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California

How many hospitals are there in California? (Google) 

https://www.ahd.com/state_statistics.html

https://www.ahd.com/states/hospital_CA.html

    • Statistics for non-federal, short-term, acute care hospitals are summarized by state. 
  • Total hospitals equal 337 (does not include federal hospitals in California 

 

How many hospitals are there in California? (Google)

  • California state total 570 hospitals. 
  • 122 are Government hospitals and 148 are private hospitals.
  • Provides specific names and locations of hospitals.

 

California Health and Human Services Agency (my pick)

    • Licensed and Certified Healthcare Facility Bed Types and Counts (XLSX)The California Department of Public Health (CDPH), Center for Health Care Quality, Licensing and Certification (L&C) Program licenses more than 30 types of healthcare facilities. This file lists the bed types and bed type capacities that are associated with California healthcare facilities that are operational and have a current license issued by the CDPH and/or a current U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) certification. The L&C Open Data facility beds file is updated monthly.
  • Significantly more hospitals than previous search (total = 1,645)
    • General Acute Hospital – 1,510
    • Acute Psychiatric Hospital – 126
    • Chemical Dependency Hospital – 9

 

Who regulates hospitals in California? (Google)

The California Department of Public Health (CDPH), Center for Health Care Quality, Licensing and Certification (L&C) Program licenses and certifies more than 30 types of healthcare facilities.

 

The California Department of State Hospitals (DSH)

The Department of State Hospitals (DSH) manages the California state hospital system, which provides mental health services to patients admitted into DSH facilities.  DSH oversees five state hospitals – Atascadero, Coalinga, Metropolitan (in Los Angeles County), Napa and Patton.

 

How Many Nursing Homes are there in California? 

There are approximately 1,230 licensed long-term care nursing facilities in California. These include free-standing nursing homes and ‘distinct part’ nursing homes which are attached to hospitals.          

 

Who regulates Long-term Care (Nursing Homes) in California?

California’s oversight of long-term care facilities is the most rigorous in the nation and the most comprehensive for any category of provider in the state. The California Department of Public Health, the Department of Social Services, the Department of Mental Health and the Department of Developmental Services each plays a role in licensing and regulating care providers.

 

Providers must meet state licensure standards, and in the skilled setting, are also governed by a stringent set of federal requirements. In addition, several other federal, state and local agencies – including the federal Centers for Medicare and Medicaid, state departments of Aging, Justice and Consumer Affairs and the Office of the State Fire Marshal – also review facility services in California.

 

What is the California Department of Public Health Responsible for?

The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. Our vision is to preserve and improve the overall health and well-being of all Californians.

 

DHCS funds health care services for about 13 million Medi-Cal beneficiaries. About one-third of Californians receive health care services financed or organized by DHCS, making the Department the largest health care purchaser in California. Our success is made possible only through collaboration with the federal government and other state agencies, counties, and partners as we invest more than $100 billion for the care of low-income families, children, pregnant women, seniors, and persons with disabilities.

 

Among the programs administered by DHCS, some of which are mandated by the federal government and others required by state law, are California Children’s Services; Child Health and Disability Prevention program; Genetically Handicapped Persons Program; Newborn Hearing Screening Program; Family Planning, Access, Care, and Treatment program; Program of All-Inclusive Care for the Elderly; Every Woman Counts; and Coordinated Care Management. DHCS also administers programs for underserved Californians, including farm workers and American Indian communities.

 

DHCS is constantly seeking to improve its services. For example, to improve access to services and ensure we spend tax dollars efficiently, more than​ 80 percent of our beneficiaries​ receive care from a Medi-Cal managed care plan. Under these models, access to health care is easier and the quality of care is improved.

 

California Department of Health Care Services All Programs and Services

https://www.dhcs.ca.gov/services/Pages/AllServices.aspx

 

What HIPAA law(s) must be followed in California? 

https://www.chhs.ca.gov/ohii/health-laws/

 

Federal Laws

The Privacy Rule requires appropriate safeguards to protect the privacy of patient-identifying health information and sets limits and conditions on the uses and disclosures of such information without patient authorization.  General exceptions allow for treatment, payment, and healthcare operations.  The Privacy Rule also gives patients’ rights over their health information, including the rights to access and request corrections.

 

HIPAA Security Rule – The Security Rule protects individuals’ electronic protected health information that is created, received, used, or maintained by a cover entity or its business associate(s).  The Security Rule requires appropriate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, availability, and security of the electronic protected health information.

 

Administrative Rules – These rules reduce paperwork and streamline business processes across the healthcare system.  Specifically, the rules include:

 

Confidentiality of Substance Use Disorder (SUD) Patient Records – 42 C.F.R. Part 2 applies to federal assisted SUD treatment programs that meet the definition of a program within the regulation.  These regulations apply to information that would identify a patient as having a SUD and allow very limited disclosures of information without a patient authorization.

 

Genetic Information Nondiscrimination Act (GINA) – GINA protects individuals against discrimination based on their genetic information in health coverage and in employment.

 

California State General Privacy Protections (in addition to HIPAA)

 

    • California Constitution, Article 1 – Declaration of Rights
      Section 1 provides all Californians with a guaranteed right to privacy.
    • Information Practices Act (IPA) – Civil Code §§ 1798 – 1798.78
      This law expands on the constitutional guarantee of privacy by providing limits on the collection, management and disclosure of personal information by state agencies.
  • Confidentiality of Medical Information Act (CMIA)
    • Disclosure of Medical Information – Civil Code §§ 56.10 – 56.16
      This law protects the privacy of an individuals’ medical information (in electronic or paper format) from unauthorized disclosure by limiting disclosures by providers of health care, health plans, and contractors.   
    • Civil Penalties for Unauthorized Access, Use, or Disclosure of Medical Information – Civil Code § 56.36
      CMIA was amended to further define administrative fines or civil penalties for any person or entity including licensed health care professionals who knowingly and willfully obtains, discloses, or uses medical information in violation of the CMIA.
  • Confidentiality of SUD Records – Health and Safety Code § 11845.5
    This law protects information and records maintained by entities, that are licensed by the California Department of Health Care Services, in connection with SUD diagnosis and treatment which is confidential and specially protected.  Information and records may be disclosed only as provided in this code section.  CMIA does not regulate these SUD information and records.
  • Physical Safeguards – Health and Safety Code § 1280.18
    This law requires health providers to establish and implement administrative, technical, and physical safeguards to protect the privacy of patient’s medical information.  Each health provider shall reasonably safeguard confidential health information from any unauthorized access, use, or disclosure.

 

Patients’ Right to Access

  • Patient Access to Health Records – Health and Safety Code § 123100 and § 123111 With minor limitations, this law gives patients the right to see and copy information maintained by health care providers relating to the patients’ health conditions. The law also gives patients the right to submit amendments to their records, if the patients believe that the records are inaccurate or incomplete.
  • Consent by Patient for Lab Results via Internet or other Electronic Means – Health and Safety Code § 123148 If the patient requests, a health care provider shall provide the results of the laboratory test to the patient in written or oral form. Consent must be obtained (consistent with CMIA) to deliver results via electronic means. Electronic delivery or results shall be consistent with applicable federal law or state law. HIV antibody test, hepatitis infection tests, abusing the use of drugs, and tests related to routinely processed tissues revealing malignant results may not be conveyed by electronic means, unless the specific requirements of subdivision (f) of Health and Safety Code section 123148 are met. Test results and health information may not be used for commercial purpose without patient consent.

 

Uses and Disclosures

  • The information is in this section is a small subset of the state laws related to uses and disclosures of health information.  For more information about specific uses and disclosures, refer to the Statewide Health Information Policy Manual (SHIPM) or State Health Information Guidance (SHIG).
  • Lanterman-Petris-Short Act (LPS) – Welfare and Institutions Code § 5328 et seq.
    Information and records obtained in the course of providing services to involuntarily and some voluntary recipients of services are confidential and specifically protected under LPS.  Patient information obtained by the county or city mental health departments, state hospitals, regional centers (under the California Department of Developmental Services), or other public or private entities (such as community mental health clinics) are also protected under LPS.  In general, information and records may be disclosed as provides in LPS.  The CMIA regulates most of what is not regulated by LPS.  If a facility is not regulated by LPS, it is likely regulated by CMIA.  
  • Access to Mental Health Information by Patients’ Rights Advocate – Welfare and Institutions Code § 5541
    Patients’ rights advocates must obtain written authorization from the client or the guardian ad litem to access, copy, or use the client’s confidential records and information. The client or guardian may revoke such authorization at any time.
  • Medical Information, Collection for Direct Marketing Purposes – Civil Code § 1798.91
    Businesses are prohibited from seeking to obtain medical information from an individual for direct marketing purposes without, (1) clearly disclosing how the information will be used and shared, and (2) getting the individual’s consent.
  • Persons with Developmental Disabilities, Confidential Information and Records; Disclosure; Consent – Welfare and Institutions Code § 4514
    All information and records acquired in the course of providing intake, assessment, and services to persons with developmental disabilities shall be confidential. Information and records are to be disclosed only as provided in this section.
  • Mandated Blood Testing and Confidentiality to Protect Public Health – Health and Safety Code §§ 120975 – 121020
    This law protects the privacy of individuals who are the subject of blood testing for human immunodeficiency virus (HIV).  No person shall be compelled to provide information in any state, county, city, or other local civil, criminal, administrative, legislative or other proceedings that would reveal the identity of any individual who is the subject of an HIV blood test. Exceptions are provided in Health and Safety Code § 1603.1, § 1603.3, and § 121022.
  • Disclosures by State or Local Public Health Agencies of Records relating to HIV or AIDS – Health and Safety Code § 121025
    HIV or acquired immunodeficiency syndrome (AIDS) related public health records containing personally identifying information, developed or acquired by public health agencies shall be confidential and not disclosed except as otherwise provided by law for public health purposes or with written authorization from the person who is the subject of the record or their guardian or conservator.
  • Confidentiality of Committed Mentally Abnormal Sex Offenders – Welfare and Institutions Code § 4135
    The supervision, care, and treatment records of persons committed to the State Department of State Hospitals as a mentally abnormal sex offender shall not be inspected by any person not employed by the department unless the court through an order permits examination of such records.

 

Breach Notification 

  • Breach Notification – Civil Code § 1798.29 and § 1798.82
    State agencies and businesses that collect personal information are required to notify each person in their database should there be a security breach involving personal information.  Personal information includes:  Social Security number, driver’s license number, account number, credit or debit card number, or security code or password for accessing their financial account as well as medical information and health insurance information.

     

    • “medical information” means any information regarding an individual’s medical history, mental or physical condition, or medical treatment or diagnosis by a health care professional.
    • “health insurance information” mean any unique identifier used by a health insurer to identify the individual, or any information in an individual’s application and claims history, including any appeals records.
  • Health Facilities Data Breach – Health and Safety Code § 1280.15
    Certain health facilities are required to prevent unlawful or unauthorized access to, or use or disclosure of, a patient’s medical information. It sets fines and notification requirements for breaches of patient medical information and requires facilities to report such breaches to the California Department of Public Health.

 

The California Consumer Privacy Act of 2018

The California Consumer Privacy Act of 2018 (CCPA) gives consumers more control over the personal information that businesses collect about them and the CCPA regulations provide guidance on how to implement the law. This landmark law secures new privacy rights for California consumers, including:

 

The CCPA applies to for-profit businesses that do business in California and meet any of the following:

  • Have a gross annual revenue of over $25 million.
  • Buy, receive, or sell the personal information of 50,000 or more California residents, households, or devices; or
  • Derive 50% or more of their annual revenue from selling California residents’ personal information.

 

What are common compliance issues in California?

 

Cal/OSHA Citations: https://www.dir.ca.gov/dosh/COVID19citations.html

 

Office of the Inspector General Enforcement Actions

https://oig.hhs.gov/fraud/enforcement/?type=cia-reportable-events,stipulated-penalties-and-material-breaches

 

Compliance Related: 

https://www.pwc.com/us/en/industries/health-industries/top-health-industry-issues.html

https://www.acc.com/resource-library/top-ten-us-health-care-compliance-issues-2020

 

See download from SAI Global – 2021 Healthcare Compliance Benchmark Survey

 

See download from McDermott Will & Emery – Healthcare Enforcement Quarterly Roundup

 

340B Drug Discount Program

 

List of 340B Hospitals in California

https://www.340bhealth.org/files/CA.pdf

 

List of 340B Hospitals by State

https://www.340bhealth.org/members/advocacy-tools/list-of-340b-hospitals-by-state/list/

 

Criteria for Hospital Participation in the 340B Drug Discount Program

https://www.340bhealth.org/members/340b-program/criteria-for-hospital-participation/

 

National findings that may be useful:

AHA has defined two types of health care systems, and both involve an ownership, lease, sponsorship or contract management relationship with a central organization. 

https://www.aha.org/system/files/media/file/2021/01/Fast-Facts-health-systems-infographic-2021-jan21.pdf

 

Fast Facts and Infographics on U.S. Hospitals 2021

https://www.aha.org/system/files/media/file/2021/01/Fast-Facts-2021-table-FY19-data-14jan21.pdf

https://www.aha.org/system/files/media/file/2021/01/Fast-Facts-Hospitals-Infographic-2021-jan21.pdf

 

Fast Facts: U.S. Rural Hospitals Infographic

Rural hospitals are those hospitals not located within a metropolitan area as defined by the U.S. Office and Management and Budget and the U.S. Census Bureau.

 

How many doctors and nurses work in hospitals? Find out here.

Clinicians are the lifeblood of a hospital. Ensuring that enough doctors and nurses are available to meet patient’s needs is a key public health issue facing hospital leaders.