20250AB__228296AMD INTRODUCED 2026-02-19 AMENDED_ASSEMBLY 2026-04-13 AMENDED_ASSEMBLY 2026-04-23 AMENDED_SENATE 2026-06-22 2025 AB AMD Introduced by Assembly Member Alanis (Coauthor: Assembly Member Bonta)</caml:AuthorText>"?> (Coauthors: Assembly Members Bonta and Flora) (Coauthor: Senator Alvarado-Gil) LEAD_AUTHOR ASSEMBLY Alanis <caml:Contribution>COAUTHOR</caml:Contribution><caml:House>ASSEMBLY</caml:House><caml:Name>Bonta</caml:Name></caml:Legislator>"?> COAUTHOR ASSEMBLY Bonta COAUTHOR ASSEMBLY Flora COAUTHOR SENATE Alvarado-Gil

An act to add

Section 1251.7 to the Health and Safety Code, relating to health facilities. health facilities Health facilities: emergency medical services. Existing law requires the State Department of Public Health to license and regulate various health facilities, including general acute care hospitals. Existing law requires the department to issue a special permit, in addition to a license, to a health facility to offer one or more special services, such as an emergency center, if specified requirements are met, including that the department finds that the standards of care and services are adequate and appropriate.

Existing law requires the department to issue a special permit to allow a general acute care hospital to offer emergency stabilization services at a location that is neither inside nor contiguous to the applicant hospital if the hospital provides satisfactory evidence to the department that, among other things, the hospital has a written transfer agreement with the hospital closest to the location where emergency stabilization services will be provided and satisfactory evidence to the department that this location meets certain requirements, including that the location is in the town of Paradise within the County of Butte and serves the same area previously served by Feather River Hospital.

This bill would require the department to issue a waiver, as specified, to a publicly owned and operated general acute care hospital, in collaboration with Del Puerto Health Care District, to operate one rural emergency stabilization care unit and waive designated general acute care hospital licensure requirements if specified conditions are met. The bill would limit the term of the waiver based on prescribed factors, including the completion of a hospital build within a 5-mile radius of the emergency stabilization care unit or within years from the initial issuance of the waiver, except as specified.

This bill would make legislative findings and declarations as to the necessity of a special statute for Del Puerto Health Care District. MAJORITY NO YES NO NO NO NO NO NO NO NO The people of the State of California do enact as follows:

SECTION

Section 1251.7 is added to the Health and Safety Code , to read: 1251.7. (

a) The Legislature finds and declares all of the following:

(1) Del Puerto Health Care District serves the residents of the City of Patterson and surrounding west side communities in the County of Stanislaus, providing essential health care services, including primary care, urgent care, ambulance services, and other outpatient and community-based services.

(2) Residents of Patterson and neighboring communities are largely rural and may have limited access to transportation and to health care resources located outside the district’s service area, making local access to timely emergency and stabilization services particularly important.

(3) The community served by Del Puerto Health Care District includes a significant number of individuals with coverage under the federal Medicare Program and the Medi-Cal program, as well as uninsured and underinsured residents, for whom delays in access to appropriate levels of care can result in worsened health outcomes.

(4) Del Puerto Health Care District is planning and developing a health care campus in the City of Patterson that will include an ambulance and administration center, primary and behavioral health services, and, in later phases, higher acuity services such as skilled nursing and an acute care hospital, in order to meet current and future community health needs.

(5) During the period in which the district is planning, developing, and constructing new facilities and expanded services, including the construction of a full scale general acute care hospital, it is necessary to ensure that residents of the City of Patterson and surrounding communities have access to emergency stabilization services close to home, including services that can appropriately receive and stabilize patients prior to transport to a general acute care hospital when clinically indicated.

(6) Therefore, it is the intent of the Legislature in enacting this

section to require the department to provide a waiver for a general acute care hospital, as defined in subdivision (

a) of

Section 1250, so long as it is publicly owned and operated, in collaboration with Del Puerto Health Care District, to provide emergency stabilization services at a location that is neither inside nor contiguous to the applicant hospital, in order to ensure that residents of the City of Patterson and the surrounding communities have access to emergency stabilization services during the development and implementation of the district’s long-term health care campus plans.

(7) It is further the intent of the Legislature that this waiver be deemed a rural emergency stabilization care unit to provide the highest quality of emergency stabilization services feasible and be staffed by physicians who are board certified in emergency medicine or have equivalent training and experience in emergency care.

(8) It is not the intent of the Legislature to establish a model for a freestanding emergency department, which is currently, and remains, prohibited by state law. (

b) For purposes of this section, the following

definitions apply: (1) “Department” means the State Department of Public Health. (2) “District” means Del Puerto Health Care District. (3) “General acute care hospital” has the same meaning as in subdivision (

a) of

Section 1250. (4) “Hospital project” means a general acute care hospital that is intended to serve substantially the same population as the district and that will include a licensed emergency department. (5) “Rural emergency stabilization care unit” means a facility operated by the district that is not licensed as a general acute care hospital pursuant to subdivision (

a) of

Section 1250, is not located inside or contiguous to a general acute care hospital, and provides 24-hour emergency medical screening, stabilization, and triage services for unscheduled patients who present with emergency medical conditions. (c)<xhtml:span class="EnSpace"/>Notwithstanding any other law, including

Section 1250, the department may issue a special permit to the district authorizing the district to operate one rural emergency stabilization care unit, and may waive general acute care hospital licensure requirements that, by their terms, require inpatient beds, inpatient nursing units, or other services that cannot be provided at a rural emergency stabilization care unit, if all of the following conditions are met:</xhtml:p><xhtml:p>(1)<xhtml:span class="EnSpace"/>The rural emergency stabilization care unit complies with the requirements of this

section and with all emergency department-related requirements that the department determines are necessary to protect patient health and safety.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>The district has executed and maintains in effect written transport and transfer agreements that satisfy the requirements of subdivision (d).</xhtml:p><xhtml:p>(3)<xhtml:span class="EnSpace"/>The operation of the rural emergency stabilization care unit is consistent with, and does not abrogate, any applicable collective bargaining agreement covering employees of the district or of any contracting hospital or other health care entity providing services at the rural emergency stabilization care unit.</xhtml:p><xhtml:p>(d)<xhtml:span class="EnSpace"/>As a condition of operation under this section, the district shall enter into and maintain written transport and transfer agreements with every general acute care hospital that maintains a licensed emergency department and is located within a 30-mile radius of the rural emergency stabilization care unit, as measured along commonly used public roadways.

Each agreement shall, at a minimum, address acceptance of transfers when clinically appropriate and subject to capacity, transfer timeframes, communication protocols, and coordination with ambulance providers serving the area.</xhtml:p><xhtml:p>(e)<xhtml:span class="EnSpace"/>A rural emergency stabilization care unit authorized under this

section shall comply with all of the following requirements:</xhtml:p><xhtml:p>(1)<xhtml:span class="EnSpace"/>Provide medical screening, stabilization, and triage for all patients who present with an emergency medical condition, without regard to insurance status or ability to pay.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>Comply with nurse-to-patient staffing requirements equivalent to those for a basic emergency department, as specified in regulations adopted pursuant to

Section 1276.4.</xhtml:p><xhtml:p>(3)<xhtml:span class="EnSpace"/>Maintain onsite, at all times, at least one physician with training and experience in emergency medicine, as determined by the department, and sufficient additional qualified medical, nursing, and ancillary staff to provide safe emergency care.</xhtml:p><xhtml:p>(4)<xhtml:span class="EnSpace"/>Provide or contract for basic laboratory and radiology services, as determined by the department to be appropriate and feasible in a standalone setting.</xhtml:p><xhtml:p>(5)<xhtml:span class="EnSpace"/>Adopt and implement written policies and procedures for triage, transfer, and coordination with the local emergency medical services agency, including criteria for when patients shall be transported directly to a general acute care hospital emergency department rather than to the rural emergency stabilization care unit.</xhtml:p><xhtml:p>(6)<xhtml:span class="EnSpace"/>Operate in a manner that does not diminish or impair any right or protection afforded to employees under an applicable collective bargaining agreement, including, but not limited to, wages, hours, and working conditions.</xhtml:p><xhtml:p>(f)<xhtml:span class="EnSpace"/>(1)<xhtml:span class="EnSpace"/>The rural emergency stabilization care unit shall not maintain licensed inpatient beds and shall not admit patients as inpatients.

The rural emergency stabilization care unit shall, consistent with patient safety, transfer or discharge patients within hours of registration, except in an emergency where a longer period is necessary to stabilize the patient for safe transfer.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>The district shall report to the department any case in which a patient remains at the rural emergency stabilization care unit for more than hours from registration.</xhtml:p><xhtml:p>(g)<xhtml:span class="EnSpace"/>(1)<xhtml:span class="EnSpace"/>The district shall apply for the special permit on a form and in a manner prescribed by the department and shall submit any information the department deems necessary to evaluate compliance with this section.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>The department may inspect the rural emergency stabilization care unit at any time to verify compliance and may deny, suspend, or revoke the special permit for noncompliance with this

section or any other applicable law, following notice and an opportunity for hearing.</xhtml:p><xhtml:p>(h)<xhtml:span class="EnSpace"/>A rural emergency stabilization care unit authorized under this

section shall submit utilization and outcomes data to the department, and to the Department of Health Care Access and Information if required, in the form and at intervals specified by the department.</xhtml:p><xhtml:p>(i)<xhtml:span class="EnSpace"/>This

section applies only to Del Puerto Health Care District and to a single rural emergency stabilization care unit operated by the district. Another entity shall not rely on this

section as authority to operate a rural emergency stabilization care unit.</xhtml:p><xhtml:p>(j)<xhtml:span class="EnSpace"/>(1)<xhtml:span class="EnSpace"/>The special permit issued under this

section shall have an initial term of two years and may be renewed by the department for successive terms of two years, not to exceed a cumulative total of years from the date of initial issuance, except as provided in paragraphs (2) to (5), inclusive.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>If, before the end of the cumulative 10-year period described in paragraph (1), the district submits complete construction documents for a hospital project to the Department of Health Care Access and Information for review, the department shall extend the term of the special permit until the earlier of either of the following:</xhtml:p><xhtml:p>(A)<xhtml:span class="EnSpace"/>Issuance of a certificate of occupancy for the hospital project.</xhtml:p><xhtml:p>(B)<xhtml:span class="EnSpace"/>Fifteen years from the date of initial issuance of the special permit.</xhtml:p><xhtml:p>(3)<xhtml:span class="EnSpace"/>If the Department of Health Care Access and Information (HCAI) approves the district’s construction plans, the hospital shall report to the HCAI, in the manner required by the HCAI, on its progress to timely complete its plan, on a quarterly basis, as determined by the HCAI.</xhtml:p><xhtml:p>(4)<xhtml:span class="EnSpace"/>If, before the end of the cumulative periods described in paragraphs (1) and (2), the district commences vertical construction of the hospital project, the department shall further extend the term of the special permit until both of the following have occurred:</xhtml:p><xhtml:p>(A)<xhtml:span class="EnSpace"/>The hospital project has received a certificate of occupancy and an initial license as a general acute care hospital pursuant to

Section 1250.</xhtml:p><xhtml:p>(B)<xhtml:span class="EnSpace"/>The governing board of the district has adopted a resolution finding that the hospital’s emergency department is open and able to receive patients at the intended level of service.</xhtml:p><xhtml:p>(5)<xhtml:span class="EnSpace"/>Notwithstanding paragraphs (1) to (4), inclusive, the special permit shall not remain in effect later than one year after the date on which the hospital project first begins providing emergency department services to the public.</xhtml:p><xhtml:p>(k)<xhtml:span class="EnSpace"/>(1)<xhtml:span class="EnSpace"/>Upon the later of the events described in subparagraphs (

A) and (

B) of paragraph (4) of subdivision (j), both of the following shall apply:</xhtml:p><xhtml:p>(A)<xhtml:span class="EnSpace"/>The special permit and any licensure waiver authorized by this

section shall become inoperative for new patient registrations at the rural emergency stabilization care unit, except as necessary to complete the transfer or discharge of patients then under care.</xhtml:p><xhtml:p>(B)<xhtml:span class="EnSpace"/>The district shall wind down and cease operation of the rural emergency stabilization care unit as expeditiously as is consistent with patient safety and in no event later than one year after the date on which the hospital project first begins providing emergency department services to the public.</xhtml:p><xhtml:p>(2)<xhtml:span class="EnSpace"/>On January of the year following the date on which the rural emergency stabilization care unit ceases operations pursuant to paragraph (1), this

section is repealed.</xhtml:p>"?> (

c) Notwithstanding any other law, including

Section 1250, the department shall issue a waiver for a general acute care hospital, as defined in subdivision (

a) of

Section 1250, so long as it is publicly owned and operated, in collaboration with Del Puerto Health Care District, to provide emergency stabilization services at a rural emergency stabilization care unit that is neither inside nor contiguous to the applicant hospital, and shall waive general acute care hospital licensure requirements that, by their terms, require inpatient beds, inpatient nursing units, or other services that cannot be provided onsite but are provided in a noncontiguous setting, if all of the following conditions are met:

(1) The location is within the City of Patterson in the County of Stanislaus and is intended to serve the same general population as is served by Del Puerto Health Care District.

(2) The location meets the regulatory requirements applicable to emergency departments described in subdivisions (a), (b), (d), (e), (f), (g), (h), (i), (k), (l), and (

n) of, and paragraph (6) of subdivision (

m) of,

Section of, subdivision (

a) of

Section of, and Sections 70417, 70419, 70651, 70655, 70657, and of, Title of the California Code of Regulations.

(3) The location meets the nurse-to-patient staffing requirements of a basic emergency department, as specified in the regulations adopted pursuant to

Section 1276.4.

(4) The location complies with the hospital’s existing collective bargaining agreements.

(5) The location is open hours a day, 7 days a week.

(6) The location provides medical, pharmacy, nursing, clinical laboratory, and radiological services onsite in compliance with

Article 3 (commencing with

Section 70201) of

Chapter of Division of Title of the California Code of Regulations.

(7) The location complies with the federal Emergency Medical Treatment and Active Labor Act (Section 1395dd of Title of the United States Code) and with

Section 1317.

(8) The location has informed the local emergency medical services agency about the types of medical conditions and injuries that the facility cannot treat and for which the patient needs to be transported directly to a general acute care hospital emergency department.

(9) Notwithstanding subdivision (

i) of

Section of Title of the California Code of Regulations, the wording of exterior signs states “EMERGENCY STABILIZATION SERVICES, PHYSICIAN ON DUTY.”

(10) The location stabilizes for transport or release a patient within hours of registration. The location reports to the department any failure to stabilize a patient for transfer or release of the patient within hours.

(11) Upon registration, the location provides a patient with a written notice that the patient should consult with their health care coverage carrier about which services may be covered and for which copayments and charges the patient may be responsible.

(12) The location posts information identifying the three nearest hospitals ranked by estimated driving time from the nearest to the farthest away.

(13) The location posts a sign, at or near any public entrance of the location, stating that patients requiring surgery, trauma care, or an inpatient bed will be transported to the nearest hospital.

(14) The location meets the physical plant requirements and has received clearance from the Department of Health Care Access and Information as appropriate for the setting and services being provided at the location.

(15) The applicant hospital has submitted and received approval on an application that meets the requirements of subdivision (d). (d)

(1) The application shall be submitted pursuant to

Section and shall include all of the following: (

A) A plan of operation that shall, at a minimum, address the location’s plan for patient care, infection control, waste disposal, and linen services. (

B) The policy and procedure that the location will implement for the emergency transportation of patients that cannot be served by the facility. The policy and procedure shall comply with the standards of practice and shall include all of the following: (

i) How the patient will be transported to the nearest general acute care hospital emergency department. (ii) The timeframe for transfer to the nearest general acute care hospital with an emergency department. (iii) How the location will ensure patient safety during the transfer. (

C) A written transfer agreement with all hospitals within a 25-mile radius with an emergency department. (

D) A community outreach and education plan to ensure the community is informed of the types of services that the facility is capable of providing. The plan shall include instructions identifying the care that the facility is capable of providing and indicating the types of injuries or conditions for which a patient should be transported directly to the nearest general acute care hospital emergency department. (

E) A triage algorithm that the location developed and will implement in collaboration with the local emergency medical services agency to determine appropriate patients for transport to the location.

(2) Notwithstanding

Section 1267, a waiver issued pursuant to this

section shall expire two years from the date of its issuance, and may be renewed every two years, for a combined period not to exceed years from the initial date of issuance.

(3) If, prior to expiration of the waiver, the district has submitted complete construction documents to the Department of Health Care Access and Information for review of a general acute care hospital to be located within the district, the department shall extend the waiver until the issuance of a certificate of occupancy for that hospital.

(4) The department may deny a request for approval or renewal of the waiver if the location fails to meet the requirements of this

chapter pursuant to

Section 1269. The department may suspend or revoke the waiver pursuant to

Article 5 (commencing with

Section 1294). (

e) A hospital issued a waiver pursuant to this

section shall report all of the following:

(1) For purposes of the Annual Report of Hospitals required by regulations adopted pursuant to

Section 1250.8, report bed and service utilization data separately by each facility issued a single consolidated license pursuant to this section.

(2) Hospital reporting requirements specified in

Section 1279.1 regarding adverse events and the reporting requirements specified in

Section of Title of the California Code of Regulations.

(3) By March of each year, a detailed report on the types of services, number of patients served, and any adverse patient outcomes during the prior calendar year. (

f) Notwithstanding any other law, the department may, without taking regulatory action pursuant to

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, implement, interpret, or make specific this

section by means of an All Facilities Letter or similar instruction. (

g) This

section shall remain operative only until a hospital build is completed within a five-mile radius of the emergency stabilization care unit or within years from the initial issuance of the waiver issued pursuant to this

section unless, prior to the expiration of that 10-year period, the district has submitted complete construction documents to the Department of Health Care Access and Information for review of a general acute care hospital or has commenced vertical construction of that hospital, in which case this

section shall remain operative until issuance of a certificate of occupancy for that hospital.

SEC. 2. The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of

Section of

Article IV of the California Constitution because of all of the following: (

a) Residents, workers, and visitors in the City of Patterson face comparable—and in many cases more burdensome—access conditions to emergency medical services when compared to other designated areas. (

b) Average travel distances from the City of Patterson to the nearest full-service acute care hospital or trauma center are approximately miles, with average drive times of minutes or more. (

c) These access delays are driven by persistent geographic isolation, limited roadway options, agricultural and freight traffic, rail crossings, State Highway congestion, and weather-related disruptions, including fog and flooding. (

d) The access challenges in the City of Patterson reflect structural constraints and ongoing gaps in timely emergency medical services in a rural, medically underserved community, rather than temporary emergencies such as wildfires.