1273 - 1274] ( Article 2.5 repealed and added by Stats. 1985, Ch. 11, Sec. 4. )

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    Committee members must serve without compensation, but they are entitled to current per diem, subsistence, and travel reimbursement for duty-related expenses.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2.5. Health Care Advisory Committee [1273 - 1274] ( Article 2.5 repealed and added by Stats. 1985, Ch. 11, Sec. 4. ) ## 1273. Members of the committee shall serve without compensation, but shall receive the current per diem, subsistence, and travel reimbursement paid to state managers, supervisors, and confidential employees for expenses incurred in the performance of their duties. (Repealed and added by Stats. 1985, Ch. 11, Sec. 4. Effective March 6, 1985.)
  107. 127340.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    The section says private not-for-profit hospitals provide community benefits and should periodically review and reaffirm their commitment to helping meet community health care needs.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127340. The Legislature finds and declares all of the following: (a) Private not-for-profit hospitals meet certain needs of their communities through the provision of essential health care and other services. Public recognition of their unique status has led to favorable tax treatment by the government. In exchange, nonprofit hospitals assume a social obligation to provide community benefits in the public interest. (b) Hospitals and the environment in which they operate have undergone dramatic changes. The pace of change will accelerate in response to health care reform. In light of this, significant public benefit would be derived if private not-for-profit hospitals reviewed and reaffirmed periodically their commitment to assist in meeting their communities’ health care needs by identifying and documenting benefits provided to the communities which they serve. (c) California’s private not-for-profit hospitals provide a wide range of benefits to their communities in addition to those reflected in the financial data reported to the state. (d) Unreported community benefits that are often provided but not otherwise reported include, but are not limited to, all of the following: (1) Community-oriented wellness and health promotion. (2) Prevention services, including, but not limited to, health screening, immunizations, school examinations, and disease counseling and education. (3) Adult day care. (4) Child care. (5) Medical research. (6) Medical education. (7) Nursing and other professional training. (8) Home-delivered meals to the homebound. (9) Sponsorship of free food, shelter, and clothing to the homeless. (10) Outreach clinics in socioeconomically depressed areas. (e) Direct provision of goods and services, as well as preventive programs, should be emphasized by hospitals in the development of community benefit plans. (Added by Stats. 1996, Ch. 1023, Sec. 353. Effective September 29, 1996.)
  108. 127345.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    This section defines terms used in the article about hospital community benefits.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127345. As used in this article, the following terms have the following meanings: (a) “Charity care” means free health services provided without expectation of payment to persons who meet the organization’s criteria for financial assistance and are unable to pay for all or a portion of the services. Charity care shall be reported at cost, as reported to the Department of Health Care Access and Information. Charity care does not include bad debt defined as uncollectible charges that the organization recorded as revenue but wrote off due to a patient’s failure to pay. (b) “Community benefits plan” means the written document prepared for annual submission to the Department of Health Care Access and Information that shall include, but shall not be limited to, a description of the activities that the hospital has undertaken in order to address identified community needs within its mission and financial capacity, and the process by which the hospital developed the plan in consultation with the community. (c) “Community” means the service areas or patient populations for which the hospital provides health care services. (d) (1) Solely for the planning and reporting purposes of this article, “community benefit” means a hospital’s activities that are intended to address community needs and priorities primarily through disease prevention and improvement of health status, including, but not limited to, any of the following: (A) Health care services, rendered to vulnerable populations, including, but not limited to, charity care and the unreimbursed cost of providing services to the uninsured, underinsured, and those eligible for Medi-Cal, Medicare, California Children’s Services Program, or county indigent programs. (B) The unreimbursed cost of services included in subdivision (d) of Section 127340. (C) Financial or in-kind support of public health programs. (D) Donation of funds, property, or other resources that contribute to a community priority. (E) Health care cost containment. (F) Enhancement of access to health care or related services that contribute to a healthier community. (G) Services offered without regard to financial return because they meet a community need in the service area of the hospital, and other services including health promotion, health education, prevention, and social services. (H) Food, shelter, clothing, education, transportation, and other goods or services that help maintain a person’s health. (2) “Community benefit” does not mean activities or programs that are provided primarily for marketing purposes or are more beneficial to the organization than to the community. (e) “Community needs assessment” means the process by which the hospital identifies, for its primary service area as determined by the hospital, unmet community needs. (f) “Community needs” means those requisites for improvement or maintenance of health status in the community. (g) “Hospital” means a private not-for-profit acute hospital licensed under subdivision (a), (b), or (f) of Section 1250 and is owned by a corporation that has been determined to be exempt from taxation under the United States Internal Revenue Code. “Hospital” does not mean any of the following: (1) Hospitals that are dedicated to serving children and that do not receive direct payment for services to any patient. (2) Small and rural hospitals as defined in Section 124840, unless the hospital is part of a hospital system. (3) A district hospital organized and governed pursuant to the Local Health Care District Law (Division 23 (commencing with Section 32000)) or a nonprofit corporation that is affiliated with the health care district hospital owner by means of the district’s status as the nonprofit corporation’s sole corporate member pursuant to subparagraph (B) of paragraph (1) of subdivision (h) of Section 14169.31 of the Welfare and Institutions Code. (h) “Mission statement” means a hospital’s primary objectives for operation as adopted by its governing body. (i) “Vulnerable populations” means any population that is exposed to medical or financial risk by virtue of being uninsured, underinsured, or eligible for Medi-Cal, Medicare, California Children’s Services Program, or county indigent programs. “Vulnerable populations” also includes both of the following: (1) Racial and ethnic groups experiencing disparate health outcomes, including Black/African American, American Indian, Alaska Native, Asian Indian, Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Vietnamese, Native Hawaiian, Guamanian or Chamorro, Samoan, or other nonwhite racial groups, as well as individuals of Hispanic/Latino origin, including Mexicans, Mexican Americans, Chicanos, Salvadorans, Guatemalans, Cubans, and Puerto Ricans. (2) Socially disadvantaged groups, including all of the following: (A) The unhoused. (B) Communities with inadequate access to clean air and safe drinking water, as defined by an environmental California Healthy Places Index score of 50 percent or lower. (C) People with disabilities. (D) People identifying as lesbian, gay, bisexual, transgender, or queer. (E) Individuals with limited English proficiency. (Amended by Stats. 2021, Ch. 751, Sec. 1. (AB 1204) Effective January 1, 2022.)
  109. 127346.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    The department may fine hospitals for failing to adopt, update, or submit community benefit plans, may give a 60-day extension, and must post an annual report and make submitted plans public.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127346. (a) The Department of Healthcare Access and Information may impose a fine not to exceed five thousand dollars ($5,000) on hospitals for failure to adopt, update, or submit community benefit plans consistent with Section 127350. (b) The department may grant a hospital an automatic 60-day extension for submitting annual community benefit plans. (c) The department shall annually prepare, and post on its internet website, a report that includes all of the following: (1) The amount each hospital spent on community benefits. (2) The amount of community benefit spending attributable to charity care, the unpaid cost of government-sponsored health care programs, and community benefit programs and activities. (3) A list of all hospitals that failed to report community benefits spending. (d) The department shall make all community benefit plans submitted by hospitals pursuant to Section 127350 available to the public on its internet website. (Amended by Stats. 2021, Ch. 143, Sec. 80. (AB 133) Effective July 27, 2021.)
  110. 127350.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    Each hospital must complete and update community-benefits planning, report it to the Department of Health Care Access and Information, and post the plan online.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127350. Each hospital shall do all of the following: (a) By July 1, 1995, reaffirm its mission statement that requires its policies integrate and reflect the public interest in meeting its responsibilities as a not-for-profit organization. (b) By January 1, 1996, complete, either alone, in conjunction with other health care providers, or through other organizational arrangements, a community needs assessment evaluating the health needs of the community serviced by the hospital, that includes, but is not limited to, a process for consulting with community groups and local government officials in the identification and prioritization of community needs that the hospital can address directly, in collaboration with others, or through other organizational arrangement. The community needs assessment shall be updated at least once every three years. (c) By April 1, 1996, and annually thereafter adopt and update a community benefits plan for providing community benefits either alone, in conjunction with other health care providers, or through other organizational arrangements. (d) (1) Annually submit its community benefits plan, including, but not limited to, the activities that the hospital has undertaken in order to address community needs within its mission and financial capacity to the Department of Health Care Access and Information. The hospital shall assign and report the economic value of community benefits provided in furtherance of its plan, and include a description of how needs identified in the assessment are being addressed and which needs are not being addressed, and why. Effective with hospital fiscal years, beginning on or after January 1, 1996, each hospital shall file a copy of the plan with the department not later than 150 days after the hospital’s fiscal year ends. (2) Hospitals under the common control of a single corporation or another entity may file a consolidated report if the report includes each hospital’s community benefit financial data and describes the benefits provided to the communities in the hospitals’ geographic area. Hospitals on a consolidated license may file a consolidated community benefit plan report if they serve the same geographic area. (3) Each hospital’s community benefit report shall contain an explanation of the methodology used to determine the hospital’s costs, written in plain English. (e) Annually post its community benefits plan on its internet website. (Amended by Stats. 2021, Ch. 143, Sec. 81. (AB 133) Effective July 27, 2021.)
  111. 127355.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    A hospital must include specified elements in its community benefits plan.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127355. The hospital shall include all of the following elements in its community benefits plan: (a) Mechanisms to evaluate the plan’s effectiveness including, but not limited to, a method for soliciting the views of the community served by the hospital and identification of community groups and local government officials consulted during the development of the plan. (b) Measurable objectives to be achieved within specified timeframes. (c) Community benefits categorized into the following framework: (1) Medical care services. (2) Other benefits for vulnerable populations. (3) Other benefits for the broader community. (4) Health research, education, and training programs. (5) Nonquantifiable benefits. (Added by Stats. 1996, Ch. 1023, Sec. 353. Effective September 29, 1996.)
  112. 127360.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. )

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    The article cannot be used to justify a hospital’s tax-exempt status, and the department may require hospitals to directly report their charity activities.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 2. Hospitals: Community Benefits [127340 - 127360] ( Article 2 added by Stats. 1996, Ch. 1023, Sec. 353. ) ## 127360. Nothing in this article shall be used to justify the tax-exempt status of a hospital under state law. Nothing in this article shall preclude the department from requiring hospitals to directly report their charity activities. (Amended by Stats. 2021, Ch. 143, Sec. 82. (AB 133) Effective July 27, 2021.)
  113. 127370.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    The Legislature states that health care data should better reflect racial, ethnic, disability, language, and socioeconomic disparities.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127370. The Legislature finds and declares all of the following: (a) The COVID-19 health emergency has thrown into sharp relief longstanding health inequities along racial, ethnic, and socioeconomic lines. Black, Hispanic, and Indigenous people have been disproportionately affected during the pandemic; for example, the age-adjusted mortality rate among Black people with COVID-19 is more than three times as high as that of Whites. (b) Disparities in access to care and quality of care contribute to racial health disparities. The disparate impact of the pandemic has highlighted the tiered nature of the current health care system, a structure that significantly impacts the quality of care patients receive along racial, ethnic, and socioeconomic lines. (c) Reporting on the racially disproportionate impact of COVID-19 has called attention to the need for further data on racial and ethnic disparities in health care. (d) Data currently reported by California hospitals that could be used to analyze access to and quality of care by age, sex, race, ethnicity, language, disability status, sexual orientation, gender identity, and socioeconomic status is not available to consumers or the general public. (e) Although nonprofit hospitals are currently required to develop and report on their community benefits plans to provide services to vulnerable populations in their service areas, the law should be updated to ensure that the needs of vulnerable populations, including racial and ethnic groups experiencing disparate health outcomes and socially disadvantaged groups, are specifically considered and addressed. (f) All California health systems and large physician providers, whether operated as nonprofit or for-profit, and by a county, the University of California, or other governmental entity, should systematically collect and publish racial and ethnic data for a range of standard access, quality, and outcome measures, as well as their processes to overcome biases in the provision of and access to health care services. (g) As part of President Joe Biden’s January 2021 Executive Order Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, the federal Centers for Medicare and Medicaid Services are developing health equity measures as part of the proposed rules for other Medicare prospective payment systems, which may include stratification of quality measure results by race, ethnicity, dual eligible status, disability status, LGBTQ+ identity, and socioeconomic status and a standardized set of demographic data elements by hospital at the time of admission. (h) The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are standardized, evidence-based measures of health care access and quality that are readily used with hospital inpatient administrative data for all payor categories to measure and track clinical performance and outcomes. The four areas for which AHRQ has developed indicators focus on adult prevention, pediatric prevention, inpatient quality, and patient safety. The state has used these indicators in the past to explore racial and ethnic disparities at an aggregate level. (i) The dearth of racially and ethnically disaggregated data reflecting the health of communities of color underlies the challenges of a fully informed public health response, and is a matter of statewide concern. It will benefit the state’s public health response for hospitals and health systems to share information with the state, consumers, and the public using the standardized AHRQ QIs and NCQA HEDIS measures, as it will facilitate input by affected communities into addressing longstanding racial, ethnic, and socioeconomic health disparities, and thereby contribute to well-informed health policy. (j) Facilitating the public sharing of data on health care disparities will assist the state and civil rights advocates in enforcing existing civil rights laws, including Section 11135 of the Government Code, the Unruh Civil Rights Act (Section 51 of the Civil Code), Title VI of the Civil Rights Act of 1964 (Public Law 88-352), and Section 1557 of the Patient Protection and Affordable Care Act (Public Law 111-148). (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  114. 127371.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    This section defines several terms used in the article, including advisory committee, disparity reduction, equity report, hospital, hospital system, integrated system, patient population, and vulnerable populations.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127371. As used in this article: (a) “Advisory committee” means the Health Care Equity Measures Advisory Committee established pursuant to Section 127376. (b) “Disparity reduction” means a reduction in variation in disease occurrence, including communicable diseases and chronic conditions, as well as health outcomes for vulnerable populations. (c) “Equity report” means a written document prepared for annual submission to the Department of Health Care Access and Information pursuant to this article. (d) “Hospital” means an acute hospital licensed pursuant to subdivision (a), (b), or (f) of Section 1250. (e) “Hospital system” means an entity or system of entities that includes or owns two or more hospitals within the state, of which at least one is a general acute care hospital, as defined in subdivision (a) of Section 1250. (f) “Integrated system” means an entity or system of entities that includes one or more hospitals and is related to one or more hospitals, health plans, or physician groups through parent-subsidiary relationships, contractual relationships, or common boards and shared senior management. (g) “Patient population” means all of the people served by a hospital. (h) “Vulnerable populations” includes both of the following: (1) Racial and ethnic groups experiencing disparate health outcomes, including Black/African American, American Indian, Alaska Native, Asian Indian, Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Vietnamese, Native Hawaiian, Guamanian or Chamorro, Samoan, or other nonwhite racial groups, as well as individuals of Hispanic/Latino origin, including Mexicans, Mexican Americans, Chicanos, Salvadorans, Guatemalans, Cubans, and Puerto Ricans. (2) Socially disadvantaged groups, including all of the following: (A) The unhoused. (B) Communities with inadequate access to clean air and safe drinking water, as defined by an environmental California Healthy Places Index score of 50 percent or lower. (C) People with disabilities. (D) People identifying as lesbian, gay, bisexual, transgender, or queer. (E) Individuals with limited English proficiency. (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  115. 127372.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    Hospitals must prepare annual equity reports and include specific disparity analyses and health equity plans.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127372. (a) A hospital shall prepare an annual equity report. The equity report shall include an analysis of health status and access to care disparities for patients on the basis of age, sex, race, ethnicity, language, disability status, sexual orientation, gender identity, and payor. (b) On and after September 30, 2025, but not until 12 months after the release of the federal Centers for Medicare and Medicaid Services’ health equity quality measures for their proposed rules for other Medicare prospective payment systems, the annual equity report submitted by a hospital shall report on the Agency for Healthcare Research and Quality’s Quality Indicators or any other relevant measures specified by the advisory committee, including measures of access, quality, and outcomes by age, sex, race, ethnicity, language, disability status, sexual orientation, gender identity, and payor for the hospital’s patient populations, pursuant to the recommendations provided by the advisory committee. The equity report shall also include a plan to prioritize and address disparities for vulnerable populations identified in the data, with measurable objectives and specific timeframes, pursuant to the recommendations provided by the advisory committee and consistent with subdivision (d). (c) A hospital system with more than one hospital shall present the information in the equity report disaggregated at the individual hospital level and aggregated across all hospitals in the system. (d) A hospital’s equity report shall include a health equity plan to achieve disparity reduction for disparities identified in the data, as specified by the advisory committee, with measurable objectives and specific timeframes for disparity reduction. This shall include addressing both of the following: (1) The 10 widest disparities in health care quality for vulnerable populations, access, or outcomes, as determined by the advisory committee. (2) Performance across all of the following priority areas: (A) Person-centered care. (B) Patient safety. (C) Addressing patient social determinants of health. (D) Effective treatment. (E) Care coordination. (F) Access to care. (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  116. 127373.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    Hospitals must include a plain-English methodology explanation in equity reports, submit and file the report annually with the Department, and post it on their website in a visible way.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127373. (a) A hospital shall do all of the following with respect to an equity report prepared pursuant to Section 127372: (1) Include in the equity report an explanation of the methodology used, written in plain English. (2) Annually submit the equity report to the Department of Health Care Access and Information. A hospital shall file a copy of the report with the department for the relevant calendar years according to the reporting schedule established by the department. (3) Annually post the equity report on the hospital’s internet website. The report shall be available via a link that includes the words “Equity Report” or a substantially similar term, which shall be visible on the main page of the hospital’s internet website as loaded by a standard internet browser in an easily readable font size without having to scroll down. (b) A hospital under the common control of a single corporation or another entity may file a consolidated equity report if the report includes each hospital’s equity data. (c) Hospitals that are part of an integrated system may prepare and submit a single joint equity report if the report separately addresses each hospital’s equity analysis. (d) Data and information included in annual equity reports shall be reported to the extent information is available and disclosed in a manner that protects the personal information of patients pursuant to state and federal privacy laws, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191). (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  117. 127374.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    The department may fine a hospital that does not adopt, update, or submit an equity report, and it must also publish annual hospital noncompliance information and make submitted equity reports public.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127374. (a) The Department of Health Care Access and Information may impose a fine not to exceed five thousand dollars ($5,000) against a hospital that fails to adopt, update, or submit an equity report consistent with this article and any implementing regulations adopted by the department. (b) The department may grant a hospital an automatic 60-day extension to submit an equity report. (c) The department shall annually prepare, and post on its internet website, a report that includes a list of all hospitals that failed to submit equity reports. (d) The department shall make all equity reports submitted pursuant to this article available to the public on its internet website. (e) Data and information posted on hospital internet websites and submitted to and made public by the department shall be disclosed in a manner that protects the personal information of patients pursuant to deidentification requirements as specified by the department, as well as any state and federal privacy laws, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191). (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  118. 127375.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    The Department of Health Care Access and Information must adopt rules, regulations, or informal guidance needed to carry out this article.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127375. The Department of Health Care Access and Information shall adopt any rules, regulations, or informal guidance necessary to further the objectives of this article. (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  119. 127376.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. )

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    The Department must create an advisory committee, the Director must appoint its members, and the committee must meet, advise the Director, and publish recommendations by the stated deadlines.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2. Health Policy Research and Evaluation [127340 - 127376] ( Chapter 2 heading added by Stats. 1995, Ch. 415, Sec. 9. ) ## ARTICLE 3. The Medical Equity Disclosure Act [127370 - 127376] ( Article 3 added by Stats. 2021, Ch. 751, Sec. 2. ) ## 127376. (a) The Department of Health Care Access and Information shall convene a Health Care Equity Measures Advisory Committee, composed of at least one academic health care quality and measurement expert and at least six stakeholder representatives, including at least one representative of each of the following: (1) Associations representing public hospitals and health systems. (2) Associations representing private hospitals and health systems. (3) Organized labor. (4) Organizations representing consumers. (5) Organizations representing vulnerable populations. (6) A representative of the department. (b) (1) The advisory committee membership shall consist of no fewer than 9 persons and no more than 11 persons. (2) The Director of the Department of Health Care Access and Information shall appoint the advisory committee members pursuant to subdivision (a). The initial terms of the committee members shall be established to create staggered terms of office by drawing lots at the first meeting of the committee. One-half of the committee members shall serve a two-year term, and one-half of the committee members shall serve a one-year term. After their initial term of office is complete, a committee member shall serve a two-year term. Each appointed member shall serve a term of two years. Each appointed member shall serve at the discretion of the director and may be removed at any time. (3) The chairperson of the advisory committee shall be an appointed member and shall be elected by a majority of the appointed members. (c) (1) The advisory committee shall assist and advise the director in reviewing and amending the appropriate measures that align with the health equity measures developed by the federal Centers for Medicare and Medicaid Services at the hospital-, hospital system-, and integrated system-level related to access, quality, and outcomes, including any relevant Agency for Healthcare Research and Quality’s Quality Indicators, that hospitals are required to report in their annual equity reports pursuant to Section 127372. (2) The advisory committee shall provide recommendations pursuant to paragraph (1) no later than December 31, 2022, or 120 days after the release of the health equity measures by the federal Centers for Medicare and Medicaid Services, whichever occurs later. These recommendations shall be published on the department’s internet website. (d) (1) The advisory committee shall assist and advise the director in reviewing, amending, and evaluating, as necessary, the appropriate disparities and performance areas to be addressed in the health equity plan that a hospital is required to include in their annual equity reports pursuant to Section 127372. (2) The advisory committee shall consider differences in patient populations and geographic areas served when reviewing health equity plans. (3) No later than September 30, 2027, or 24 months after the release of the health equity measures by the federal Centers for Medicare and Medicaid Services, whichever occurs later, the advisory committee shall make recommendations to the department regarding the health equity plan, as described in Section 127372. These recommendations shall be published on the department’s internet website. (e) (1) The advisory committee shall, through its meetings, provide a forum for stakeholder and public engagement. (2) The advisory committee shall meet at least twice per year or when requested by the director. (Added by Stats. 2021, Ch. 751, Sec. 2. (AB 1204) Effective January 1, 2022.)
  120. 1274.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2.5. Health Care Advisory Committee [1273 - 1274] ( Article 2.5 repealed and added by Stats. 1985, Ch. 11, Sec. 4. )

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    The committee must meet when called by the director, and in any case at least once per year.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 2.5. Health Care Advisory Committee [1273 - 1274] ( Article 2.5 repealed and added by Stats. 1985, Ch. 11, Sec. 4. ) ## 1274. The committee shall meet on call of the director but no less than one time per year. (Amended by Stats. 1986, Ch. 1351, Sec. 2.)
  121. 127400.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    This section defines terms used for hospital fair pricing policies, including who counts as a financially qualified patient, self-pay patient, and hospital.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127400. As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to services rendered to a financially qualified patient, an allowance that is applied after the hospital’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges. (b) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code. (c) “Financially qualified patient” means a patient who is both of the following: (1) A patient who is a self-pay patient, as defined in subdivision (f), or a patient with high medical costs, as defined in subdivision (g). (2) A patient who has a family income that does not exceed 400 percent of the federal poverty level. (d) “Hospital” means a facility that is required to be licensed under subdivision (a), (b), or (f) of Section 1250, except a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Corrections and Rehabilitation. (e) “Department” means the Department of Health Care Access and Information. (f) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the hospital. Self-pay patients may include charity care patients. (g) “A patient with high medical costs” means a person whose family income does not exceed 400 percent of the federal poverty level, as defined in subdivision (b). For these purposes, “high medical costs” means any of the following: (1) Annual out-of-pocket costs incurred by the individual at the hospital that exceed the lesser of 10 percent of the patient’s current family income or family income in the prior 12 months. Out-of-pocket costs means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. (2) Annual out-of-pocket expenses that exceed 10 percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months. Out-of-pocket expenses means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. (3) A lower level determined by the hospital in accordance with the hospital’s charity care policy. (h) “Patient’s family” means the following: (1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act, whether living at home or not. (2) For persons under 18 years of age or for a dependent child 18 to 20 years of age, inclusive, parent, caretaker relatives, and parent’s or caretaker relatives’ other dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act. (i) “Reasonable payment plan” means monthly payments that are not more than 10 percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for any of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses. (j) “Guarantor” means a person who has legal financial responsibility for the patient’s health care services. (Amended by Stats. 2024, Ch. 511, Sec. 1. (AB 2297) Effective January 1, 2025.)
  122. 127400.5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    This section defines “charity care” as free care and “discounted payment” (or “discount payment”) as care charges that are reduced but not free.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127400.5. For purposes of this chapter, the following terms have the following meanings: (a) “Charity care” means free care. (b) “Discounted payment” or “discount payment” means any charge for care that is reduced but not free. (Added by Stats. 2024, Ch. 511, Sec. 2. (AB 2297) Effective January 1, 2025.)
  123. 127401.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    This section assigns enforcement of the article to different health agencies based on the violation date, bars duplicate penalties, and says a director’s action against a hospital does not stop because the hospital is sold unless the director gives written consent.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127401. (a) The State Department of Public Health shall be responsible for the enforcement of the provisions of this article for violations occurring prior to January 1, 2024. The Department of Health Care Access and Information shall be responsible for the enforcement of the provisions of this article for violations occurring on or after January 1, 2024. (b) For investigations involving hospital actions required by this article occurring on or after January 1, 2024, the Department of Health Care Access and Information shall also have enforcement authority to assess penalties for violations that occurred on or after January 1, 2022, that arise out of the same investigation. The State Department of Public Health and the Department of Health Care Access and Information shall not impose a penalty for any violation for which the other department has imposed a penalty. Any action brought by the Director of the Department of Health Care Access and Information against a hospital shall not abate by reason of a sale or other transfer of ownership of the hospital that is a party to the action except with the express written consent of the director. (Amended by Stats. 2024, Ch. 511, Sec. 3. (AB 2297) Effective January 1, 2025.)
  124. 127405.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must keep written charity care and discount payment policies, explain how eligibility is decided, and follow limits on eligibility, documentation, and billing practices.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127405. (a) (1) (A) Each hospital shall maintain an understandable written policy regarding discount payments for financially qualified patients as well as an understandable written charity care policy. Uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level, as defined in subdivision (b) of Section 127400, shall be eligible for participation under a hospital’s charity care policy or discount payment policy. Notwithstanding any other provision of this article, a hospital may choose to grant eligibility for its discount payment policy or charity care policies to patients with incomes over 400 percent of the federal poverty level. Both the charity care policy and the discount payment policy shall state the process used by the hospital to determine whether a patient is eligible for charity care or discounted payment. In the event of a dispute, a patient may seek review from the business manager, chief financial officer, or other appropriate manager as designated in the charity care policy and the discount payment policy. (B) The written policy regarding discount payments shall also include a statement that an emergency physician, as defined in Section 127450, who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounts to uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level. This statement shall not be construed to impose any additional responsibilities upon the hospital. (2) Rural hospitals, as defined in Section 124840, may establish eligibility levels for financial assistance and charity care at less than 400 percent of the federal poverty level as appropriate to maintain their financial and operational integrity. (b) (1) A hospital’s discount payment policy and charity care policy shall clearly state eligibility criteria based upon income consistent with the application of the federal poverty level. In determining eligibility under its discount payment policy or charity care policy, a hospital shall not consider the monetary assets of the patient. (2) A hospital shall not require a patient to apply for Medicare, Medi-Cal, or other coverage before the patient is screened for, or provided, discount payment. When screening for eligibility for discount payment, a hospital may require the patient to participate in a screening for Medi-Cal eligibility. (c) A discount payment policy shall include an extended payment plan to allow payment of the discounted price over time. The policy shall provide that the hospital and the patient shall negotiate the terms of the payment plan, and take into consideration the patient’s family income and essential living expenses. A hospital may also consider the availability of a patient’s health savings account held by the patient or the patient’s family. If the hospital and the patient cannot agree on the payment plan, the hospital shall use the formula described in subdivision (i) of Section 127400 to create a reasonable payment plan. (d) (1) A hospital shall limit expected payment for services it provides to a patient at or below 400 percent of the federal poverty level, as defined in subdivision (b) of Section 127400, eligible under its discount payment policy to the amount of payment the hospital would expect, in good faith, to receive for providing services from Medicare or Medi-Cal, whichever is greater. If the hospital provides a service for which there is no established payment by Medicare or Medi-Cal, the hospital shall establish an appropriate discounted payment. Patients eligible under this article shall not be required to undergo an independent dispute resolution process. (2) The hospital may require a patient or guarantor to pay the hospital the entire amount of any reimbursement sent directly to the patient or guarantor by a third-party payer for that hospital’s services. (3) If the patient receives a legal settlement, judgment, or award under a liable third party action that includes payment for health care services or medical care related to the injury, the hospital may require the patient or guarantor to reimburse the hospital for the related health care services rendered up to the amount reasonably awarded for that purpose. (e) A patient, or patient’s legal representative, who requests a discounted payment, charity care, or other assistance in meeting their financial obligation to the hospital shall make every reasonable effort to provide the hospital with documentation of income and health benefits coverage. If the person requests charity care or a discounted payment and fails to provide information that is reasonable and necessary for the hospital to make a determination, the hospital may consider that failure in making its determination. (1) For purposes of determining eligibility for discounted payment or charity care, documentation of income shall be limited to recent pay stubs or income tax returns. The hospital may accept other forms of documentation of income but shall not require those other forms. If a patient does not submit an application or documentation of income, a hospital may presumptively determine that a patient is eligible for charity care or discounted payment based on information other than that provided by the patient or based on a prior eligibility determination. (2) Information obtained pursuant to paragraph (1) shall not be used for collections activities. This paragraph does not prohibit the use of information obtained by the hospital, collection agency, or assignee independently of the eligibility process for charity care or discounted payment. (3) Eligibility for discounted payments or charity care shall be determined at any time the hospital is in receipt of information specified in paragraph (1). A hospital shall not impose time limits for applying for charity care or discounted payments, nor deny eligibility based on the timing of a patient’s application. (f) (1) A hospital may waive or reduce Medi-Cal and Medicare cost-sharing amounts as part of its charity care program or discount payment program. (2) In waiving or reducing Medicare cost-sharing amounts, the hospital may consider the patient’s monetary assets to the extent required for the hospital to be reimbursed under the Medicare program for Medicare bad debt without seeking to collect cost-sharing amounts from the patient as required by federal law, including, but not limited to, Section 413.89 of Title 42 of the Code of Federal Regulations. Monetary assets include only assets that are convertible to cash and do not include retirement or deferred compensation plans qualified under the Internal Revenue Code, nonqualified deferred compensation plans, or assets below the maximum community spouse resource allowance under Section 1396r–5(d) of Title 42 of the United States Code. (Amended by Stats. 2024, Ch. 511, Sec. 4. (AB 2297) Effective January 1, 2025.)
  125. 127406.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must screen patients for charity care or discounted payment eligibility in specified situations and must give notice, allow opt-out, and follow written screening and verification rules.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127406. (a) For purposes of this section, the following terms shall have the following meanings: (1) “Presumptively determine” means a determination made by a hospital that a patient who did not submit an application or documentation of income, as described in paragraph (1) of subdivision (e) of Section 127405, is eligible to participate in the charity care or discounted payment programs maintained by the hospital pursuant to this article. (2) “Screen” or “screening” means the process a hospital uses to identify if a patient may be eligible for charity care or discounted payment. This process shall serve as an alternative to requiring an application for eligibility determination. (b) (1) Commencing July 1, 2027, a hospital shall screen patients to determine if they meet any of the following criteria and, if so, presumptively determine that a patient is eligible for participation under the hospital’s charity care policy or discount payment policy, subject to verification pursuant to paragraph (2): (A) The patient or any member of the patient’s family, as defined in subdivision (h) of Section 127400, is enrolled in CalFresh, CalWORKs, or Tribal Temporary Assistance for Needy Families (Tribal TANF), Women, Infants, and Children (WIC), California Alternate Rates for Energy (CARE), the Low-Income Home Energy Assistance Program (LIHEAP), Housing Choice Voucher (HCV) program, and any other programs as determined by the department and any additional programs determined by each hospital that would reasonably reflect the approximate patient household income. Enrollment in any program listed in this subparagraph shall be considered sufficient evidence that a patient is financially qualified under Section 127400. (B) The patient or a member of the patient’s family, as defined in Section 127400, was determined to be eligible for participation under the hospital’s charity care policy or discount payment policy for services billed or provided during the previous six-month period. However, the hospital may ask the patient if their income or insurance has changed during the last six months. (i) If the patient attests that their income and insurance has not changed since last being approved for charity care or discounted payment, the hospital shall provide the patient charity care or discounted payment based on their previous determination of eligibility. (ii) If the patient attests that their income and insurance has changed since last being approved for charity care or discounted payment, the hospital may reevaluate their eligibility. (iii) A patient that is approved for charity care or discounted payment based on a determination of eligibility within the prior six months shall not be considered a new determination of eligibility. (C) The patient is experiencing homelessness. (2) If a hospital is unable to automatically or independently verify the circumstances described in subparagraph (A) or (B) of paragraph (1), the hospital may require verification from the patient. The patient shall make every reasonable effort to provide the requested verification and the hospital shall assist the patient in obtaining verification when feasible. A hospital shall accept a self-attestation of eligibility for the circumstances described in subparagraph (C) of paragraph (1). (3) A hospital shall not require a patient to apply for Medicare, Medi-Cal, or other coverage before the patient is screened for, or provided with, discounted payment. However, a hospital may require the patient to participate in a screening for Medi-Cal eligibility when screening for discounted payment pursuant to this subdivision. (c) (1) Commencing July 1, 2027, a hospital shall screen a patient for eligibility for participation under the hospital’s charity care policy and discount payment policy if the patient is any of the following: (A) Uninsured. (B) Enrolled in Medi-Cal with cost sharing or eligible for Medi-Cal under the Hospital Presumptive Eligibility (HPE) program. (C) Enrolled in a Covered California health plan. (2) (A) A hospital shall inform a patient of its intent to screen the patient for eligibility for discounted payment or charity care and that any personal and financial information provided by the patient will be used solely for those purposes. (B) The hospital shall inform the patient of their right to opt out of screening. The hospital shall provide the patient with a form to sign to opt out of screening. The form shall clearly state that screening was offered, that the patient may revoke their decision to opt out of screening at any time, and that opting out of screening will not affect the patient’s ability to apply for charity care or discounted payment at any time in the future. The signed form shall be placed in the patient’s medical record. (3) A hospital shall not require a patient to apply for Medicare, Medi-Cal, or other coverage before the patient is screened for, or provided with, discounted payment. However, a hospital may require the patient to participate in a screening for Medi-Cal eligibility when screening for discounted payment pursuant to this subdivision. (4) If the screening concludes that a patient is financially qualified, as defined in Section 127400, the hospital shall determine if the patient is eligible for participation under the hospital’s charity care policy or discount payment policy without requiring the patient to complete a separate application. (5) A hospital may verify a patient’s eligibility as part of or after the screening to determine if a patient is financially qualified. (A) A hospital that chooses to verify eligibility may attempt to independently verify the patient’s information before billing the patient. (B) If the hospital is unable to independently verify eligibility pursuant to subparagraph (A), the hospital shall request verification from the patient before billing the patient. The verification request shall be in writing and include the documentation necessary to determine eligibility under the hospital’s charity care and discount payment policy. (C) The hospital may collect all of the information required to verify eligibility before discharge. (d) A hospital may, at its discretion or as established in its charity care policy or discount payment policy, do any of the following: (1) Presumptively determine that a patient who does not meet the criteria described in subdivision (b) is eligible for charity care or discounted payment. (2) Screen a patient who does not meet the criteria described in subdivision (c) for eligibility for charity care or discounted payment. (e) Consistent with paragraph (2) of subdivision (a) of Section 127405, this section shall not preclude a rural hospital’s ability to establish eligibility levels for charity care and discounted payment at less than 400 percent of the federal poverty level, as appropriate to maintain their financial and operational integrity. (f) Effective July 1, 2027, each hospital shall establish a written process for screening patients consistent with this section within its charity care policy and discount payment policy pursuant to Section 127405 that is accessible to the public pursuant to subdivision (c) of Section 127410 and is provided to the department pursuant to Section 127435. The names of any software products and any other third-party services used to presumptively determine, or determine, eligibility for charity care and discounted payment shall be disclosed with the written process. (g) Screening conducted pursuant to this section shall not be considered a request or application for charity care or a discounted payment and shall not disqualify a patient, or patient’s legal representative, from requesting charity care or discounted payment, or submitting an application or documentation of income for the purposes of determining eligibility for charity care or discounted payment. (h) A hospital may accept voluntary submission of information or documentation that would assist the hospital in the screening process as long as the hospital does not compel the patient to provide the information as a condition of screening. (i) A hospital may use existing patient information in the screening process for the sole purpose of determining eligibility for charity care or discounted payment. A hospital may incorporate the use of this information into its standard intake, registration, or billing workflows. This information may include, but is not limited to, any of the following: (1) Existing patient medical or billing records. (2) Information routinely collected during patient registration or admission. (3) Information voluntarily supplied by the patient. (4) Prior eligibility determination for charity care or discounted payment. (5) Any other information routinely collected or maintained by a hospital that reasonably indicates financial hardship or eligibility for charity care or discount payment under the hospital’s charity care policy or discount payment policy. (j) A hospital may, but is not required to, use third-party software tools or services, or contract with a third party, including a public agency, to conduct screening. However, a hospital that elects to conduct screening using third-party software tools or services, or by contracting with a third party, shall ensure all of the following conditions are met: (1) The process shall not cause any negative impact on a patient’s credit score. (2) Evaluations are based on eligibility criteria established in the hospital’s written charity care policy and discount payment policy pursuant to subdivision (b) of Section 127405. Evaluations shall not consider any assessment, evaluation, or score that predicts the patient’s propensity to pay. (3) The third-party software tool or service is used in a way that is reasonably calculated to lead to an accurate result. (4) In the event a third-party service or software tool fails to return information about the patient, or specifies the patient’s income is unknown, the hospital shall make a good faith effort to evaluate the patient’s eligibility status based on information available to the hospital or voluntarily provided by the patient. (k) A hospital shall document any information or methods it utilized pursuant to subdivisions (i) and (j) to screen a patient. (l) (1) A hospital shall provide a written notice to patients presumptively determined to be eligible, pursuant to subdivision (b), or determined to be eligible, pursuant to subdivision (c), for charity care or discounted payment. This written notice may be sent prior to, or in conjunction with, a billing notice. In no event shall a billing statement be sent to a patient who is presumptively determined to be eligible, pursuant to subdivision (b), or determined to be eligible, pursuant to subdivision (c), for charity care or discounted payment, prior to the issuance of this notice. (2) Any billing statement sent to a patient who is presumptively determined to be eligible, pursuant to subdivision (b), or determined to be eligible, pursuant to subdivision (c), for charity care or discounted payment, shall reflect the adjustments made to the patient’s hospital charges under the hospital’s charity care policy or discount payment policy. (m) If the screening process described in subdivision (b) or (c) determines that a patient may be eligible for charity care or discounted payment, but is later determined to be ineligible, or if the hospital is unable to verify a patient’s eligibility, the hospital shall promptly provide the patient with written notice of the hospital’s charity care policy and discount payment policy, as required by Section 127410. (n) Written notices required by this section shall be provided in English and the language spoken by the patient, consistent with Section 12693.30 of the Insurance Code and applicable state and federal law. (Added by Stats. 2025, Ch. 450, Sec. 1. (AB 1312) Effective January 1, 2026.)
  126. 127410.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must give patients a written notice about discount payment and charity care policies, when to provide it, how to provide it, and where to post it publicly.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127410. (a) Each hospital shall provide patients with a written notice that shall contain information about availability of the hospital’s discount payment and charity care policies, including information about eligibility, as well as contact information for a hospital employee or office from which the person may obtain further information about these policies. The notice shall also include the internet address for the Health Consumer Alliance (https://healthconsumer.org), and shall explain that there are organizations that will help the patient understand the billing and payment process, as well as information regarding Covered California and Medi-Cal presumptive eligibility, if the hospital participates in the presumptive eligibility program. The notice shall also include the internet address for the hospital’s list of shoppable services, pursuant to Section 180.60 of Title 45 of the Code of Federal Regulations. This written notice shall be provided in addition to the estimate provided pursuant to Section 1339.585. The notice shall also be provided to patients who receive emergency or outpatient care and who may be billed for that care, but who were not admitted. The notice shall be provided in English, and in languages other than English. The languages to be provided shall be determined in a manner similar to that required pursuant to Section 12693.30 of the Insurance Code. Written correspondence to the patient required by this article shall also be in the language spoken by the patient, consistent with Section 12693.30 of the Insurance Code and applicable state and federal law. (b) The written notice shall be provided at the time of service if the patient is conscious and able to receive written notice at that time. If the patient is not able to receive notice at the time of service, the notice shall be provided during the discharge process. If the patient is not admitted, the written notice shall be provided when the patient leaves the facility. If the patient leaves the facility without receiving the written notice, the hospital shall mail the notice to the patient within 72 hours of providing services. (c) Notice of the hospital’s policy for financially qualified and self-pay patients shall be clearly and conspicuously posted in locations that are visible to the public, including, but not limited to, all of the following: (1) Emergency department, if any. (2) Billing office. (3) Admissions office. (4) Other outpatient settings, including observation units. (5) Prominently displayed on the hospital’s internet website, with a link to the policy itself. (d) With the exception of emergency room visits, a hospital may provide the written notice described in this section in either hard copy or using the patient’s preferred electronic notification method if the patient has previously consented to receive clinical or nonclinical electronic communications about their health care services. The written notice related to an emergency room visit shall be provided to the patient in hard copy. If the notice is provided electronically, the notice shall be sent separately from any other electronic communications sent to the patient and shall prominently indicate in the subject line that the notice is related to the hospital’s discount payment and charity care policies. (Amended by Stats. 2025, Ch. 243, Sec. 6. (SB 862) Effective January 1, 2026.)
  127. 127420.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must try to learn whether a patient has coverage that may pay for care, and in certain billing situations must give the patient a clear notice and help with coverage or charity-care applications.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127420. (a) Each hospital shall make all reasonable efforts to obtain from the patient or the patient’s representative information about whether private or public health insurance or sponsorship may fully or partially cover the charges for care rendered by the hospital to a patient, including, but not limited to, any of the following: (1) Private health insurance, including coverage offered through the California Health Benefit Exchange. (2) Medicare. (3) The Medi-Cal program, the California Children’s Services program, or other state-funded programs designed to provide health coverage. (b) If a hospital bills a patient who has not provided proof of coverage by a third party at the time the care is provided or upon discharge, as a part of that billing, the hospital shall provide the patient with a clear and conspicuous notice that includes all of the following: (1) A statement of charges for services rendered by the hospital. (2) A request that the patient inform the hospital if the patient has health insurance coverage, Medicare, Medi-Cal, or other coverage. (3) A statement that, if the consumer does not have health insurance coverage, the consumer may be eligible for Medicare, Medi-Cal, coverage offered through the California Health Benefit Exchange, California Children’s Services program, other state- or county-funded health coverage, or charity care. (4) A statement indicating how patients may obtain applications for the Medi-Cal program, coverage offered through the California Health Benefit Exchange, or other state- or county-funded health coverage programs and that the hospital will provide these applications. The hospital shall also provide patients with a referral to a local consumer assistance center housed at legal services offices. If the patient does not indicate coverage by a third-party payer specified in subdivision (a) or requests a discounted price or charity care, then the hospital shall provide an application for the Medi-Cal program or other state- or county-funded health coverage programs. This application shall be provided prior to discharge if the patient has been admitted or to patients receiving emergency or outpatient care. (5) Information regarding the financially qualified patient and charity care application, including the following: (A) A statement that indicates that if the patient lacks, or has inadequate, insurance, and meets certain low- and moderate-income requirements, the patient may qualify for discounted payment or charity care. (B) The name and telephone number of a hospital employee or office from whom or which the patient may obtain information about the hospital’s discount payment and charity care policies, and how to apply for that assistance. (C) If a patient applies, or has a pending application, for another health coverage program at the same time that the patient applies for a hospital charity care or discount payment program, neither application shall preclude eligibility for the other program. (Amended by Stats. 2021, Ch. 473, Sec. 9. (AB 1020) Effective January 1, 2022.)
  128. 127425.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals face detailed limits on selling and collecting patient debt, including notice, recordkeeping, payment-plan, and collection restrictions.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127425. (a) A hospital shall not sell patient debt to a debt buyer, as defined in Section 1788.50 of the Civil Code, unless all of the following apply: (1) The hospital has found the patient ineligible for financial assistance or the patient has not responded to any attempts to bill or offer financial assistance for 180 days. (2) The hospital includes contractual language in the sales agreement in which the debt buyer agrees to return, and the hospital agrees to accept, any account in which the balance has been determined to be incorrect due to the availability of a third-party payer, including a health plan or government health coverage program, or the patient is eligible for charity care or financial assistance. (3) The debt buyer agrees to not resell or otherwise transfer the patient debt, except to the originating hospital or a tax-exempt organization described in Section 127444, or if the debt buyer is sold or merged with another entity. (4) The debt buyer agrees not to charge interest or fees on the patient debt. (5) The debt buyer is licensed as a debt collector by the Department of Financial Protection and Innovation. (b) A hospital shall have a written policy about when and under whose authority patient debt is advanced for collection, whether the collection activity is conducted by the hospital, an affiliate or subsidiary of the hospital, or by an external collection agency, or debt buyer. (c) A hospital shall establish a written policy defining standards and practices for the collection of debt, and shall obtain a written agreement from any agency that collects hospital receivables that it will adhere to the hospital’s standards and scope of practices. This agreement shall require the affiliate, subsidiary, debt buyer, or external collection agency of the hospital that collects the debt to comply with the hospital’s definition and application of a reasonable payment plan, as defined in subdivision (i) of Section 127400. The policy shall not conflict with other applicable laws and shall not be construed to create a joint venture between the hospital and the external entity, or otherwise to allow hospital governance of an external entity that collects hospital receivables. In determining the amount of a debt a hospital may seek to recover from patients who are eligible under the hospital’s charity care policy or discount payment policy, the hospital may consider only income as limited by Section 127405. (d) At time of billing, a hospital shall provide a written summary consistent with Section 127410, which includes the same information concerning services and charges provided to all other patients who receive care at the hospital. (e) Before assigning a bill to collections, or selling patient debt to a debt buyer, a hospital shall send a patient a notice with all of the following information: (1) The date or dates of service of the bill that is being assigned to collections or sold. (2) The name of the entity the bill is being assigned or sold to. (3) A statement informing the patient how to obtain an itemized hospital bill from the hospital. (4) The name and plan type of the health coverage for the patient on record with the hospital at the time of services or a statement that the hospital does not have that information. (5) An application for the hospital’s charity care and financial assistance. (6) The date or dates the patient was originally sent a notice about applying for financial assistance, the date or dates the patient was sent a financial assistance application, and, if applicable, the date a decision on the application was made. (f) A hospital, any assignee of the hospital, or other owner of the patient debt, including a collection agency or debt buyer, shall not do either of the following: (1) Report adverse information to a consumer credit reporting agency. (2) Commence civil action against the patient for nonpayment before 180 days after initial billing. (g) If a patient is attempting to qualify for eligibility under the hospital’s charity care or discount payment policy and is attempting in good faith to settle an outstanding bill with the hospital by negotiating a reasonable payment plan or by making regular partial payments of a reasonable amount, the hospital shall not send the unpaid bill to any collection agency, debt buyer, or other assignee, unless that entity has agreed to comply with this article. (h) (1) The hospital or other assignee that is an affiliate or subsidiary of the hospital shall not, in dealing with patients eligible under the hospital’s charity care or discount payment policies, use wage garnishments or liens on any real property as a means of collecting unpaid hospital bills. (2) A collection agency, debt buyer, or other assignee that is not a subsidiary or affiliate of the hospital shall not, in dealing with any patient under the hospital’s charity care or discount payment policies, use as a means of collecting unpaid hospital bills, any of the following: (A) A wage garnishment, except by order of the court upon noticed motion, supported by a declaration filed by the movant identifying the basis for which it believes that the patient has the ability to make payments on the judgment under the wage garnishment, which the court shall consider in light of the size of the judgment and additional information provided by the patient before or at the hearing concerning the patient’s ability to pay, including information about probable future medical expenses based on the current condition of the patient and other obligations of the patient. (B) Notice or conduct a sale of any real property owned, in part or completely, by the patient. (C) Liens on any real property. (3) This requirement does not preclude a hospital, collection agency, debt buyer, or other assignee from pursuing reimbursement and any enforcement remedy or remedies from third-party liability settlements, tortfeasors, or other legally responsible parties. (i) Extended payment plans offered by a hospital to assist patients eligible under the hospital’s charity care policy, discount payment policy, or any other policy adopted by the hospital for assisting low-income patients with no insurance or high medical costs in settling outstanding past due hospital bills, shall be interest free. The hospital extended payment plan may be declared no longer operative after the patient’s failure to make all consecutive payments due during a 90-day period. Before declaring the hospital extended payment plan no longer operative, the hospital, collection agency, debt buyer, or assignee shall make a reasonable attempt to contact the patient by telephone and, to give notice in writing, that the extended payment plan may become inoperative, and of the opportunity to renegotiate the extended payment plan. Before the hospital extended payment plan being declared inoperative, the hospital, collection agency, debt buyer, or assignee shall attempt to renegotiate the terms of the defaulted extended payment plan, if requested by the patient. The hospital, collection agency, debt buyer, or assignee shall not commence a civil action against the patient or responsible party for nonpayment before the time the extended payment plan is declared to be no longer operative. For purposes of this section, the notice and telephone call to the patient may be made to the last known telephone number and address of the patient. (j) (1) A hospital shall maintain all records relating to money owed to the hospital by a patient or a patient’s guarantor for five years, including, but not limited to, all of the following: (A) Documents related to litigation filed by the hospital. (B) A contract and significant related records by which a hospital assigns or sells medical debt to a third party. (C) A list, updated at least annually, of every person, including the person’s name and contact information, that meets at least one of the following criteria: (i) The person is a debt collector to whom the hospital sold or assigned a debt that a patient of the hospital owed the hospital. (ii) The person is retained by the hospital to pursue litigation for debts owed by patients on behalf of the hospital. (2) Any contract entered into by a hospital related to the assignment or sale of medical debt shall require the assignee or buyer and any subsequent assignee or buyer to maintain records related to litigation for five years. (3) For purposes of this subdivision, “debt collector” and “person” have the same meanings as defined in Section 1788.2 of the Civil Code. (k) This section does not diminish or eliminate any protections consumers have under existing federal and state debt collection laws, or any other consumer protections available under state or federal law. If the patient fails to make all consecutive payments for 90 days and fails to renegotiate a payment plan, this subdivision does not limit or alter the obligation of the patient to make payments on the obligation owing to the hospital pursuant to any contract or applicable statute from the date that the extended payment plan is declared no longer operative, as set forth in subdivision (i). (Amended by Stats. 2024, Ch. 520, Sec. 10.5. (SB 1061) Effective January 1, 2025.)
  129. 127426.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    The period in Section 127425 is extended if the patient has a pending coverage appeal and makes a reasonable effort to keep the hospital informed, until the appeal is finally decided.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127426. (a) The period described in Section 127425 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of that appeal is made, if the patient makes a reasonable effort to communicate with the hospital about the progress of any pending appeals. (b) For purposes of this section, “pending appeal” includes any of the following: (1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code. (2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code. (3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code. (4) An appeal regarding Medicare coverage consistent with federal law and regulations. (Added by Stats. 2006, Ch. 755, Sec. 1. Effective January 1, 2007.)
  130. 127430.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Before starting collection activity against a patient, the hospital or the debt holder must give the patient a clear written notice with required debt-collection rights information and a nonprofit credit-counseling statement.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127430. (a) Prior to commencing collection activities against a patient, the hospital, any assignee of the hospital, or other owner of the patient debt, including a collection agency, shall provide the patient with a clear and conspicuous written notice containing both of the following: (1) A plain language summary of the patient’s rights pursuant to this article, the Rosenthal Fair Debt Collection Practices Act (Title 1.6C (commencing with Section 1788) of Part 4 of Division 3 of the Civil Code), and the federal Fair Debt Collection Practices Act (Subchapter V (commencing with Section 1692) of Chapter 41 of Title 15 of the United States Code). The summary shall include a statement that the Federal Trade Commission enforces the federal act. The summary shall be sufficient if it appears in substantially the following form: “State and federal law require debt collectors to treat you fairly and prohibit debt collectors from making false statements or threats of violence, using obscene or profane language, and making improper communications with third parties, including your employer. Except under unusual circumstances, debt collectors may not contact you before 8:00 a.m. or after 9:00 p.m. In general, a debt collector may not give information about your debt to another person, other than your attorney or spouse. A debt collector may contact another person to confirm your location or to enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission by telephone at 1-877-FTC-HELP (382-4357) or online at www.ftc.gov.” (2) A statement that nonprofit credit counseling services may be available in the area. (b) The notice required by subdivision (a) shall also accompany any document indicating that the commencement of collection activities may occur. (c) The requirements of this section shall apply to the entity engaged in the collection activities. If a hospital assigns or sells the debt to another entity, the obligations shall apply to the entity, including a collection agency, engaged in the debt collection activity. (Amended by Stats. 2007, Ch. 347, Sec. 4. Effective January 1, 2008.)
  131. 127435.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must give the department specified pricing and charity-care policy documents, and the department must publish them online; patients cannot be denied financial assistance available under the website policy when they were first billed.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127435. (a) A hospital shall provide to the department a copy of its discount payment policy, charity care policy, eligibility procedures for those policies, review process, and the application for charity care or discounted payment programs, as well as a copy of its debt collection policy. The department may determine whether the information is to be provided electronically or in some other similar manner. The information shall be provided at least biennially on January 1, or when a significant change is made. If no significant change has been made by the hospital since the information was previously provided, notifying the department of the lack of change shall meet the requirements of this section. The department shall make this information available to the public on its internet website. (b) The department shall review a hospital’s policy for compliance with this article by January 1, 2023, and whenever a significant change is made and submitted to the department. (c) A patient shall not be denied financial assistance that would be available pursuant to the policy published on the department’s internet website at the time the patient was first billed. (Amended by Stats. 2024, Ch. 511, Sec. 6. (AB 2297) Effective January 1, 2025.)
  132. 127436.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    The director must investigate certain patient complaints and can impose administrative penalties on hospitals that violate this article.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127436. (a) Upon promulgation of regulations as required in subdivisions (b) and (c) no later than January 1, 2024, the Director of the Department of Health Care Access and Information shall impose an administrative penalty for each violation against a hospital that fails to comply with this article, unless the administrative penalty is waived or reduced by the department in the interest of fairness. For purposes of this section, multiple violations identified during the same investigation shall constitute a single violation for purposes of assessing an administrative penalty. (b) Upon receipt of a complaint by a patient that a hospital has not followed the requirements of Sections 127405 to 127435, inclusive, the director shall do all of the following: (1) Review the patient’s eligibility for charity care or financial assistance under the hospital’s published financial assistance policy in effect at the time the patient was first billed. (2) Review the hospital’s compliance with this article. (3) If, after completing the actions in paragraphs (1) and (2), the director believes that the hospital may have violated this article, issue a notice to the hospital describing the alleged violation. The notice shall state all of the facts supporting the alleged violation. The hospital shall have 30 days after issuance of the notice to file a response with the director. (4) If, after considering all of the information included in any response filed by the hospital, the director determines that a violation has occurred, assess an administrative penalty. The administrative penalty may be up to forty thousand dollars ($40,000), which amount shall be adjusted every five years to reflect the percentage change in the calendar year average, for the five-year period, of the medical care index of the Consumer Price Index, as published by the United States Bureau of Labor Statistics. The department shall promulgate regulations establishing criteria to determine the amount of an administrative penalty. The criteria shall include, at a minimum, all of the following: (A) The actual financial harm to patients, if any. (B) The nature, scope, and severity of the violation, including whether the hospital’s policies, postings, and screening practices are in compliance with Sections 127405 to 127435, inclusive, or whether the violation was a mistake that resulted in a violation of those policies and practices. (C) The facility’s history of compliance with related state and federal statutes and regulations. (D) Factors beyond the facility’s control that restrict the facility’s ability to comply with this chapter or the rules and regulations promulgated thereunder. (E) The demonstrated willfulness of the violation. (F) The extent to which the facility detected the violation and took steps to immediately correct the violation and prevent the violation from recurring. (G) The special circumstances of small and rural hospitals, as defined in Section 124840, if that consideration is needed to protect access to quality care in those hospitals. (5) Notify the patient of the violation and the patient’s right to reimbursement pursuant to Section 127440. (6) Begin collection efforts for the penalty after the deadline to appeal pursuant to subdivision (c) has passed, or, if the hospital files an appeal, when all appeals have been exhausted and the department’s findings have been upheld. (c) The department shall promulgate regulations to establish a process whereby a hospital may appeal the director’s determination that a violation has occurred or the amount of any penalty assessed, subject to the following requirements: (1) A hospital shall have 30 days from issuance to appeal any determination or penalty. (2) A hospital may submit any relevant evidence during the appeal process. (3) The department shall provide the patient who filed a complaint with timely notice of the appeal and a copy of any evidence submitted by the hospital, and offer the patient 30 days to submit a response, including any additional evidence in support of the complaint. (4) The department shall consider all relevant evidence. (5) The department may reduce or waive an assessment in the interest of fairness. (6) The department may reduce or waive a penalty if a violation was due to factors beyond the hospital’s control, such as a patient failing to provide accurate information or an unauthorized person removing signage from hospital walls. (Amended by Stats. 2024, Ch. 511, Sec. 7. (AB 2297) Effective January 1, 2025.)
  133. 127437.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Creates the Hospital Fair Pricing Penalties Fund in the State Treasury and directs certain administrative penalty money into it.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127437. The Hospital Fair Pricing Penalties Fund is created in the State Treasury. Any moneys collected from administrative penalties pursuant to this article shall be deposited into the fund. Upon appropriation by the Legislature, the department may use moneys from the fund to carry out this article. (Added by Stats. 2026, Ch. 27, Sec. 40. (SB 164) Effective June 29, 2026.)
  134. 127440.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals must reimburse patients for overpayments, including interest, and refund the patient within 30 days, but do not have to do so if the amount due is under $5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127440. (a) The hospital shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest. Interest owed by the hospital to the patient shall accrue at the rate set forth in Section 685.010 of the Code of Civil Procedure, beginning on the date payment by the patient is received by the hospital. However, a hospital is not required to reimburse the patient or pay interest if the amount due is less than five dollars ($5.00). The hospital shall refund the patient within 30 days. (b) The hospital may reimburse the patient, but is not required to do so, if the hospital or the department determines that a patient qualified for financial assistance at the time the patient was first billed and either of the following has occurred: (1) It has been five years or more since the last payment to the hospital, hospital assignee, or debt buyer. (2) The patient debt was sold to a debt buyer in accordance with state law in effect at the time the debt was sold, if sold before January 1, 2022. (c) This section does not diminish or eliminate any rights or responsibilities a hospital may have, nor any rights that a patient may have under existing federal and state laws, including, but not limited to, 26 CFR Sec. 1.501(r)-6. (Amended by Stats. 2024, Ch. 511, Sec. 8. (AB 2297) Effective January 1, 2025.)
  135. 127443.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    This section says the rights, remedies, and penalties in this article are cumulative and do not replace those available under other laws.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127443. The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under other laws. (Added by Stats. 2006, Ch. 755, Sec. 1. Effective January 1, 2007.)
  136. 127444.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Hospitals may keep using their charge schedules and may transfer patient debt in certain ways, but health plans, insurers, and others may not cut reimbursement because a hospital waived patient bills under charity care or discount policies.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127444. (a) This article does not prohibit a hospital from uniformly imposing charges from its established charge schedule or published rates or preclude the recognition of a hospital’s established charge schedule or published rates for purposes of applying any payment limit, interim payment amount, or other payment calculation based upon a hospital’s rates or charges under the Medi-Cal program, the Medicare Program, workers’ compensation, or other federal, state, or local public program of health benefits. (b) This article does not prohibit a hospital, debt collector, or debt buyer from selling or otherwise transferring patient debt to an organization that is exempt from taxation under Section 501(c)(3) of the Internal Revenue Code for the explicit purpose of the tax-exempt organization abolishing the patient debt by cancellation of the indebtedness, or otherwise prohibit payment of the patient’s debt by a third party. (c) A health care service plan, insurer, or any other person shall not reduce the amount it would otherwise reimburse a claim for hospital services because a hospital has waived, or will waive, collection of all or a portion of a patient’s bill for hospital services in accordance with the hospital’s charity care or discount payment policy, notwithstanding any contractual provision. (Amended by Stats. 2021, Ch. 473, Sec. 14. (AB 1020) Effective January 1, 2022.)
  137. 127445.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    Money paid for services under a hospital discounted-payment or charity-care policy does not count as the hospital’s usual or published charges for certain payment-limit calculations.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127445. Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under a hospital’s discounted payment or charity care policy shall not constitute a hospital’s uniform, published, prevailing, or customary charges, its usual fees to the general public, or its charges to non-Medi-Cal purchasers under comparable circumstances, and shall not be used to calculate a hospital’s median non-Medicare or Medi-Cal charges, for purposes of any payment limit under the federal Medicare Program, the Medi-Cal program, or any other federal or state-financed health care program. (Added by Stats. 2006, Ch. 755, Sec. 1. Effective January 1, 2007.)
  138. 127446.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. )

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    If a federal determination means a hospital’s charge schedule or published rates are not customary or prevailing, the affected requirement becomes inoperative for general acute care hospitals, and the State Department of Public Health must seek federal guidance on modifications.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 1. Hospital Fair Pricing Policies [127400 - 127446] ( Heading of Article 1 renumbered from Article 3 (of Chapter 2) by Stats. 2010, Ch. 445, Sec. 2. ) ## 127446. To the extent that any requirement of Section 127400, 127401, or 127405 results in a federal determination that a hospital’s established charge schedule or published rates are not the hospital’s customary or prevailing charges for services, the requirement in question shall be inoperative for all general acute care hospitals, including, but not limited to, a hospital that is licensed to and operated by a county or a hospital authority established pursuant to Section 101850. The State Department of Public Health shall seek federal guidance regarding modifications to the requirement in question. All other requirements of this article shall remain in effect. (Amended by Stats. 2007, Ch. 483, Sec. 36. Effective January 1, 2008.)
  139. 127450.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    This section defines key terms used for emergency physician fair pricing policies, including financially qualified patient, emergency care, hospital, self-pay patient, high medical costs, and reasonable payment formula.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127450. As used in this article, the following terms have the following meanings: (a) “Allowance for financially qualified patient” means, with respect to emergency care rendered to a financially qualified patient, an allowance that is applied after the emergency physician’s charges are imposed on the patient, due to the patient’s determined financial inability to pay the charges. (b) “Emergency care” means emergency medical services and care, as defined in Section 1317.1, that is provided by an emergency physician in the emergency department of a hospital. (c) “Emergency physician” means a physician and surgeon licensed pursuant to Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code who is credentialed by a hospital and either employed or contracted by the hospital to provide emergency medical services in the emergency department of the hospital, except that an “emergency physician” shall not include a physician specialist who is called into the emergency department of a hospital or who is on staff or has privileges at the hospital outside of the emergency department. (d) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under authority of subsection (2) of Section 9902 of Title 42 of the United States Code. (e) “Financially qualified patient” means a patient who is both of the following: (1) A patient who is a self-pay patient or a patient with high medical costs. (2) A patient who has a family income that does not exceed 400 percent of the federal poverty level. (f) “Hospital” means a facility that is required to be licensed under subdivision (a) of Section 1250, except a facility operated by the State Department of State Hospitals, the State Department of Developmental Services, or the Department of Corrections and Rehabilitation. (g) “Department” means the Department of Health Care Access and Information. (h) “Self-pay patient” means a patient who does not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid, and whose injury is not a compensable injury for purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by the emergency physician. Self-pay patients may include charity care patients. (i) “A patient with high medical costs” means a person whose family income does not exceed 400 percent of the federal poverty level if that individual does not receive a discounted rate from the emergency physician as a result of their third-party coverage. For these purposes, “high medical costs” means any of the following: (1) Annual out-of-pocket costs incurred by the individual at the hospital that provided emergency care that exceed 10 percent of the patient’s family income in the prior 12 months. Out-of-pocket costs means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. (2) Annual out-of-pocket expenses that exceed 10 percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months. Out-of-pocket expenses means any expenses for medical care that are not reimbursed by insurance or a health coverage program, such as Medicare copays or Medi-Cal cost sharing. The emergency physician may waive the request for documentation. (3) A lower level determined by the emergency physician in accordance with the emergency physician’s discounted payment policy. (j) “Patient’s family” means the following: (1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act, whether living at home or not. (2) For persons under 18 years of age or for a dependent child 18 to 20 years of age, inclusive, parent, caretaker relatives, and parent’s or caretaker relatives’ other dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act. (k) “Reasonable payment formula” means monthly payments that are not more than 10 percent of a patient’s family income for a month, excluding deductions for essential living expenses. “Essential living expenses” means, for purposes of this subdivision, expenses for all of the following: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas, and repairs, installment payments, laundry and cleaning, and other extraordinary expenses. (Amended by Stats. 2024, Ch. 511, Sec. 9. (AB 2297) Effective January 1, 2025.)
  140. 127451.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    A violation of this article is not treated as a violation of a physician and surgeon’s licensure terms.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127451. A violation of this article shall not constitute a violation of the terms of a physician and surgeon’s licensure. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  141. 127452.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Emergency physicians must limit expected charges for eligible low-income patients, stop billing if they seek Maddy Fund reimbursement, and cannot impose application time limits or use income documentation for collections.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127452. (a) Uninsured patients or patients with high medical costs who are at or below 400 percent of the federal poverty level shall be eligible to apply to an emergency physician for a discount payment pursuant to a discount payment policy. Notwithstanding any other provision of this article, an emergency physician may choose to grant eligibility for a discount payment policy to patients with incomes over 400 percent of the federal poverty level. (b) An emergency physician shall limit expected payment for services provided to a patient at or below 400 percent of the federal poverty level and who is eligible under the emergency physician’s discount payment policy to an amount that is no greater than 50 percent of the median of billed charges based on a nationally recognized database of physician and surgeon charges until the nonprofit FAIR Health, Inc. creates a database that makes available the rate of payment received by physician and surgeons from commercial insurers for the same services in the same or similar geographic region. When FAIR Health, Inc. makes available the rate of payment received by physicians and surgeons from commercial insurers for the same services in the same or similar geographic region, the amount of expected payment under this section shall be no greater than the median or average of rates paid by commercial insurers for the same or similar services in the same or similar geographic region. (c) (1) If an emergency physician seeks reimbursement from the Maddy Fund pursuant to Section 1797.98c, then the emergency physician shall, at that time, cease any further billing or collection activity for that patient. (2) If the emergency physician does not receive reimbursement from the Maddy Fund after attempting to obtain reimbursement from the Maddy Fund, then the provisions of this article shall apply. (3) If the emergency physician does not attempt to seek reimbursement from the Maddy Fund, the provisions of this article shall apply. (d) A patient, or patient’s legal representative, who requests a discounted payment or other assistance in meeting their financial obligation to the emergency physician shall make every reasonable effort to provide the emergency physician with documentation of income and health benefits coverage, if the emergency physician requests the documentation. If the patient, or the patient’s legal representative, requests a discounted payment and fails to provide information that is reasonable and necessary for the emergency physician to make a determination, the emergency physician may consider that failure in making its determination. (1) For purposes of determining eligibility for discounted payment, the emergency physician may rely on the determination made by the hospital at which emergency care was provided. If the emergency physician chooses to make a separate determination of eligibility for discounted payment, documentation of income shall be limited to recent pay stubs or income tax returns. The emergency physician, at their discretion, may accept self-attestation by a patient, or a patient’s legal representative, but shall not request documentation of income other than that authorized in this paragraph. (2) Information obtained pursuant to paragraph (1) shall not be used for collections activities. This paragraph does not prohibit the use of information obtained by the emergency physician, collection agency, or assignee independent of the eligibility process for discounted payment. (3) Eligibility for discounted payments shall be determined at any time the emergency physician is in receipt of information specified in paragraph (1). An emergency physician shall not impose time limits for applying for discount payments, nor deny eligibility based on the timing of a patient’s application. (e) An emergency physician may waive or reduce Medi-Cal and Medicare cost-sharing amounts as part of their discount payment program. (Amended by Stats. 2024, Ch. 511, Sec. 10. (AB 2297) Effective January 1, 2025.)
  142. 127454.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Emergency physicians must try to find out whether a patient has insurance or other coverage, and must give a clear billing notice with specified information when billing a patient without proof of third-party coverage.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127454. (a) Each emergency physician shall make all reasonable efforts to obtain from the patient, or his or her representative, information about whether private or public health insurance or sponsorship may fully or partially cover the charges for emergency care rendered by the emergency physician to a patient, including, but not limited to, any of the following: (1) Private health insurance, including coverage offered through the California Health Benefit Exchange. (2) Medicare. (3) The Medi-Cal program, the Healthy Families Program, the California Children’s Services program, or other state- or county-funded programs designed to provide comprehensive health coverage. (b) If the emergency physician or his or her representative bills a patient who has not provided proof of coverage by a third party at the time the care is provided or upon discharge, as a part of that billing, the emergency physician shall provide the patient with a clear and conspicuous notice that includes all of the following: (1) A statement of charges for services rendered by the emergency physician. (2) A request that the patient inform the emergency physician if the patient has health insurance coverage, Medicare, Healthy Families Program, Medi-Cal, or other coverage. (3) A statement that if the consumer does not have health insurance coverage, the consumer may be eligible for Medicare, Healthy Families Program, Medi-Cal, coverage through the California Health Benefit Exchange, California Children’s Services program, other state- or county-funded health coverage, or discounted payment care. (4) Information regarding the financially qualified patient and discounted payment application, including the following: (A) A statement that indicates that if the patient lacks, or has inadequate, insurance, and meets certain low- and moderate-income requirements, the patient may qualify for discounted payment. That statement shall also provide patients with a referral to a local consumer assistance center housed at legal services offices. (B) The name and telephone number of the emergency physician’s employee or office from whom or which the patient may obtain information about the emergency physician’s discount payment policy, and how to apply for that assistance. (C) If a patient applies, or has a pending application for, another health coverage program at the same time that he or she applies for charity care or a discount payment program, neither application shall preclude eligibility for the other program. (c) (1) In addition to the statement of the charges, if the emergency physician uses the following notice in any billing, that emergency physician shall be deemed to have complied with the notice requirements of this section: “If you are uninsured or have high medical costs, please contact ____ (name of person responsible for discount payment policy) at ____ (area code and phone number) for information on discounts and programs for which you may be eligible, including the Medi-Cal program. If you have coverage, please tell us so that we may bill your plan.” (2) If the emergency physician or the assignee of the emergency physician lacks the capacity to provide the notice specified in paragraph (1), the emergency physician or his or her assignee shall be deemed to have complied with the notice requirements of this section if the information required under this section is provided upon request and if the following is printed on the bill in 14-point bold type: “If uninsured or high medical bill, call re: discount.” (Amended by Stats. 2014, Ch. 758, Sec. 6. (SB 1276) Effective January 1, 2015.)
  143. 127455.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Emergency physicians must keep written billing and collection policies and restrict certain collection actions and credit reporting for eligible patients and extended payment plans.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127455. (a) Each emergency physician shall have a written policy about when and under whose authority patient debt is advanced for collection. (b) Each emergency physician shall establish a written policy defining standards and practices for the collection of debt, and shall obtain a written agreement from any agency that collects emergency physician receivables that it will adhere to the emergency physician’s standards and scope of practice. This agreement shall require the affiliate, subsidiary, or external collection agency of the physician that collects the debt to comply with the physician’s definition and application of a reasonable payment formula, as defined in subdivision (k) of Section 127450. The policy shall not conflict with other applicable laws and shall not be construed to create a joint venture between the emergency physician and the external entity, or otherwise to allow physician and surgeon governance of an external entity that collects physician and surgeon receivables. In determining the amount of a debt the emergency physician may seek to recover from patients who are eligible under the emergency physician’s charity care policy or discount payment policy, the emergency physician may consider only income as limited by Section 127452. (c) For a patient that lacks coverage, or for a patient that provides information that they may be a patient with high medical costs, the emergency physician, an assignee of the emergency physician, or other owner of the patient debt, including a collection agency, shall not report adverse information to a consumer credit reporting agency or commence civil action against the patient for nonpayment at any time before 150 days after initial billing. (d) If a patient is attempting to qualify for eligibility under the emergency physician’s discount payment policy and is attempting in good faith to settle an outstanding bill with the physician and surgeon by negotiating an extended payment plan, the emergency physician or their assignee, including a collection agency, shall not report adverse information to a consumer credit agency or commence a civil action. (e) (1) The emergency physician or other assignee shall not, in dealing with patients eligible under the emergency physician’s discount payment policies, use wage garnishments or liens on any real property as a means of collecting unpaid emergency physician bills. (2) A collection agency or other assignee shall not, in dealing with any patient under the emergency physician’s discount payment policy, use as a means of collecting unpaid emergency physician bills, any of the following: (A) A wage garnishment, except by order of the court upon noticed motion, supported by a declaration filed by the movant identifying the basis for its belief that the patient has the ability to make payments on the judgment under the wage garnishment, that the court shall consider in light of the size of the judgment and additional information provided by the patient before or at the hearing concerning the patient’s ability to pay, including information about probable future medical expenses based on the current condition of the patient and other obligations of the patient. (B) Notice or conduct a sale of any real property owned, in part or completely, by the patient. (C) Liens on any real property. (3) This requirement does not preclude the emergency physician, collection agency, or other assignee from pursuing reimbursement and any enforcement remedy or remedies from third-party liability settlements, tortfeasors, or other legally responsible parties. (f) Extended payment plans offered by an emergency physician to assist patients eligible under the emergency physician’s discount payment policy or any other policy adopted by the emergency physician for assisting low-income patients with no insurance or high medical costs in settling outstanding past due emergency physician bills, shall be interest free. The emergency physician’s extended payment plan may be declared no longer operative after the patient’s failure to make all consecutive payments due during a 90-day period. Before declaring the emergency physician’s extended payment plan no longer operative, the emergency physician, collection agency, or assignee shall make a reasonable attempt to contact the patient by telephone, if the telephone number is known, and to give notice in writing that the extended payment plan may become inoperative, and of the opportunity to renegotiate the extended payment plan. Before the emergency physician’s extended payment plan being declared inoperative, the emergency physician, collection agency, or assignee shall attempt to renegotiate the terms of the defaulted extended payment plan, if requested by the patient. If the patient wishes to renegotiate the terms of the defaulted extended payment plan but no agreement can be reached on the amount of the payment, the emergency physician or their assignee shall apply the reasonable payment formula in subdivision (k) of Section 127450 to determine a monthly payment amount for a subsequent extended payment plan. If the reasonable payment formula would result in a payment of less than ten dollars ($10) a month, the subsequent extended payment plan shall be ten dollars ($10) per month. The emergency physician, collection agency, or assignee shall not report adverse information to a consumer credit reporting agency or commence a civil action against the patient or responsible party for nonpayment before the time the extended payment plan is declared to be no longer operative. If after having defaulted on an extended payment plan the patient has entered into another extended payment plan with payments in the amount of either the reasonable payment formula or ten dollars ($10) per month and the patient fails to make all consecutive payments due during a 90-day period, that extended payment plan is inoperative. For purposes of this section, the notice and telephone call to the patient may be made to the last known telephone number and address of the patient. (g) For purposes of determining the reasonable payment formula in subdivision (k) of Section 127450, the emergency physician or their assignee may rely on the determination of family income and essential living expenses made by the hospital at which emergency care was provided. The emergency physician or their assignee, at their discretion, may accept self-attestation of family income and essential living expenses by a patient or a patient’s legal representative. (h) This section shall not be construed to diminish or eliminate any protections consumers have under existing federal and state debt collection laws, or any other consumer protections available under state or federal law. If the patient fails to make all consecutive payments for 90 days and fails to renegotiate a payment plan, this subdivision does not limit or alter the obligation of the patient to make payments on the obligation owing to the emergency physician pursuant to any contract or applicable statute from the date that the extended payment plan is declared no longer operative, as set forth in subdivision (f). (Amended by Stats. 2024, Ch. 511, Sec. 11. (AB 2297) Effective January 1, 2025.)
  144. 127456.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    The period in Section 127455 is extended if the patient has a pending appeal for coverage and makes a reasonable effort to keep the emergency physician informed; the extension lasts until the appeal is finally determined.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127456. (a) The period described in Section 127455 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of that appeal is made, if the patient makes a reasonable effort to communicate with the emergency physician about the progress of any pending appeals. (b) For purposes of this section, “pending appeal” includes any of the following: (1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code. (2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code. (3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code. (4) An appeal regarding Medicare coverage consistent with federal law and regulations. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  145. 127457.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Before further collection activity on a patient debt, the emergency physician or related debt holder must give a clear written notice; until then, they may not report adverse information to a credit reporting agency or file a civil action.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127457. (a) After the period described in Section 127455, and upon the completion of appeals consistent with Section 127456, prior to commencing further collection activities against a patient, the emergency physician, any assignee of the emergency physician, or other owner of the patient debt, including a collection agency, shall not report adverse information to a consumer credit reporting agency or commence a civil action, until after the patient has been provided with a clear and conspicuous written notice containing both of the following: (1) A plain language summary of the patient’s rights pursuant to this article, the Rosenthal Fair Debt Collection Practices Act (Title 1.6C (commencing with Section 1788) of Part 4 of Division 3 of the Civil Code), and the federal Fair Debt Collection Practices Act (Subchapter V (commencing with Section 1692) of Chapter 41 of Title 15 of the United States Code). The summary shall include a statement that the Federal Trade Commission enforces the federal act. The summary shall be sufficient if it appears in substantially the following form: “State and federal law require debt collectors to treat you fairly and prohibit debt collectors from making false statements or threats of violence, using obscene or profane language, and making improper communications with third parties, including your employer. Except under unusual circumstances, debt collectors may not contact you before 8 a.m. or after 9 p.m. In general, a debt collector may not give information about your debt to another person, other than your attorney or spouse. A debt collector may contact another person to confirm your location or to enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission by telephone at 1-877-FTC-HELP (382-4357) or online at www.ftc.gov.” (2) A statement that nonprofit credit counseling services may be available in the area. (b) The notice required by subdivision (a) shall also accompany any document indicating that the commencement of collection activities may occur. (c) The requirements of this section shall apply to the entity engaged in reporting adverse information to a consumer credit reporting agency or commencing a civil action against the patient. If an emergency physician assigns or sells the debt to another entity, the obligations shall apply to the entity, including a collection agency, engaged in the debt collection activity. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  146. 127458.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    An emergency physician must refund overpayments to the patient, including interest, and must give the patient a credit for the amount due for at least 60 days; no reimbursement or interest is required if the amount due is under $5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127458. The emergency physician shall reimburse the patient or patients any amount actually paid in excess of the amount due under this article, including interest. Interest owed by the emergency physician to the patient shall accrue at the rate set forth in Section 685.010 of the Code of Civil Procedure, beginning on the date payment by the patient is received by the emergency physician. However, an emergency physician is not required to reimburse the patient or pay interest if the amount due is less than five dollars ($5). The emergency physician shall give the patient a credit for the amount due for at least 60 days from the date the amount is due. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  147. 127459.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    The article’s rights, remedies, and penalties are cumulative and do not replace other laws’ rights, remedies, or penalties.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127459. The rights, remedies, and penalties established by this article are cumulative, and shall not supersede the rights, remedies, or penalties established under other laws. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  148. 127460.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Emergency physicians may charge from their established schedules or published rates, and health care service plans, insurers, and others may not cut reimbursement because the physician waived patient collection under a discount payment policy.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127460. Nothing in this article shall be construed to prohibit the emergency physician from uniformly imposing charges from its established charge schedule or published rates, nor shall this article preclude the recognition of an emergency physician’s established charge schedule or published rates for purposes of applying any payment limit, interim payment amount, or other payment calculation based upon an emergency physician’s rates or charges under the Medi-Cal program, the Medicare Program, workers’ compensation, or other federal, state, or local public program of health benefits. No health care service plan, insurer, or any other person shall reduce the amount it would otherwise reimburse a claim for emergency physician services because an emergency physician has waived, or will waive, collection of all or a portion of a patient’s bill for emergency physician services in accordance with the emergency physician’s discount payment policy, notwithstanding any contractual provision. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  149. 127461.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    Payments made for services under an emergency physician’s discounted payment policy cannot be treated as the physician’s standard or usual charges for certain health program payment-limit calculations.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127461. Notwithstanding any other provision of law, the amounts paid by parties for services resulting from reduced or waived charges under an emergency physician’s discounted payment policy shall not constitute an emergency physician’s uniform, published, prevailing, or customary charges, its usual fees to the general public, or its charges to non-Medi-Cal purchasers under comparable circumstances, and shall not be used to calculate an emergency physician’s median non-Medicare or non-Medi-Cal charges, for purposes of any payment limit under the federal Medicare Program, the Medi-Cal program, or any other federal or state-financed health care program. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  150. 127462.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. )

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    If a federal determination means an emergency physician’s schedule or published rates are not customary or prevailing charges, that requirement becomes inoperative for all emergency physicians, and the State Department of Public Health must seek federal guidance on modifications.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 2. Emergency Physician Fair Pricing Policies [127450 - 127462] ( Article 2 added by Stats. 2010, Ch. 445, Sec. 4. ) ## 127462. To the extent that any requirement of this article results in a federal determination that an emergency physician’s established charge schedule or published rates are not the physician and surgeon’s customary or prevailing charges for services, the requirement in question shall be inoperative for all emergency physicians. The State Department of Public Health shall seek federal guidance regarding modifications to the requirement in question. All other requirements of this article shall remain in effect. (Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
  151. 127470.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 3. Prescription Drug Pricing for Covered Entities [127470 - 127471] ( Article 3 added by Stats. 2023, Ch. 414, Sec. 1. )

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    This section defines key terms used in the article, including covered drug, covered entity, pharmacy benefit manager, and specified pharmacy.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 3. Prescription Drug Pricing for Covered Entities [127470 - 127471] ( Article 3 added by Stats. 2023, Ch. 414, Sec. 1. ) ## 127470. For purposes of this article: (a) “Covered drug” means a drug purchased by a covered entity that is subject to the federal pricing requirements set forth in Section 256b of Title 42 of the United States Code. (b) “Covered entity” means a provider defined as a covered entity in Section 256b of Title 42 of the United States Code. (c) “Pharmacy benefit manager” has the same meaning as defined in Section 4430 of the Business and Professions Code and includes a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager. (d) “Specified pharmacy” means a pharmacy owned by, or under contract with, a covered entity that is registered with the 340B discount drug purchasing program to dispense covered drugs on behalf of the covered entity, whether in person or via mail. (Added by Stats. 2023, Ch. 414, Sec. 1. (SB 786) Effective January 1, 2024.)
  152. 127471.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 3. Prescription Drug Pricing for Covered Entities [127470 - 127471] ( Article 3 added by Stats. 2023, Ch. 414, Sec. 1. )

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    A pharmacy benefit manager must not discriminate against covered entities or specified pharmacies, or interfere with covered drugs, pricing benefits, contracting, or complaints.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.5. Fair Pricing Policies [127400 - 127471] ( Chapter 2.5 heading added by Stats. 2010, Ch. 445, Sec. 1. ) ## ARTICLE 3. Prescription Drug Pricing for Covered Entities [127470 - 127471] ( Article 3 added by Stats. 2023, Ch. 414, Sec. 1. ) ## 127471. (a) A pharmacy benefit manager shall not impose any requirements, conditions, or exclusions that do either of the following: (1) Discriminate against a covered entity or a specified pharmacy in connection with dispensing covered drugs. (2) Prevent a covered entity from retaining the benefit of discounted pricing for the purchase of covered drugs. (b) Discrimination prohibited pursuant to subdivision (a) includes, but is not limited to, all of the following: (1) Payment terms, reimbursement methodologies, or other terms and conditions that distinguish between covered drugs and other drugs, account for the availability of discounts under the 340B discount drug purchasing program described in Section 256b of Title 42 of the United States Code in determining reimbursement, or are less favorable than the payment terms or reimbursement methodologies for similarly situated entities that are not furnishing or dispensing covered drugs. (2) Terms or conditions applied to covered entities or specified pharmacies based on the furnishing or dispensing of covered drugs or their status as a covered entity or specified pharmacy, including restrictions or requirements for participation in specialty, standard, or preferred pharmacy networks, or requirements related to the frequency or scope of audits. (3) Refusing to contract with or terminating a contract with a covered entity or specified pharmacy, or otherwise excluding a covered entity or specified pharmacy from a specialty, standard or preferred network, on the basis that the entity or pharmacy is a covered entity or a specified pharmacy or for reasons other than those that apply equally to entities or pharmacies that are not covered entities or specified pharmacies. (4) Retaliation against a covered entity or specified pharmacy based on its exercise of any right or remedy under this article. (5) Interfering with an individual’s choice to receive a covered drug from a covered entity or specified pharmacy, whether in person or via direct delivery, mail, or other form of shipment. (6) Restricting or prohibiting a covered entity from raising a grievance or speaking publicly about any pharmacy benefit manager that violates this subdivision or from filing a legal action against a pharmacy benefit manager for violating this subdivision. (c) This section does not apply to the Medi-Cal program or the federal Medicare Program but does apply to pharmacy benefit managers that contract with managed care organizations that serve Medi-Cal or Medicare members. (d) The provisions of this section shall not be waived, voided, or nullified by contract. (e) This article shall only be implemented to the extent that it is consistent with Section 256b of Title 42 of the United States Code or any rules or regulations adopted thereunder. (Added by Stats. 2023, Ch. 414, Sec. 1. (SB 786) Effective January 1, 2024.)
  153. 1275.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    The department must adopt, amend, or repeal necessary regulations, and the health planning office must adopt and enforce building-safety regulations for health facility physical plants.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275. (a) (1) The department shall adopt, amend, or repeal, in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code and Chapter 4 (commencing with Section 18935) of Part 2.5 of Division 13, any reasonable rules and regulations as may be necessary or proper to carry out the purposes and intent of this chapter and to enable the state department to exercise the powers and perform the duties conferred upon it by this chapter, not inconsistent with any other law including, but not limited to, the California Building Standards Law, Part 2.5 (commencing with Section 18901) of Division 13. (2) All regulations in effect on December 31, 1973, which were adopted by the State Board of Public Health, the State Department of Public Health, the State Department of Mental Hygiene, or the State Department of Health relating to licensed health facilities shall remain in full force and effect until altered, amended, or repealed by the director or pursuant to Section 25 or other provisions of law. (b) Notwithstanding this section or any other law, the Office of Statewide Health Planning and Development shall adopt and enforce regulations prescribing building standards for the adequacy and safety of health facility physical plants. (c) The building standards adopted by the State Fire Marshal, and the Office of Statewide Health Planning and Development pursuant to subdivision (b), for the adequacy and safety of freestanding physical plants housing outpatient services of a health facility licensed under subdivision (a) or (b) of Section 1250 shall not be more restrictive or comprehensive than the comparable building standards established, or otherwise made applicable, by the State Fire Marshal and the Office of Statewide Health Planning and Development to clinics and other facilities licensed pursuant to Chapter 1 (commencing with Section 1200). (d) Except as provided in subdivision (f), the licensing standards adopted by the department under subdivision (a) for outpatient services located in a freestanding physical plant of a health facility licensed under subdivision (a) or (b) of Section 1250 shall not be more restrictive or comprehensive than the comparable licensing standards applied by the department to clinics and other facilities licensed under Chapter 1 (commencing with Section 1200). (e) Except as provided in subdivision (f), the state agencies specified in subdivisions (c) and (d) shall not enforce any standard applicable to outpatient services located in a freestanding physical plant of a health facility licensed pursuant to subdivision (a) or (b) of Section 1250, to the extent that the standard is more restrictive or comprehensive than the comparable licensing standards applied to clinics and other facilities licensed under Chapter 1 (commencing with Section 1200). (f) All health care professionals providing services in settings authorized by this section shall be members of the organized medical staff of the health facility to the extent medical staff membership would be required for the provision of the services within the health facility. All services shall be provided under the respective responsibilities of the governing body and medical staff of the health facility. (g) (1) Notwithstanding any other law, the department may, without taking regulatory action pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, update references in the California Code of Regulations to health care standards of practice adopted by a recognized state or national association when the state or national association and its outdated standards are already named in the California Code of Regulations. When updating these references, the department shall: (A) Post notice of the department’s proposed adoption of the state or national association’s health care standards of practice on its Internet Web site for at least 45 days. The notice shall include the name of the state or national association, the title of the health care standards of practice, and the version of the updated health care standards of practice to be adopted. (B) Notify stakeholders that the proposed standards have been posted on the department’s Internet Web site by issuing a mailing to the most recent stakeholder list on file with the department’s Office of Regulations. (C) Submit to the Office of Administrative Law the notice required pursuant to this paragraph. The office shall publish in the California Regulatory Notice Register any notice received pursuant to this subparagraph. (D) Accept public comment for at least 30 days after the conclusion of the 45-day posting period specified in subparagraph (A). (2) If a member of the public requests a public hearing during the public comment period, a hearing shall be held and comments shall be considered prior to the adoption of the state or national association’s health care standards of practice. (3) If no member of the public requests a public hearing, the department shall consider any comments received during the public comment period prior to the adoption of the health care standards. (4) Written responses to public comments shall not be required. If public comments are submitted in opposition to the adoption of the proposed standards, or the state or national association named in the California Code of Regulations no longer exists, the department shall seek adoption of the standards using the regulatory process specified in Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. A state or national association named in the California Code of Regulations that has changed its name does not constitute an association that no longer exists. (5) If no opposition is received by the department, the department shall update its Internet Web site to notify the public that the standard has been adopted and the effective date of that standard. (h) For purposes of this section, “freestanding physical plant” means any building which is not physically attached to a building in which inpatient services are provided. (Amended by Stats. 2015, Ch. 435, Sec. 2. (AB 614) Effective January 1, 2016.)
  154. 1275.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Psychiatric health facility regulations must set safety, sanitation, staffing, service, and patient-treatment standards, and they must include certain patient protections and exemptions.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.1. (a) Notwithstanding any rules or regulations governing other health facilities, the regulations developed by the State Department of Health Care Services, or a predecessor, for psychiatric health facilities shall prevail. The regulations applying to psychiatric health facilities shall prescribe standards of adequacy, safety, and sanitation of the physical plant, of staffing with duly qualified licensed personnel, and of services based on the needs of the persons served thereby. (b) (1) The regulations shall include standards appropriate for treatment of three levels of disorder: (A) Involuntary ambulatory patients receiving treatment for a mental health disorder. (B) Voluntary ambulatory patients receiving treatment for a mental health disorder. (C) Involuntary ambulatory patients receiving treatment for a severe substance use disorder, as defined in subdivision (o) of Section 5008 of the Welfare and Institutions Code. (2) For purposes of this subdivision, “ambulatory patients” shall include, but not be limited to, persons who are deaf, blind, or have physical disabilities. Disoriented persons who are not bedridden or wheelchair users shall also be considered ambulatory patients. (c) The regulations shall not require, but may permit building and services requirements for hospitals which are only applicable to physical health care needs of patients that can be met in an affiliated hospital or in outpatient settings including, but not limited to, such requirements as surgical, dietary, laboratory, laundry, central supply, radiologic, and pharmacy. (d) The regulations shall include provisions for an “open planning” architectural concept. (e) The regulations shall exempt from seismic requirements all structures of Type V and of one-story construction. (f) Standards for involuntary patients shall include provisions to allow for restraint and seclusion of patients. These standards shall provide for adequate safeguards for patient safety and protection of patient rights. (g) The regulations shall provide for the retention by the psychiatric health facility of a consultant pharmacist, who shall supervise and review pharmaceutical services within the facility and perform any other services, including prevention of the unlawful diversion of controlled substances subject to abuse, as the State Department of Health Care Services may by regulation require. Regulations adopted pursuant to this subdivision shall take into consideration the varying bed sizes of psychiatric health facilities. (Amended by Stats. 2024, Ch. 644, Sec. 2. (SB 1238) Effective January 1, 2025.)
  155. 1275.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    State department regulations for chemical dependency recovery hospitals must set safety, staffing, sanitation, and service standards, include an open-planning design concept, and exempt freestanding structures from seismic requirements.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.2. (a) Notwithstanding any rules or regulations governing other health facilities, the regulations adopted by the state department for chemical dependency recovery hospitals shall prevail. The regulations applying to chemical dependency recovery hospitals shall prescribe standards of adequacy, safety, and sanitation of the physical plant, of staffing with duly qualified personnel, and of services based on the needs of the persons served thereby. (b) The regulations shall include provisions for an “open planning” architectural concept. (c) Notwithstanding the provisions of Chapter 1 (commencing with Section 15000) of Division 12.5, the regulations shall exempt from seismic requirements all freestanding structures of a chemical dependency recovery hospital. Chemical dependency recovery services provided as a supplemental service in general acute care beds or general acute psychiatric beds shall not be exempt from seismic requirements. (d) Regulations shall be developed pursuant to this section and presented for adoption at a public hearing within 180 days of the effective date of this section. (e) In order to assist in the rapid development of regulations for chemical dependency recovery hospitals, the director of the state department, not later than 30 days after the effective date of this section, shall convene an advisory committee composed of two representatives of the State Department of Health Care Services, one representative of the Office of Statewide Health Planning and Development, two persons with experience operating facilities with alcohol or medicinal drug dependency programs, and any other persons having a professional or personal nonfinancial interest in development of such regulations. The members of such advisory committee who are not state officers or employees shall pay their own expenses related to participation on the committee. The committee shall meet at the call of the director until such time as the proposed regulations are presented for adoption at public hearing. (Amended by Stats. 2013, Ch. 22, Sec. 14. (AB 75) Effective June 27, 2013. Operative July 1, 2013, by Sec. 110 of Ch. 22.)
  156. 1275.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    State health and developmental services departments must jointly issue licensing regulations for certain intermediate care facilities, and those regulations must cover resident services, assessments, community resource use, plan approval, physician consultation, and licensing fee schedules.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.3. (a) The State Department of Public Health and the State Department of Developmental Services shall jointly develop and implement licensing regulations appropriate for an intermediate care facility/developmentally disabled-nursing and an intermediate care facility/developmentally disabled-continuous nursing. (b) The regulations adopted pursuant to subdivision (a) shall ensure that residents of an intermediate care facility/developmentally disabled-nursing and an intermediate care facility/developmentally disabled-continuous nursing receive appropriate medical and nursing services, and developmental program services in a normalized, least restrictive physical and programmatic environment appropriate to individual resident need. In addition, the regulations shall do all of the following: (1) Include provisions for the completion of a clinical and developmental assessment of placement needs, including medical and other needs, and the degree to which they are being met, of clients placed in an intermediate care facility/developmentally disabled-nursing and an intermediate care facility/developmentally disabled-continuous nursing and for the monitoring of these needs at regular intervals. (2) Provide for maximum utilization of generic community resources by clients residing in a facility. (3) Require the State Department of Developmental Services to review and approve an applicant’s facility program plan as a prerequisite to the licensing and certification process. (4) Require that the physician providing the certification that placement in the intermediate care facility/developmentally disabled-nursing or intermediate care facility/developmentally disabled-continuous nursing is needed, consult with the physician who is the physician of record at the time the person’s proposed placement is being considered by the interdisciplinary team. (c) Regulations developed pursuant to this section shall include licensing fee schedules appropriate to facilities which will encourage their development. (d) Until the departments adopt regulations pursuant to this section relating to services by an intermediate care facility/developmentally disabled-nursing, the licensed intermediate care facility/developmentally disabled-nursing shall comply with federal certification standards for intermediate care facilities for individuals with intellectual disabilities, as specified in Sections 483.400 to 483.480, inclusive, of Title 42 of the Code of Federal Regulations, in effect immediately preceding January 1, 2018. (e) This section shall not supersede the authority of the State Fire Marshal pursuant to Sections 13113, 13113.5, 13143, and 13143.6 to the extent that these sections are applicable to community care facilities. (Amended by Stats. 2018, Ch. 34, Sec. 6. (AB 1810) Effective June 27, 2018.)
  157. 1275.4.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Each skilled nursing facility must adopt and implement an antimicrobial stewardship policy by January 1, 2017, and comply with this section.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.4. (a) On or before January 1, 2017, each skilled nursing facility, as defined in subdivision (c) of Section 1250, shall adopt and implement an antimicrobial stewardship policy that is consistent with antimicrobial stewardship guidelines developed by the federal Centers for Disease Control and Prevention, the federal Centers for Medicare and Medicaid Services, the Society for Healthcare Epidemiology of America, or similar recognized professional organizations. (b) All skilled nursing facilities, as defined in subdivision (c) of Section 1250, shall comply with this section. Failure to comply with the requirements of this section may subject the facility to the enforcement actions set forth in Section 1423. (Added by Stats. 2015, Ch. 764, Sec. 2. (SB 361) Effective October 10, 2015.)
  158. 1275.41.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    During a declared communicable disease emergency, skilled nursing facilities must report communicable disease data, including related deaths, and notify residents and families about cases; the health department can set reporting details and publish weekly death totals with privacy protections.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.41. (a) (1) In the event of a declared emergency related to a communicable disease, a skilled nursing facility, as defined in subdivision (c) of Section 1250, shall report communicable disease data in a format and schedule as required by the State Department of Public Health. (2) The communicable disease data reported pursuant to this section shall include, but not be limited to, information about each disease-related death and suspected disease-related death, which shall be reported to the State Department of Public Health within 24 hours of the death. (3) The State Department of Public Health shall make the total number of disease-related deaths and suspected disease-related deaths reported pursuant to this section and the location at which they occurred, in a manner that protects patients’ medical privacy, available on its internet website on a weekly basis. (b) During a declared emergency related to a communicable disease, a skilled nursing facility shall notify residents and their representatives and family members about cases of the communicable disease in compliance with state and federal privacy laws, as instructed by the department. (c) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction. (Added by Stats. 2020, Ch. 287, Sec. 2. (AB 2644) Effective January 1, 2021.)
  159. 1275.5.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Old licensing regulations for hospitals, certain care facilities, and psychiatric health facilities stay in force until the director updates or repeals them.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.5. (a) The regulations relating to the licensing of hospitals, heretofore adopted by the State Department of Public Health pursuant to former Chapter 2 (commencing with Section 1400) of Division 2, and in effect immediately prior to July 1, 1973, shall remain in effect and shall be fully enforceable with respect to any hospital required to be licensed by this chapter, unless and until the regulations are readopted, amended, or repealed by the director. (b) The regulations relating to private institutions receiving or caring for persons with mental health disorders, persons with developmental disabilities, and persons who lack legal competence to make decisions heretofore adopted by the Department of Mental Hygiene pursuant to Chapter 1 (commencing with Section 7000) of Division 7 of the Welfare and Institutions Code, and in effect immediately prior to July 1, 1973, shall remain in effect and shall be fully enforceable with respect to any facility, establishment, or institution for the reception and care of persons with mental health disorders, persons with developmental disabilities, and persons who lack legal competence to make decisions required to be licensed by the provisions of this chapter unless and until those regulations are readopted, amended, or repealed by the director. (c) (1) All regulations relating to the licensing of psychiatric health facilities heretofore adopted by the State Department of Health Services, pursuant to authority now vested in the State Department of Health Care Services by Section 4080 of the Welfare and Institutions Code, and in effect immediately preceding September 20, 1988, shall remain in effect and shall be fully enforceable by the State Department of Health Care Services with respect to any facility or program required to be licensed as a psychiatric health facility, unless and until readopted, amended, or repealed by the Director of Health Care Services. (2) The State Department of Health Care Services shall succeed to and be vested with all duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to licensing psychiatric health facilities. (Amended by Stats. 2014, Ch. 144, Sec. 28. (AB 1847) Effective January 1, 2015.)
  160. 1275.6.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    A licensed health facility may provide certain health services in an alternative setting, and the state department and OSHPD must set and enforce standards for that use.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.6. (a) A health facility licensed pursuant to subdivision (a) or (b) of Section 1250 may provide in any alternative setting health care services and programs which may be provided by any other provider of health care outside of a hospital building or which are not otherwise specifically prohibited by this chapter. In addition, the state department and the Office of Statewide Health Planning and Development shall adopt and enforce standards which permit the ability of a health facility licensed pursuant to subdivision (a) or (b) of Section 1250 to use its space for alternative purposes. (b) In adopting regulations implementing this section, and in reviewing an application or other request by a health facility licensed pursuant to subdivision (a) or (b) of Section 1250, pursuant to Section 1265, and subdivision (b) of Section 1276, relating to services provided in alternative settings, the state department may adopt or impose reasonable standards and conditions which promote and protect patient health, safety, security, and quality of health care. (c) Pending the adoption of regulations referred to in subdivision (b), the state department may condition approval of the alternative service or alternative setting on reasonable standards consistent with this section and subdivisions (d) and (e) of Section 1275. The state department and the Office of Statewide Health Planning and Development may adopt these standards by mutual agreement with a health facility proposing a service and may, after consultation with appropriate professional and trade associations, establish guidelines for hospitals wishing to institute an alternative service or to provide a service in an alternative setting. Services provided outside of a hospital building under this section shall be subject to the licensing standards, if any, that are applicable to the same or similar service provided by nonhospital providers outside of a hospital building. The intent of this subdivision is to assure timely introduction of safe and efficacious innovations in health care services by providing a mechanism for the temporary implementation and evaluation of standards for alternative services and settings and to facilitate the adoption of appropriate regulations by the state department. (d) All health care professionals providing services in settings authorized by this section shall be members of the organized medical staff of the health facility to the extent medical staff membership would be required for the provision of the services within the health facility. All services shall be provided under the respective responsibilities of the governing body and medical staff of the health facility. Nothing in this section shall be construed to repeal or otherwise affect Section 2400 of the Business and Professions Code, or to exempt services provided under this section from licensing standards, if any, established by or otherwise applicable to, the same or similar service provided by nonhospital providers outside of a hospital building. (e) For purposes of this section, “hospital building” shall have the same meaning as that term is defined in Section 15026. (Added by Stats. 1987, Ch. 1171, Sec. 2.)
  161. 1275.7.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    The state department must adopt regulations, and maternity-service hospitals and health facilities must create written baby-protection policies and procedures and review them periodically.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.7. (a) The Legislature makes the following findings and declarations: (1) The theft of newborn babies from hospitals is a serious societal problem that must be addressed. (2) There is no statutory requirement that hospitals offering maternity services establish policies and procedures that protect newborns and their parents from physical harm and emotional distress resulting from baby thefts. (3) Societal change has popularized a more open and natural birthing process, which, unfortunately, increases the risk of thefts of newborns from hospitals and other health facilities offering maternity services. (4) Baby thefts detrimentally affect the emotional and physical health of newborns and their families. (5) It is the intent of the Legislature in enacting this chapter to take reasonable steps toward reducing baby thefts. (b) On or before July 1, 1991, the state department shall adopt regulations requiring any hospital or other health facility offering maternity services to establish written policies and procedures designed to promote the protection of babies and the reduction of baby thefts from hospitals or other health facilities offering maternity services. Those hospitals and facilities shall establish the policies and procedures no later than 60 days after the regulations become effective. (c) The state department shall review the policies and procedures established by the hospitals and other health facilities, as required by subdivision (b), to determine compliance with the regulations adopted by the state department, pursuant to subdivision (b). (d) Hospitals and other health facilities offering maternity services shall periodically review their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years. (Added by Stats. 1990, Ch. 768, Sec. 1.)
  162. 1275.8.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Certain hospitals must adopt and follow a linen laundry processing policy by January 1, 2020, and keep it aligned with CDC and CMS infection-control guidance.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.8. (a) On or before January 1, 2020, each general acute care hospital, as defined in subdivision (a) of Section 1250, and acute psychiatric hospital, as defined in subdivision (b) of Section 1250, shall adopt and implement a linen laundry processing policy that is consistent and in accordance with the most recent infection control guidelines and standards developed by the following: (1) The federal Centers for Disease Control and Prevention. (2) The federal Centers for Medicare and Medicaid Services. (b) A general acute care hospital and an acute psychiatric hospital that uses a medical laundry service provider shall comply with the requirements of subdivision (a). (Added by Stats. 2018, Ch. 587, Sec. 2. (AB 2679) Effective January 1, 2019.)
  163. 1275.9.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    A general acute care hospital must tell patients or their representatives that the patient may restrict or prohibit use or disclosure of protected health information in the hospital directory, and it must do so in writing or verbally.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1275.9. (a) A general acute care hospital shall inform a patient or the patient’s representative, at the time of admission or as soon as reasonably possible in cases of patient incapacity or an emergency treatment circumstance, that the patient may restrict or prohibit the use or disclosure of protected health information in the hospital’s patient directory, as provided in Section 164.510 of Title 45 of the Code of Federal Regulations, in both of the following manners: (1) Using a separate paper or digital document that only includes an acknowledgment of receipt of the hospital’s notice of privacy practices required by Section 164.520 of Title 45 of the Code of Federal Regulations and information regarding the hospital’s directory and the included protected health information. The separate document shall include a check box for the patient or the patient’s representative to mark to restrict or prohibit use or disclosure of the protected health information in the hospital’s patient directory. (2) Having hospital personnel verbally inform the patient or the patient’s representative of the patient’s right to restrict or prohibit the use or disclosure of protected health information. (b) The information required pursuant to subdivision (a) shall be made available or provided in the top five languages, other than English, in the hospital’s service area. (c) For the purposes of this section, “patient’s representative” means a person who has legal authority to make decisions regarding medical care on behalf of the patient. (d) This section shall become operative on July 1, 2026. (Added by Stats. 2025, Ch. 384, Sec. 1. (AB 894) Effective January 1, 2026. Operative July 1, 2026, by its own provisions.)
  164. 12750.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 1. Definitions and Scope [12750 - 12751] ( Chapter 1 added by Stats. 2004, Ch. 496, Sec. 1. )

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    This section defines “flamethrowing device” and “permitholder” for this part.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 1. Definitions and Scope [12750 - 12751] ( Chapter 1 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12750. For purposes of this part, the following definitions shall apply: (a) “Flamethrowing device” means any nonstationary and transportable device designed or intended to emit or propel a burning stream of combustible or flammable liquid a distance of at least 10 feet. (b) “Permitholder” means a person who holds a flamethrowing device permit issued pursuant to this part. (Added by Stats. 2004, Ch. 496, Sec. 1. Effective January 1, 2005.)
  165. 127500.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. )

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    This chapter is named the California Health Care Quality and Affordability Act and may be cited by that name.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127500. This chapter shall be known, and may be cited, as the California Health Care Quality and Affordability Act. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  166. 127500.2.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. )

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    This section defines terms used in the health care affordability chapter.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127500.2. As used in this chapter, the following definitions apply: (a) (1) “Administrative costs and profits” means the total sum of all expenses not included in the numerator of the medical loss ratio calculation under state or federal law, including, but not limited to, all of the following: (A) All categories of administrative expenditures. (B) Net additions to reserves. (C) Rate dividends or rebates. (D) Profits or losses. (E) Taxes and fees. (2) For purposes of this chapter, “administrative costs and profits” for a fully integrated delivery system means those associated with its nonprofit health care services plan. (b) “Affordability for consumers” means considering the totality of costs paid by consumers for covered benefits, including the enrollee share of premium and cost-sharing amounts paid towards the maximum out-of-pocket amount, including deductibles, copays, coinsurance, and other forms of cost sharing for public and private health coverage. (c) “Affordability for purchasers” means considering the cost to purchasers, including, but not limited to, health plans and health insurers, employers purchasing group coverage, and the state, for health coverage and shall include premium costs, actuarial value of coverage for covered benefits, and the value delivered on health care spending in terms of improved quality and cost efficiency. (d) “Alternative payment model” means a state or nationally recognized payment approach that financially incentivizes high-quality and cost-efficient care. (e) “Board” means the Health Care Affordability Board established by Section 127501.10. (f) “Director” means the Director of the Department of Health Care Access and Information. (g) (1) “Exempted provider” means a provider that meets standards established by the board for exemption from either of the following: (A) The statewide health care target. (B) Specific targets set for health care sectors, including fully integrated delivery systems, geographic regions, and for individual health care entities. (2) The factors used in setting standards for exemption may include, but are not limited to, annual gross and net revenues, patient volume, and high-cost outliers in a given service or geographic region. (3) In determining whether a provider is an exempted provider, the board shall also consider any affiliates, subsidiaries, or other entities that control, govern, or are financially responsible for the provider or that are subject to the control, governance, or financial control of the provider. (4) A physician practice that does not meet the definition in subdivision (r) is an exempted provider. (h) “Fully integrated delivery system” means a system that includes a physician organization, health facility or health system, and a nonprofit health care service plan that provides health care services to enrollees in a specific geographic region of the state through an affiliate hospital system and an exclusive contract between the nonprofit health care service plan and a single physician organization in each geographic region to provide those medical services. (i) “Geographic region” may either be the regions specified in Section 1385.01 or may be otherwise defined by the board. (j) “Health care cost target” means the target percentage for the maximum annual increase in per capita total health care expenditures. (k) “Health care entity” means a payer, provider, or a fully integrated delivery system. (l) “Hedge fund” means a pool of funds managed by investors for the purpose of earning a return on those funds, regardless of the strategies used to manage the funds. Hedge funds include, but are not limited to, a pool of funds managed or controlled by private limited partnerships or other types of private corporate or partnership formations. A hedge fund does not include either of the following: (1) Natural persons or other entities that contribute, or promise to contribute, funds to the hedge fund, but otherwise do not participate in the management of the hedge fund or the fund’s assets, or in any change in control of the hedge fund or the fund’s assets. (2) Entities that solely provide or manage debt financing secured in whole or in part by the assets of a health care facility, including, but not limited to, banks and credit unions, commercial real estate lenders, bond underwriters, and trustees. (m) “Insurance market” means the public and private health insurance markets. (n) “Line of business” means the different individual, small, and large group business lines, as defined in Section 1348.95 of this code and Section 10127.19 of the Insurance Code, as well as Medi-Cal, Medicare, Covered California, or self-insured public employee health plans. (o) “Management services organization” means an entity that provides management and administrative support services for a provider in support of the delivery of health care services, excluding the direct provision of health services. Management and administrative support services shall include provider rate negotiation, revenue cycle management, or both. A management services organization does not include entities that own one or more health facilities, as defined in subdivision (a) or (b) of Section 1250. (p) “Material change” means any change in ownership, operations, or governance for a health care entity, involving a material amount of assets of a health care entity. (q) “Payer” means private and public health care payers, including all of the following: (1) A health care service plan or a specialized mental health care service plan, as defined in the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2) or a Medi-Cal managed care plan contracted with the State Department of Health Care Services to provide full scope benefits to a Medi-Cal enrollee pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code. (2) A health insurer licensed to provide health insurance or specialized behavioral health-only policies, as defined in Section 106 of the Insurance Code. (3) A publicly funded health care program, including, but not limited to, Medi-Cal and Medicare. (4) A third-party administrator. (5) Any other public or private entity, other than an individual, that pays for or arranges for the purchase of health care services on behalf of employees, dependents, or retirees. (r) “Physician organization” includes any of the following: (1) An organization described in paragraph (2) of subdivision (g) of Section 1375.4. (2) A risk-bearing organization, as defined in Section 1375.4. (3) A restricted health care service plan and limited health care service plan under subdivision (a) of Section 1300.49 of Title 28 of the California Code of Regulations. The inclusion of restricted health care service plans and limited health care service plans in the definition of “physician organization” does not narrow, abrogate, or otherwise alter the regulatory authority of the Department of Managed Health Care over these entities. (4) A medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206. (5) A medical group practice, a professional medical corporation, a medical partnership, or any lawfully organized group of physicians and surgeons that provides, delivers, furnishes, or otherwise arranges for health care services and is comprised of 25 or more physicians. (6) Notwithstanding paragraph (5), an organization of less than 25 physicians, but that is a high-cost outlier whose costs for the same services provided are substantially higher compared to the statewide average, as identified through data sources that include, but are not limited to, data from state and federal agencies, other relevant supplemental data, such as financial data on providers that is submitted to state agencies, or data reported to HCAI under the Health Care Payments Data Program, established pursuant to Chapter 8.5 (commencing with Section 127671). The cost of delivering the same services in a geographic region shall be considered to the extent that cost substantially deviates from the statewide average and reflects higher costs in that region unrelated to the market dominance of providers in that region or unrelated to the ownership, management, or asset structure chosen by the organization. (s) “Private equity group” means an investor or group of investors who primarily engage in the raising or returning of capital and who invest, develop, dispose of, or purchase any equity interest in assets, either as a parent company or through another entity the investor or investors completely or partially own or control. A private equity group does not include natural persons or other entities that contribute or promise to contribute funds to the private equity group, but otherwise do not participate in the management of the private equity group or the group’s assets, or in any change in control of the private equity group or the group’s assets. (t) “Provider” means any of the following that delivers or furnishes health care services: (1) A physician organization. (2) A health facility, as defined in Section 1250, including a general acute care hospital. (3) A clinic conducted, operated, or maintained as an outpatient department of a hospital, as described in subdivision (d) of Section 1206. (4) A clinic described in subdivision (l) of Section 1206. (5) A clinic described in subdivision (a) of Section 1204. (6) A specialty clinic, as described in paragraphs (1) to (3), inclusive, of subdivision (b) of Section 1204. (7) An ambulatory surgical center or accredited outpatient setting. (8) A clinical laboratory licensed or registered with the State Department of Public Health under Chapter 3 (commencing with Section 1200) of the Business and Professions Code. (9) An imaging facility that employs or contracts with persons that are subject to the Radiation Control Law (Chapter 8 (commencing with Section 114960) of Part 9 of Division 104), or the Radiologic Technologists Act (Article 5 (commencing with Section 106955) of Chapter 4 of Part 1, or Article 6 (commencing with Section 107150) of Chapter 4 of Part 1 of Division 104). (u) “Purchaser” means an individual, organization, or business entity that purchases health care services, including, but not limited to, trust funds, trade associations, and private and public employers who provide health care benefits to their employees, members, and dependents. (v) “Total health care expenditures” means all health care spending in the state by public and private sources, including all of the following: (1) All claims-based payments and encounters for covered health care benefits. (2) All non-claims-based payments for covered health care benefits, such as capitation, salary, global budget, other alternative payment methods, or supplemental provider payments pursuant to the Medi-Cal program. (3) All cost sharing for covered health care benefits paid by residents of this state, including, but not limited to, copayments, coinsurance, and deductibles. (4) Administrative costs and profits. (5) Pharmacy rebates and any inpatient or outpatient prescription drug costs not otherwise included in this subdivision. (Amended by Stats. 2025, Ch. 641, Sec. 1. (AB 1415) Effective January 1, 2026.)
  167. 127500.5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. )

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    This section states California’s findings and intent for health care affordability, cost containment, transparency, and accountability.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 1. General Provisions and Definitions [127500 - 127500.5] ( Article 1 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127500.5. (a) The Legislature finds and declares all of the following: (1) It is in the public interest that all Californians receive health care that is accessible, affordable, equitable, high-quality, and universal. (2) While California has reduced the uninsured share of its population to a historic low of 7 percent through implementation of the federal Patient Protection and Affordable Care Act (PPACA: Public Law 111-148) and other state efforts, affordability has reached a crisis point as health care costs continue to grow. (3) As costs rise, employers are increasingly shifting the cost of premiums and deductibles to employees, negatively impacting the potential for wage growth. Between 2010 and 2018, wages in the state kept pace with inflation by increasing by 19 percent. Meanwhile, families with job-based coverage experienced a 45 percent increase in premiums, or more than twice the rate of wage growth. During the same period, families experienced a 70 percent increase in PPO deductibles, or nearly four times the rate of wage growth. While health insurance premium increases for 2021 may be considered moderate due to lower utilization of preventive, routine, and nonemergency services as a result of the novel coronavirus (COVID-19) pandemic, this abatement in health care cost growth is expected to be temporary. (4) Escalating health care costs are being driven primarily by high prices and the underlying factors or market conditions that drive prices, particularly in geographic areas and sectors where there is a lack of competition due to consolidation, market power, venture capital activity, the role of profit margins, and other market failures. Consolidation through acquisitions, mergers, or corporate affiliations is pervasive across the industry and involves health care service plans, health insurers, hospitals, physician organizations, pharmacy benefit managers, and other health care entities. Further, market consolidation occurs in various forms, including horizontal, vertical, and cross industry mergers, transitions from nonprofit to for-profit status or vice versa, and any combination involving for-profit and nonprofit entities, such as a nonprofit entity merging with, acquiring, or entering into a corporate affiliation with a for-profit entity or vice versa. (5) Californians of color experience health disparities, including barriers to accessing care, receiving lower quality of care, lack of access to culturally and linguistically competent care, and experiencing worse health outcomes. Certain communities, including low-income, Black, Latino, Pacific Islander, and essential workers, have been disproportionately impacted by COVID-19 in terms of higher rates of infection, hospitalizations, and deaths. These negative health outcomes further highlight a public health imperative to reduce racial and ethnic disparities in health care. (6) The COVID-19 pandemic has exposed vulnerabilities within the current system with regard to provider payments. Physician fee-for-service payment has increased over the past decade, while the use of population-based prepayment has decreased in the employer-sponsored coverage market. As Californians stayed home, the loss of fee-for-service (FFS) payment revenue for providers has downstream impacts on access to care and for health care workers’ economic security. Beyond exposing providers to considerable financial instability, FFS payments may not be the most effective way to incentivize providers to deliver high-quality and cost-efficient care or offer the flexibility to make practice changes that enable improved access, care coordination, patient engagement, and quality. (7) Primary care is foundational to an effective health care system and evidence supports that greater use of primary care has been associated with lower costs, higher patient satisfaction, reduced low birth weight, fewer hospitalizations and emergency department visits, and lower mortality, among other key outcomes. However, the United States as a whole spends a far lower share of health care expenditures on primary care and experiences worse outcomes in life expectancy and mortality than other countries. (8) Behavioral health needs are common among Californians, with most who need it not receiving treatment. National research finds that persons with mental health or substance use disorders have approximately two to three times higher medical costs than those with no behavioral health diagnosis. This research also shows that total health care spending on mental health and substance use disorder services have remained relatively flat between 2012 and 2017. Models that integrate primary care and behavioral health services have been shown to improve access to effective behavioral health services that improve health outcomes, as well as deliver a return on investment by reducing downstream health care costs. (9) Surveys show that people are delaying or going without care due to concerns about cost, or are getting care but struggling to pay the resulting bill. In California, one in four people report problems paying or being unable to pay their medical bills, with two-thirds cutting back on basic household items like food and clothing to pay those bills. Concerns about affordability of coverage and care are expected to be exacerbated during the economic recession related to the COVID-19 pandemic, particularly among lower-wage workers. (10) High drug prices contribute significantly to health care costs. Prescription drugs account for nearly one-fifth of health care spending. The Centers for Medicare and Medicaid Services project that prescription drug spending will grow faster and outpace other categories of health care spending in the years to come. Cost-effectiveness analyses often find that drugs are priced in excess of the value they deliver to patients. (11) The State of California has a substantial public interest in the price and cost of health care coverage. California is a major purchaser through the Public Employees’ Retirement System, the State Department of Health Care Services, the Department of General Services, the Department of Corrections and Rehabilitation, and other entities acting on behalf of a state purchaser. The government also provides major tax expenditures through the tax exclusion of employer-sponsored coverage and tax deductibility of coverage purchased by individuals, as well as tax deductibility of excess health care costs for individuals and families. (b) It is the intent of the Legislature to have a comprehensive view of health care spending, cost trends, and variation to inform actions to reduce the overall rate of growth in health care costs while maintaining quality of care, with the goal of improving affordability, access, and equity of health care for Californians. (c) It is the intent of the Legislature to encourage policies, payments, and initiatives that improve the affordability, quality, equity, efficiency, access, and value of health care service delivery, with a particular focus on ensuring health equity and reducing disparities in care, access, and outcomes across California. (d) It is the intent of the Legislature to recognize and consider the unique health care needs of people with disabilities and chronic illnesses and the associated challenges with access, affordability, equity, quality, and delivery of health care. (e) It is the intent of the Legislature for the State of California to achieve more affordable health care and better outcomes by consistently measuring and promoting sustained systemwide investment in primary care and behavioral health. (f) It is the intent of the Legislature to facilitate increased adoption of alternative payment models that reward high-quality and cost-efficient care, including strategies for shared savings and downside risk arrangements and population-based payments. (g) It is the intent of the Legislature to promote the goal of health care affordability while recognizing the need to maintain and increase the supply of trained, culturally and linguistically competent health care workers, and to monitor the effects of cost containment efforts on health care workforce stability, high-quality health care jobs, and the training needs of health care workers. It is the intent of the Legislature that cost containment does not constrain the health care workforce that California needs, including the competitive wages and benefits of frontline health care workers. (h) It is the intent of the Legislature that health care cost targets not be used to place a floor or ceiling on health care workforce compensation. (i) It is the intent of the Legislature to increase transparency on mergers, acquisitions, and corporate affiliations involving health care service plans, health insurers, hospitals or hospital systems, physician organizations, pharmacy benefit managers, and other health care entities that may impact market competition and affordability for consumers and purchasers. (j) It is the intent of the Legislature to analyze cost and quality trends in the pharmaceutical sector, study the impact of drug prices and pharmaceutical market failures on affordability, and inform policy interventions to improve competition and lower consumer costs. (k) It is the intent of the Legislature in enacting this chapter to provide accountability to the State of California for the affordability and cost of health care in California. (l) It is the intent of the Legislature in enacting this chapter that the setting of health care cost targets distinguish between health care entities that deliver cost-efficient, high quality care and those that deliver high-cost care without commensurate improvements in overall quality. (m) It is the intent of the Legislature in enacting this chapter that enforcement actions to address growth in per capita total health care expenditures are implemented in a progressive manner, such that health care entities are assisted to come into compliance with cost targets, including through technical assistance and performance improvement plans, before assessing administrative penalties unless there are egregious violations as specified in Section 127502.5. (n) To avoid duplication of efforts and to avoid inconsistency between federal and state laws, it is the intent of the Legislature that collaboration occur between relevant regulatory agencies regarding whether a health care entity is in compliance or noncompliance with the cost targets. (o) It is the intent of the Legislature, therefore, to establish a single entity within state government charged with doing all of the following: (1) Developing a comprehensive strategy for cost containment in California, including measuring progress towards reducing the rate of growth in per capita total health care spending and ultimately lowering consumer spending on premiums and out-of-pocket costs, while maintaining quality, access, and equity of care, as well as promoting workforce stability and maintaining high-quality health care jobs. (2) Addressing cost increases in excess of health care cost targets through public transparency, opportunities for remediation, and other progressive enforcement actions to achieve cost targets that optimize value in health care spending. (3) Referring transactions that may reduce market competition or increase costs to the Attorney General for further review. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  168. 127501.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    This section creates the Office of Health Care Affordability, places it within the Department of Health Care Access and Information, and gives it responsibility for health care cost oversight, reporting, and enforcement.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501. (a) There is hereby established, within the Department of Health Care Access and Information, the Office of Health Care Affordability. The Director of the Department of Health Care Access and Information shall be the director of the office and shall carry out all functions of that position, including enforcement. (b) The office shall be responsible for analyzing the health care market for cost trends and drivers of spending, developing data-informed policies for lowering health care costs for consumers and purchasers, creating a state strategy for controlling the cost of health care and ensuring affordability for consumers and purchasers, and enforcing cost targets. (c) The office shall do all of the following: (1) Increase cost transparency through public reporting of per capita total health care spending and factors contributing to health care cost growth. (2) Support the board, through data collection and analysis and recommendations, to establish a statewide health care cost target for per capita total health care spending. (3) Support the board, through data collection and analysis and recommendations, to establish specific health care cost targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate. (4) Collect and analyze data from existing and emerging public and private data sources that allow the office to track spending, set cost targets, approve performance improvement plans, monitor impacts on health care workforce stability, and carry out all other functions of the office. (5) Analyze cost and quality trends for drugs covered by pharmaceutical and medical benefits. The office shall consider the data in the reports required pursuant to Section 1367.243 and Section 10123.205 of the Insurance Code and pharmaceutical data reported in the Health Care Payments Data Program, established pursuant to Chapter 8.5 (commencing with Section 127671). (6) Oversee the state’s progress towards meeting the health care cost target by providing technical assistance, requiring public testimony, requiring submission of and monitoring compliance with performance improvement plans, and assessing administrative penalties through enforcement actions, including escalating administrative penalties for noncompliance. (7) Promote, measure, and publicly report performance on quality and health equity through the adoption of a priority set of standard quality and equity measures for health care entities, with consideration for minimizing administrative burden and duplication. (8) Advance standards for promoting the adoption of alternative payment models. (9) Measure and promote sustained systemwide investment in primary care and behavioral health. (10) Advance standards for health care workforce stability and training, as these relate to costs. (11) Disseminate best practices from entities that comply with the cost target, including a summary of affordability efforts that enable the entity to meet the cost target. (12) Review and evaluate consolidation, market power, and other market failures through cost and market impact reviews of mergers, acquisitions, or corporate affiliations involving health care service plans, health insurers, hospitals, physician organizations, pharmacy benefit managers, and other health care entities. (13) Analyze trends in the price of health care technologies. (14) Analyze trends in the cost of labor for both management and administration, as well as nonsupervisorial health care workforce, as well as analyzing the profits of health care entities, if that data is available. (15) Conduct ongoing research and evaluation on payers, fully integrated delivery systems, management services organizations, and providers, including physician organizations, to determine whether the definitions or other provisions of this chapter include those entities that significantly affect health care cost, quality, equity, and workforce stability. (16) Adopt and promulgate regulations for the purpose of carrying out this chapter. (17) Establish advisory or technical committees, as necessary. (d) For purposes of implementing this chapter, including hiring staff and consultants, through the procurement authority and processes of the department, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the office may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Until January 1, 2026, contracts entered into or amended pursuant to this chapter are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and are exempt from the review or approval of any division of the Department of General Services. (Amended by Stats. 2025, Ch. 641, Sec. 2. (AB 1415) Effective January 1, 2026.)
  169. 127501.10.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    This section creates the Health Care Affordability Board and sets rules for who appoints its members, how long they serve, how much they are paid, and how the board meets.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.10. (a) There is hereby established, within the office, the Health Care Affordability Board. The board shall be composed of eight members, as follows: (1) Four members shall be appointed by the Governor and confirmed by the Senate. (2) One member shall be appointed by the Senate Committee on Rules. (3) One member shall be appointed by the Speaker of the Assembly. (4) The Secretary of Health and Human Services or their designee. (5) The CalPERS Chief Health Director or their deputy shall serve as a nonvoting member of the board. (b) Members of the board who are appointed shall be appointed for a term of four years, except that the initial appointment by the Senate Committee on Rules shall be for a term of five years, the initial appointment by the Speaker of the Assembly shall be for a term of two years, and one of the initial appointments by the Governor shall be for a term of three years. A member of the board may continue to serve until the appointment and qualification of a successor. Vacancies shall be filled by appointment for the unexpired term. (c) (1) Each person appointed to the board shall have demonstrated and acknowledged expertise in at least one of the following areas: health care economics; health care delivery; health care management or health care finance and administration, including payment methodologies; health plan administration and finance; health care technology; research and treatment innovations; competition in health care markets; primary care; behavioral health, including mental health and substance use disorder services; purchasing or self-funding group health care coverage for employees; enhancing value and affordability of health care coverage; or organized labor that represents health care workers. (2) Appointing authorities shall consider the expertise of the other members of the board and attempt to make appointments so that the board’s composition of members reflects a diversity of expertise on health care entities, purchasers, and consumer advocacy groups, who also meet the requirements of paragraph (1). (3) In making appointments to the board, the appointing authorities shall take into consideration the state’s diversity in culture, race, ethnicity, sexual orientation, gender identity, and geography so that the board’s composition reflects the communities of California. Appointing authorities shall consider the experience the board member has as a patient or caregiver of a patient with a chronic condition requiring ongoing health care, which may include behavioral health care or a disability. (4) (A) An appointee to the board shall not receive financial compensation from, or be employed by, a health care entity that is subject to the cost targets, an entity subject to cost and market impact reviews, or an exempted provider. (B) For purposes of this paragraph, an appointee’s prohibited financial compensation and employment does not include employment by a health care entity solely as a tenured academic instructor with duties and compensation unrelated to the health care operations of the entity. (C) For purposes of this paragraph, financial compensation does not include compensation received pursuant to a retirement plan. (D) For purposes of this paragraph, financial compensation does not include clinical volunteer services if all of the following conditions are met: (i) The board member is a health care professional who was actively participating in that profession prior to appointment to the board. (ii) The board member does not receive compensation for performing volunteer services and does not have an ownership interest or other financial interest in the entity, facility, clinic, or provider group. (iii) The clinical volunteer services are performed at the University of California or a nonprofit educational institution; a facility, clinic, or provider group operated by, or affiliated with, an academic medical center of either the University of California or a nonprofit educational institution; or a facility, clinic, or provider group operated by a state agency or county health system that does not directly contract with the office. (E) For purposes of subparagraph (D), compensation and financial interest for a health care professional who performs clinical volunteer services does not include either of the following: (i) A contribution to a professional liability insurance program made by the entity, facility, clinic, or provider group for the member or staff. (ii) The provision of physical space, equipment, support staff, or other supports made by the entity, facility, clinic, or provider group for the member or staff necessary for the performance of clinical volunteer services described in subparagraph (D). (5) The board shall elect a chair. (d) (1) Each member of the board shall receive a per diem of five hundred dollars ($500) for each day actually spent in the discharge of official duties, not to exceed 30 days per year, and shall be reimbursed for traveling and other expenses necessarily incurred in the performance of official duties. After June 30, 2026, the per diem shall be one hundred dollars ($100) per day. (2) Notwithstanding any other law, a public officer or employee shall not receive per diem salary compensation for serving on the board on any day when the officer or employee also received compensation for their regular public employment. (e) (1) The board shall meet at least quarterly or at the call of the chair. (2) The board shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code), except that the board may hold closed sessions when considering matters related to the office assessing administrative penalties, requiring performance improvement plans under Section 127502.5, and discussing nonpublic information and documents received by the office and board under this chapter. (3) The board shall be subject to Article 3 (commencing with Section 87300) of Chapter 7 of Title 9 of the Government Code, and the regulations promulgated thereunder. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  170. 127501.11.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The board must set and approve key health care affordability measures, and the director must present related items to the board. The office may set up committees, and must do so if the board requests it.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.11. (a) After receiving input, including recommendations, from the office and the advisory committee, and receiving public comments, the board shall establish all of the following: (1) A statewide health care cost target. (2) The definitions of health care sectors, which may include geographic regions and individual health care entities, as appropriate, except fully integrated delivery systems as defined in subdivision (h) of Section 127500.2, and specific targets by health care sector, which may include fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate. (3) The standards that need to be met for exemption from health care cost targets or submitting data directly to the office, including the definition of exempted providers. (b) The board shall approve all of the following: (1) Methodology for setting cost targets and adjustment factors to modify cost targets when appropriate. (2) The scope and range of administrative penalties and the penalty justification factors for assessing penalties. (3) The benchmarks for primary care and behavioral health spending. (4) The statewide goals for the adoption of alternative payment models and standards that may be used between payers and providers during contracting. (5) The standards to advance the stability of the health workforce that may apply in the approval of performance improvement plans. (c) The director shall present to the board for discussion all of the following: (1) Options for statewide health care cost targets, specific targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate. (2) The collection, analysis, and public reporting of data for the purposes of implementing this chapter. (3) The risk adjustment methodologies for the reporting of data on total health care expenditures and per capita total health care expenditures. (4) Review and input on performance improvement plans prior to approval, including delivery of periodic updates about compliance with performance improvement plans to inform any adjustment to the standards for imposing those plans. (5) Review and input on administrative penalties to inform any adjustments to the scope and range of administrative penalties and the penalty justification for assessing penalties. (6) Factors that contribute to cost growth within the state’s health care system, including the pharmaceutical sector. (7) Strategies to improve affordability for both individual consumers and purchasers of health care, including data collection, targets, and other steps. (8) Recommendations for administrative simplification in the health care delivery system. (9) Approaches for measuring access, quality, and equity of care. (10) Recommendations for updates to statutory provisions necessary to promote innovation and to enable the increased adoption of alternative payment models. (11) Methods of addressing consolidation, market power, and other market failures. (d) (1) To support the board’s decisionmaking, the board may request data analysis to be conducted or collected by the office. (2) The office may establish advisory or technical committees, as necessary. The office shall establish advisory or technical committees at the request of the board. These committees may be standing committees or time-limited workgroups, at the discretion of the board. Members of these committees shall comply with the requirements in paragraph (1) of subdivision (c) of Section 127501.10. A committee established by the board may include members who are health care entities, consumer organizations representing health care consumers or patients, organized labor representing health care workers, or patients or caregivers of patients with a chronic condition requiring ongoing health care, which may include behavioral health care or a disability. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  171. 127501.12.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The board must create and appoint a Health Care Affordability Advisory Committee, and the committee may give input but cannot direct the office’s work or access confidential nonpublic information.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.12. (a) (1) The board shall establish a Health Care Affordability Advisory Committee to provide input, including recommendations, to the board and the office on a range of areas, including, but not limited to, all of the following: (A) A statewide health care cost target and specific targets by health care sector and geographic region. (B) The methodology for setting cost targets and adjustment factors to modify cost targets when appropriate. (C) Definitions of health care sectors. (D) Benchmarks for primary care and behavioral health spending. (E) Statewide goals for the adoption of alternative payment models and standards. (F) Quality and equity metrics. (G) Standards to advance the stability of the health care workforce. (H) Other areas requested by the board or the office. (2) The advisory committee may provide input, including recommendations, to the board regarding board requests for data analysis performed by the office, but does not have authority to direct data analysis or any other work performed by the office. (b) (1) The board shall appoint the members of the advisory committee. Appointments shall be made by a majority vote of the voting members of the board. When appointing members to the advisory committee, the board shall aim for broad representation, including, at a minimum, representatives of consumer and patient groups, payers, fully integrated delivery systems, hospitals, organized labor, health care workers, medical groups, physicians, and purchasers, and shall apply the same considerations of demonstrated knowledge, expertise, diversity, and personal experience outlined in paragraphs (1) to (3), inclusive, of subdivision (c) of Section 127501.10. (2) Each appointed member shall serve at the discretion of the board and may be removed at any time by a majority vote of the voting members of the board. (3) The advisory committee members shall not have access to confidential, nonpublic information that is accessible to the board and office. Instead, the advisory committee shall only have access to information that is publicly available. Neither the board nor the office shall disclose any confidential, nonpublic information to the advisory committee members. (4) Advisory committee members shall receive reimbursement for travel and other actual costs. (c) (1) The advisory committee shall meet at least four times per year or when requested by the board. (2) At least one member of the board shall attend the advisory committee meetings. (3) Advance notice of any advisory committee meetings shall be posted on the office’s internet website to allow for public participation at the meetings. Meeting minutes of all advisory committee meetings and input, including recommendations, on proposed cost targets shall be posted on the office’s internet website. (d) The board shall consider input, including recommendations, from the advisory committee, along with public comments, in the board’s deliberation and decisionmaking. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  172. 127501.2.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office may adopt necessary rules and regulations as emergency regulations until January 1, 2027, and the board must discuss any such rule or regulation at least once before adoption.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.2. (a) Until January 1, 2027, any necessary rules and regulations for the purpose of implementing this chapter may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. (b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, including subdivisions (e) and (h) of Section 11346.1, an emergency regulation adopted pursuant to this section shall be repealed by operation of law unless the adoption, amendment, or repeal of the regulation is promulgated by the office pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code within five years of the initial adoption of the emergency regulation. (c) Any rule or regulation adopted pursuant to this section shall be discussed by the board during at least one board meeting before the office adopts the rule or regulation. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  173. 127501.3.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must respond to Legislature requests for additional information, including by testifying at hearings and commenting on proposed legislation or policy issues.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.3. (a) The office shall be responsive to requests for additional information from the Legislature, including providing testimony during hearings and commenting on proposed legislation or policy issues. (b) The Legislature finds and declares that activities, including, but not limited to, responding to legislative or executive inquiries, tracking and commenting on legislation and regulatory activities, and preparing reports on the implementation of this chapter and the performance of the office, are necessary state requirements. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  174. 127501.4.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must collect needed data from health care entities and can require several health care actors to submit reports and information.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.4. (a) (1) Notwithstanding any other state or local law, the office shall collect data and other information it determines necessary from health care entities, except exempted providers, to carry out the functions of the office. To the extent consistent with federal law and to the greatest extent possible, the office may use existing and emerging public and private data sources to minimize administrative burdens and duplicative reporting, including data or information from federal agencies as well as state agencies. The office may request data and information from, or enter into a data sharing agreement with, the State Department of Health Care Services, Covered California, the Department of Managed Health Care, the Department of Insurance, the Labor and Workforce Development Agency, the Business and Consumer Services Agency, and other relevant state agencies that monitor compliance of plans and providers with access standards, including timely access, language access, geographic access, and other access standards as provided by law and regulation. The office may also enter into a data sharing agreement with these state agencies that collect payer and provider financial data or other data or information about the health care workforce. (2) In furtherance of this chapter, and with the intent to reduce administrative burdens, the office shall coordinate with the State Department of Health Care Services on data and other information necessary to report both of the following: (A) Total health care expenditures and per capita total health care expenditures for Medi-Cal services. (B) Medical loss ratios required under applicable state and federal laws. (C) Quality and equity measures to assess performance for the Medi-Cal program or other programs administered by the State Department of Health Care Services. (3) (A) The office shall obtain from the Department of Managed Health Care and the Department of Insurance information about health care services plans, as defined in subdivision (b) of Section 1345, and insurers offering policies of health insurance, as defined in subdivision (b) of Section 106 of the Insurance Code. The information shall be for coverage in the individual, small group, and large group markets for both grandfathered and nongrandfathered products. The information shall include, but not be limited to, all of the following: (i) Information on premiums, cost sharing, benefits, and other information required under Article 6.2 (commencing with Section 1385.01) of Chapter 2.2 of Division 2 of this code and Article 4.5 (commencing with Section 10181) of Chapter 1 of Part 2 of Division 2 of the Insurance Code. (ii) Trend factors by benefit category, such as inpatient hospitalization and physician services, including price, utilization, and cost as a percentage of Medicare, as required by Section 1385.045 of this code and Section 10181.45 of the Insurance Code. (iii) Medical loss ratio for each health care service plan or health insurer under applicable state and federal laws. (iv) Cost containment and quality improvement efforts reported consistent with Sections 1385.03 and 1385.045 of this code and Sections 10181.3 and 10181.45 of the Insurance Code. (v) Prescription drug costs consistent with Section 1367.243 and Article 6.1 (commencing with Section 1385.001) of Chapter 2.2 of Division 2 of this code and Section 10123.205 of the Insurance Code. (vi) Information regarding health equity and quality required under Article 11.9 (commencing with Section 1399.870) of Chapter 2.2 of Division 2, including data and results. (B) The Department of Managed Health Care and the Department of Insurance shall provide the above information in the initial submission of data to the office for the five years prior to 2023, to the extent that information is available, and annually thereafter. (b) The office shall establish requirements for payers and fully integrated delivery systems to submit data and other information necessary to do all of the following: (1) Measure total health care expenditures and per capita total health care expenditures. (2) Determine whether health care entities met health care cost targets. (3) Identify the annual change in health care costs of health care entities. (4) Approve and monitor implementation of performance improvement plans. (5) Assess performance on quality and equity measures. (c) The office shall, in a manner prescribed by the office, establish requirements for providers to submit data in support of this section as necessary to carry out the functions of the office. (d) (1) For the purpose of the baseline health care spending report published pursuant to subdivision (a) of Section 127501.6, payers and fully integrated delivery systems shall submit data on total health care expenditures for the 2022 and 2023 calendar years on or before September 1, 2024. Enforcement shall not be implemented pursuant to this baseline report, except any enforcement actions necessary to ensure compliance with the deadline for submitting data. (2) For the first annual report, published pursuant to subdivision (b) of Section 127501.6, payers and fully integrated delivery systems shall submit data on total health care expenditures for the 2024 and 2025 calendar years based on a reporting schedule established by the office. For subsequent annual reports, payers and fully integrated delivery systems shall submit data for the relevant calendar years according to the reporting schedule established by the office. (e) (1) The office shall require health care entities to submit data and other information as necessary to fulfill its functions and measure total health care expenditures and per capita total health care expenditures by sectors. (2) For the calculation of total health care expenditures and per capita total health care expenditures by sectors, the office shall use the Health Care Payments Data Program, established pursuant to Chapter 8.5 (commencing with Section 127671), to the greatest extent possible, to minimize reporting burdens for health care entities, and may also use data from federal agencies. (f) The office shall require payers, fully integrated delivery systems, hospitals, and physician organizations to report data and other information, as necessary, for the single set of standard quality measures pursuant to Section 127503. (g) (1) The office shall require payers, fully integrated delivery systems, restricted health care service plans, and limited health care service plans, as defined in Section 1300.49 of Title 28 of the California Code of Regulations, to submit data and other information to measure the adoption of alternative payment models pursuant to Section 127504. (2) The office shall establish requirements for payers, fully integrated delivery systems, restricted health care service plans, and limited health care service plans, as defined in Section 1300.49 of Title 28 of the California Code of Regulations, to report data and other information, including, but not limited to, the types of payment models, adoption by line of business, the number of members covered by alternative payment models, the percent of budget dedicated to alternative payments, or cost and quality performance measures tied to those payment models. (h) (1) The office shall require payers, fully integrated delivery systems, restricted health care service plans, and limited health care service plans, as defined in Section 1300.49 of Title 28 of the California Code of Regulations, to submit data and other information to measure the percentage of total health care expenditures allocated to primary care and behavioral health pursuant to Section 127505. (2) For the calculation of total health care expenditures allocated to primary care and behavioral health, the office shall do all of the following: (A) Use the Health Care Payments Data Program, established pursuant to Chapter 8.5 (commencing with Section 127671), to the greatest extent possible, to minimize reporting burdens for health care entities. (B) Determine the categories of health care professionals who should be considered primary care and behavioral health providers and consider existing state and national approaches, as appropriate. (C) Determine specific procedure codes that should be considered primary care and behavioral health services and consider existing state and national approaches, as appropriate. (D) Determine the categories of payments to primary care or behavioral health care providers and practices, including non-claims-based payments, such as alternative payment models, that should be included when determining the total amount spent on primary care and behavioral health. (i) (1) With consideration to minimizing reporting burdens and expenses, the office shall require providers and any physician organizations that are part of a fully integrated delivery system to submit audited financial reports, similar to those required in paragraphs (a) to (e), inclusive, of Section 128735. This paragraph does not apply to exempted providers. (2) For physician organizations defined in paragraph (5) of subdivision (p) of Section 127500, and providers that do not routinely prepare audited financial reports, the office shall require a comprehensive financial statement that includes details regarding annual costs, annual receipts, realized capital gains and losses, and accumulated surplus and accumulated reserves using the standard accounting method routinely used by the physician organization or provider. The comprehensive financial statement shall be supported by sworn written declarations by the chief financial officer, chief executive officer, or other officer who has financial management and oversight responsibilities for the physician organization or provider, certifying that the financial statement is complete, true, and correct in all material matters to the best of their knowledge, and that the provider does not routinely prepare audited financial reports. This paragraph does not apply to exempted providers and physician organizations that are part of a fully integrated delivery system. (3) The board, members of the board, the office, the department, and the employees, contractors, and advisors of the office and the department shall keep the audited financial reports and comprehensive financial statements confidential, and shall use the confidential information and documents only as necessary for the function of the office. (4) This subdivision does not apply to providers that are already required to report under Section 128735 or risk bearing organizations (RBOs) that are required to file quarterly and annual financial statements under Section 1375.4 of this code and Section 1300.75.4.2 of Title 28 of the California Code of Regulations. (5) Notwithstanding any other law, all information and documents obtained under this subdivision shall not be required to be disclosed pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code) or any similar local law requiring the disclosure of public records. (j) (1) Consistent with subdivision (a), the office shall obtain data from existing state and federal data sources and from regulated entities to effectively monitor impacts to health care workforce stability and training needs. (2) In order for an adjustment to cost targets to be made under paragraph (7) of subdivision (d) of Section 127502, a provider, a fully integrated delivery system, or other associated party shall produce actual or projected nonsupervisory employee organized labor costs, including increased expenditures related to compensation, and any other supporting information to validate the adjustment, as may be requested by the office pertaining to the actual or projected organized labor costs. (3) The office may collect all of the following types of data and make it accessible to the public: (A) Overall trends in the health care workforce, including, but not limited to, statewide and regional workforce supply, unemployment and wage data, trends and projections of wages and compensation, projections of workforce supply by region and specialty, training needs, and other future trends in the health care workforce. (B) The number and classification of workers in internship, clinical placements, apprenticeships, and other training programs sponsored by an employer. (C) The percentage of employees employed through a registry or casual employment. (D) The number of workers at health care entities that were retrained through established public training programs. (E) Investments by health care entities in private training and retraining programs. (F) The number of workers subject to relocation, termination, or mass layoff as described in Chapter 4 (commencing with Section 1400) of Part 4 of Division 2 of the Labor Code. (4) The office may request additional data from health care entities if it finds that the data is needed to effectively monitor impacts to health care workforce stability and training needs. (5) The office may annually request from health care entities that are in compliance with the cost target, a summary of best practices used for improving health care affordability, if any. (k) In furtherance of this section, the office shall promulgate regulations to collect data and other information it determines necessary from health care entities, except exempted providers, to carry out the functions of the office. The regulations may include, but are not limited to, detailed reporting schedules, technical specifications, and other resources to ensure the submission of accurate data in a standardized format within the specified timeframes. Prior to adopting regulations and approving the reporting schedules, technical specifications, and other resources, the office shall engage relevant stakeholders, hold a public meeting to solicit input, and provide a response to input received. (l) The amendments made to this section by the act adding this subdivision shall become operative on July 1, 2026. (Amended by Stats. 2026, Ch. 28, Sec. 97. (SB 170) Effective June 29, 2026. Operative July 1, 2026, by its own provisions.)
  175. 127501.5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must set requirements for management services organizations to submit data and other information.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.5. The office shall, in a manner prescribed by the office, establish requirements for management services organizations to submit data and other information as necessary to carry out the functions of the office. (Added by Stats. 2025, Ch. 641, Sec. 3. (AB 1415) Effective January 1, 2026.)
  176. 127501.6.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must prepare and publish health care spending reports, present them publicly, collect comments, submit them to the Governor and Legislature, and post them online.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.6. (a) For data submitted to the office under paragraph (1) of subdivision (d) of Section 127501.4, the office shall prepare a report on baseline health care spending consistent with subparagraph (A) of paragraph (2) of subdivision (b) on or before June 1, 2025. (b) (1) On or before June 1, 2027, the office shall prepare and publish its first annual report concerning health care spending trends and underlying factors, for the 2024 and 2025 calendar years, along with policy recommendations to control costs and improve quality performance and equity of the health care system, while maintaining access to care and high-quality jobs and workforce stability. The report shall be based on the office’s analysis of data and other information collected pursuant to this chapter. (2) The annual report shall include all of the following: (A) Total health care expenditures, per capita total health care expenditures, and, as appropriate, disaggregated data by categories such as service category, consumer out-of-pocket spending, and health care sector or geographic region, as specified in Section 127502. (B) The state’s progress towards achieving the health care cost target and improving affordability for consumers and purchasers of health care, while improving quality, reducing health disparities, and maintaining access to care and high-quality jobs and workforce stability. (C) Upon implementation of the Health Care Payments Data Program pursuant to Chapter 8.5 (commencing with Section 127671), or the availability of an alternative source of health care spending data for payers and fully integrated delivery systems required to report to the office, drivers of overall cost and cost growth, including cost trends by health care sector, such as type of provider or service type. Alternative sources of data shall include, but not be limited to, data provided to existing multipayer claims databases or other state or federal agencies. Any analysis of cost trends in the pharmaceutical sector shall account for the effect of drug rebates and other price concessions in the aggregate, without disclosing any product- or manufacturer-specific rebate or price concession information, and without limiting or otherwise affecting the confidential or proprietary nature of any rebate or price concession agreement. (D) Factors that contribute to cost growth within the state’s health care system. (E) Access, quality, and equity of care measures and data, as available. Access includes timely access, language access, geographic access, and other measures of access reported through available data. (F) Performance improvement plans required, administrative penalties imposed and assessed, and the amount returned to consumers and purchasers, if any. (G) A summary of best practices for improving affordability while maintaining access, quality, and equity of care, as well as any concerns regarding impacts on the health care workforce stability and training needs of health care workers, as feasible. (c) (1) Prior to and following the completion of the report on baseline health care spending, the office shall present the report’s findings to the board and the broader public at a public meeting of the board. (2) On or before July 1, 2027, and at least 30 days after posting the annual report, and each year thereafter, the office shall present the annual report at a public meeting of the board to inform the board, policymakers, including the Governor and the Legislature, and the broader public about implementation of this chapter, including health care cost targets, cost trends, and actionable recommendations for mitigating cost growth. (3) (A) The office shall seek comments on the findings of the annual report from health care entities, purchasers, consumer advocacy organizations, organizations representing employers who purchase health coverage, representatives of trust funds and other self-insured purchasers of health benefits, and experts on matters relevant to health care affordability, costs, quality, access, and equity of care, workforce stability, and administrative simplification. The office shall also solicit and collect comments from the public, submitted orally, electronically, or in writing, regarding the impacts of health care affordability efforts on health care workforce stability or training needs. All comments may be posted on the office’s internet website to the extent that they are in compliance with state guidelines for the appropriateness of communications. (B) The office shall notify the relevant regulatory agency and the Attorney General if a health care entity is impacting health care workforce stability or quality jobs, lowering quality, or reducing access or equity of care. (d) The annual report and the report on baseline health care spending shall be submitted to the Governor and the Legislature and shall be made available to the public on the office’s internet website, along with key data and statistics supporting its findings. The reports submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code. (e) The public meetings shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code). (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  177. 127501.7.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office may make interagency data-sharing agreements with specified agencies, and it must follow the confidentiality rules that would apply to the source agency for disclosure.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.7. (a) (1) Notwithstanding any other law regarding the confidentiality of data submitted by health care service plans or other entities to the Department of Managed Health Care, the office and the Department of Managed Health Care may enter into an interagency agreement for the transfer of data pursuant to Section 127501.4 and any other data maintained by the Department of Managed Health Care deemed necessary by the office to implement this chapter. (2) The interagency agreement shall specify that the office shall comply with any confidentiality requirements of the data that would otherwise apply to the Department of Managed Health Care with respect to disclosure. When confidentiality of data applies, the office may aggregate data for disclosure so that it does not reveal information specific to any particular health care service plan or other entity. (b) (1) Notwithstanding any other law regarding the confidentiality of data submitted by health insurers or other entities to the Department of Insurance, the office and the Department of Insurance may enter into an interagency agreement for the transfer of data pursuant to Section 127501.4 and any other data maintained by the Department of Insurance deemed necessary by the office to implement this chapter. (2) The interagency agreement shall specify that the office shall comply with any confidentiality requirements of the data that would otherwise apply to the Department of Insurance with respect to disclosure. When confidentiality of data applies, the office may aggregate data for disclosure so that it does not reveal information specific to any particular health insurer or other entity. (c) (1) Notwithstanding any other law regarding the confidentiality of data submitted by health plans or other entities to the State Department of Health Care Services, the office and the State Department of Health Care Services may enter into an interagency agreement for the transfer of data pursuant to Section 127501.4 and any other data maintained by the State Department of Health Care Services deemed necessary by the office to implement this chapter. (2) The interagency agreement shall specify that the office shall comply with any confidentiality requirements of the data that would otherwise apply to the State Department of Health Care Services with respect to disclosure. When confidentiality of data applies, the office may aggregate data for disclosure so that it does not reveal information specific to any particular Medi-Cal managed care plan or other entity. (d) (1) Notwithstanding any other law regarding the confidentiality of data submitted by qualified health plans or other entities to Covered California, the office and Covered California may enter into an interagency agreement for the transfer of data pursuant to Section 127501.4 and any other data maintained by Covered California deemed necessary by the office to implement this chapter. (2) The interagency agreement shall specify that the office shall comply with any confidentiality requirements of the data that would otherwise apply to Covered California with respect to disclosure. When confidentiality of data applies, the office may aggregate data for disclosure so that it does not reveal information specific to any particular qualified health plan or other entity. (e) (1) Notwithstanding any other law regarding the confidentiality of data submitted to a state agency, the office may enter into an interagency agreement for the transfer of data pursuant to Section 127501.4 and any other data maintained by the state agency deemed necessary by the office to implement this chapter. (2) The interagency agreement shall specify that the office shall comply with any confidentiality requirements of the data that would otherwise apply to the state agency with respect to disclosure. When confidentiality of data applies, the office may aggregate data for disclosure so that it does not reveal specific confidential information. (f) For the purposes of this section, information that is otherwise publicly available, or that has not been confidentially maintained by the source, shall not be considered nonpublic information. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  178. 127501.8.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The Health Care Affordability Fund is created in the State Treasury, and its money must be spent to prioritize returning funds to consumers and purchasers.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 2. Office of Health Care Affordability [127501 - 127501.12] ( Article 2 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127501.8. (a) There is hereby established in the State Treasury the Health Care Affordability Fund for the purpose of receiving and expending revenues collected pursuant to this chapter. This fund is subject to appropriation by the Legislature. (b) All moneys in the fund shall be expended in a manner that prioritizes the return of the moneys to consumers and purchasers. (c) The office may identify any opportunities to leverage existing public and private financial resources to provide technical assistance to health care entities and support to the office. Any private or public moneys obtained may be placed in the Health Care Affordability Fund, for use by the office upon appropriation by the Legislature. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  179. 127502.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 3. Health Care Cost Targets [127502 - 127502.5] ( Article 3 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The board must set statewide and sector health care cost targets, and the office must develop the methodology, publish recommendations, and support public reporting.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 3. Health Care Cost Targets [127502 - 127502.5] ( Article 3 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127502. (a) The board shall establish a statewide health care cost target. (b) (1) The board shall establish specific targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate. The board shall define health care sectors, which may include geographic regions and individual health care entities, as appropriate, except for fully integrated delivery systems, and the office shall promulgate regulations accordingly. (2) The board may adjust cost targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate, when warranted to account for the baseline costs in comparison to other health care entities in the health care sector and geographic region. (3) The setting of different targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate, shall be informed by historical cost data and other relevant supplemental data, such as financial data on health care entities submitted to state agencies and the Health Care Payments Data Program, as well as consideration of access, quality, equity, and health care workforce stability and quality jobs pursuant to Section 127506. (c) The health care cost targets shall meet all of the following requirements: (1) Promote a predictable and sustainable rate of change in per capita total health care expenditures. (2) (A) Be based on a target percentage, with consideration of economic indicators or population-based measures, and be developed based on a methodology that is available and transparent to the public. (B) Economic indicators may include established measures reflecting the broader economy, the labor markets, and consumer cost trends. (C) Population-based measures may include changes in the state’s demographic factors that may influence demand for health care services, such as aging. (3) Be set for each calendar year, with consideration of multiyear targets to provide health care entities with consistency, be updated periodically, and shall consider relevant adjustment factors. (4) Be developed, applied, and enforced. (5) Promote the goal of improved affordability for consumers and purchasers of health care, while maintaining quality and equitable care, including consideration of the impact on persons with disabilities and chronic illness. (6) Promote the stability of the health care workforce, including the development of the future workforce, such as graduate medical education teaching, training, apprenticeships, and research. (7) Be adjusted for a provider or fully integrated delivery system’s cost target, as appropriate upon a showing that nonsupervisory employee organized labor costs are projected to grow faster than the rate of any applicable cost targets. (d) (1) Consistent with paragraph (1) of subdivision (b) of Section 127501.11, the office shall develop a methodology, for approval by the board, to set health care cost targets. The methodology shall be available and transparent to the public. (2) The methodology shall review historical trends and projections for economic indicators and population-based measures. (3) The methodology shall review historical trends in costs for Medi-Cal, Medicare, and commercial health care coverage. The methodology shall provide differential treatment of the 2020 and 2021 calendar years due to the impacts of COVID-19 on health care spending and health care entities. (4) The methodology shall review potential factors to adjust future cost targets, including, but not limited to, the health care employment cost index, labor costs, the consumer price index for urban wage earners and clerical workers, impacts due to known emerging diseases, trends in the price of health care technologies, provider payer mix, state or local mandates such as required capital improvement projects, and any relevant state and federal policy changes impacting covered benefits, provider reimbursement, and costs. (5) (A) With respect to Medi-Cal, the methodology shall consider provision of nonfederal share, determined to be appropriate by the Director of Health Care Services, associated with Medi-Cal payments, such as expenditures by providers or provider-affiliated entities that serve as the nonfederal share associated with Medi-Cal reimbursement. (B) The methodology may also consider all of the following: (i) Supplemental payments to qualifying providers who provide services to Medi-Cal and underinsured patients. (ii) Provisions of nonfederal share or reimbursement of state costs not associated with specific Medi-Cal reimbursement, but that supports the Medi-Cal program, and any other reimbursements and fees assessed by the State Department of Health Care Services, as determined appropriate by the Director of Health Care Services. (iii) Health care-related taxes or fees that, in whole or in part, provide the nonfederal share associated with Medi-Cal payments or support the Medi-Cal program, as determined appropriate by the Director of Health Care Services. (C) The methodology shall allow the board, to the extent necessary for the Medi-Cal program to comply with federal requirements to help ensure that full federal financial participation is available and not otherwise jeopardized related to services, programs, benefits, and contracts that involve funds disbursed by the State Department of Health Care Services, including but not limited to funds authorized pursuant to Title XIX (42 U. S.C. Sec. 1396 et seq.) of the Social Security Act or Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.), to adjust any targets, when warranted, as they pertain to health care entities in the Medi-Cal program, upon the request of the Director of Health Care Services. (6) (A) The methodology shall allow the board to adjust cost targets downward, when warranted, for health care entities that deliver high-cost care that is not commensurate with improvements in quality, and upward, when warranted, for health care entities that deliver low cost, high quality care. (B) Data sources on cost and quality performance of health care entities may include, but are not limited to, all of the following: (i) Cost and quality performance data reported by or sourced from recognized quality improvement and transparency initiatives. (ii) Any other relevant supplemental data, such as financial data on health care entities, submitted to state agencies, and data on costs, payments, and quality from the Health Care Payments Data Program established pursuant to Chapter 8.5 (commencing with Section 127671). (iii) Any relevant federal, state, or local data. (7) The methodology shall require the board to adjust cost targets for a provider or a fully integrated delivery system as appropriate to account for actual or projected nonsupervisory employee organized labor costs, including increased expenditures related to compensation. For an adjustment to be effectuated, the provider, the fully integrated delivery system, or other associated party shall submit a request with supporting documentation in a format prescribed by the office. To validate the basis for the requested adjustment, the office may request or accept further information, such as any single labor agreement that is final and reflects the actual or projected increased nonsupervisory employee organized labor costs. The office may audit the submitted data and supporting information as necessary. (e) The methodology for setting a sector target for an individual health care entity shall be developed taking into account the following: (1) Allow for the setting of cost targets based on the entity’s status as a high-cost outlier. (2) Allow for the setting of cost targets that encourage an individual health care entity to serve populations with greater health care risks by incorporating all of the following: (A) A risk factor adjustment reflecting the health status of the entity’s patient mix, consistent with risk adjustment methodology developed under subdivision (f). (B) An equity adjustment accounting for the social determinants of health and other factors related to health equity for the entity’s patient mix, consistent with subdivision (g). (C) A geographic cost adjustment reflecting the relative cost of doing business, including labor costs in the communities the entity operates. (f) (1) In consultation with the board, the office shall establish risk adjustment methodologies for the reporting of data on total health care expenditures and may rely on existing risk adjustment methodologies. The methodology shall be available and transparent to the public. (2) To select appropriate risk adjustment methodologies or inform the way any adjustments are applied to unadjusted data to account for the underlying health status of the population, the office may convene technical committees, as necessary. (3) The risk adjustment methodologies selected or used to inform any adjustments shall take into account the impact of perverse incentives that may inflate the measurement of population risk, such as upcoding. The office may audit submitted data and make periodic adjustments to address those issues as necessary. (g) In consultation with the board, the office shall establish equity adjustment methodologies to take into account social determinants of health and other factors related to health equity, to the extent data is available and methodology has been developed and validated. (h) (1) Targets set for payers shall also include targets on administrative costs and profits to deter growth in administrative costs and profits. (2) The targets established for a payer’s administrative costs and profits under this subdivision may be subject to annual adjustment, but shall not increase to the extent the costs for the medical care portion of the medical loss ratio exceed a target. (3) The office shall consult with the Department of Managed Health Care, the State Department of Health Care Services, and the Department of Insurance to ensure any targets for payers established by the office consider actuarial soundness and rate review requirements imposed by or upon those departments. (i) (1) Until the board approves sector targets for fully integrated delivery systems, fully integrated delivery systems shall comply with the statewide cost target. (2) Targets set for fully integrated delivery systems shall include all health care services, costs, and lines of business managed by that system in each separately administered geographic service area of the state. The system shall provide sufficient data and information, comparable to other unintegrated payers and providers, including patient risk mix, to the office to enable analysis and public reporting of performance, including by sector, insurance market, line of business, and separately administered geographic service area. (3) Targets for fully integrated delivery systems shall include targets on payer administrative costs and profits. (4) After the board approves sector targets for fully integrated delivery systems, a fully integrated delivery system shall be subject to a target for each of its geographic service areas in which a single medical group is responsible for providing, or arranging for the provision of, all professional services to the payer’s enrollees. (j) The office shall direct the public reporting of performance on the health care cost targets, which may include analysis of changes in total health care expenditures on an aggregate and per capita basis for all of the following: (1) Statewide. (2) By geographic region. (3) By insurance market and line of business, including for each payer. (4) For health care entities, both unadjusted and using a risk adjustment methodology against the covered lives or patient populations, as applicable, for which they serve. (5) For impact on affordability for consumers and purchasers of health care. (k) The office shall direct the analysis and public reporting of contributions of health care entities to cost growth in the state using data that includes, but is not limited to, data submitted to the office, data from state and federal agencies, other relevant supplemental data, such as financial data on health care entities, that is submitted to state agencies, and the Health Care Payments Data Program, established pursuant to Chapter 8.5 (commencing with Section 127671). (l) (1) The board shall establish a statewide health care cost target for the 2025 calendar year and for each calendar year thereafter. The 2025 baseline target shall be a reporting year only and shall not be subject to enforcement pursuant to Section 127502.5. The targets established for the 2026 calendar year, and each calendar year thereafter, shall be enforced for compliance pursuant to Section 127502.5. (2) (A) On or before October 1, 2027, the board shall define initial health care sectors, which may include geographic regions and individual health care entities, as appropriate, except fully integrated delivery systems, considering factors such as delivery system characteristics. Sectors may be further defined over time. (B) Not later than June 1, 2028, the board shall establish specific targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities, as appropriate, in accordance with this chapter. (C) The development of sector targets shall be done in a manner that minimizes fragmentation and potential cost shifting and that encourages cooperation in meeting statewide and geographic region targets. (D) Sector targets adopted under this subdivision shall specify which single sector target is applicable if a health care entity falls within two or more sectors. (m) (1) The board shall hold a public meeting to discuss the development and adoption of recommendations for statewide cost targets, or specific targets by health care sector, including fully integrated delivery systems, geographic regions, and individual health care entities. The board shall deliberate and consider input, including recommendations from the office, the advisory committee, and public comment. Cost targets and other decisions of the board consistent with this section shall not be adopted, enforced, revised, or updated until presented at a subsequent public meeting. The meetings shall be subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code) consistent with paragraph (2) of subdivision (e) of Section 127501.10. (2) The office shall publish on its internet website its recommendations for proposed cost targets for the board’s review and consideration. The board shall discuss recommendations at a public meeting for proposed targets on or before March 1 of the year prior to the applicable target year. (3) The board shall receive and consider public comments for 45 days after the board meeting. (4) The board shall adopt final targets on or before June 1, at a board meeting. The board shall remain in session, and members shall not receive per diem under Section 127501.10, until the board adopts all required cost targets for the following calendar year. (n) The adoption of cost targets under this section is exempt from the requirements of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (o) For purposes of this section, “individual health care entity” does not include an exempted provider. (p) (1) Statewide and sector-specific health care cost targets do not apply to exempted providers. Upon approval by the board, the office shall promulgate regulations defining who is an exempted provider. (2) This section does not exempt claims and non-claims-based payments for exempted providers, and associated cost-sharing amounts paid by consumers, from inclusion in the calculation of total health care expenditures and per capita total health care expenditures that uses data submitted by payers. (Amended by Stats. 2022, Ch. 738, Sec. 5. (AB 204) Effective September 29, 2022.)
  180. 127502.5.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 3. Health Care Cost Targets [127502 - 127502.5] ( Article 3 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The director and office must enforce health care cost targets against health care entities, give notice and a response period, and can require performance improvement plans, public testimony, technical assistance, and penalties.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 3. Health Care Cost Targets [127502 - 127502.5] ( Article 3 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127502.5. (a) The director shall enforce the cost targets established by this chapter against health care entities in a manner that ensures compliance with targets, allows each health care entity opportunities for remediation, and ensures health care entities do not implement performance improvement plans in ways that are likely to erode access, quality, equity, or workforce stability. The director shall consider each entity’s contribution to cost growth in excess of the applicable target and any actions by the entity that have eroded, or are likely to erode, access, quality, equity, or workforce stability, factors that contribute to spending in excess of the applicable target, and the extent to which each entity has control over the applicable components of its cost target. The director shall review information and other relevant data from additional sources, as appropriate, including data from the Health Care Payments Data Program, to determine the appropriate health care entity that may be subject to enforcement actions under this section. Commensurate with the health care entity’s offense or violation, the director may take the following progressive enforcement actions: (1) Provide technical assistance to the entity to assist it to come into compliance. (2) Require or compel public testimony by the health care entity regarding its failure to comply with the target. (3) Require submission and implementation of performance improvement plans, including input from the board. (4) Assess administrative penalties in amounts initially commensurate with the failure to meet the targets, and in escalating amounts for repeated or continuing failure to meet the targets. (b) Prior to taking any enforcement action, the office shall do all of the following: (1) Notify the health care entity that it has exceeded the health care cost target. (2) Give the health care entity not less than 45 days to respond and provide additional data, including information in support of a waiver described in subdivision (i). (3) If the office determines that the additional data and information meets the burden established by the office to explain all or a portion of the entity’s cost growth in excess of the applicable target, the office may modify its findings, as appropriate. (4) The director shall consult with the Director of Managed Health Care, the Director of Health Care Services, or the Insurance Commissioner, as applicable, prior to taking any of the enforcement actions specified in this section with respect to a payer regulated by the respective department to ensure any technical assistance, performance improvement plans, or other measures authorized by this section are consistent with laws applicable to regulating health care service plans, health insurers, or a Medi-Cal managed care plan contracted with the State Department of Health Care Services. (c) (1) If a health care entity exceeds an applicable cost target, the office shall notify the health care entity of their status and provide technical assistance. The office shall make public the extent to which the health care entity exceeded the target. The office may require a health care entity to submit and implement a performance improvement plan that identifies the causes for spending growth and shall include, but not be limited to, specific strategies, adjustments, and action steps the health care entity proposes to implement to improve spending performance during a specified time period. The office shall request further information, as needed, in order to approve a proposed performance improvement plan. The director may approve a performance improvement plan consistent with those areas requiring specific performance or correction for up to three years. The director shall not approve a performance improvement plan that proposes to meet cost targets in ways that are likely to erode access, quality, equity, or workforce stability. The standards developed under Article 7 (commencing with Section 127506) may be considered in the approval of a performance improvement plan. (2) The office shall monitor the health care entity for compliance with the performance improvement plan. The office shall publicly post the identity of a health care entity implementing a performance improvement plan and, at a minimum, a detailed summary of the entity’s compliance with the requirements of the performance improvement plan while the plan remains in effect and shall transmit an approved performance improvement plan to appropriate state regulators for the entity. (3) A health care entity shall work to implement the performance improvement plan as submitted to, and approved by, the office. The office shall monitor the health care entity for compliance with the performance improvement plan. (4) The board, the members of the board, the office, the department, and employees, contractors, and advisors of the office and the department shall keep confidential all nonpublic information and documents obtained under this subdivision, and shall not disclose the confidential information or documents to any person, other than the Attorney General, without the consent of the source of the information or documents, except in an administrative penalty action, or a public meeting under this section if the office believes that disclosure should be made in the public interest after taking into account any privacy, trade secret, or anticompetitive considerations. Prior to disclosure in a public meeting, the office shall notify the relevant party and provide the source of nonpublic information an opportunity to specify facts documenting why release of the information is damaging or prejudicial to the source of the information and why the public interest is served in withholding the information. Information that is otherwise publicly available, or that has not been confidentially maintained by the source, shall not be considered nonpublic information. This paragraph does not limit the board’s discussion of nonpublic information during closed sessions of board meetings. (5) Notwithstanding any other law, all nonpublic information and documents obtained under this subdivision shall not be required to be disclosed pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code), or any similar local law requiring the disclosure of public records. (d) (1) If the director determines that a health care entity is not compliant with an approved performance improvement plan and does not meet the cost target, the director may assess administrative penalties commensurate with the failure of the health care entity to meet the target. An entity that has fully complied with an approved performance improvement plan by the deadline established by the office shall not be assessed administrative penalties. However, the director may require a modification to the performance improvement plan until the cost target is met. (2) The administrative penalty shall be deposited into the Health Care Affordability Fund. (3) Prior to assessing an administrative penalty against a health care entity, the director may consider related provision of nonfederal share, determined to be appropriate by the Director of Health Care Services, associated with Medi-Cal payments, such as expenditures by providers or provider-affiliated entities that serve as the nonfederal share associated with Medi-Cal reimbursement. (4) To the extent that an administrative penalty is related to a Medi-Cal expenditure, including federal financial participation, the office shall coordinate with the State Department of Health Care Services to ensure appropriate treatment and return of any federal funds pursuant to Subpart F commencing with Section 433.300 of Part 433 of Title 42 of the Code of Federal Regulations. (5) If, after the implementation of one or more performance improvement plans, the health care entity is repeatedly noncompliant with the performance improvement plan, the director may assess escalating administrative penalties that exceed the penalties imposed under paragraphs (1) and (2) of this subdivision and paragraph (4) of subdivision (a). (6) The director shall consider all of the following to determine the penalty: (A) The nature, number, and gravity of the offenses. (B) The fiscal condition of the health care entity, including revenues, reserves, profits, and assets of the entity, as well as any affiliates, subsidiaries, or other entities that control, govern, or are financially responsible for the entity or are subject to the control, governance, or financial control of the entity. (C) The market impact of the entity. (e) Administrative penalties shall not constitute expenditures for the purpose of meeting cost targets. The imposition of administrative penalties shall not alter or otherwise relieve the health care entity of the obligation to meet a previously established cost target or a cost target for subsequent years. (f) (1) For payers and fully integrated delivery systems, the director also shall enforce cost targets established by Section 127502 against the cost growth for administrative costs and profits. (2) If a payer exceeds the target for per capita growth in total health care expenditures, but has met its target for administrative costs and profits, the payer shall submit relevant documentation or supporting evidence for the drivers of excess cost growth. (3) This subdivision does not relieve a payer of its obligation to meet targets for per capita growth in total health care expenditures established by Section 127502, and does not limit enforcement actions for payers under this section. (g) If data indicate adverse impacts on cost, access, quality, equity, or workforce stability from consolidation, market power, or other market failures, the director may, at any point, require that a cost and market impact review be performed on a health care entity, consistent with Section 127507.2. (h) (1) The director may directly assess administrative penalties when a health care entity has failed to comply with this chapter by doing any of the following: (A) Willfully failing to report complete and accurate data. (B) Repeatedly neglecting to file a performance improvement plan with the office. (C) Repeatedly failing to file an acceptable performance improvement plan with the office. (D) Repeatedly failing to implement the performance improvement plan. (E) Knowingly failing to provide information required by this section to the office. (F) Knowingly falsifying information required by this section. (2) The director may call a public meeting to notify the public about the health care entity’s violation and declare the entity as imperiling the state’s ability to monitor and control health care cost growth. (i) The office may establish requirements for health care entities to file for a waiver of enforcement actions due to reasonable factors outside the entity’s control, such as changes in state or federal law or anticipated costs for investments and initiatives to minimize future costly care, such as increasing access to primary and preventive services, or under extraordinary circumstances, such as an act of God or catastrophic event. The entity shall submit documentation or supporting evidence of the reasonable factors, anticipated costs, or extraordinary circumstances. The office shall request further information, as needed, in order to approve or deny an application for a waiver. (j) As applied to the administrative penalties for acts in violation of this chapter, the remedies provided by this section and by any other law are not exclusive and may be sought and employed in any combination to enforce this chapter. (k) Following an administrative hearing, a health care entity adversely affected by a final order imposing an administrative penalty authorized by this chapter may seek independent judicial review by filing a petition for a writ of mandate in accordance with Section 1094.5 of the Code of Civil Procedure. (l) After an order imposing an administrative penalty becomes final, and if a petition for a writ of mandate has not been filed within the time limits prescribed in Section 11523 of the Government Code, the office may apply to the clerk of the appropriate court for a judgment in the amount of the administrative penalty. The application, which shall include a certified copy of the final order of the administrative hearing officer, shall constitute a sufficient showing to warrant the issuance of the judgment. The court clerk shall enter the judgment immediately in conformity with the application. The judgment so entered has the same force and effect as, and is subject to all the provisions of law relating to, a judgment in a civil action, and may be enforced in the same manner as any other judgment of the court in which it is entered. (Amended by Stats. 2023, Ch. 131, Sec. 130. (AB 1754) Effective January 1, 2024.)
  181. 127503.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 4. Quality and Equity Performance [127503- 127503.] ( Article 4 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must create standard health care quality and equity measures and use them in reporting, coordination, and periodic updates.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 4. Quality and Equity Performance [127503- 127503.] ( Article 4 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127503. (a) (1) The office shall adopt a single set of standard measures for assessing health care quality and equity across payers, fully integrated delivery systems, hospitals, and physician organizations. Performance on quality and health equity measures shall be included in the annual report required in Section 127501.6. (2) The standard quality and equity measures shall use recognized clinical quality, patient experience, patient safety, and utilization measures for health care service plans, health insurers, hospitals, and physician organizations. (3) The standard quality and equity measures shall reflect the diversity of California in terms of race, ethnicity, sex, age, language, sexual orientation, gender identity, and disability status. The standard quality and equity measures shall be appropriate for a population under 65 years of age, including children and adults. (4) The standard quality and equity measures shall consider available means for reliable measurement of disparities in health care, including race, ethnicity, sex, age, language, sexual orientation, gender identity, and disability status. (5) The office shall reduce administrative burden by selecting quality and equity measures that simplify reporting and align performance measurement with other payers, programs, and state agencies, including leveraging existing voluntary and required reporting to the greatest extent possible. The office shall further reduce administrative burden by encouraging other payers and programs to use the same reporting mechanisms. (6) Public reporting developed pursuant to this article shall consider differences among payers, fully integrated delivery systems, hospitals, and physician organizations, including factors such as plan or network design or line of business, provider payer mix, and the risk mix associated with the covered lives or patient population for which they are primarily responsible. (b) In implementing this section, the office shall coordinate with the Department of Managed Health Care to align with requirements under Article 11.9 (commencing with Section 1399.870) of Chapter 2.2 of Division 2. The office shall also coordinate with the State Department of Health Care Services, Covered California, and the Public Employees’ Retirement System, and shall consult with state departments, external quality improvement organizations and forums, payers, physicians, other providers, and consumer advocates or stakeholders with expertise in quality or equity measurement. (c) The office shall periodically review and update the priority set of standard measures for assessing the quality and equity of care pursuant to subdivision (a). (Amended by Stats. 2022, Ch. 738, Sec. 6. (AB 204) Effective September 29, 2022.)
  182. 127504.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 5. Alternative Payment Models [127504- 127504.] ( Article 5 added by Stats. 2022, Ch. 47, Sec. 19. )

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    The office must promote alternative payment models, set goals and benchmarks, adopt standards by July 1, 2024, review them at least every five years, report on adoption, and consult with relevant departments and organizations.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 5. Alternative Payment Models [127504- 127504.] ( Article 5 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127504. (a) The office shall promote the shift from payments based on fee-for-service to alternative payment models that provide financial incentive for equitable high-quality and cost-efficient care. In furtherance of this goal, the office shall convene health care entities and organize an alternative payment model working group, set statewide goals for the adoption of alternative payment models, and measure the state’s progress toward those goals. With input from the working group, the office shall set benchmarks that include, but are not limited to, increasing the percentage of total health care expenditures delivered through alternate payment models or the percentage of membership covered by an alternative payment model. (b) (1) To advance statewide goals for adoption of alternative payment models, the office shall consider existing alternative payment models and work with the working group to develop standards for alternative payment models that may be used during contracting between health care entities. The office shall adopt the standards for alternative payment models on or before July 1, 2024. (2) The standards for alternative payment models shall focus on encouraging and facilitating multipayer participation and alignment, improving affordability, efficiency, equity, and quality by considering the current best evidence for strategies such as investments in primary care and behavioral health, shared risk arrangements, or quality-based or population-based payments. (3) The standards shall include minimum criteria for what is considered an alternative payment model, but be flexible enough to allow for innovation and evolution over time. The standards shall be consistent, and align, to the extent possible, with the quality and equity measures outlined in Article 4 (commencing with Section 127503) to encourage physicians and other providers to make investments and aim to see year-over-year improvement. (4) The standards shall address appropriate incentives to physicians and other providers and balanced measures, including, but not limited to, total cost of care and quality, access, and equity requirements and shared savings models, to protect against perverse incentives and unintended consequences. (5) The standards shall attempt to reduce administrative burden by incorporating alternative payment models that facilitate multipayer participation and align with other state payers and programs or national models. (6) The office shall review the standards at least every five years or more frequently, as appropriate, in order to determine whether the standards are rewarding high-quality, cost-efficient, and equitable care. (c) The office shall include an analysis of alternative payment model adoption in the annual report required in Section 127501.6. (d) In implementing this section, the office shall consult with state and federal departments to ensure consistency with state and federal laws, and shall also consult with external organizations promoting alternative payment models and other entities and individuals with expertise in health care financing and quality and equity measurements. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  183. 127505.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 6. Primary Care and Behavioral Health Investments [127505- 127505.] ( Article 6 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    The office must measure, promote, and report on investment in primary care and behavioral health, set spending benchmarks, and consult relevant state and external experts.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 6. Primary Care and Behavioral Health Investments [127505- 127505.] ( Article 6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127505. (a) (1) The office shall measure and promote a sustained systemwide investment in primary care and behavioral health. In furtherance of this goal, the office shall measure the percentage of total health care expenditures allocated to primary care and behavioral health and set spending benchmarks. Spending benchmarks for primary care shall consider current and historic underfunding of primary care services. (2) The intent of the spending benchmarks is to build and sustain infrastructure and capacity, specifically methods of reimbursement that shift greater health care resources and investments away from specialty care and toward supporting and facilitating innovation and care improvement in primary care and behavioral health. It is intended that increased support for primary care and behavioral health will not increase costs to consumers or increase the total costs of health care. However, shifting resources may take time and not be associated with immediate savings. (3) Benchmarks and public reporting developed pursuant to this article shall consider differences among payers and fully integrated delivery systems, including factors such as plan or network design or line of business, the diversity of settings and facilities through which primary care can be delivered, including clinical and nonclinical settings, the use of both claims-based and non-claims-based payments, and the risk mix associated with the covered lives or patient population for which they are primarily responsible. (4) In addition to measuring performance of health care entities with the spending benchmarks, the office shall promote improved outcomes for primary care and behavioral health, including, but not limited to, health care entities making investments in, or adopting models that do, any or all of the following: (A) Promote the importance of primary care and adopt practices that give consumers a regular source of primary care. (B) Increase access to advanced primary care models and adoption of measures that demonstrate their success in improving quality and outcomes. (C) Integrate primary care and behavioral health services, including screenings for behavioral health conditions in primary care settings or delivery of behavioral health support for common behavioral health conditions, such as anxiety, depression, or substance use disorders. (D) Leverage alternative payment models that provide resources at the practice level to enable improved access and team-based approaches for care coordination, patient engagement, quality, and population health. Team-based approaches support the sharing of accountability for delivery of care between physicians and nurse practitioners, physician assistants, medical assistants, nurses and nurse case managers, social workers, pharmacists, and traditional and nontraditional primary and behavioral health care providers, such as peer support specialists, community health works, and others. (E) Deliver higher value primary care and behavioral health services with an aim toward reducing disparities. (F) Leverage telehealth and other digital health solutions to expand access to primary care and behavioral health services, care coordination, and care management. (G) Implement innovative approaches that integrate primary care and behavioral health with broader social and public health services. (b) The office shall include an analysis of primary care and behavioral health spending and growth, and relevant quality and equity performance measures, in the annual report required pursuant to Section 127501.6. (c) In implementing this section, the office shall consult with state departments, external organizations promoting investment in primary care and behavioral health, and other entities and individuals with expertise in primary care, behavioral health, and health equity. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  184. 127506.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 7. Health Care Workforce Stability [127506- 127506.] ( Article 7 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    The office must monitor health care costs and workforce stability, and develop workforce-stability standards by July 2024 with consultation and public input.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 7. Health Care Workforce Stability [127506- 127506.] ( Article 7 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127506. (a) The intent of this section is to monitor the effects of cost targets on health care workforce stability, high-quality jobs, and training needs of health care workers, in addition to adjustments to cost targets pertaining to nonsupervisory employee organized labor costs pursuant to paragraph (7) of subdivision (d) of Section 127502. The Legislature intends that the office use a transparent process that allows for public input to monitor how health care entities achieve the cost targets and highlight best practices and discourage practices harmful to workers and patients. (b) The office shall monitor health care costs while promoting health care workforce stability, including the competitive wages and benefits of frontline health care workers, and the professional judgment of health professionals acting within their scope of practice. The office shall monitor health care workforce stability with the goal that workforce shortages do not undermine health care affordability, access, quality, equity, and culturally and linguistically competent care. The office shall also promote the goal of health care affordability, while recognizing the need to maintain and increase the supply of trained health care workers. (c) To assist health care entities in implementing cost-reducing strategies that advance the stability of the health care workforce, and without exacerbating existing health care workforce shortages, the office, on or before July 2024, in consultation with the board and with input from organized labor representing health care workers, health care entities, and other entities and individuals with expertise in the health care workforce, shall develop standards to advance the stability of the health care workforce. The standards may be considered in the setting of cost targets pursuant to Section 127502 or in the approval of performance improvement plans imposed pursuant to Section 127502.5. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  185. 127507.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    This section requires the office to monitor health care market trends and requires certain health care-related entities to give written notice of qualifying material-change transactions.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127507. (a) The office shall monitor cost trends, including conducting research and studies on the health care market, including, but not limited to, the impact of consolidation, market power, venture capital activity, profit margins, and other market failures on competition, prices, access, quality, and equity. In a manner supportive of the efforts of the Attorney General, the Department of Managed Health Care, and the Department of Insurance, as appropriate, the office shall promote competitive health care markets by examining mergers, acquisitions, corporate affiliations, or other transactions that entail a material change to ownership, operations, or governance structure involving health care service plans, health insurers, hospitals or hospital systems, physician organizations, providers, pharmacy benefit managers, and other health care entities. The office shall prospectively analyze those transactions likely to have significant effects, seek input from the parties and the public, and report on the anticipated impacts to the health care market. The role of the office is to collect and report information that is informative to the public. (b) This article does not apply to an exempted provider unless that provider is being acquired by, or affiliating with, an entity that is not an exempted provider. If an entity that is not an exempted provider is acquiring or affiliating with an exempted provider, the entity that is not an exempted provider shall meet the requirements of this article. (c) (1) A health care entity shall provide the office with written notice of agreements or transactions that do either of the following: (A) Sell, transfer, lease, exchange, option, encumber, convey, or otherwise dispose of a material amount of its assets to one or more entities. (B) Transfer control, responsibility, or governance of a material amount of the assets or operations of the health care entity to one or more entities. (2) (A) A noticing entity shall provide the office with written notice of agreements or transactions between the noticing entity and a health care entity or management services organization, or an entity that owns or controls the health care entity or management services organization that do either of the following: (i) Sell, transfer, lease, exchange, option, encumber, convey, or otherwise dispose of a material amount of the health care entity’s or management services organization’s assets to one or more entities. (ii) Transfer control, responsibility, or governance of a material amount of the assets or operations of the health care entity or management services organization to one or more entities. (B) In addition to reporting obligations under subparagraph (A), a management services organization shall provide the office with written notice of any agreement or transaction that is described in clauses (i) and (ii) of subparagraph (A) between the management services organization and any other entity. (C) The office shall adopt regulations to eliminate duplicative reporting if a noticing entity or health care entity is required to submit notice to the office under more than one provision in subdivision (c). (3) Written notice pursuant to paragraph (1) shall be provided to the office at least 90 days prior to entering into the agreement or transaction. If the conditions in paragraph (1) of subdivision (a) of Section 127507.2 apply, the office shall make the notice of material change publicly available, including all information and materials submitted to the office for review with regard to the material change. (4) The office shall adopt regulations for proposed material changes that warrant a notification, establish appropriate fees, and consider appropriate thresholds, including, but not limited to, annual gross and net revenues and market share in a given service or region. (d) The requirement to provide notice of a material change pursuant to subdivision (c) does not apply to any of the following: (1) Agreements or transactions involving health care service plans that are subject to review by the Director of the Department of Managed Health Care for cost impact or market consolidation under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2). (2) Agreements or transactions involving health insurers that are subject to review by the Insurance Commissioner under Article 14 (commencing with Section 1091) of Chapter 1 of Part 2, of Division 1 of the Insurance Code. (3) Agreements or transactions where a county is purchasing, acquiring, or taking control, responsibility, or governance of an entity to ensure continued access in that county. (4) Agreements or transactions involving nonprofit corporations that are subject to review by the Attorney General under Article 2 (commencing with Section 5914) of Chapter 9 of Part 2, Division 2 of Title 1 of the Corporations Code. (e) Agreements or transactions exempted under subdivision (d) from the requirement to provide a notice of material change may be referred to the office for a cost and market impact review by the reviewing authority. (f) This article does not limit the Attorney General’s review of the conversion or restructuring of charitable trusts held by a nonprofit health facility or by an affiliated nonprofit health system or the Attorney General’s review of any health care agreement or transaction under any state or federal law. (g) This article does not narrow, abrogate, or otherwise alter the corporate practice of medicine doctrine, which expressly prohibits the practice of medicine or control of medicine, medical corporations, medical partnerships, or physician practices by entities or individuals other than licensed physicians and surgeons. (h) For purposes of this article, “noticing entity” includes all of the following: (1) A private equity group or hedge fund. (2) A newly created business entity created for the purpose of entering into agreements or transactions with a health care entity. (3) A management services organization. (4) An entity that owns, operates, or controls a provider, regardless of whether the provider is currently operating, providing health care services, or has a pending or suspended license. (Amended by Stats. 2025, Ch. 641, Sec. 4. (AB 1415) Effective January 1, 2026.)
  186. 127507.2.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    The office must review certain material health care changes when they may significantly affect competition, cost targets, or purchaser and consumer costs, and it must follow notice, reporting, confidentiality, and timeline rules.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127507.2. (a) (1) If the office finds that a material change noticed pursuant to Section 127507 is likely to have a risk of a significant impact on market competitions, the state’s ability to meet cost targets, or costs for purchasers and consumers, the office shall conduct a cost and market impact review that examines factors relating to a health care entity’s business and its relative market position, including, but not limited to, changes in size and market share in a given service or geographic region, prices for services compared to other providers for the same services, quality, equity, cost, access, or any other factors the office determines to be in the public interest. The office also may conduct cost and market impact reviews on any health care entity based on a determination by the director under subdivision (g) of Section 127502.5, or in association with agreements or transactions referred to the office by a reviewing authority listed in paragraphs (1) to (4), inclusive, of subdivision (d) of Section 127507. (2) In conducting the review, the office shall consider the benefits of the material change to consumers of health care services, where those benefits could not be achieved without that transaction, including, but not limited to, increased access to health care services, higher quality, and more efficient health care services where consumers of health care services benefit directly from those efficiencies. The party subject to the review may provide information demonstrating the benefits of the material change or information demonstrating the benefits of an integrated organization where the material change would increase those benefits, and where the benefits involve cost, quality, or access to care for consumers of health care services. (3) (A) Within 60 days of receipt of a notice of material change, the office shall either advise the noticing health care entity of the office’s determination to conduct a cost and market impact review or provide a written waiver from the review. An agreement or transaction for which a cost and market impact review proceeds shall not be implemented until 60 days after the office issues a final report. (B) The office may adopt regulations that expedite these timelines, as warranted, depending on the nature of the agreement or transaction. (4) In furtherance of this article, the office shall conduct investigations, including, but not limited to, compelling, by subpoena, health care entities and other relevant market participants to submit data and documents. (5) Upon completion of the cost and market impact review, the office shall make factual findings and issue a preliminary report of its findings. After allowing for the affected parties and the public to respond in writing to the findings in the preliminary report, the office shall issue its final report. (b) The office shall adopt regulations for notification to affected parties for the basis of the review, factors considered in the review, requests for data and information from affected parties, the public, and other relevant market participants, and relevant timelines. (c) (1) The office, the department, employees, contractors, and advisors of the office and the department, the board, and the board members shall keep confidential all nonpublic information and documents obtained under this article that were not required with the notice of material change or from the parties to the transaction, and shall not disclose the confidential information or documents to any person, other than the Attorney General, without the consent of the source of the information or documents, except in a preliminary report or final report under this section if the office believes that disclosure should be made in the public interest after taking into account any privacy, trade secret, or anticompetitive considerations. Prior to disclosure in a report, the office shall notify the relevant party and provide the source of nonpublic information an opportunity to specify facts documenting why release of the information is damaging or prejudicial to the source of the information and why the public interest is served in withholding the information. Information that is otherwise publicly available, or that has not been confidentially maintained by the source, shall not be considered nonpublic information. (2) Notwithstanding any other law, all nonpublic information and documents obtained under this article shall not be required to be disclosed pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code), or any similar local law requiring the disclosure of public records. (d) (1) The office may refer its findings, including the totality of documents gathered and data analysis performed, to the Attorney General for further review of any unfair methods of competition, anticompetitive behavior, or anticompetitive effects. (2) This section does not limit the authority of the Attorney General to protect consumers in the health care market or to protect the economy of the state, or any significant part thereof, insofar as health care is concerned, under any state or federal law. The authority of the Attorney General to maintain competitive markets and prosecute state and federal antitrust and unfair competition violations shall not be narrowed, abrogated, or otherwise altered by this section. (Amended by Stats. 2023, Ch. 131, Sec. 131. (AB 1754) Effective January 1, 2024.)
  187. 127507.4.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    The office may contract with state agencies and experts or consultants, and a reviewed health care entity must promptly reimburse the office for covered review costs on request.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127507.4. In furtherance of this article, the office may do all of the following: (a) Contract with, consult, and receive advice from any state agency on terms and conditions that the office deems appropriate. (b) Contract with experts or consultants to assist in reviewing a proposed agreement or transaction. (1) Contract costs shall not exceed an amount that is reasonable and necessary to conduct the review and complete the report. (2) The office shall be entitled to reimbursement from the health care entity subject to review for all actual, reasonable, and direct costs incurred in reviewing, evaluating, and making the determination referred to in Section 127507.2, including administrative costs. The health care entity subject to review shall promptly pay the office, upon request, for all of those costs. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  188. 127507.6.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. )

    Verify source ↗

    The office may obtain court-ordered remedies and recover attorney’s fees and costs to enforce this article.

    ## Health and Safety Code - HSC ## DIVISION 107. HEALTH CARE ACCESS AND INFORMATION [127000 - 130079] ( Heading of Division 107 amended by Stats. 2021, Ch. 143, Sec. 28. ) ## PART 2. HEALTH POLICY AND PLANNING [127280 - 127774] ( Part 2 added by Stats. 1995, Ch. 415, Sec. 9. ) ## CHAPTER 2.6. Health Care Affordability [127500 - 127507.6] ( Chapter 2.6 added by Stats. 2022, Ch. 47, Sec. 19. ) ## ARTICLE 8. Health Care Market Trends [127507 - 127507.6] ( Article 8 added by Stats. 2022, Ch. 47, Sec. 19. ) ## 127507.6. In addition to any legal remedies, the office shall be entitled to specific performance, injunctive relief, and other equitable remedies a court deems appropriate for enforcement of any of the requirements of this article and shall be entitled to recover its attorney’s fees and costs incurred in remedying each violation. (Added by Stats. 2022, Ch. 47, Sec. 19. (SB 184) Effective June 30, 2022.)
  189. 12751.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 1. Definitions and Scope [12750 - 12751] ( Chapter 1 added by Stats. 2004, Ch. 496, Sec. 1. )

    Verify source ↗

    This section exempts certain fire-service personnel from this part’s rules for handling flamethrowing devices when they are on duty and using the device for fire suppression.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 1. Definitions and Scope [12750 - 12751] ( Chapter 1 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12751. This part shall not apply to the sale, purchase, possession, transportation, storage, or use of a flamethrowing device by a person if all of the following apply: (a) The person is regularly employed by or a paid officer, employee, or member of a fire department, fire protection district, or firefighting agency of the federal government, the state, a city, a county, a city and county, district, public or municipal corporation, or political subdivision of this state. (b) The person is on duty and acting within the course and scope of his or her employment. (c) The flamethrowing device is used by the fire department, fire protection district, or firefighting agency described in subdivision (a) in the course of fire suppression. (Added by Stats. 2007, Ch. 30, Sec. 1. Effective January 1, 2008.)
  190. 12755.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. )

    Verify source ↗

    A person may not use or possess a flamethrowing device unless they have a valid permit issued by the State Fire Marshal.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12755. No person shall use or possess a flamethrowing device without a valid flamethrowing device permit issued by the State Fire Marshal pursuant to this part. (Added by Stats. 2004, Ch. 496, Sec. 1. Effective January 1, 2005.)
  191. 12756.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. )

    Verify source ↗

    The State Fire Marshal must adopt regulations for flamethrowing device permits, including background-investigation standards and rules for use, storage, and transportation.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12756. The State Fire Marshal shall adopt regulations to administer this part and establish standards for the background investigation of an applicant for, and holder of, a flamethrowing device permit, and for the use, storage, and transportation of a flamethrowing device. In adopting these regulations, the State Fire Marshal shall consult with the Department of Justice regarding regulations for the use and possession of destructive devices (Chapter 12.5 (commencing with Section 970) of Division 1 of Title 11 of the California Code of Regulations). These regulations for the use and possession of destructive devices may provide suggestions for potential methods to utilize in developing standards and shall serve as guidance only. At a minimum, the regulations adopted by the State Fire Marshal shall require a permitholder to possess a current, valid certificate of eligibility issued by the Department of Justice pursuant to subdivisions (a) to (c), inclusive, of Section 26710 of the Penal Code. (Amended by Stats. 2010, Ch. 178, Sec. 40. (SB 1115) Effective January 1, 2011. Operative January 1, 2012, by Sec. 107 of Ch. 178.)
  192. 12757.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. )

    Verify source ↗

    The State Fire Marshal may issue or renew a flamethrowing-device permit only if the applicant or permit holder meets specified conditions.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12757. The State Fire Marshal may issue or renew a permit to use and possess a flamethrowing device only if all of the following conditions are met: (a) The applicant or permitholder is not addicted to any controlled substance. (b) The applicant or permitholder possesses a current, valid certificate of eligibility issued by the Department of Justice pursuant to subdivisions (a) to (c), inclusive, of Section 26710 of the Penal Code. (c) The applicant or permitholder meets the other standards specified in regulations adopted pursuant to Section 12756. (Amended by Stats. 2010, Ch. 178, Sec. 41. (SB 1115) Effective January 1, 2011. Operative January 1, 2012, by Sec. 107 of Ch. 178.)
  193. 12758.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. )

    Verify source ↗

    An applicant or permitholder can get a hearing if the State Fire Marshal denies or revokes a flamethrowing device permit, and the State Fire Marshal must revoke the permit if the permitholder does not comply with the part’s requirements and related regulations.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12758. (a) If the State Fire Marshal denies an application for, or the renewal of, or revokes a flamethrowing device permit, the applicant for a flamethrowing device permit or permitholder shall be entitled to a hearing conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. (b) The State Fire Marshal shall revoke a flamethrowing device permit if the permitholder does not comply with the requirements of this part and the regulations adopted pursuant to this part. (Added by Stats. 2004, Ch. 496, Sec. 1. Effective January 1, 2005.)
  194. 12759.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. )

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    The State Fire Marshal must establish fees under this part, and those fees must be deposited in the State Fire Marshal Licensing and Certification Fund.

    ## Health and Safety Code - HSC ## DIVISION 11. EXPLOSIVES [12000 - 12761] ( Division 11 enacted by Stats. 1939, Ch. 60. ) ## PART 3. FLAMETHROWING DEVICES [12750 - 12761] ( Part 3 added by Stats. 2004, Ch. 496, Sec. 1. ) ## CHAPTER 2. Administration [12755 - 12759] ( Chapter 2 added by Stats. 2004, Ch. 496, Sec. 1. ) ## 12759. The State Fire Marshal shall establish fees pursuant to this part that shall be deposited in the State Fire Marshal Licensing and Certification Fund. (Added by Stats. 2004, Ch. 496, Sec. 1. Effective January 1, 2005.)
  195. 1276.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Health facilities must use the program-flexibility process for certain changes, and the department must review, post, and decide on requests within set timelines.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276. (a) The building standards published in the California Building Standards Code by the Department of Health Care Access and Information, and the regulations adopted by the State Department of Public Health shall, as applicable, prescribe standards of adequacy, safety, and sanitation of the physical plant, of staffing with duly qualified licensed personnel, and of services, based on the type of health facility and the needs of the persons served thereby. (b) These regulations shall permit program flexibility by the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, bulk purchasing of pharmaceuticals, or conducting of pilot projects as long as statutory requirements are met and the use has the prior written approval of the State Department of Public Health or the Department of Health Care Access and Information, as applicable. The approval of the department or the Department of Health Care Access and Information shall provide for the terms and conditions under which the exception is granted. A written request plus supporting evidence shall be submitted by the applicant or licensee to the department or Department of Health Care Access and Information regarding the exception, as applicable. (c) While it is the intent of the Legislature that health facilities shall maintain continuous, ongoing compliance with the licensing rules and regulations, it is the further intent of the Legislature that the State Department of Public Health expeditiously review and approve, if appropriate, applications for program flexibility. The Legislature recognizes that health care technology, practice, pharmaceutical procurement systems, and personnel qualifications and availability are changing rapidly. Therefore, requests for program flexibility require expeditious consideration. (d) The department shall, on or before April 1, 1989, develop a standardized form and format for requests by health facilities for program flexibility. Health facilities shall thereafter apply to the department for program flexibility in the prescribed manner. After the department receives a complete application requesting program flexibility, it shall have 60 days within which to approve, approve with conditions or modifications, or deny the application. Denials and approvals with conditions or modifications shall be accompanied by an analysis and a detailed justification for any conditions or modifications imposed. Summary denials to meet the 60-day timeframe shall not be permitted. (e) To the extent that an application by a health facility for program flexibility, or for an extension of program flexibility, includes a request to allow the health facility to designate a bed or multiple beds in a critical care unit as requiring a lower level of care, including, but not limited to, the level of care provided in an intermediate care, step-down, telemetry, medical-surgical, specialty care, or pediatric services unit, that application shall be referred to as a “critical care unit program flexibility request.” This subdivision and subdivision (f) do not confer on the department any new or additional authority to modify staffing ratios. (f) (1) The department shall require, as support for a critical care unit program flexibility request, the applicant or licensee to submit supporting evidence that includes documentation establishing the need for program flexibility and that the proposed alternative will not jeopardize the health, safety, and well-being of patients and is needed for increased operational efficiency. (A) Any critical care unit program flexibility request, including supporting evidence submitted with the request, shall be posted on the department’s publicly accessible internet website within five calendar days of receipt by the department. (B) The department, at the time it posts a health facility’s critical care unit program flexibility request, shall provide a method to electronically collect public comment specifically on the application for a period of 30 days. (C) The 60-day timeframe provided for in subdivision (d) shall not commence until a facility’s critical care unit program flexibility request and supporting evidence have been posted on the department’s internet website. (2) (A) A health facility that makes a critical care unit program flexibility request shall comply with both of the following requirements: (i) Conspicuously post the critical care unit program flexibility request form and a notice next to its license stating that a critical care unit program flexibility request and supporting evidence have been submitted to the department. (ii) Immediately make its best effort to notify affected employees and employee representatives of the critical care unit program flexibility request and direction to where to find the request and supporting evidence, and where to provide public comment. (B) A facility’s critical care unit program flexibility request will not be deemed complete for purposes of the 60-day timeframe pursuant to subdivision (d) until the facility has complied with this paragraph. (3) In no event shall the department approve a health facility’s critical care unit program flexibility request for a period of more than one year. (4) Any approval of a health facility’s critical care unit program flexibility request may be revoked by the department at any time, including on the grounds that there is no longer a need for program flexibility, that the approved alternative jeopardizes the health, safety, and well-being of patients, or that the approved alternative does not adequately protect patient safety. (5) (A) The 30-day comment period required by subparagraph (B) of paragraph (1) shall not apply when a hospital submits a critical care unit program flexibility request due to a health care emergency. Critical care unit program flexibility requests approved pursuant to this paragraph shall not be effective for more than 90 days, and any request to extend the term of critical care unit program flexibility that was approved pursuant to this paragraph shall be subject to the regular process provided for in this subdivision. (B) For purposes of this paragraph, “health care emergency” means an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to health care delivery requiring immediate medical interventions and care. (6) This subdivision shall become operative on January 1, 2023. (g) Notwithstanding any other law or regulation, the State Department of Public Health shall provide flexibility in its pharmaceutical services requirements to permit any state department that operates state facilities subject to these provisions to establish a single statewide formulary or to procure pharmaceuticals through a departmentwide or multidepartment bulk purchasing arrangement. It is the intent of the Legislature that consolidation of these activities be permitted in order to allow the more cost-effective use and procurement of pharmaceuticals for the benefit of patients and residents of state facilities. (h) On or before February 1, 2023, the department shall post all of the following information on its internet website: (1) A list of applicants for critical care unit program flexibility and the date of the application. (2) A list of health facilities with approved critical care unit program flexibility and the effective start and end date of the approval. (3) If approved, the notification of approval for critical care unit program flexibility, which shall include the application for critical care unit program flexibility; the regulation or regulations impacted; beds, units, or departments affected; and any conditions placed on the approval. (4) A department contact for the public to submit a complaint related to an approved critical care unit program flexibility. (Amended by Stats. 2021, Ch. 716, Sec. 1. (AB 1422) Effective January 1, 2022.)
  196. 1276.05.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Certain hospitals may get case-by-case flexibility for interim space use, but they must give public notice, and some waivers are barred.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276.05. (a) The Office of Statewide Health Planning and Development shall allow any general acute care hospital facility that needs to relocate services on an interim basis as part of its approval plan for compliance with Article 8 (commencing with Section 130000) or Article 9 (commencing with Section 130050) in the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing with Section 129675) of Part 7 of Division 107) flexibility in achieving compliance with, or in substantial satisfaction of the objectives of, building standards adopted pursuant to Section 1276 with regard to the use of interim space for the provision of hospital services, or both, on a case-by-case basis so long as public safety is not compromised. (b) The state department shall allow any facility to which subdivision (a) applies flexibility in achieving compliance with, or in substantial satisfaction of, the objectives of licensing standards, or both, with regard to the use of interim space for the provision of hospital services, or both, on a case-by-case basis so long as public safety is not compromised. (c) Hospital licensees, upon application for program flexibility under this section, shall provide public notice of the proposed interim use of space that houses at least one of the eight basic services that are required in a general acute care hospital in a manner that is likely to reach a substantial number of residents of the community served by the facility and employees of the facility. (d) No request shall be approved under this section for a waiver of any primary structural system, fire and life safety requirements, or any requirement with respect to accessibility for persons with disabilities. (e) In approving any request pursuant to this section for flexibility, the office shall consider public comments. (f) The state department shall establish a unit with two statewide liaisons for the purposes of the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 (Chapter 1 (commencing with Section 129675) of Part 7 of Division 107), to do all of the following: (1) Serve as a central resource for hospital representatives on licensing issues relative to Article 8 or Article 9 in the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983 and provide licensing information to the public, upon request. (2) Serve as liaison with the Office of Statewide Health Planning and Development, the State Fire Marshal, the Seismic Safety Commission, and other entities as necessary on hospital operational issues with respect to Article 8 or Article 9 in the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983. (3) Ensure statewide compliance with respect to licensing issues relative to hospital buildings that are required to meet standards established by Article 8 or Article 9 in the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983. (4) Process requests for program flexibility under subdivision (a). (5) Accept and consider public comments on requests for flexibility. (g) Each compliance plan, in providing for an interim use of space in which flexibility is requested, shall identify the duration of time proposed for the interim use of the space. Upon any amendment of a hospital’s approved compliance plan, any hospital for which a flexibility plan has been approved pursuant to subdivision (a) shall provide a copy of the amended plan to the State Department of Health Services within 30 days. (Amended by Stats. 2001, Ch. 228, Sec. 1. Effective September 4, 2001.)
  197. 1276.1.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    The department may set personnel standards for licensed health facilities itself or adopt them by reference. If it adopts standards by reference, it must either describe the referenced requirements in the regulation, keep them on file for public inspection, or have direct statutory authority to use them.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276.1. In setting personnel standards for licensed health facilities pursuant to Section 1276, the department may set such standards itself or may adopt them by reference to named standard-setting organizations. If the department adopts standards for a category of health personnel by reference to a specified organization, the department shall either: (a) List in the regulation the education, training, experience, examinations, or other requirements set by the specified organization; or (b) Retain on file and available for public inspection a listing of the education, training, experience, examinations, or other requirements set by the specified organization; or (c) Have direct statutory authority or requirement to use the standards of the specified organization. (Added by Stats. 1978, Ch. 1106.)
  198. 1276.2.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    In freestanding skilled nursing facilities, these rules limit when a registered nurse is required and set conditions for using a licensed vocational nurse instead.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276.2. Standards and regulations adopted by the state department pursuant to Section 1276 shall not require the use of a registered nurse for the performance of any service or staffing of any position in freestanding skilled nursing facilities that may lawfully be performed or staffed by a licensed vocational nurse pursuant to the Vocational Nursing Practice Act (Chapter 6.5 (commencing with Section 2840) of Division 2 of the Business and Professions Code) and applicable federal regulations, when a facility is unable to obtain a registered nurse, except that a licensed vocational nurse employed in accordance with this section shall be a permanent employee of the facility. The facility shall make a good faith effort to obtain a registered nurse prior to determining that it is unable to obtain a registered nurse for the relevant shift, and this effort shall be noted in the facility’s records. The facility shall make provision for a registered nurse to be available for consultation and professional assistance during the hours in which a licensed vocational nurse is used as provided by this section. The facility shall maintain a record of the identity and phone number of the registered nurse that is to be available for consultation and professional assistance, as required by this section. If the substitution of a licensed vocational nurse for a registered nurse occurs more often than seven days per month, the facility shall obtain program flexibility approval from the state department pursuant to subdivision (b) of Section 1276. Nothing in this section shall permit a licensed vocational nurse to act as director of nurses pursuant to the Vocational Nursing Practice Act. This section applies to staffing for the evening and night shifts only, except that if the level of care is determined by the state department to be inadequate, the state department may require the facility to provide additional staffing. This section shall not apply to the Medi-Cal regulations adopted pursuant to Sections 14114 and 14132.25 of the Welfare and Institutions Code. (Added by Stats. 1994, Ch. 645, Sec. 1. Effective January 1, 1995.)
  199. 1276.3.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    Licensed health facilities with surgical suites and procedural rooms must provide fire and panic safety information and training, use approved fire safety guidelines, and decide the training format and hours.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276.3. (a) The Legislature finds and declares that the citizens of California are in danger of being injured and killed in the state’s surgical suites and procedural rooms in licensed health facilities, because of the many intense heat sources present in an oxygen-rich environment. It is the intent of the Legislature that this section promote maximum fire and panic safety standards in surgical suites and procedural rooms in licensed health facilities, and other areas that pose a danger due to the presence of oxygen, in California. (b) (1) The state department, shall promote safety by requiring that licensed health facilities that have surgical suites and procedural rooms provide information and training in fire and panic safety in oxygen rich environments, including equipment, safety, and emergency plans, as part of an orientation for new employees, and ongoing inservice training. (2) The licensed health facilities described in paragraph (1) shall use the fire safety guidelines in oxygen rich environments published by the Association of Operating Room Nurses or any other nationally recognized body or organization, and approved by the state department. (c) The licensed health facilities described in paragraph (1) of subdivision (b) shall determine the modality of training and the number of hours of training required. (Added by Stats. 1992, Ch. 992, Sec. 1. Effective January 1, 1993.)
  200. 1276.4.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. )

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    The department must adopt nurse-to-patient ratio regulations and related staffing rules, and health facilities must have nursing orientation policies.

    ## Health and Safety Code - HSC ## DIVISION 2. LICENSING PROVISIONS [1200 - 1796.88] ( Division 2 enacted by Stats. 1939, Ch. 60. ) ## CHAPTER 2. Health Facilities [1250 - 1339.59] ( Chapter 2 repealed and added by Stats. 1973, Ch. 1202. ) ## ARTICLE 3. Regulations [1275 - 1289.5] ( Article 3 added by Stats. 1973, Ch. 1202. ) ## 1276.4. (a) By January 1, 2002, the State Department of Public Health shall adopt regulations that establish minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for all health facilities licensed pursuant to subdivision (a) or (f) of Section 1250. No later than July 31, 2027, or one and one-half years after adoption of emergency regulations pursuant to subdivision (k), whichever is sooner, the State Department of Public Health shall adopt regulations pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), as specified in subdivision (k), that establish minimum, specific, and numerical licensed nurse-to-patient ratios for health facilities licensed pursuant to subdivision (b) of Section 1250. The State Department of Public Health shall adopt these regulations in accordance with the department’s licensing and certification regulations as stated in Sections 70053.2, 70215, and 70217 of Title 22 of the California Code of Regulations, and the professional and vocational regulations in Section 1443.5 of Title 16 of the California Code of Regulations. The department shall review these regulations five years after adoption and shall report to the Legislature regarding any proposed changes. Flexibility shall be considered by the department for rural general acute care hospitals in response to their special needs. As used in this subdivision, “hospital unit” means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit. The regulation addressing the emergency department shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in the emergency department. (b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care. (c) “Critical care unit” as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses. (d) All health facilities licensed under subdivision (a), (b), or (f) of Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff. (e) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area, and has demonstrated current competence in providing care in that area. (f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive orientation and be subject to competency validation consistent with Sections 70016.1 and 70214 of Title 22 of the California Code of Regulations. (g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in Section 70059.1 of Title 22 of the California Code of Regulations. (h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control. (i) The regulations adopted by the department shall augment and not replace existing nurse-to-patient ratios that exist in regulation or law for the intensive care units, the neonatal intensive care units, or the operating room. (j) The regulations adopted by the department shall not replace existing licensed staff-to-patient ratios for hospitals operated by the State Department of State Hospitals. (k) (1) The regulations adopted by the department for health facilities licensed under subdivision (b) of Section 1250 that are not operated by the State Department of State Hospitals shall take into account the special needs of the patients served in the psychiatric units. (2) The department shall adopt emergency regulations pursuant to this subdivision no later than January 31, 2026. The department may readopt any emergency regulation authorized by this subdivision that is the same as, or substantially equivalent to, an emergency regulation previously adopted under this subdivision. (3) The adoption of emergency regulations pursuant to this subdivision and two readoptions of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Emergency regulations and readoptions authorized by this section shall be exempt from review by the Office of Administrative Law. The emergency regulations and the readoptions authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State. Notwithstanding any other provision of law, the adoption and readoptions of these emergency regulations shall be exempt from the requirements of subdivision (b) of Section 11346.1 of the Government Code and each shall remain in effect for no more than 180 days. (4) The emergency regulations adopted pursuant to this subdivision may include, but are not limited to, the following: (A) Staffing standards, including nurse-to-patient, specific to acute psychiatric hospitals. (B) Requirements used to determine appropriate staffing based on patient acuity and care needs. (C) Requirements that the State Department of Public Health deems necessary or relevant to staffing policies and procedures to promote patient safety. (l) The department may take into consideration the unique nature of the University of California teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The department shall coordinate with the Board of Registered Nursing to ensure that staffing ratios are consistent with the Board of Registered Nursing approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a University of California clinical facility approved by the Board of Registered Nursing provided there will be sufficient direct care registered nurse preceptors available to ensure safe patient care. (Amended by Stats. 2025, Ch. 21, Sec. 2. (AB 116) Effective June 30, 2025.)

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