Another Headache for Hospitals: Notices for Closing or Moving Services
What you need to know:
Hospitals will be required to give a 30-day notice to Licensing, the county and the public before closing or relocating any supplemental service.
When:
Jan. 1, 2009
Why:
The Legislature believes that “dramatic changes are underway in the delivery of health care” and “[m]any of these changes . . . are occurring without public disclosure or discussion.” If notice was required, “affected communities and groups, physicians, other interested health professionals, and public bodies could provide input about how best to maintain the safety of patient care and access to needed care while maximizing cost-effectiveness.”
On September 27, Gov. Schwarzenegger signed Assembly Bill 2400 into law. The new law—supported by Health Access California, a nonprofit organization that promotes health care reform, and labor organizations—requires hospitals (except county hospitals) to provide a 30-day notice to Licensing, the county and the public before closing a hospital, eliminating a supplemental service or relocating a supplemental service to a different campus.
Background
Under current licensing laws, hospitals are licensed for basic, supplemental and special services. Supplemental services include intensive care, perinatal, rehabilitation, skilled nursing and pediatric services, as well as outpatient, dental, podiatric, physical and occupational therapy, speech therapy, and social services. Special services are chronic dialysis, emergency services, radiation oncology, neonatal intensive care, burn center, acute psychiatric, cardiac surgery and catheterization and renal transplantation.
Current law also requires a hospital to provide 90 days of public notice before reducing or eliminating emergency services and 30 days of notice before closing a hospital or a special service. There are also special notice requirements before closing skilled nursing services, laboratories and other types of services. Except for closing emergency services, there are no requirements to post public notice or notify the local county of closing or relocating services.
What's new: the notice requirements
- When is notice required? The 30-day advance notice is required in three instances:
- Closure of a hospital;
- Eliminating a supplemental service; or
- Relocating “the provision of a supplemental service” to a different campus.
- Closure of a hospital;
- Who receives the notice?
- Licensing;
- The board of supervisors for the county in which the hospital is located; and
- Affected facilities—notice must be posted at the facility's entrance.
- Licensing;
- What is the content of the notice?
- A description of the proposed closure, elimination or relocation (e.g., beds eliminated, decrease in the number of personnel or a summary of the affected service);
- A description of the three nearest available comparable services in the community, including the nearest available comparable services available to Medicare and Medi-Cal patients; and
- The telephone number and address of the (i) hospital, (ii) its parent entity, (iii) a contract manager of the hospital; and (iv) the chief executive officer.
- A description of the proposed closure, elimination or relocation (e.g., beds eliminated, decrease in the number of personnel or a summary of the affected service);
What does this mean to hospitals?
Despite the broad findings by the Legislature seeking a public dialogue on hospital service closures and relocations, the new law does not require public hearings or grant Licensing new authority to reject applications to close or relocate supplemental services.
However, the new legislation is not without some uncertainty, for which Licensing will be required to fill in the holes. Some examples:
- Is notice required to close or relocate a special service? SB 2400 uses the term “supplemental service,” and does not refer to “special services.”
- Does “eliminating” a service include the suspension of a service?
- Does “eliminating” a service include closing an off-campus location of a service, but not eliminating the provision of the same service at other locations?
- Does a “campus” of a hospital include each off-site location, including space in office buildings (e.g., satellite physical therapy centers)?
- For moving services within buildings adjacent to the main hospital, what is the “campus” of a hospital for licensing purposes? (Under Medicare rules, buildings within 250 yards of the main facility are part of the main hospital campus; Licensing usually lists each service location on the license that has a different address than the main hospital.)
What should hospitals do?
Until the holes in the new law are filled in (and don't hold your breath), hospitals should consult with legal counsel or contact their local Licensing field office, before closing or relocating a supplemental service, to verify whether notice is required. Hospitals should also be prepared to handle the inevitable public-relations challenges that will result from attention to a closure or relocation by the media, politicians and interested groups.