Health facilities: emergency medical services.

The bill shifts from a dual structure (a special permit for the district plus a separate waiver for a hospital) to a single waiver mechanism. The department must now issue the waiver ('shall') rather than having discretion to grant a special permit ('may').

The special statute findings were narrowed from referencing 'Del Puerto Health Care District in the County of Stanislaus' to focusing specifically on 'the City of Patterson,' and the reference to 'underserved designated areas' was removed.

The waiver is issued to a publicly owned and operated general acute care hospital in collaboration with Del Puerto Health Care District, rather than directly to the district itself as under the old special permit.

Transfer agreement radius reduced from 30 miles (old special permit) to 25 miles (new application requirement). The old detailed operational requirements (physician on site at all times, onsite lab and radiology, written triage/transfer policies, no inpatient beds) were removed and replaced with a shorter list of conditions including specific Title 22 regulatory citations, EMPLA compliance, nurse-to-patient staffing, and HCAI physical plant clearance.

New patient-facing requirements: exterior signage must read 'EMERGENCY STABILIZATION SERVICES, PHYSICIAN ON DUTY'; patients must receive written notice about insurance coverage at registration; the facility must post the three nearest hospitals ranked by driving time; and a sign near public entrances must state that patients needing surgery, trauma care, or an inpatient bed will be transported to the nearest hospital.

Application now requires a community outreach and education plan and a triage algorithm developed with the local EMS agency, neither of which existed in the prior version.

The complex multi-stage expiration timeline (initial 2 years, extendable to 15 years with construction documents, further extension with vertical construction, then a 1-year wind-down period followed by automatic repeal) was replaced with a simpler structure: waiver expires after 2 years, renewable every 2 years up to 10 years total; section remains operative until a hospital is built within 5 miles or 10 years pass, extendable until certificate of occupancy if construction documents are submitted or vertical construction begins.

The old provision stating that 'another entity shall not rely on this section as authority to operate a rural emergency stabilization care unit' was removed, along with the automatic repeal one year after the unit ceases operations.

New provision allows the department to implement, interpret, or make specific the section by means of an All Facilities Letter or similar instruction without formal regulatory rulemaking under Government Code Chapter 3.5.

The entity authorized to operate the rural emergency stabilization care unit changed from Del Puerto Health Care District alone to a publicly owned and operated general acute care hospital in collaboration with the district. This broadens who can operate the facility.

The term 'special permit' was replaced throughout with 'waiver,' changing the legal nature from a discretionary authorization to something the department is required to issue when conditions are met.

A new subdivision (c) adds 15 detailed operational conditions for the waiver, including: location must be within City of Patterson; compliance with specific Title 22 regulatory sections; 24/7 operation; onsite medical, pharmacy, nursing, lab, and radiology services; EMTALA compliance; specific exterior signage reading 'EMERGENCY STABILIZATION SERVICES, PHYSICIAN ON DUTY'; posting the three nearest hospitals by driving time; a sign stating patients needing surgery, trauma care, or inpatient beds will be transported to the nearest hospital; and HCAI physical plant clearance.

A new subdivision (d) establishes an application process requiring a plan of operation, emergency transportation policy, written transfer agreements with all hospitals within a 25-mile radius (reduced from 30 miles in the prior version), a community outreach and education plan, and a triage algorithm developed with the local EMS agency.

A new subdivision (g) adds a sunset provision: the section remains operative only until a hospital build is completed within a five-mile radius of the care unit or within 10 years from initial issuance of the waiver, unless construction documents have been submitted to HCAI or vertical construction has commenced, in which case it remains operative until a certificate of occupancy is issued.

A new subdivision (e) requires the hospital to report bed and service utilization data separately, report adverse events under Section 1279.1 and Title 22 Section 70737, and submit a detailed annual report by March 1 covering services provided, patient counts, and adverse outcomes.

A new subdivision (f) authorizes the department to implement, interpret, or make specific the section via an All Facilities Letter or similar instruction without taking formal regulatory action under the Administrative Procedure Act.

The definition of 'rural emergency stabilization care unit' was retained but the overall definitional framework was reorganized. The term 'hospital project' is preserved as a general acute care hospital intended to serve substantially the same population with a licensed emergency department.

The entire provision allowing a general acute care hospital to obtain a special permit for emergency stabilization services at a location neither inside nor contiguous to the applicant hospital in Patterson is deleted. This removed a parallel pathway that had required transfer agreements, 24-hour operation, specific staffing, signage, and a $15,000 application fee with a 10-year maximum term.

Legislative findings in Section 2 are revised: 'City of Patterson Del Puerto Health Care District' is shortened to 'Del Puerto Health Care District,' the phrase 'considerable' is added to describe access conditions, and 'other designated areas' is changed to 'other designated underserved areas.'

The defined term 'Rural emergency stabilization center' is changed to 'Rural emergency stabilization center care unit' throughout the bill, including in the definition section, operative provisions, and sunset clauses.

A new paragraph (3) in subdivision (j) requires that if HCAI approves the district's construction plans, the hospital must report to HCAI on a quarterly basis on its progress toward timely completing the plan, as determined by HCAI.

Assembly Member Bonta is added as a coauthor of the bill.

A new section is added authorizing Del Puerto Health Care District to operate one rural emergency stabilization center under a special permit from the State Department of Public Health. This is distinct from the original provision, which only allowed a general acute care hospital to offer emergency stabilization services at a non-contiguous location in collaboration with the district.

The bill title changes from 'to add Section 1251.7' to 'to add and repeal Section 1251.7,' reflecting the new automatic repeal provision tied to the hospital project's completion.

Legislative findings in Section 2 are updated to reference 'Del Puerto Health Care District' explicitly alongside the City of Patterson, broadening the geographic framing from just the city to the entire district.

New definitions are added for 'Department,' 'District,' 'General acute care hospital,' 'Hospital project' (a general acute care hospital intended to serve substantially the same population as the district with a licensed emergency department), and 'Rural emergency stabilization center' (a facility operated by the district, not licensed as a general acute care hospital, providing 24-hour emergency screening, stabilization, and triage).

The district must enter into and maintain written transport and transfer agreements with every general acute care hospital that has a licensed emergency department within a 30-mile radius (measured along public roadways). Each agreement must address acceptance of transfers, timeframes, communication protocols, and coordination with ambulance providers.

The rural emergency stabilization center is prohibited from maintaining licensed inpatient beds or admitting patients as inpatients. Patients must be transferred or discharged within 24 hours of registration, except in emergencies requiring longer stabilization for safe transfer.

The special permit has an initial term of 2 years, renewable for successive 2-year terms up to a cumulative 10 years. If the district submits complete construction documents for the hospital project, the permit extends until the earlier of a certificate of occupancy or 15 years from initial issuance. If vertical construction commences, it extends further until both a certificate of occupancy and an initial license are obtained and the district's governing board adopts a resolution finding the ED is open. The permit cannot remain in effect more than 1 year after the hospital project first provides ED services to the public.

Upon the hospital project's ED opening, the special permit becomes inoperative for new patient registrations (except to complete transfers or discharges of patients already under care). The district must wind down and cease operations within 1 year of the hospital's ED opening. The section is automatically repealed on January 1 of the year following the center's cessation of operations.

The department may inspect the center at any time, and may deny, suspend, or revoke the special permit for noncompliance following notice and an opportunity for hearing. The district must report utilization and outcomes data to the department and to the Department of Health Care Access and Information.