Bill Text: CA SB1432 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health facilities: seismic standards.

Spectrum: Slight Partisan Bill (Democrat 7-3)

Status: (Engrossed) 2024-05-22 - Read third time. Passed. (Ayes 37. Noes 0.) Ordered to the Assembly. [SB1432 Detail]

Download: California-2023-SB1432-Amended.html

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Amended  IN  Senate  April 18, 2024

Amended  IN  Senate  March 18, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 1432

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Introduced by Senators Caballero, Alvarado-Gil, Dodd, Eggman, and Newman
(Coauthors: Senators Becker and Grove)

February 16, 2024

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An act to amend Sections 127502, 130060, 130063, 130065, 130066, and 130066.5 of, and to add Sections 130065.1, 130065.2, 130065.3, 130065.4, 130065.5, 130065.6, and 130065.7 to, the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL'S DIGEST

SB 1432, as amended, Caballero. Health facilities: seismic standards.

(1) Existing law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983, establishes, under the jurisdiction of the Office of Health Care Access and Information, a program of seismic safety building standards for certain hospitals constructed on and after March 7, 1973.

Existing law requires that, by January 1, 2030, owners of these hospitals must either demolish, replace, or change to nonacute care use all hospital buildings that are not in compliance with these standards or seismically retrofit all acute care inpatient hospital buildings so they are in substantial compliance with these standards.

This bill would revise the compliance deadline for these requirements from January 1, 2030, to January 1, 2038. The bill would also create an abeyance by which a rural hospital or critical access hospital, or both, will not be required to meet these requirements until adequate funding is made available to the hospital for purposes of attaining substantial compliance. The bill would impose specified requirements for a rural hospital or critical access hospital subject to an abeyance, including that a rural hospital or critical access hospital provide specified information to the State Department of Public Health no later than July 1, 2027, and would require the department to post and maintain on its internet website a list of rural hospitals and critical access hospitals that are subject to an abeyance. The bill would include definitions pertaining to these requirements.

The bill would require the department, on or before January 1, 2026, to adopt regulations and standards or revise regulations and standards, or both, to extend the deadlines for meeting the structural performance and nonstructural performance requirements. The bill would specify that regulatory submissions made by the department to the California Building Standards Commission are deemed to be emergency regulations.

The bill would require an owner of an acute care inpatient hospital that does not substantially comply with the seismic safety regulations or standards to submit a seismic compliance master plan, as specified, to the department by no later than January 1, 2027. The bill would require, among other things, the owner to annually update the department with any changes or adjustments to its seismic compliance master plan, and the department to post each seismic compliance master plan submitted on its internet website within 90 calendar days of receipt.

The bill would require an acute care inpatient hospital with one or more specified hospital buildings to submit a Patient Alternate Care Sites and Transfer Plan to the department, as specified, by no later than January 1, 2026, to address continued care for the hospital’s patients following a seismic event through alternate care sites on the hospital campus and other health care facilities. The bill would require the hospital to submit updates to the plan, if any, on an annual basis to the department, and would remove the requirement to submit annual updates as of the date the hospital no longer has one or more specified buildings.

The bill would require, on or before July 1, 2028, the Office of Statewide Health Planning and Development and the Office of Health Care Affordability to submit to the director an analysis of each cost estimate submitted by an owner of specified hospital buildings. The bill would require the department to provide a report to the Legislature on or before January 1, 2029, with specified information.

The bill would require the department, in consultation with the California Health Facilities Financing Authority, to submit a report to the Legislature on or before January 1, 2026, as specified.

The bill would require the Office of Statewide Health Planning and Development to convene a stakeholder workgroup on or before January 1, 2026, to facilitate input, as specified. The bill would require the Office of Statewide Health Planning and Development to provide a report to the Legislature by July 1, 2026, detailing any findings and recommendations from the stakeholder workgroup.

(2) Existing law requires the owner of specified hospital facilities whose building does not substantially comply with seismic safety regulations or standards to submit to the department an attestation that the board of directors of that hospital is aware the hospital building is required to meet the January 1, 2030, deadline for substantial compliance. Existing law requires, before January 1, 2024, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with seismic safety regulations or standards to post in a lobby or waiting area generally accessible to patients or the public a notice provided by the department that the hospital is not in compliance with the seismic safety requirements the hospital is required to meet by January 1, 2030. Existing law requires, on or before January 1, 2024, and annually thereafter, the owner of an acute inpatient hospital that includes a building that does not substantially comply with seismic safety regulations or standards to provide an annual status update on the Structural Performance Category ratings of the buildings and the services provided in each hospital building on the hospital campus to specified entities until each of the hospital buildings owned by that hospital building owner is compliant. Existing law requires, by July 1 2, 2023, the department to develop the notice required to be posted to clearly convey to patients and the public that the hospital building does not meet seismic safety standards intended to ensure the hospital will be capable of continued operation following an earthquake.

The bill would instead require, before January 1, 2026, the owner of specified hospital facilities whose building does not substantially comply with seismic safety regulations or standards to submit to the department an attestation that the board of directors of that hospital is aware the building is required to meet either the January 1, 2038, deadline, or a subsequent date that is applicable to a rural hospital or critical access hospital subject to an abeyance. The bill would require, before January 1, 2026, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with the seismic safety regulations or standards to post in any lobby or waiting area generally accessible to patients or the public a specified notice. The bill would require the department to develop the notice before July 1, 2025. The bill would also require, on or before January 1, 2026, and annually thereafter, the owner to provide an annual status update, as specified.

(3)Existing law establishes, within the Department of Health Care Access and Information, the Office of Health Care Affordability to analyze the health care market for costs trends and drivers of spending, develop data-informed policies for lowering health care costs for consumers and purchasers, set and enforce cost targets, and create a state strategy for controlling the cost of health care and ensuring affordability for consumers and purchasers. Existing law establishes the Health Care Affordability Board, composed of 8 members, as specified. Existing law requires the board to establish a statewide health care cost target and specific targets by health care sector, which are required to meet specified requirements. Existing law requires the office to develop a methodology, with specified requirements, to be approved by the board to set health care costs targets.

The bill would require the health care targets be upwardly adjusted for a provider or fully integrated delivery system, as appropriate, to account for the impact of estimated or actual expenditures associated with meeting seismic safety regulations or standards. The bill would also require the methodology to require the board to upwardly adjust cost targets for a provider or fully integrated delivery system, as appropriate, to account for the impact of estimated or actual expenditures associated with meeting seismic safety regulations or standards.

(4)

(3) The bill would specify that the provisions of this act are severable.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.Section 127502 of the Health and Safety Code is amended to read:

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.

(8)Be upwardly adjusted for a provider or fully integrated delivery system, as appropriate, to account for the impact of estimated or actual expenditures associated with meeting the seismic safety regulations or standards described in Section 130065.

(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.

(8)The methodology shall require the board to upwardly adjust cost targets for a provider or a fully integrated delivery system, as appropriate, to account for the impact of estimated or actual expenditures associated with meeting the seismic safety regulations or standards described in Section 130065.

(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.

SEC. 2.SECTION 1.

 Section 130060 of the Health and Safety Code is amended to read:

130060.

 (a) (1) After January 1, 2008, a general acute care hospital building that is determined to be a potential risk of collapse or pose significant loss of life shall only be used for nonacute care hospital purposes, unless an extension of this deadline has been granted and either of the following occurs before the end of the extension:

(A) A replacement building has been constructed and a certificate of occupancy has been granted by the department for the replacement building.

(B) A retrofit has been performed on the building and a construction final has been obtained by the department.

(2) An extension of the deadline may be granted by the department upon a demonstration by the owner that compliance will result in a loss of health care capacity that may not be provided by other general acute care hospitals within a reasonable proximity. In its request for an extension of the deadline, a hospital shall state why the hospital is unable to comply with the January 1, 2008, deadline requirement.

(3) Prior to granting an extension of the January 1, 2008, deadline pursuant to this section, the department shall do all of the following:

(A) Provide public notice of a hospital’s request for an extension of the deadline. The notice, at a minimum, shall be posted on the department’s internet website, and shall include the facility’s name and identification number, the status of the request, and the beginning and ending dates of the comment period, and shall advise the public of the opportunity to submit public comments pursuant to subparagraph (C). The department shall also provide notice of all requests for the deadline extension directly to interested parties upon request of the interested parties.

(B) Provide copies of extension requests to interested parties within 10 working days to allow interested parties to review and provide comment within the 45-day comment period. The copies shall include those records that are available to the public pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).

(C) Allow the public to submit written comments on the extension proposal for a period of not less than 45 days from the date of the public notice.

(b) (1) It is the intent of the Legislature, in enacting this subdivision, to facilitate the process of having more hospital buildings in substantial compliance with this chapter and to take nonconforming general acute care hospital inpatient buildings out of service more quickly.

(2) The functional contiguous grouping of hospital buildings of a general acute care hospital, each of which provides, as the primary source, one or more of the hospital’s eight basic services as specified in subdivision (a) of Section 1250, may receive a five-year extension of the January 1, 2008, deadline specified in subdivision (a) of this section pursuant to this subdivision for both structural and nonstructural requirements. A functional contiguous grouping refers to buildings containing one or more basic hospital services that are either attached or connected in a way that is acceptable to the State Department of Health Care Services. These buildings may be either on the existing site or a new site.

(3) To receive the five-year extension, a single building containing all of the basic services or at least one building within the contiguous grouping of hospital buildings shall have obtained a building permit prior to 1973 and this building shall be evaluated and classified as a nonconforming, Structural Performance Category-1 (SPC-1) building. The classification shall be submitted to and accepted by the Department of Health Care Access and Information. The identified hospital building shall be exempt from the requirement in subdivision (a) until January 1, 2013, if the hospital agrees that the basic service or services that were provided in that building shall be provided, on or before January 1, 2013, as follows:

(A) Moved into an existing conforming Structural Performance Category-3 (SPC-3), Structural Performance Category-4 (SPC-4), or Structural Performance Category-5 (SPC-5) and Non-Structural Performance Category-4 (NPC-4) or Non-Structural Performance Category-5 (NPC-5) building.

(B) Relocated to a newly built compliant SPC-5 and NPC-4 or NPC-5 building.

(C) Continued in the building if the building is retrofitted to an SPC-5 and NPC-4 or NPC-5 building.

(4) A five-year extension is also provided to a post-1973 building if the hospital owner informs the Department of Health Care Access and Information that the building is classified as SPC-1, SPC-3, or SPC-4 and will be closed to general acute care inpatient service use by January 1, 2013. The basic services in the building shall be relocated into an SPC-5 and NPC-4 or NPC-5 building by January 1, 2013.

(5) SPC-1 buildings, other than the building identified in paragraph (3) or (4), in the contiguous grouping of hospital buildings shall also be exempt from the requirement in subdivision (a) until January 1, 2013. However, on or before January 1, 2013, at a minimum, each of these buildings shall be retrofitted to an SPC-2 and NPC-3 building, or no longer be used for general acute care hospital inpatient services.

(c) On or before March 1, 2001, the department shall establish a schedule of interim work progress deadlines that hospitals shall be required to meet to be eligible for the extension specified in subdivision (b). To receive this extension, the hospital building or buildings shall meet the year 2002 nonstructural requirements.

(d) (1) A hospital building that is eligible for an extension pursuant to this section and that is not subject to an abeyance pursuant to Section 130065.1, shall meet the January 1, 2038, nonstructural and structural deadline requirements if the building is to be used for general acute care inpatient services after January 1, 2038.

(2) A hospital building of a rural hospital or critical access hospital that is subject to an abeyance pursuant to Section 130065.1 shall not be required to meet the nonstructural and structural requirements referenced in paragraph (1) until such time that adequate funding is made available to the hospital for such purposes.

(e) Upon compliance with subdivision (b), the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section. The department shall make copies of these notices available on its internet website.

(f) (1) A hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) may request an additional extension of up to two years for a hospital building that it owns or operates and that meets the criteria specified in paragraph (2), (3), or (5).

(2) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A) The hospital building is under construction at the time of the request for extension under this subdivision and the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b).

(B) The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C) The hospital received a building permit for the construction described in subparagraph (A) at least two years prior to the applicable deadline for the building.

(D) The hospital submitted a construction timeline at least two years prior to the applicable deadline for the building demonstrating the hospital’s intent to meet the applicable deadline. The timeline shall include all of the following:

(i) The projected construction start date.

(ii) The projected construction completion date.

(iii) Identification of the contractor.

(E) The hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D), but factors beyond the hospital’s control make it impossible for the hospital to meet the deadline.

(3) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A) The hospital building is owned by a health care district that has, as owner, received the extension of the January 1, 2008, deadline, but where the hospital is operated by an unaffiliated third-party lessee pursuant to a facility lease that extends at least through December 31, 2009. The district shall file a declaration with the department with a request for an extension stating that, as of the date of the filing, the district has lacked, and continues to lack, unrestricted access to the subject hospital building for seismic planning purposes during the term of the lease, and that the district is under contract with the county to maintain hospital services when the hospital comes under district control. The department shall not grant the extension if an unaffiliated third-party lessee will operate the hospital beyond December 31, 2010.

(B) The hospital building plans were submitted to the department and were deemed ready for review by the department at least four years prior to the applicable deadline for the building. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that will be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C) The hospital received a building permit for the construction described in subparagraph (B) by December 31, 2011.

(D) The hospital submitted, by December 31, 2011, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the deadline of December 31, 2014. The timeline shall include all of the following:

(i) The projected construction start date.

(ii) The projected construction completion date.

(iii) Identification of the contractor.

(E) The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the office pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).

(F) The hospital granted an extension pursuant to this paragraph shall submit an additional status report to the department, equivalent to that required by subdivision (c) of Section 130061, no later than June 30, 2013.

(4) An extension granted pursuant to paragraph (3) shall be applicable only to the health care district applicant and its affiliated hospital while the hospital is operated by the district or an entity under the control of the district.

(5) The department may grant the additional extension if the hospital building subject to the extension meets all of the following criteria:

(A) The hospital owner submitted to the department, prior to June 30, 2009, a request for review using current computer modeling utilized by the department and based upon software developed by the Federal Emergency Management Agency (FEMA), referred to as Hazards US, and the building was deemed SPC-1 after that review.

(B) The hospital building plans for the building are submitted to the department and deemed ready for review by the department prior to July 1, 2010. The hospital shall indicate, upon submission of its plans, the SPC-1 building or buildings that shall be retrofitted or replaced to meet the requirements of this section as a result of the project.

(C) The hospital receives a building permit from the department for the construction described in subparagraph (B) prior to January 1, 2012.

(D) The hospital submits, prior to January 1, 2012, a construction timeline for the building demonstrating the hospital’s intent and ability to meet the applicable deadline. The timeline shall include all of the following:

(i) The projected construction start date.

(ii) The projected construction completion date.

(iii) Identification of the contractor.

(E) The hospital building is under construction at the time of the request for the extension, the purpose of the construction is to meet the requirements of subdivision (a) to allow the use of the building as a general acute care hospital building after the extension deadline granted by the department pursuant to subdivision (a) or (b), and the hospital is making reasonable progress toward meeting the timeline set forth in subparagraph (D).

(F) The hospital owner completes construction such that the hospital meets all criteria to enable the department to issue a certificate of occupancy by the applicable deadline for the building.

(6) A hospital located in the County of Sacramento, San Mateo, or Santa Barbara or the City of San Jose or the City of Willits that has received an additional extension pursuant to paragraph (2) or (5) may request an additional extension until September 1, 2015, to obtain either a certificate of occupancy from the department for a replacement building, or a construction final from the department for a building on which a retrofit has been performed.

(7) A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.

(8) The department may revoke an extension granted pursuant to this subdivision for any hospital building where the work of construction is abandoned or suspended for a period of at least one year, unless the hospital demonstrates in a public document that the abandonment or suspension was caused by factors beyond its control.

(g) (1) Notwithstanding subdivisions (a), (b), (c), and (f), and Sections 130061.5 and 130064, a hospital that has received an extension of the January 1, 2008, deadline pursuant to subdivision (a) or (b) also may request an additional extension of up to seven years for a hospital building that it owns or operates. The department may grant the extension subject to the hospital meeting the milestones set forth in paragraph (2).

(2) The hospital building subject to the extension shall meet all of the following milestones, unless the hospital building is reclassified as SPC-2 or higher as a result of its Hazards US score:

(A) The hospital owner submits to the department, no later than September 30, 2012, a letter of intent stating whether it intends to rebuild, replace, or retrofit the building, or remove all general acute care beds and services from the building, and the amount of time necessary to complete the construction.

(B) The hospital owner submits to the department, no later than September 30, 2012, a schedule detailing why the requested extension is necessary, and specifically how the hospital intends to meet the requested deadline.

(C) The hospital owner submits to the department, no later than September 30, 2012, an application ready for review seeking structural reassessment of each of its SPC-1 buildings using current computer modeling based upon software developed by FEMA, referred to as Hazards US.

(D) The hospital owner submits to the department, no later than January 1, 2015, plans ready for review consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B).

(E) The hospital owner submits a financial report to the department at the time the plans are submitted pursuant to subparagraph (D). The report shall demonstrate the hospital owner’s financial capacity to implement the construction plans submitted pursuant to subparagraph (D).

(F) The hospital owner receives a building permit consistent with the letter of intent submitted pursuant to subparagraph (A) and the schedule submitted pursuant to subparagraph (B), no later than July 1, 2018.

(3) To evaluate public safety and determine whether to grant an extension of the deadline, the department shall consider the structural integrity of the hospital’s SPC-1 buildings based on its Hazards US scores, community access to essential hospital services, and the hospital owner’s financial capacity to meet the deadline as determined by either a bond rating of BBB or below or the financial report on the hospital owner’s financial capacity submitted pursuant to subparagraph (E) of paragraph (2). The criteria contained in this paragraph shall be considered by the department in its determination of the length of an extension or whether an extension should be granted.

(4) The extension or subsequent adjustments granted pursuant to this subdivision may not exceed the amount of time that is reasonably necessary to complete the construction specified in paragraph (2).

(5) If the circumstances underlying the request for extension submitted to the department pursuant to paragraph (2) change, the hospital owner shall notify the department as soon as practicable, but in no event later than six months after the hospital owner discovered the change of circumstances. The department may adjust the length of the extension granted pursuant to paragraphs (2) and (3) as necessary, but in no event longer than the period specified in paragraph (1).

(6) A hospital denied an extension pursuant to this subdivision may appeal the denial to the Hospital Building Safety Board.

(7) The department may revoke an extension granted pursuant to this subdivision for any hospital building when it is determined that any information submitted pursuant to this section was falsified, or if the hospital failed to meet a milestone set forth in paragraph (2), or where the work of construction is abandoned or suspended for a period of at least six months, unless the hospital demonstrates in a publicly available document that the abandonment or suspension was caused by factors beyond its control.

(8) Regulatory submissions made by the department to the California Building Standards Commission to implement this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations.

(9) The hospital owner that applies for an extension pursuant to this subdivision shall pay the office an additional fee, to be determined by the department, sufficient to cover the additional reasonable costs incurred by the department for maintaining the additional reporting requirements established under this section, including, but not limited to, the costs of reviewing and verifying the extension documentation submitted pursuant to this subdivision. This additional fee shall not include any cost for review of the plans or other duties related to receiving a building or occupancy permit.

(10) This subdivision shall become operative on the date that the State Department of Health Care Services receives all necessary federal approvals for a 2011–12 fiscal year hospital quality assurance fee program that includes three hundred twenty million dollars ($320,000,000) in fee revenue to pay for health care coverage for children, which is made available as a result of the legislative enactment of a 2011–12 fiscal year hospital quality assurance fee program.

(h) A critical access hospital located in the City of Tehachapi may submit a seismic safety extension application pursuant to subdivision (g), notwithstanding deadlines in that subdivision that are earlier than the effective date of the act that added this subdivision. The submitted application shall include a timetable as required pursuant to subdivision (g).

(i) (1) A hospital located in the Tarzana neighborhood of the City of Los Angeles that has received extensions pursuant to subdivisions (b) and (g) may request an additional extension for a single building until October 1, 2022, in order to obtain a certificate of occupancy from the department for a replacement building.

(2) The hospital owner seeking the extension shall submit a written request that includes a timeline specifying how the hospital intends to meet the new deadline, including the construction document submission dates. The following timeline shall be met for construction document submissions:

(A) No later than January 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the second increment with information including the building core and shell of the hospital. Failure to submit the construction documents by January 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(B) No later than March 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the first increment with information including the structural foundation, frame, and underslab utilities of the hospital. Failure to submit the construction documents by March 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(C) No later than September 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the third increment with information on the build-out of the hospital. Failure to submit the construction documents by September 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(D) No later than November 1, 2018, the hospital owner shall submit construction documents, deemed ready for review, related to the first final review of the fourth increment with information on the seismic support and anchorage of the hospital. Failure to submit the construction documents by November 1, 2018, shall result in the assessment of a fine of five thousand dollars ($5,000) per calendar day until the documents are submitted.

(E) The hospital owner may submit a written request to the department seeking an extension of the deadlines set forth in subparagraphs (A), (B), (C), and (D). The written request shall state with specificity the reason for the request and how the reason preventing compliance with the deadlines was outside of the control of the hospital owner. After review of the request for extension, the department may grant the request for a period of time not to exceed 30 calendar days. If the department grants the request for an extension, no fine shall accrue or be imposed during the extension period.

(3) Notwithstanding any other law, any fines assessed pursuant to paragraph (2) shall be deposited into the General Fund following a determination on appeal, if any. A hospital assessed a fine pursuant to this subdivision may appeal the assessment to the Hospital Building Safety Board, provided the hospital posts the funds for any fines to be held by the department pending the resolution of the appeal.

(4) The department shall not issue a certificate of occupancy for the single replacement building until all assessed fines accrued pursuant to paragraph (2) have been paid in full, or, if an appeal is pending, have been posted subject to resolution of an appeal. Fines deposited by the hospital pursuant to paragraph (3) shall be considered paid in full for purposes of issuing a certificate of occupancy pursuant to this paragraph. This paragraph is in addition to, and is not intended to supersede, any other requirements that must be met by the hospital for issuance by the department of a certificate of occupancy.

SEC. 3.SEC. 2.

 Section 130063 of the Health and Safety Code is amended to read:

130063.

 (a) With regard to a general acute care hospital building located in Seismic Zone 3 as indicated in the 1995 edition of the California Building Standards Code, any hospital may request an exemption from Non-Structural Performance Category-3 requirements in Title 24 of the California Code of Regulations if the hospital building complies with the year 2002 nonstructural requirements.

(b) The department shall determine the maximum allowable level of earthquake ground shaking potential for purposes of this section.

(c) To qualify for an exemption under this section, a hospital shall provide a site-specific engineering geologic report that demonstrates an earthquake ground shaking potential below the maximum allowable level of earthquake ground shaking potential determined by the department pursuant to subdivision (b).

(d) (1)  To demonstrate an earthquake ground shaking potential as provided in subdivision (c), a hospital shall submit a site-specific engineering geologic report to the department.

(2) The department shall forward the report received from a hospital to the Division of Mines and Geology in the Department of Conservation for purposes of a review.

(3) If, after review of the analysis, the Division of Mines and Geology concurs with the findings of the report, it shall return the report with a statement of concurrence to the office. Upon the receipt of the statement, if the ground shaking potential is below that established pursuant to subdivision (b), the department shall grant the exemption requested.

(e) (1) A hospital building that is eligible for an exemption under this section and that is not subject to an abeyance pursuant to Section 130065.1, shall meet the January 1, 2038, nonstructural requirement deadline if the building is to be used for general acute care inpatient services after January 1, 2038.

(2) A hospital building of a rural hospital or critical access hospital that is subject to an abeyance pursuant to Section 130065.1 shall not be required to meet the nonstructural requirements referenced in paragraph (1) until such time that adequate funding is made available to the hospital for such purposes.

(f) A hospital requesting an exemption pursuant to this section shall pay the actual expenses incurred by the department and the Division of Mines and Geology.

(g) All regulatory submissions to the California Building Standards Commission made by the department for purposes of this section shall be deemed to be emergency regulations and shall be adopted as emergency regulations. This emergency regulation authority shall remain in effect until January 1, 2004.

SEC. 4.SEC. 3.

 Section 130065 of the Health and Safety Code is amended to read:

130065.

 (a) In accordance with the compliance schedule approved by the department, but in any case no later than January 1, 2038, or a subsequent date applicable to a rural hospital or critical access hospital subject to an abeyance pursuant to Section 130065.1, owners of all acute care inpatient hospitals shall either:

(1) Demolish, replace, or change to nonacute care use all hospital buildings not in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.

(2) Seismically retrofit all acute care inpatient hospital buildings so that they are in substantial compliance with the regulations and standards developed by the department pursuant to the Alfred E. Alquist Hospital Facilities Seismic Safety Act and this act.

(b) Upon compliance with this section, the hospital shall be issued a written notice of compliance by the department. The department shall send a written notice of violation to hospital owners that fail to comply with this section.

SEC. 5.SEC. 4.

 Section 130065.1 is added to the Health and Safety Code, to read:

130065.1.

 (a) For purposes of this article, the following definitions shall apply:

(1) “Critical access hospital” means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program, as described in section 1250.7.

(2) “Rural hospital” has the same meaning as “rural general acute care hospital” as set forth in subdivision (a) of section 1250.

(b) A general acute care hospital that is a rural hospital or critical access hospital, or both, shall not be required to comply with the requirements of Section 130065 until such time that adequate funding is made available to the hospital for purposes of attaining substantial compliance with Section 130065.

(c) In a form and manner as specified by the department, a rural hospital or critical access hospital subject to an abeyance from the requirements of Section 130065 as described in subdivision (b) shall provide the following to the department, no later than July 1, 2027:

(1) The hospital’s most recent cost estimate for meeting the requirements of Section 130065, as described in subparagraph (D) of paragraph (2) of subdivision (b) of Section 130065.3.

(2) An analysis and supporting documentation demonstrating the hospital’s inability to finance or otherwise fund the costs to comply with the requirements of Section 130065. This shall include, but is not limited to, a description of the hospital’s efforts to secure financing from other relevant sources, such as state funds, federal grants, or private foundation funds.

(3) An analysis and supporting documentation demonstrating the risk of hospital closure, or reduction or suspension of health care services provided at the hospital, or both, and the impact to health care access as a result of the costs to comply with Section 130065.

(d) A hospital subject to an abeyance pursuant to this section shall update the department of any changes to its information described in subdivision (c) on an annual basis, in a form and manner as specified by the department.

(e) The department shall post and maintain on its internet website a list of rural hospitals and critical access hospitals that are subject to an abeyance from the requirements of Section 130065 as described in subdivision (b).

SEC. 6.Section 160065.2 is added to the Health and Safety Code, to read:

160065.2.

On or before January 1, 2026, the department shall adopt regulations and standards, or revise existing regulations and standards, or both, to extend the deadlines for meeting the structural performance and nonstructural performance requirements pursuant to Section 130065, as amended by the Act which added this section, and Section 130065.1. Regulatory submissions made by the department to the California Building Standards Commission pursuant to this section shall be deemed to be emergency regulations and shall be adopted as such.

SEC. 5.

 Section 130065.2 is added to the Health and Safety Code, to read:

130065.2.

 On or before January 1, 2026, the department shall adopt regulations and standards, or revise existing regulations and standards, or both, to extend the deadlines for meeting the structural performance and nonstructural performance requirements pursuant to Section 130065, as amended by the Act which added this section, and Section 130065.1. Regulatory submissions made by the department to the California Building Standards Commission pursuant to this section shall be deemed to be emergency regulations and shall be adopted as such.

SEC. 7.SEC. 6.

 Section 130065.3 is added to the Health and Safety Code, to read:

130065.3.

 (a) An owner of an acute care inpatient hospital building that does not substantially comply with the seismic safety regulations or standards described in Section 130065 as of the effective date of this section, shall submit a seismic compliance master plan to the department no later than January 1, 2027, in a form and manner determined by the department, that includes the information described in subdivision (b).

(b) Each seismic compliance master plan shall include the following:

(1) An inventory of each acute care inpatient service that is provided in any hospital building that is rated Structural Performance Category-2 (SPC-2).

(2) For each hospital building that does not substantially comply with Section 130065 as of the effective date of this section that is planned for retrofit or replacement, the plan shall identify:

(A) Whether the hospital owner intends to retrofit the SPC-2 building to SPC-4D, or rebuild the building to SPC-5.

(B) The project number or numbers assigned by the department, if any, for retrofit or rebuilding.

(C) The projected construction start date or dates, and projected construction completion date or dates, if available.

(D) The estimated costs to substantially comply with the Structural and Non-Structural Performance Category requirements of Section 130065.

(E) The most recent project status and approvals.

(F) The number of inpatient beds and patient days, by type of unit and type of service provided in the building.

(3) For each hospital building that does not substantially comply with Section 130065 as of the effective date of this section that is planned to be removed from acute care inpatient service, the plan shall identify:

(A) The projected date or dates the building will be removed from inpatient service.

(B) The inpatient services currently delivered in the building.

(C) The number of inpatient beds and patient days, by type of unit and type of service provided in the building.

(D) The planned uses of the building to be removed from service.

(E) Whether the inpatient services and beds currently provided in the building will be relocated to a new or retrofitted building, and any corresponding building sites or project numbers associated with such planned relocation.

(4) For each facility for which one or more hospital buildings are planned to be removed from inpatient service, any net change in the number of inpatient beds, by type of unit and type of service, taking into account beds provided in buildings to be removed from inpatient service, beds provided in buildings to be retrofitted or replaced, and beds provided in any other buildings used for acute care inpatient services by the facility.

(5) The planned final configuration of all buildings on the hospital campus depicting how each building will comply with the requirements of Section 130065, whether by retrofit or rebuild, and the type of services that will be provided in each building.

(c) An owner of a general acute care hospital shall annually update the department, in a form and manner determined by the department, with any changes or adjustments to its seismic compliance master plan submitted pursuant to this section.

(d) On or before January 1, 2026, the department shall issue guidance for calculating the estimated costs of compliance required pursuant to subparagraph (D) of paragraph (2) of subdivision (b). This guidance shall specify, at a minimum, the types of costs to be included in the estimate, such as hospital equipment and technology, or other costs not directly related to compliance with Section 130065.

(e) The department shall post each seismic compliance master plan submitted pursuant to this section on its internet website within 90 calendar days of receipt.

(f) For a hospital owner that fails to submit a seismic compliance master plan pursuant to this section by January 1, 2027, the department shall assess a fine of ten dollars ($10) per licensed acute care bed per day, but in no case to exceed one thousand dollars ($1,000) per day, for each SPC-2 building until the owner complies with the submission requirement. The proceeds of any fines assessed pursuant to this subdivision shall be deposited into the General Fund. A hospital owner who is assessed a fine pursuant to this subdivision may appeal the assessment to the Hospital Building Safety Board.

SEC. 8.SEC. 7.

 Section 130065.4 is added to the Health and Safety Code, to read:

130065.4.

 (a) An acute care inpatient hospital with one or more hospital buildings classified as Structural Performance Category-2 (SPC-2) as of the effective date of this section shall submit a Patient Alternate Care Sites and Transfer Plan to the department, in a form and manner determined by the department, no later than January 1, 2026. The plan shall address continued care for the hospital’s patients following a seismic event through alternate care sites on the hospital campus and transfers to other health care facilities.

(b) The plan required by subdivision (a) shall include all of the following:

(1) The number of patients that could potentially be affected by SPC-2 buildings on the hospital campus.

(2) Locations on the hospital campus that could be utilized as alternate care sites for the hospital’s patients, including but not limited to, other inpatient or outpatient units, temporary structures, and areas not typically used for patient care.

(3) The capacity for transfers to other hospitals or other appropriate care settings in the subject hospital’s service area, and description of how the hospital would transfer and transport any patients to such sites.

(4) A description of the hospital’s process for communicating the following information to employees affected by the seismic event, and their bargaining representatives, if applicable:

(A) The request for waivers from law or normal operations from the State Department of Public Health and the Emergency Medical Services Authority (EMSA), if any.

(B) The timeline for the use of any requested or utilized State Department of Public Health and EMSA waivers, if applicable.

(C) A timeline for repairs and reopening of the SPC-2 building, if available.

(D) Updates and revisions to the timeline for repairs and reopening of the SPC-2 building, if available.

(E) The use of alternate care sites, if applicable.

(F) The availability of open or temporary positions within the hospital or hospital system.

(c) In developing its plan required by subdivision (a), the hospital shall consult with the medical health operational area coordinator, the local emergency medical services authority, and other county entities and other hospitals within the subject hospital’s service area, as appropriate.

(d) The hospital shall submit updates to the plan required by subdivision (a), if any, on an annual basis to the department, in a form and manner determined by the department. As of the date the hospital no longer has one or more buildings classified as SPC-2, the hospital shall no longer be required to submit annual updates pursuant to this subdivision.

SEC. 9.SEC. 8.

 Section 130065.5 is added to the Health and Safety Code, to read:

130065.5.

 (a) On or before July 1, 2028, the Office of Statewide Health Planning and Development and the Office of Health Care Affordability shall submit to the director an analysis of each cost estimate submitted by an owner of an acute care inpatient hospital pursuant to subparagraph (D) of paragraph (2) of subdivision (b) of Section 130065.3.

(b) (1) On or before January 1, 2029, the department shall provide the Legislature with a report to include all both of the following:

(A) Each cost estimate analysis submitted to the director as described in subdivision (a).

(B) An estimate of the total statewide cost to retrofit each Structural Performance Category-2 (SPC-2) building to SPC-4D and Non-Structural Performance Category-5 (NPC-5), or rebuild to SPC-5 and NPC-5, in order to comply with the requirements of Section 130065. In estimating the total statewide cost, the department shall consider the hospital-specific cost estimates submitted pursuant to subparagraph (D) of paragraph (2) of subdivision (b) of Section 130065.3, and may consider other sources the department deems appropriate.

(C)An analysis of the potential effect of the cost estimated pursuant to subparagraph (B) will have on affordability for consumers and purchasers, which shall include:

(i)An estimate of the annual expenditures by acute care inpatient hospitals on activities necessary to reach compliance with the seismic safety standards described in subparagraph (B), on a statewide basis and for each hospital owner. This estimate shall separately account for the cost of debt financing of these activities and the scheduled term of repayment for such debt.

(ii)The impact of the estimated expenditures described in clause (i) on the ongoing ability of hospitals and other affected health care entities to meet any applicable health care cost target pursuant to Article 3 (commencing with Section 127502) of Chapter 2.6 of Part 2. The analysis shall compare any related growth in expenditures on seismic compliance activities with allowable growth under the applicable health care cost target or targets, after accounting for trends in other categories of expense for hospitals or other health care entities, as applicable.

(2) The director shall provide the Health Care Affordability Board, established pursuant to Section 127501.10, and the Health Care Affordability Advisory Committee, established pursuant to Section 127501.12, with the report required in this subdivision on the same date as it is provided to the Legislature pursuant to paragraph (1). The director shall present the major findings of the report during at least one meeting of the Health Care Affordability Board and the Health Care Affordability Advisory Committee within six months of the submission of the report to the Legislature.

(3) The report required pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.

(c)For purposes of this section, “health care entity” shall have the same meaning as set forth in subdivision (k) of Section 127500.2.

SEC. 10.SEC. 9.

 Section 130065.6 is added to the Health and Safety Code, to read:

130065.6.

 (a) The department, in consultation with the California Health Facilities Financing Authority, shall submit to the Legislature by January 1, 2026, a Hospital Construction Financing Overview report.

(b) The report required pursuant to this section shall include the following, at a minimum:

(1) An inventory of current federal, state, and local financing programs and funding opportunities that are potentially available to an owner of an acute care inpatient hospital for purposes of funding construction costs associated with meeting the requirements of Section 130065. This shall include, but is not limited to, the amount of funding available, any costs associated with accessing associated financing, and the eligibility, application, and reporting requirements for each program or opportunity inventoried.

(2) Options and recommendations for new or expanded financing programs and funding opportunities that could be made available for hospital construction costs associated with meeting the requirements of Section 130065, including but not limited to, state infrastructure funds, grants, no-cost or low-cost loans, and general obligation bond financing. In making its recommendations, the department shall consider the impact of escalating construction costs and the ongoing ability of hospitals to pay debt service.

(c) The report required pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 11.SEC. 10.

 Section 130065.7 is added to the Health and Safety Code, to read:

130065.7.

 (a) On or before January 1, 2026, the Office of Statewide Health Planning and Development shall convene a stakeholder workgroup to facilitate input on how the requirements in Section 130065 impact ongoing access to health care services at the local and regional levels. This shall include, but is not limited to, consideration of potential changes to the inpatient services available as a result of the Section 130065 requirements, such as the reduction, suspension, and closure of inpatient service lines in the subject locality or region.

(b) The stakeholder convening required pursuant to this section shall include, at a minimum, representatives for hospitals, physicians, workers, consumers, and counties.

(c) (1) On or before July 1, 2026, the Office of Statewide Health Planning and Development shall provide a report to the Legislature detailing any findings and recommendations arising out of the stakeholder convening conducted pursuant to this section.

(2) The report required pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 12.SEC. 11.

 Section 130066 of the Health and Safety Code is amended to read:

130066.

 Before January 1, 2026, the owner of an acute care inpatient hospital whose building does not substantially comply with the seismic safety regulations or standards described in Section 130065 as of the effective date of this section shall submit to the department an attestation that the board of directors of that hospital is aware that the hospital building is required to meet either the January 1, 2038, deadline, or a subsequent date as applicable to a rural hospital or critical access hospital subject to an abeyance pursuant to Section 130065.1, for substantial compliance with those regulations and standards.

SEC. 13.SEC. 12.

 Section 130066.5 of the Health and Safety Code is amended to read:

130066.5.

 (a) Before January 1, 2026, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065 as of the effective date of this section shall post in any lobby or waiting area generally accessible to patients or the public a notice provided by the department that the hospital is not in compliance with the seismic safety requirements that the hospital is required to meet by either January 1, 2038, or a subsequent date as applicable to a rural hospital or critical access hospital subject to an abeyance pursuant to Section 130065.1. The notice shall be posted until the time the owner receives notification from the department that it meets the requirements described in Section 130065.

(b) On or before January 1, 2026, and annually thereafter, the owner of an acute care inpatient hospital that includes a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065 as of the effective date of this section shall provide an annual status update on the Structural Performance Category ratings of the buildings and the services provided in each hospital building on the hospital campus to all of the following entities until the owner receives notification from the department that it meets the requirements described in Section 130065:

(1) The county board of supervisors in whose jurisdiction the hospital building is located.

(2) The city council in whose jurisdiction the hospital building is located, if applicable.

(3) Any labor union representing workers who work in a building that does not substantially comply with the seismic safety regulations or standards described in Section 130065.

(4) The board of directors of the special district or joint powers agency that provides fire and emergency medical services in the jurisdiction in which the hospital building is located, if applicable.

(5) The department.

(6) The board of directors of the hospital.

(7) The local office of emergency services or the equivalent agency.

(8) The Office of Emergency Services.

(9) The medical health operational area coordinator.

(c) Before July 1, 2025, the department shall develop the notice required in subdivision (a) with the intent that the notice will clearly convey to patients and the public that the hospital building does not meet seismic safety standards intended to ensure that the hospital will be capable of continued operation following an earthquake. For SPC-2 buildings, the notice shall clearly state, “The State of California has determined that this building does not significantly jeopardize life, but may not be repairable or functional following an earthquake.” For other buildings that are not compliant with the seismic safety regulations or standards described in Section 130065, the notice shall state, “The State of California has determined that the hospital building is at risk of not being functional to provide care to its patients or the community after an earthquake.” In its discretion, the department may develop multiple notices in order to provide a more detailed description of different hospital buildings’ failure to meet the seismic safety regulations or standards described in Section 130065.

SEC. 14.SEC. 13.

 The provisions of this act are severable. If any provision of this act or its application is held invalid for any reason by a decision of any court of competent jurisdiction, that decision shall not affect the validity of any other provisions or applications of this Act that can be given effect without the invalid provision or application.