City of Alameda Health Care District October 6, 2008 Agenda

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PUBLIC NOTICE

CITY OF ALAMEDA HEALTH CARE DISTRICT BOARD OF DIRECTORS MEETING

AGENDA Monday, October 6, 2008

*CLOSED SESSION – 5:30 p.m. OPEN SESSION –7:30 p.m. Location:

Alameda Hospital (Dal Cielo Conference Room) 2070 Clinton Avenue Alameda, CA 94501

Office of the Clerk: (510) 814-4001

Regular Meeting Members of the public who wish to comment on agenda items will be given an opportunity before or during the consideration of each agenda item. Those wishing to comment must complete a speaker card indicating the agenda item that they wish to address.

I. Call to Order Robert Deutsch, MD II. Roll Call Kristen Thorson III. General Public Comments IV. Closed Session (Expected to start at approximately 6:00 p.m. and expected to last 1.5 hours)

1) Approval of Closed Session Minutes –September 8, 2008 2) Medical Executive Committee Report and Approval H & S Code Sec. 32155

of Credentialing Recommendations 3) Instructions to Bargaining Representatives Gov’t Code Sec. 54957.6

Regarding Salaries, Fringe Benefits and Working Conditions 4) Consultation with Legal Counsel Regarding Gov’t Code Sec. 54956.9(a) Pending Litigation

City of Alameda Health Care District October 6, 2008 Agenda

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5) Discussion of Report Involving Trade Secrets H & S Code Sec. 32106 6) Quality Improvement Committee Report (QIC) H & S Code Sec. 32155 6) Public Employee Performance Evaluation Gov’t Code Sec 54957

Title: Chief Executive Officer V. Reconvene to Public Session (Expected to start at approximately 7:30 p.m.)

1) Announcements from Closed Session Robert Deutsch, MD

VI. Consent Agenda

1. Approval of September 8, 2008 Minutes ACTION ITEM [enclosure]

2. Biennial Review and Approval of City of Alameda Health Care District Conflict of Interest

Code #2008-0Y ACTION ITEM [enclosure]

3. Approval for the Formation of a Pension Committee and Reallocation of Fund from Fixed

Income to Balanced Portfolio ACTION ITEM [enclosure]

VII. Regular Agenda 1. Finance and Management Committee Report David A. Neapolitan

Acceptance of August Financial Statements

ACTION ITEM [enclosure]

Fiscal Year (FY) 2008 Audit Presentation [enclosure] Rick Jackson, TCA

Partners Acceptance of FY 2008 Audit ACTION ITEM

2. Information Systems Overview Presentation Robert Lundy-Paine

3. Strategic Planning and Community Relations Committee Report Robert Bonta

City of Alameda Health Care District October 6, 2008 Agenda

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4. Chief Executive Officer’s Report Deborah E. Stebbins

September Statistics and Updates OIG Survey Update

Appraisal for South Shore (625 Willow Street) Building

Opening Discussions with Local 250

5. Medical Staff President Report Steve Lowery, MD

Approval of the Proposed Revision to Article 1, Section B,

Admission Exceptions, of the Medical Staff Rules and Regulations ACTION ITEM [enclosure]

6. General Public Comments

7. Board Comments

8. Adjournment

The next regularly scheduled board meeting will be on Monday, November 3, 2008. Closed Session will begin at 6:00 p.m. Open Session will follow at approximately 7:30 p.m.

Minutes of the Board of Directors September 9 , 2008

Directors Present: Jordan Battani Robert Bonta Jeptha Boone, M.D. Robert Deutsch, MD Steve Wasson

Management Present: Deborah E. Stebbins Kerry Easthope David A. Neapolitan

Medical Staff Present: Steve Lowery, M.D.

Legal Counsel Present:

Excused: Thomas Driscoll, Esq.

Submitted by: Kristen Thorson Topic Discussion Action / Follow-Up

1. Call to Order

Jordan Battani called the Open Session of the Board of Directors of the City of Alameda Health Care District to order at 6:00 p.m.

2. Roll Call

Kristen Thorson called roll, noting that all Directors were present.

3. General Public

Comments

None at this time.

4. Closed Session

At 6:02 p.m. the meeting adjourned Executive Closed Session.

5. Reconvene to

Public Session & Adjournment

Director Battani reconvened the meeting into public session at 7:45 p.m. and made the following closed session announcements.

6. Closed Session Announcements

[1] Minutes [2] Quality Improvement Committee

[1] The Closed Session Minutes for the June 30, 2008 meeting were approved. [2] The Quality Improvement Committee Report for June and July was accepted as presented.

District Board Meeting Minutes 09.08.08

Topic Discussion Action / Follow-Up 7. Consent Agenda

[1] Approval of Minutes § August 4, 2008

[2] Biennial Review and Approval of City of Alameda Health Care District Conflict of Interest Code #2008-0Y

[3] Approval of Aesthetic Upgrades to 501 South Shore Center West

Director Bonta removed item 2 from the consent agenda for discussion and clarification. Management will check with legal counsel on the reason why the detail in the disclosure categories was omitted from the revised version. Dr. Boone moved to approve the balance of the consent calendar (items 1 & 3). Director Bonta seconded the motion. The motion carried unanimously.

8. Regular Agenda

[1]Finance and Management Committee Report Acceptance of the July 2008 Financial Statements CFO David Neapolitan presented the July 2008 Financial Statements as presented noting a profit for the month of $57,276. Mr. Neapolitan also reviewed the key statistics and daily key indicators for the month of July. Having no questions from the Board, Mr. Neapolitan asked for acceptance of the financial statements. Audit Update TCA Partners completed the field review the first week of August. Management and auditor continue to work on several open issues. The operating loss for the year is a loss of $2.3 million. Mr. Neapolitan stated that the Auditor felt that the accounts receivable reserves were on target and would not need to be adjusted. The draft audit report will be presented to the Finance and Management Committee on September 24, 2008 and to the Board for final approval on October 6, 2008. After discussion with legal counsel and auditor, due to the size of the Board of Directors and the size of our facility, management informed the Board there would not be a need for separate Audit Committee. Instead audit related issues will be reported to the Finance and Management Committee. [2] Asian Health Services Presentation Alice Cheng, RN presented to the Board of Directors a summary of the activities and projects surrounding the Asian Health Services and Outreach Program. A copy of the presentation is available in Administration for review. The Board of Directors thanked Ms. Cheng for her work with the Asian outreach program and efforts.

Director Boone moved to accept the July 2008 Financial Statements as presented. Director Wasson seconded the motion, the motion carried unanimously.

District Board Meeting Minutes 09.08.08

Topic Discussion Action / Follow-Up [3] Strategic Planning and Community Relations Report. Rob Bonta reported on the last committee meeting of September 5, 2008. A draft plan was presented to the committee that included Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Critical Success Factors, and goals for 6 key areas of focus. The meeting was very productive with input from those in attendance. The next meeting has not yet been determined but Mr. Bonta will keep the Board informed and provide additional lead time prior to the next meeting. [4] Chief Executive Officer’s Report Deborah E. Stebbins reported on the following items: Governance Institute Membership Ms. Stebbins presented to the Board information about becoming a member of the Governance Institute. The Governance Institute is a leadership development organization for governing bodies such as the Board of Directors. Director Boone recommended the organization highly and said that prior Boards attended conferences and seminars and thought that they were very worthwhile. Along with educational opportunities, the Governance institute also offers tools and resources. Dr. Deutsch thought that a presentation by a representative of the Governance Institute to the Board of Directors would be valuable prior to making a decision. Board Election / Transition With the recent Board election and upcoming transition, Ms. Stebbins recommended to the Board that they may think about contacting different service organization within the city to host candidate forums with the Health Care District to inform the public about the hospital. Since there will not be a formal election, this would give the Board Members an opportunity to report to the public in a different setting other than Board meetings. Management will contact Rotary, League of Women Voters, and the Alameda Chamber of Commerce. Employee Recognition Event: The Employee Tenure Recognition Event will be held on September 23, 2008. The Hospital will be recognizing employees with 5, 10, 15, 20, 25, 30, and 35 years of service. All Board members are invited to attend.

Director Deutsch made a motion to move forward with the Governance Institute Membership by allowing the Institute to make a presentation at an upcoming Board meeting. Director Bonta seconded the motion. The motion carried unanimously.

District Board Meeting Minutes 09.08.08

Topic Discussion Action / Follow-Up Statistics:

August August Budget

July Actual

Average Daily Census 82.60 84.39 65.10 Patient Days 2,227 2,259 2,018 ER Visits 1,336 1,436 1,378 OP Registrations 2,441 2,626 2,554 Total Surgeries 448 382 548

Community Relations/Foundation The Annual Report to the Community Newsletter will be mailed to Alameda residents on approximately September 22, 2008. The Foundation will be having their annual fundraiser on September 13, 2008. The fundraising goal for the event is $85,000 and 225 persons attending. Last year the event raised $74,000 with 205 people attending. [5] Medical Staff President Report Dr. Lowery reported that the Medical staff committees did not meet in August, thus there is no formal report this month.

8. General Public

Comments

None at this time.

10. Board Comments

None at this time.

11. Adjournment

A motion was made to adjourn the meeting and being no further business, the meeting was adjourned at 9:00 p.m.

Attest:

Jordan Battani Robert Bonta

President Secretary

District Board Meeting Minutes 09.08.08

DISTRICT BOARD/MINUTES/REG.090808

City of Alameda Health Care District September 8, 2008 Conflict of Interest Code #2008-0Y

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CONFLICT OF INTEREST CODE #2008-0Y

CITY OF ALAMEDA HEALTH CARE DISTRICT

1. Standard Code of FPPC

The Political Reform Act (Government Code section 81000, et seq.) requires state and local government agencies to adopt and promulgate conflict of interest codes. The City of Alameda Health Care District (“District”) is therefore required to adopt such a code.

The Fair Political Practices Commission (“FPPC”) has adopted a regulation (2 California Code of Regulations section 18730) which contains the terms of a standard conflict of interest code, which may be incorporated by reference in an agency’s code, and which may be amended by the FPPC to conform to amendments in the Political Reform Act following public notice and hearing.

2. Adoption of Standard Code of FPPC

Therefore, the terms of 2 California Code of Regulations section 18730 and any amendments or revisions adopted by the FPPC are hereby incorporated by reference. This regulation and the attached Appendix designating officials and employees and establishing disclosure categories shall constitute the Conflict of Interest Code of the District. This code shall take effect when approved by the Alameda County Board of Supervisors.

3. Filing of Statements of Economic Interests

Designated employees and public officials who manage public investments shall file statements of economic interests with the Secretary to the Board of Directors of the District. The agency shall make all statements available for public inspection and reproduction, pursuant to Government Code Section 81008.

APPROVED AND ADOPTED by the City of Alameda Health Care District on the __th day of _______, 2008.

_______________________________ Jordan Batttani President, Board of Directors ATTEST: _______________________________ Robert Bonta Secretary, Board of Directors

City of Alameda Health Care District September 8, 2008 Conflict of Interest Code #2008-0Y

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APPENDIX TO CONFLICT OF INTEREST CODE

OF THE CITY OF ALAMEDA HEALTH CARE DISTRICT

Preamble

Any person designated in Section I of this Appendix who is unsure of any right or obligation arising under this Code may request a formal opinion or letter of advice from the FPPC or an opinion from the District’s General Counsel. (Gov. Code § 83114; 2 CCR § 18730(b)(11).) A person who acts in good faith in reliance on an opinion issued to him or her by the FPPC shall not be subject to criminal or civil penalties for so acting, provided that all material facts are stated in the opinion request. (Gov. Code § 83114(a).)

Opinions rendered by General Counsel do not provide any statutory defense to an alleged violation of conflict of interest statutes or regulations. The prosecuting agency may, but is not required to, consider a requesting party’s reliance on General Counsel’s opinion as evidence of good faith. In addition, the District may consider whether such reliance should constitute a mitigating factor to any disciplinary action that the District may bring against the requesting party under Government Code section 91003.5.

I.

Designated Employees

Designated Employees Categories Disclosed

Members of the District Board of Directors All

Chief Executive Officer All

Chief Operating Officer All

Chief Financial Officer All

General Counsel All

Consultants1 ---

1 With respect to consultants, the CEO may determine in writing that a particular consultant, although a “designated employee,” is hired to perform a range of duties that are limited in scope and thus is not required to comply with all the written disclosure requirements described in these categories. Such determination shall include a description of the consultant's duties and, based upon that description, a statement of the extent of disclosure requirements. The CEO’s determination is a public record and shall be retained for public inspection by the District in the same manner as this Conflict of Interest Code. Nothing herein excuses any such consultant from any other provision of this Conflict of Interest Code.

City of Alameda Health Care District September 8, 2008 Conflict of Interest Code #2008-0Y

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II. Persons Who Manage Public Investments

The Treasurer of City of Alameda Health Care District has been annually delegated responsibility for making public investments on behalf of the District, and reviewing and annually presenting the investment policy of the District to the Board of Directors for informational purposes. The Treasurer is therefore obligated to file a statement of economic interests under Government Code section 87200, rather than the conflict of interest code.

III. Disclosure Categories

Designated employees shall report all reportable investments, business positions and income, including gifts, loan and travel payments, as specified above, in:

1. Accounting or auditing services 2. Banks and savings and loans 3. Computer hardware or software, or computer services or consultants 4. Communications equipment or services 5. Educational and medical services and materials 6. Entities or persons who have filed claims against the District or have

claims pending against the District 7. Insurance brokers and agencies 8. Insurance adjusting, claims auditing or administration, or underwriting

services 9. Medical equipment, facilities, and supplies 10. Office equipment or supplies 11. Personnel and employment companies and services 12. Printing or reproduction services, publications, and distribution 13. Securities, investment or financial services companies 14. Title insurance and escrow 15. Interests in Real Property

DISTRICT BOARD/POLICIES AND CODES/2008-0y.CONFLICT OF INTEREST CODE.

Date: October 1, 2008 To: City of Alameda Health Care District Board of Directors From: Deborah E. Stebbins, Chief Executive Officer Subject: Management of Frozen Alameda Hospital Retirement Plan The purpose of this memorandum is to request Board approval for several actions relating to the oversight and investment management of the Alameda Hospital Retirement (“Echo”) Plan established in November 2002 and frozen in January 2005. Background: In 1959, Alameda Hospital installed a defined benefit plan (“Alameda Hospital Retirement Plan”) covering all hospital employees with the exception of those employees covered under alternative plans through their collective bargaining contracts. In July 2002, prior to the vote to make the Hospital a District Hospital, management terminated the Alameda Hospital Retirement Plan and purchased annuity contracts for all participants through Principal Life Insurance Company. In November, 2002, immediately after the election to convert to District Hospital status, the Echo Plan was installed with very similar benefits to the original defined benefit plan. In January 2005, the Alameda Hospital Echo Plan was frozen with Board Approval and at the recommendation of Delta One Consultants. The Echo plan was replaced by a 401(a) defined contribution plan in which the employer contributes 6% of the annual compensation for each employee after one year of employment. These contributions are made to Diversified Investment Advisors and each employee directs how these funds are to be invested through our broker, Stark-Miller Associates. In addition, employees can make their own pre-tax contributions to a 457(b) fund, which is also administered by Stark-Miller, up to an amount allowable under the tax laws. Over the years, several cash contributions were made to the Echo Plan, including:

2002 $ 350,000 2004 580,000 2005 700,000 2006 200,000 2008 (September) 45,000

The total balance in the Echo Plan as of September 24, 2008 is $1,379,000, which includes investment earnings on the cumulative deposits minus benefit payments. Note that some of these contributions were made even after the fund was frozen since liabilities continue to exist for the beneficiaries. These contributions are invested in a very conservative fixed income fund managed by Union Bank of California. Legally, District hospitals, are not subject to higher ERISA pension funding requirements. Whereas ERISA requires a minimum of 80% funding at the beginning of a plan year with a target of 100% funding over a seven (7) year time horizon of estimated pension liabilities, government entity pension plans have no minimum funding requirements. The last actuarial analysis completed this year showed that the frozen Echo Plan is currently about 69% funded in relation to its projected liabilities. In addition, probably as many as 80% of the beneficiaries will begin to draw down on their retirement benefits within the next 15 years. For these reasons, management believes that it would be prudent to begin to fund this account on a more aggressive basis with a goal of completing 100% funding of liabilities within a 15-year time frame. In addition, management has met with HighMark Capital Management, Inc., the investment management subsidiary of Union Bank of California, to discuss the current fixed income portfolio in which the fund is invested. Based on their experience in managing similar pension portfolios, HighMark recommends that it would prudent to invest the pension funds in what they call a “Balanced – Balanced Income” portfolio, comprised of 40-60% equity, 40-60% fixed income with a small percentage in cash to cover transactions by the investment manager. Over the long-term, HighMark projects that the Balanced Fund investment will generate an average annual rate of return of 6.5-7% instead of the 3-4% average return generated by fixed income fund. Management recommends the following to the Board of Directors regarding the funding and disposition of the frozen Echo Plan:

1. The Board should establish a Pension Committee directly accountable to the Board of Directors and comprised of one Board member plus three members of the executive staff: the CEO, CFO and Director of Human Resources. A formal committee charge will be drafted and brought back to the Board for approval. At a minimum, the Pension Committee will meet at least twice a year and will oversee the investment results for the frozen Echo Plan, review annual actuarial projections for the total liability of the fund, evaluate satisfaction with the Plan’s investment manager and, when appropriate, evaluate the overall design of our other retirement planning options available to our employees.

2. Authorize management to direct HighMark Capital Management to change our portfolio

of investments from a fixed income fund with a projected average annual return of 3-4% to a balanced fund portfolio with estimated average return of 6.5-7%. This transition will occur over approximately a 3 month period. In addition the Pension Committee will draft and recommend an on-going pension investment policy to the Board. A draft policy provided by HighMark for our consideration is attached (Attachment A).

3. Establish a plan to increase the additions to the fund by approximately $140,000 per

year, which should allow the fund to reach 100% funding of the current estimated liability in a 15 year timeframe, by which time a majority of the beneficiaries will have reached retirement age.

In summary, management concludes that implementation of the recommendations while in excess of pension funding levels required by law for the district, provide a more aggressive and prudent approach to increasing the funding level for the estimated Echo Plan liabilities.

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 1

INVESTMENT GUIDELINES DOCUMENT

Alameda Hospital Pension Plan

Draft

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 2

Investment Guidelines Document Overview You have hired Union Bank of California (UBOC) to manage some or all of your investment assets. UBOC has appointed HighMark Capital Management, Inc. (HCM) as investment manager for your account. In order to properly manage your account HCM requires that you confirm the investment guidelines and other information for your account, as set forth in this document. HCM will rely on this information in managing your account. Executive Summary Client Name: Alameda Hospital Background: This Investment Guidelines Document (IGD) has been prepared for

Alameda Hospital. As of July 2008, the Plan was underfunded by approximately $580,000. The Plan is currently frozen to new participants. Prior to October 2008, the Plan was 100% invested in a Stable Value Fund. In October 2008, the Plan developed an investment policy that recognized, and allowed for the inclusion of equities within the asset allocation of the Plan.

Investment Authority: Full Investment Authority Account Number(s): To be determined Risk Tolerance: Moderate to high Time Horizon: Long-Term Investment Objective: The primary objective is to maximize total Plan return, subject to the risk

and quality constraints set forth below. The Plan’s targeted rate of return is 7.0%. The Investment objective selected is the Balanced Objective. The asset allocation ranges for this objective are listed below:

Strategic Ranges: 0 - 20% Cash

30 - 50% Fixed Income 50 - 70% Equity

Communication Schedule: Committee meetings at least twice a year to discuss

performance and investment strategy. HCM Portfolio Manager: Andrew Brown. 415-705-605

Andrew.Brown@Uboc.com HCM Back up -Portfolio Manager: Delbert Chang, CFA 415-705-7603

Delbert.Chang@Uboc.com

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 3

UBOC Administrative Officer: John Fulton, 415-273-2508 John.Fulton@Uboc.com The managing director of HighMark Capital Management is Kevin Rogers, he can be contacted at 949-553-2580. Portfolio Constraints Income Needs/Cash Flow Required: To be determined Document/Legal Restrictions: None. Unique Needs and Circumstances: None Client(s) Signature: __________________ Date: __________________ Client(s) Signature: ___________________ Date: __________________ CONSENT HCM Portfolio Manager: ___________________ Date: ________________ UBOC Administrative Officer: ________________ Date: ________________

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 4

Detailed Information for Investment Guidelines Document

Overview The purpose of this Investment Guidelines document (IGD) is to assist you and your Portfolio Manager in effectively supervising, monitoring and evaluating the investment of your portfolio. Your investment program is defined in the various sections of the IGD by:

1. Stating in a written document your attitudes, expectations, objectives and guidelines for the investment of all assets.

2. Setting forth an investment structure for managing your portfolio. This structure includes

various asset classes, investment management styles, asset allocation and acceptable ranges that, in total, are expected to produce an appropriate level of overall diversification and total investment return over the investment time horizon.

3. Encouraging effective communications between you and your Portfolio Manager. 4. Complying with all applicable fiduciary, prudence and due diligence requirements

experienced investment professionals would utilize, and with all applicable laws, rules and regulations from various local, state, and federal entities that may impact your assets

Diversification Your Portfolio Manager is responsible for maintaining the balance between fixed income and equity securities based on the asset allocation. The following parameters shall be adhered to in managing the portfolio: Fixed Income • The intermediate and long-term fixed income investments (greater than one-year in

maturity) shall constitute no more than 50%, nor less than 20% of the total Plan assets.

• The high-yield portion of the Plan shall constitute no more than 8%, and as little as 0% of the total Plan assets.

• The convertible bond exposure shall constitute no more than 8%, and as little as 0% of the total Plan assets.

• The short-term fixed income investments shall constitute no more than 30%, and as little as 0% of the total Plan assets.

• The target fixed income exposure should average 35% over a market cycle (three to five years.

Equity • The domestic core equity investments of the Plan shall constitute no more than

50% nor less than 20% of the total Plan assets. • The domestic mid-capitalization equity investments of the Plan shall constitute no

more than 12%, and as little as 0% of the total Plan assets.

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 5

• The domestic small capitalization equity investments of the Plan shall constitute no more than 20% nor less than 5% of the total Plan assets.

• The international equity investments of the Plan shall constitute no more than 20% and as little as 0% of the total Plan assets.

• The real estate investments of the Plan shall constitute no more than 10% and as little as 0% of the total Plan assets.

• The target equity exposure should average 60% over a market cycle (three to five years.

Permitted Asset Classes and Security Types The following asset classes and security types have been approved by HighMark for use in client portfolios: Asset Classes

• Fixed Income o Domestic Bonds o Non-U.S. Bonds

• Equities o Domestic o Non-U.S. o Emerging Markets o REITs

• Cash and Cash Equivalents Security Types

• Equity Securities o Domestic listed and unlisted securities o Equity and equity-related securities of non-US corporations, in the form of

American Depository Receipts (“ADRs”) • Equity Mutual Funds

o Large Cap Core, Growth and Value o Mid Cap Core, Growth and Value o Small Cap Core, Growth and Value o International and Emerging Markets o REITs

• Exchange Traded Funds (ETFs) • Fixed Income Securities

o Government/Agencies o Mortgage Backed Bonds o Corporate Bonds and Notes

• Fixed Income Mutual Funds o Corporate o Government o High Yield o International and Emerging Market o Convertible o Preferred

• Closed end funds • Cash and Cash Equivalents

o Money Market Mutual Fund o Commercial Paper

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 6

o CDs and Bankers Acceptance

Prohibited asse ts

• Precious metals

• Venture Capital

• Short sales

• Purchases of Letter Stock, Private Placements, or direct payments

• Leveraged Transactions

• Commodities Transactions Puts, calls, straddles, or other option strategies, except as permitted above

• Purchases of real estate, with the exception of REITs

• Derivatives, with exception of ETFs Rebalancing Procedures From time to time, market conditions may cause your asset allocation to vary from the established target. To remain consistent with the asset allocation guidelines established by this Investment Guidelines document, your Portfolio Manager will rebalance the portfolio on a quarterly basis. Performance objectives • Total Plan. To exceed over a market cycle (three to five years) a policy index composed of

5% 3-Month Treasury bills, 35% Lehman Brothers Aggregate Bond Index, 40% S&P500 Stock Index, 10% Russell 2000 Stock Index, and 10% the Morgan Stanley Capital Index EAFE Index.

• Fixed Income: To exceed over a market cycle the annualized return of

- The Lehman Brothers Aggregate Bond Index - The median return of a universe of actively managed fixed income funds

• Domestic Core Equities: To exceed over a market cycle the annualized rate of return of - The S&P500 Index - The median return of a universe of actively managed equity funds

• Domestic Small Capitalization Stocks: to exceed over a market cycle the annualized rate of return of

- The Russell 2000 Stock Index - The median return of a universe of actively managed small cap equity funds

• International equities: To exceed over a market cycle the annualized rate of return of

- The MSCI EAFE Index - The median return of a universe of actively managed international equity funds.

The investment objectives stated in this document represent desired results that are long-term in nature, covering a period of three to five years. Any shortfalls should be explainable in terms of general economic and capital market conditions. Investment performance will be measured on a total return basis including gains, losses, and income.

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 7

Duties of Responsibilities of Portfolio Manager Your portfolio manager is expected to manage your portfolio in a manner consistent with this Investment Guidelines document and in accordance with State and Federal law and the Uniform Prudent Investor Act. HighMark Capital Management is a registered investment advisor and shall act as such until you decide otherwise. Your portfolio manager shall be responsible for:

1. Designing, recommending and implementing an appropriate asset allocation consistent with the investment objectives, time horizon, risk profile, guidelines and constraints outlined in this statement.

2. Advising the committee about the selection of and the allocation of asset categories. 3. Identifying specific assets and investment managers within each asset category. 4. Monitoring the performance of all selected assets. 5. Recommending changes to any of the above. 6. Periodically reviewing the suitability of the investments, being available to meet with

the committee at least once each year, and being available at such other times within reason at your request.

7. Preparing and presenting appropriate reports. 8. Informing the committee if changes occur in personnel that are responsible for

portfolio management or research.

You shall be responsible for:

1. The oversight of the investment portfolio. 2. Providing your portfolio manager with all relevant information on the Plan, and shall

notify him or her promptly of any changes to this information. 3. Advising your portfolio manager of any change in the Plan’s circumstances, such as

a change in the actuarial assumptions, which could possibly necessitate a change to your overall risk tolerance, time horizon or liquidity requirements; and thus would dictate a change to your overall investment objective and goals for the portfolio.

4. Monitoring performance by means of regular reviews to assure that objectives are being met and that the policy and guidelines are being followed.

The committee expressed a desire to add to their duties. This section might be an appropriate section to further clarify the responsibilities of the Alameda Hospital Pension Committee. Communication As a matter of course, your portfolio manager shall keep you apprised of any material changes in HighMark Capital’s outlook, recommended investment policy and tactics. In addition, your portfolio manager shall meet with you no less than annually to review and explain the portfolio’s investment results and any related issues. Your portfolio manager shall also be available on a reasonable basis for telephone communication when needed. Any material event that affects the ownership of HighMark Capital Management or the management of the portfolio must be reported immediately to you. Reporting TO BE DETERMINED

Alameda Hospital Pension Plan Investment Guidelines Draft September 2008 8

Disclosures Union Bank of California, N.A. and HighMark Capital Management, Inc. are wholly owned subsidiaries of UnionBanCal Corporation. Investments are not deposits or bank obligations, are not guaranteed by any government agency, and involve risk, including loss of principal. When investing in mutual funds (including ETFs) please read the prospectuses carefully.

ALAMEDA HOSPITAL

UNAUDITED

FINANCIAL STATEMENTS

FOR THE

PERIOD ENDING

08/31/08

Table of Contents: Page

Financial Management Discussion 1 - 11

Balance Sheet 12

Statement of Revenue and Expenses 13 - 15

Statement of Revenue and Expenses - Per Adjusted Patient Day 16

Key Statistics for Current Month and Year-to-Date 17

Twelve Month Rolling Cash Projection 18 - 19

ALAMEDA HOSPITALCity of Alameda Health Care District

August 31, 2008

ALAMEDA HOSPITAL August 31, 2008 The management of the Alameda Hospital (the Hospital) has prepared this discussion and analysis in order to provide an overview of the Hospital’s performance for the period ending August 31, 2008 in accordance with the Governmental Accounting Standards Board Statement No. 34, Basic Financials Statements; Management’s Discussion and Analysis for State and Local Governments. The intent of this document is to provide additional information on the Hospital’s financial performance as a whole. Financial Overview as of August 31, 2008 Total assets on the balance sheet decreased by $599,054 from the prior month as a result of a decrease of $1,862,824 of cash and cash equivalents, $351,142 of other assets and $123,396 of amortization of property plant and equipment costs offset by an increase of $1,695,765 in net patient accounts receivable.

Total cash and cash equivalents for August decreased by $1,862,824 and reflect 10.0 days of cash on hand compared to 26.0 in the prior month. The decrease in cash and cash equivalents was primarily the result of the State of California’s mandate to not make payments in the month of August and its inability to finalize the State’s budget for 2008 / 2009 and increased payment of past due accounts payable accounts.

Net patient accounts receivable increased in August by $1,695,765 compared to a decrease of $130,575 in July. Accounts receivable days were 61 compared to 51 in the prior month primarily as a result the delay of Medi-Cal payments in August.

Total liabilities decreased by $563,305 compared to a decreased by $1,068,860 in the prior month. This decrease was primarily the result of the amortization of one month of fiscal year 2009’s parcel tax proceeds in the amount of $477,000.

Accounts payable at August 31st was $4,856,131, which represents a decrease of $554,392 from the prior month. As a result, days in accounts payable decreased to 79 compared to prior month which was at 83.

Combined gross revenue was greater than budget by $129,091 or 0.6%. The majority of this variance was the result of higher than anticipated outpatient services in the month of August than was budgeted. Net patient revenue was slightly less than budgeted, $80,569 or 1.6%. The total patient days were 2,234 and included 315 patient days from the addition of the South Shore facility on August 17th compared to the prior month of 2,018 and a prior year of 1,972 days. Inpatient revenue was less than budgeted by 1.3% while outpatient revenue was greater than budgeted by 3.2%. The combined average revenue per adjusted patient day was $5,586 compared to a budgeted amount of $5,600. The average daily acute census was 29.3 compared to 33.0 in the prior month; the average daily Sub-Acute census was 32.6 versus 32.1 in the prior month and the newly added South Shore unit had an average daily census of 21.0 for the month of August.

ER visits were 1,336 or 7.0% less than the budgeted 1,436 visits. ER visits were also lower than the prior year’s August visits of 1,471 or 9.2%.

Total surgery cases were 2.5% greater than budget, with Kaiser surgical cases making up 293 or 65% of the total cases. Additionally, Kaiser gross charges decreased to $3.5 million which dropped the estimated break-even point to 271 cases in August.

Combined excess revenue over expense was $21,686 versus a combined budgeted excess of revenues over expenses of $14,748. This brings the year-to-date excess of revenues over expenses to $78,961 or 180.9% better than budget.

.

Alameda Hospital August 2008 Discussion and Analysis

Page 2

Volumes Overall actual daily census was 82.9 versus a budget of 83.2. Acute average daily census was 29.3 versus a budget of 30.1, Sub-Acute average daily census was 32.6 versus a budget of 33.1 and the newly added South Shore unit had an average daily census of 21.0 versus a budget of 20.0.

Alameda Hospital - Average Daily CensusFiscal Year 2008-2009

33.0

29.3

32.1

32.6

21.0

0

10

20

30

40

50

60

70

80

90

100

110

Actual SNF 21.0

Actual Sub-Acute 32.1 32.6Actual Acute 33.0 29.3

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Actual Budget

65.1 64.4

82.9 83.2

Total patient days in August were 13.3% greater than August 2007 and 1.1% less than budget.

2,098

1,948

1,744

1,890

1,750

1,793

1,964

1,913

2,234

2,018

1,897

2,058

1,995

2,114

2,208

1,907

1,899

1,832

2,259

1,996

1,861

2,220

1,808

2,024

1,748

1,972

1,600

1,750

1,900

2,050

2,200

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Actual - 2008-2009 Budget - 2008-2009 Prior Year - 2007-2008

Alameda Hospital August 2008 Discussion and Analysis

Page 3

August acute patient days were 2.6% (24 days) less than budgeted and 8.4% (83 days) less than the prior year. The acute average length of stay in August was 4.13 compared to a budget of 4.00.

33.0

29.3

31.6

30.1

27.928.5

30.2

34.3

37.2

34.834.0

32.9

37.1

31.5

26.5

32.0

27.1

29.4

26.0

29.3

32.7

33.9

32.4

26.5

38.5

30.4

20.0

22.0

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Aver

age

Daily

Cen

sus

Actual Acute Budget Acute Prior Year Acute

Sub-Acute patient days were 1.6% less than budget and 18.5% greater than the prior year. The following graph shows the Sub-Acute programs average daily census.

32.132.632.833.1 33.2

32.7

33.3 33.4

34.1

32.4

34.2

33.633.3

34.7

29.8

31.6

29.3

31.6

30.4

28.5

30.6

27.8

32.9

31.8

33.1

31.7

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Ave

rage

Dai

ly C

ensu

s

Actual Sub-Acute Budget Sub-Acute Prior Year Sub-Acute

Alameda Hospital August 2008 Discussion and Analysis

Page 4

August ER visits were 7.0% less than budgeted and 9.2% less than the prior year.

ER Visits1,

378

1,33

6

1,45

6

1,47

8 1,53

3 1,60

2

1,44

5 1,52

3

1,47

2

1,58

5

1,52

3

1,53

4

1,46

6

1,46

4

1,61

6

1,57

6

1,47

3

1,56

9

1,51

9

1,52

4

1,43

6 1,45

3

1,41

4 1,47

1

1,43

0

1,39

0

0

200

400

600

800

1000

1200

1400

1600

1800

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Visi

ts

Actual 2008-2009 Budget 2008-2009 Prior Year 2007-2008

August 2008 surgery cases were 448 versus the 437 budgeted and 467 in the prior year. However, out of the total surgical cases in August, 293, or 65% were Kaiser surgical cases, which is a decrease of 70 cases or 19.3% to the prior month’s proportion of Kaiser cases to total cases. Additionally, as mentioned early the total charges related to Kaiser cases decreased by $621,463 from July dropping the estimated break-even point to 271 cases. As a result of this decline in charges our reimbursement for Kaiser Outpatient cases in August increased to 21.6% as compared to 18.3% of gross charges in July.

Surgical Cases

60 48

112

97

363

293

13

10

0

100

200

300

400

500

600

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Case

s

Inpatient Surgical Outpatient Surgical Kaiser Surgical Minor- Surgical

Alameda Hospital August 2008 Discussion and Analysis

Page 5

Income Statement – Hospital Only

Gross Patient Charges Gross charges in August were greater than budgeted by $89,438, and was comprised of an unfavorable variance in inpatient gross revenues of $219,811 while outpatient gross revenues were again favorable to budget by $309,249. On an adjusted patient day basis total patient revenue was $6,388 versus the budgeted $6,369 or a 0.3% favorable variance from budget.

Alameda HospitalGross Revenue per Patient Day

Fiscal Year 2008-2009

$11,

961

$- $- $- $- $-

$9,7

99

$11,

316

$10,

705

$11,

928

$11,

729

$11,

905

$12,

172

$9,9

66

$- $- $- $- $-

$11,

345

$10,

753 $1

1,71

4

$11,

322

$11,

671

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Dol

lars

Actual Gross Revenue per Patient Day Budget Gross Revenue per Patient Day In looking at the composition of the outpatient revenues, same day surgeries makes up the majority of the outpatient revenue book of business at $4.5 million or 48.7% followed by emergency services at $2.2 million or 23.7%. The remaining 25.5% is made up of outpatient ancillary services such as radiology, laboratory, the IVT program and other outpatient services as shown in the pie chart below:

Composition of Year-to-Date Outpatient Gross Charges

Emergency Room 23%

Infusion Therapy 6%

Observation 5%Outpatient 14%Recurring 2%

Same Day Surgery 50%

Alameda Hospital August 2008 Discussion and Analysis

Page 6

When looking at the combined payor mix for the hospital, Medicare continues to hold the top payor position with total gross revenue representing 29.8% and 31.0% for the current month and year to date, respectively of our total gross patient charges with Kaiser as the second largest source of gross patient revenues at 21.7% and 22.8% for the current month and year to date, respectively. The graph below shows the percentage of revenues generated by each of the major payors as well as the current months expected reimbursement for each.

Combined Payor Mix

0.4%

6.7%

0.9% 3.4

%

18.4%

2.4%

13.7%

5.0% 6.1

%

11.2%

2.2%

0.3%

6.7%

0.6%

3.5%

19.3%

2.5%

11.8%

31.0%

4.7% 7.1

%10

.6%

1.9%

29.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Com

mer

cial

- 34

.5%

HM

O -

23.4

%

Indu

stria

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5.7%

Kai

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24.

4%

Kai

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19.4

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Med

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HM

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13.7

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Med

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- 21

.2%

Med

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2.3%

Med

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MO

- 21

.2%

Sel

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- 15

.1%

PPO

- 29

.4%

VA-

30.

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Current Month YTD

On the Hospital’s inpatient acute side, 45.2% and 48.9% for the current month and year to date, respectively of the total gross revenue was generated by Medicare patients. Expected reimbursement for inpatient Medicare cases has been estimated to be 25.8% based upon August discharges, which is slightly better than the reimbursement level experienced in July. This improvement in expected reimbursement in August is primarily the result of four (4) cases qualifying for outlier reimbursement as opposed to the month of July which had no cases hitting outlier threshold levels.

Alameda Hospital August 2008 Discussion and Analysis

Page 7

Inpatient Acute Care Payor Mix

0.1%

10.1%

1.3%

0.5% 5.4

%

2.0% 6.1

%

45.2%

7.1%

7.6% 11

.1%

3.6%

0.2%

10.0%

0.6%

0.3% 6.1

%

2.1% 3.9

%

48.9%

6.3% 8.5

% 10.9%

2.5%

0.0%10.0%

20.0%30.0%40.0%

50.0%60.0%

70.0%80.0%

Com

mer

cial -

54.

1%

HM

O -

22.1

%

Indu

stria

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7.1%

Kai

ser -

13.

4%

Kai

ser C

ontra

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3.4%

Med

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HM

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21.7

%

Med

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- 25

.4%

Med

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5.8%

Med

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e H

MO

- 26

.0%

Sel

f Pay

- 7.

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PPO

- 25

.1%

VA

- 29.

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Current Month YTD

Average length of stay for the inpatient acute care units decreased to 4.13 days which is 3.2% greater than the 4.00 average length of stay that was budgeted for fiscal year 2009.

Average Length of Stay

4.31

4.13

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09

Aver

age

Leng

th o

f Sta

y

Actual Acute Budget Acute In August, 63.7% of the Sub-Acute programs gross revenue was from Medi-Cal beneficiaries followed by 15.3% from Kaiser and 9.2% from Medicare as is seen on the graph on the following page.

Alameda Hospital August 2008 Discussion and Analysis

Page 8

Inpatient Sub-Acute Care Payor Mix

15.3%

63.7%

9.2%

6.6%

19.2%

60.3%

8.4%

5.4% 6.8

%5.2

%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Kai

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23.

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Med

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- 22

.3%

Med

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5.7%

Med

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e H

MO

- 13

.3%

Sel

f Pay

- 32

.0%

Current Month YTD

The outpatient gross revenue payor mix for August was comprised of 39.5% Kaiser, 21.9% Medicare, 14.8% PPO and 6.0% HMO and is shown on the following graph.

Outpatient Services Payor Mix

0.7%

6.0%

0.8%

1.3% 3.7

%3.2

%

21.9%

2.9% 4.7

%

14.8%

1.8%

0.6%

5.8%

0.8%

1.2%

39.1%

3.9%

3.3%

20.9%

2.8% 5.9

%

13.8%

2.0%

38.2%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%

Com

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- 31

.2%

HMO

- 25

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Indu

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3.5%

Kais

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44.0

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Med

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HM

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Med

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Med

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Med

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MO

- 16

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Self

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PPO

- 33

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VA -

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Current Month YTD

Alameda Hospital August 2008 Discussion and Analysis

Page 9

Deductions From Revenue Contractual allowances are computed as deductions from gross patient revenues based on the difference between gross patient charges and the contractually agreed upon rates of reimbursement with third party government-based programs such as Medicare, Medi-Cal and other third party payors such as Blue Cross. In the month of August contractual allowances, bad debt and charity adjustments (as a percentage of gross patient charges) were 77.47% versus the budgeted 77.14%. In August there were again no DRG “take backs” associated with the RAC project. Net Patient Service Revenue Net patient service revenues are the resulting difference between gross patient charges and the deductions from revenue. This difference reflects what the actual anticipated cash payments the Hospital is to receive for the services provided. The graph on the following page shows the level of reimbursement that the Hospital has experienced during the current month of fiscal year 2009 by major payor category.

Average Reimbursement % by PayorAugust 2008

34.54%

23.36%

25.71%

19.44%

13.71%

21.24%

30.42%

24.38%

21.17% 22.30%

15.12%

29.42%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Commercial

HMO

Indus

trial

Kaiser

Kaiser C

ontra

ct

Medi-C

al HMO

Medi-C

al

Medica

re

Medica

re HMO

Self P

ayPPO VA

Alameda Hospital August 2008 Discussion and Analysis

Page 10

Total Operating Expenses Total operating expenses were less than the fixed budget by $56,700 or 1.0%. This favorable variance resulted in expenses per adjusted patient day of $1,583 compared to a budget of $1,601 or 1.1% favorable to the volume adjusted budget. The following discusses the significant areas that make up the variance from the fixed operating budget. Salary and Registry Expenses Salary and registry costs combined were less than budgeted by $50,481, with the majority of the favorable variance ($108,921) in the salary category while registry costs exceeded budget by $58,440. The salary and registry costs per adjusted patient day were $838 versus the budgeted $854 resulting in a favorable variance of $16 per adjusted patient day. Combined productive FTE’s per adjusted occupied bed was 2.82 in August versus the budgeted 2.85. The following graph shows the combined productive and paid FTE’s per adjusted occupied bed for FY 2009.

FTE’s per Adjusted Occupied Bed

3.52

2.82

3.06

3.25

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

FTE'

s

Productive FTE/Adjusted Occupied Bed Paid FTE/Adjusted Occupied Bed

Benefits For the month of August benefits exceeded budget by $7,747 and was the result of higher than budgeted amounts for vacation accruals, $75,049 which was offset by lower than anticipated group health insurance costs of $64,248. This favorable variance was the result of a $24,177 decrease to required IBNR reserves and the receipt of $32,594 in stop loss recoveries. Professional Fees Professional medical and non-medical fees were over budget by $30,920 with the negative variance occurring in the non-medical category. Non-medical professional fees were over budget as a result of higher than expected legal fees totaling $24,777 and costs associated with the Strategic Plan development of $21,250.

Alameda Hospital August 2008 Discussion and Analysis

Page 11

Supplies Overall supplies were $26,551 under budget in August. This favorable variance from the fixed operating budget was the result of lower than budgeted costs for medical supplies of $12,842, office supplies of $8,010 and the reclassification of minor equipment costs expensed in July that should have been treated as prepaid expenses in the amount of $5,495. Balance Sheet Patient Accounts Receivable Gross patient accounts receivable increased by $6,248,589 from the prior month and the gross days in receivables increased to 61 compared to 51 in the prior month. Both increases are primarily attributable to the Medi-Cal scheduled non-payment of claims in August and the State of California’s budget crisis. Liabilities Total Current and Long Term Liabilities at August31, 2008 were $19,689,362 versus $20,301,225 in the prior month, a decrease of $611,863 or 3.0%. This decrease was the result of the amortization of one month of fiscal year 2009’s parcel tax proceeds in the amount of $477,000 and the decrease in accounts payable and accrued expenses of $554,392 offset by an increase of $323,986 of payroll related accruals.

Date: October 2, 2008 To: City of Alameda Health Care District Board of Directors From: David A. Neapolitan, Chief Financial Officer Subject: FY 2008 Audited Financial Statements, Board Report and Management

Responses to Hospital Specific Accounting Issues Enclosed are the final audited financial statements for the fiscal year ended June 30, 2008 as presented to the Finance Committee on Wednesday September 24, 2008 with some very minor grammatical and formatting corrections. In addition, enclosed is the Management Letter as prepared by TCA Partners. While the fiscal year 2008 audit went very smoothly we appreciate the recommendations and suggestions for further improvement in our financial operations that have been provided in the Board Report. Management agrees with the importance of the general accounting issues identified in this report and will continue to evaluate the organizations requirements related to taxable fringe benefit reporting, pension plan audit requirements and potential IRS Form 990 reporting requirements. The following are management’s responses to the Hospital Specific Accounting Issues section of the report: SAS 112 Management agrees that a strong internal control structure is cornerstone to not only the safeguarding of the assets of the organization but also to ensuring that the organization’s financial statements appropriately reflect the financial condition of the organization. In order to accomplish this management must ensure that controls exist that allow management or employees, in the ordinary course of performing their assigned functions, to prevent or detect misstatements on a timely basis. In order to ensure that this objective continues to be met, management will begin the process of documenting and enhancing the existing control environment in areas critical to the ability to assure that the organization’s financial statements are not materially misstated. Areas of focus will include the valuation of net patient accounts receivable, the disbursement and related payable accrual process and cash management activities. Use of the Meditech System for Received Inventory Management will investigate the use of this reporting functionality to assist in the evaluation of period-end accruals for potential liabilities related to the receipt of supplies used in hospital operations that have not yet been invoiced during the second quarter of fiscal year 2009. If appropriate, we will implement its use immediately.

FY 2008 AUDITED FINANCIAL STATEMENTS OCTOBER 2, 2008 PAGE 2

Capitalization Policy Management recognizes the importance of maintaining an appropriate balance between the cost to maintain a fixed asset inventory of items with relatively small dollar balances and the benefits of making such a change. We will investigate the impact of increasing this threshold and consider implementation of such a change with the fiscal year 2010 operating budget or earlier if there are no significant impacts to the current year’s projected operating performance.

ALAMEDA HOSPITAL MEDICAL STAFF RULES & REGULATIONS

TITLE:

ARTICLE 1: ADMISSION OF PATIENTS

EFFECTIVE DATE: 12/09/97 03/10/03

PAGE: 1 of 2

A. Priority of Admission

Patients requiring emergency surgery or intensive care monitoring and treatment shall have admission priority regardless of the physician's Medical Staff category. Accommodations shall be available in the order in which applications for such accommodations are made. For all other admissions Active Medical Staff members shall, as far as feasible, have priority over other staff members in seeking accommodations and appointments for their patients, and Associate Staff members shall, as far as feasible, have priority over Courtesy Staff members in seeking accommodations for their patients.

B. Admission Exceptions

The Medical Staff shall admit patients except the following:

1. Admissions primarily for psychiatric treatment.

2. Patients who are dangerous to themselves or to others, who are destructive to property or who are offensive to other patients for psychiatric reasons unless underly-ing medical condition necessitates admission for stabilization and/or monitoring.

3. Patients requiring facilities not available in the Hospital.

4. All Mmedical patients under the age of fourteen (14) years.

5. All Elective surgical patients under the age of two (2) five (5) years. 6. Emergency surgeries under the age of eight (8) years deemed stable for

transfer.

6.7. Surgical patients between the ages of two (2) five (5) years and fourteen (14) years whose length of stay is expected to be greater than forty-eight (48) hours.

7.8. Surgical patients between the ages of two (2) five (5) years and fourteen (14) years

with medical co-morbidities (ASA Class II or greater) or who may require cardiac/respiratory monitoring post-operatively.

8.9. Admission of outpatient surgeries <2 years < five (5) years of age will be at the

discretion of the anesthesiologist.

C. Provisional Diagnosis

No patient shall be electively admitted to the Hospital until after a provisional diagnosis has been stated and the consent of the Admitting Office is secured.

Medical Staff Rules & Regulations Article 1 - Page 2 _______________________________________________________________________________ D. Admission of Patients with Contagious Infections

Medical Staff members admitting patients with contagious infections shall be held responsible for providing the Infection Control Nurse, the Director of Nursing or the supervisor in charge at the time such information as may be necessary to assure the protection of other patients.

E. Admission of Patients - Safety Considerations

Physicians admitting patients shall be held responsible for giving such information as may be necessary to secure the protection of other patients from those who are a potential danger of any sort whatsoever.

F. Admission of Suicidal Patients

For the protection of patients, the Medical and Nursing Staffs, and the Hospital, precautions to be taken in the care of the potentially suicidal patient include:

1. Any such patient shall be admitted to a secure room. If there are no accommodations

available, the patient shall be referred, as soon as possible, to another institution where suitable facilities are available .

2. When transfer is not possible, the patient may be admitted to a general area of the

Hospital with continuous supervision. G. Attending Responsibilities

All patients must be personally seen and examined by their staff physician or the covering staff physician within 24 hours of admission and at least once per day while admitted.

H. Dental and Podiatric Admissions

Dental and podiatry admissions require a history and physical examination written by a qualified physician with admitting privileges on the Medical Staff who will be responsible for the care of the patient's medical problems. The complete medical history and physical shall be recorded within one week prior to admission. Dentists and Podiatrists shall be responsible for recording the dental or podiatry medical history.

I. Laboratory Examinations

Laboratory examinations shall be made according to Rules and Regulations found in subsequent sections. Any abnormalities must be addressed before discharge.

J. On-Call Hired Physicians

Physicians hired for on-call duty by members of the Alameda Hospital Medical Staff are intended to serve as a temporary but complete replacement for staff members insofar as the credentialing of on-call physicians allows. On-call physicians must be at least second year residents (PG2) with at least a rotating or medical internship. There must be a back-up staff physician available when an on-call physician is on duty.

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Date: October 2, 2008 To: City of Alameda Health Care District Board of Directors From: Deborah E. Stebbins, CEO Subject: Key State Issues Summary For your reference, attached is the California Hospital Association’s (CHA) 2008 Key State Issues Summary. With the Governor having acted on all bills, there will be no further updates from CHA until 2009 when the California State legislature goes back in session.

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pla

ns; p

erso

nal h

ealth

reco

rds a

nd e

-

tran

smis

sion

; lim

itatio

ns o

n re

scis

sion

of c

over

age

by p

lans

and

insu

rers

; non

pay

men

t for

adv

erse

eve

nts;

tier

ing

of in

divi

dual

mar

ket p

rodu

cts a

nd tr

ansp

aren

cy. D

ozen

s of b

ills i

n 20

08 a

ddre

ssed

a ra

nge

of is

sues

whi

ch h

ad

been

ele

men

ts o

f com

preh

ensi

ve re

form

pro

posa

ls. T

his r

epor

t lis

ts k

ey b

ills b

y su

bjec

t mat

ter o

n a

varie

ty o

f th

ose

subj

ects

incl

udin

g in

sura

nce

refo

rms,

bala

nce

billi

ng, p

rice

and

qual

ity tr

ansp

aren

cy, p

atie

nt sa

fety

and

oth

er

issu

es. A

s des

crib

ed b

elow

, CH

A o

ppos

ed so

me

of th

ose

bills

, sev

eral

of w

hich

wer

e de

feat

ed a

nd se

vera

l of

whi

ch w

ere

miti

gate

d by

neg

otia

ted

amen

dmen

ts. S

B 8

40 (K

uehl

) wou

ld h

ave

repl

aced

Cal

iforn

ia’s

cur

rent

pub

lic

and

priv

ate

heal

th c

over

age

with

a ta

x-fin

ance

d si

ngle

pay

er sy

stem

(Vet

oed

by G

over

nor)

.

X

Adv

ocat

e C

HA

bud

get

prio

ritie

s.

Prot

ect:

Med

i-Cal

fu

ndin

g an

d pa

ymen

ts

and

the

heal

th c

are

sa

fety

net

FY 2

008-

09

prop

osed

st

ate

budg

et

and

rela

ted

bills

Pend

ing

Med

i-Cal

cu

ts e

nact

ed

in F

ebru

ary

2008

Liti

gatio

n

Stat

e B

udge

t. G

over

nor S

chw

arze

negg

er si

gned

the

FY 2

008-

09 st

ate

budg

et o

n Se

ptem

ber 2

3, 8

5 da

ys in

to th

e ne

w

fisca

l yea

r. Th

e G

over

nor’

s sig

natu

re c

lear

ed th

e w

ay fo

r bac

k M

edi-C

al p

aym

ents

to b

e pa

id. B

udge

t adv

ocac

y be

gan

very

ear

ly in

200

8 an

d w

as c

ondu

cted

on

mul

tiple

fron

ts in

clud

ing

legi

slat

ive

and

gras

sroo

ts a

dvoc

acy,

lit

igat

ion,

med

ia re

latio

ns, a

nd p

ublic

adv

ocac

y. C

HA

con

duct

ed a

n ag

gres

sive

stat

ewid

e pu

blic

adv

ocac

y ca

mpa

ign.

Thi

s cal

l-to-

actio

n ca

mpa

ign

feat

ured

tele

visi

on c

omm

erci

als,

supp

ortin

g pr

int a

ds a

nd a

web

site

. CH

A

and

othe

r hea

lth c

are

prov

ider

org

aniz

atio

ns c

ontin

ue to

pur

sue

litig

atio

n se

ekin

g to

blo

ck th

e 10

per

cent

cut

s in

Med

i-Cal

pay

men

ts e

nact

ed a

nd si

gned

in F

ebru

ary

that

took

eff

ect J

uly

1 an

d w

hich

, und

er th

e bu

dget

as e

nact

ed

this

wee

k, w

ould

con

tinue

unt

il M

arch

1, 2

009,

at w

hich

tim

e sm

alle

r red

uctio

ns w

ould

take

eff

ect.

The

budg

et

cont

aine

d so

me

elem

ents

of b

udge

t ref

orm

dem

ande

d by

the

Gov

erno

r but

did

not

add

ress

the

stru

ctur

al im

bala

nce

betw

een

reve

nues

and

spen

ding

. The

stru

ctur

al im

bala

nce,

com

poun

ded

in th

e sh

ort t

erm

by

a w

eak

econ

omy

and

wea

keni

ng ta

x co

llect

ions

ass

ure

that

this

yea

r’s p

robl

ems w

ill re

cur n

ext y

ear.

2

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

HA

ZU

S ad

opte

d as

pe

rman

ent

build

ing

code

st

anda

rd

AB

221

6 si

gned

AB

296

6 am

ende

d,

then

hel

d

AB

302

8 si

gned

SB 1

272

sign

ed

X

Supp

ort:

A

B 2

216

AB

302

8

SB

127

2

Opp

ose,

then

ne

utra

l as

amen

ded:

AB

296

6

Leg

isla

tion

OSH

PD

Seis

mic

Man

date

and

Fac

ility

Issu

es. C

HA

con

tinue

d w

orki

ng d

urin

g 20

08 to

secu

re m

odifi

catio

n of

the

unfu

nded

se

ism

ic m

anda

te o

n ho

spita

ls. C

HA

supp

orts

cha

nges

that

add

ress

the

dead

lines

, bui

ldin

g ev

alua

tion

met

hodo

logy

, fu

ndin

g, a

nd p

lan

revi

ew p

roce

ss a

nd c

riter

ia a

nd is

wor

king

with

the

Off

ice

of S

tate

wid

e H

ealth

Pla

nnin

g an

d D

evel

opm

ent (

OSH

PD) o

n im

plem

enta

tion

and

appl

icat

ion

of H

AZU

S, th

e st

ate’

s new

bui

ldin

g ev

alua

tion

met

hodo

logy

. On

May

21,

the

Cal

iforn

ia B

uild

ing

Stan

dard

s Com

mis

sion

(CB

SC) a

dopt

ed th

e O

SHPD

pro

posa

l fo

r use

of H

AZU

S as

a p

erm

anen

t bui

ldin

g co

de st

anda

rd. C

HA

-spo

nsor

ed A

B 2

216

(Gai

nes)

will

ext

end

the

suns

et d

ate

for m

onth

ly ra

ther

than

wee

kly

test

ing

of d

iese

l bac

kup

gene

rato

rs to

Jan.

1, 2

011

(Sig

ned

by

Gov

erno

r). A

B 2

966

(Lie

ber)

wou

ld h

ave

shift

ed re

spon

sibi

lity

for a

cqui

ring

and

man

agin

g in

spec

tors

of r

ecor

d fr

om in

divi

dual

hos

pita

ls to

OSH

PD (S

enat

e In

activ

e Fi

le).T

he b

ill w

as a

men

ded

June

25

to b

ecom

e a

stud

y bi

ll.

Am

ong

othe

r thi

ngs,

AB

302

8 (S

alas

) will

per

mit

elec

troni

c pl

an re

view

and

app

rova

l by

OSH

PD a

nd w

ill

enha

nce

OSH

PD’s

ove

r-th

e-co

unte

r opt

ion

to e

xped

ite th

e pl

an re

view

pro

cess

(Sig

ned

by G

over

nor)

. SB

127

2 (C

ox) w

ill in

crea

se th

e C

al-M

ortg

age

Loan

Insu

ranc

e pr

ogra

m sm

all p

roje

ct lo

an a

mou

nt fr

om $

5 to

$10

mill

ion,

th

ereb

y in

crea

sing

the

num

ber o

f loa

ns e

ligib

le fo

r ins

uran

ce o

f 95%

of t

he c

onst

ruct

ion

cost

for (

Sign

ed b

y G

over

nor)

. A

B 2

298

held

by

auth

or

SB 8

94

held

by

auth

or

AB

294

2 he

ld

SB

122

1 am

ende

d,

then

ve

toed

AB

371

ve

toed

X

Opp

ose:

AB

371

A

B 2

942

AB

229

8

Opp

ose,

unt

il am

ende

d or

dr

oppe

d:

A

B 8

94

Opp

ose,

then

N

eutr

al a

s am

ende

d:

SB

122

1

Lis

ted

bills

CH

FFA

Com

mun

ity B

enef

its/N

ot-f

or-P

rofit

Hos

pita

l Iss

ues.

CH

A c

ontin

ued

durin

g 20

08 to

wor

k w

ith th

e Le

gisl

atur

e,

OSH

PD, t

he B

oard

of E

qual

izat

ion

(BO

E) a

nd th

e C

alifo

rnia

Hea

lth F

acili

ties F

inan

cing

Aut

horit

y (C

HFF

A) o

n is

sues

of c

once

rn to

not

-for

-pro

fit h

ospi

tals

. SB

894

(Duc

heny

) wou

ld h

ave

proh

ibite

d th

e A

ttorn

ey G

ener

al fr

om

cons

entin

g to

a h

ealth

faci

lity

or tr

ansa

ctio

n in

whi

ch th

e se

ller h

ad n

ot a

llow

ed fo

r a p

ublic

off

erin

g an

d ex

posu

re

in th

e op

en m

arke

t and

con

side

red

any

com

petin

g of

fers

to th

e sa

le a

nd w

ould

hav

e au

thor

ized

the

Atto

rney

G

ener

al to

not

con

sent

if a

ll or

a la

rge

part

of th

e ne

t pro

ceed

s wer

e no

t kep

t in

the

affe

cted

com

mun

ity (T

his b

ill

was

pla

ced

back

on

the

Asse

mbl

y In

activ

e Fi

le o

n Au

gust

28.

Thi

s bill

will

rem

ain

on th

e In

activ

e Fi

le).

AB

294

2 (M

a) w

ould

hav

e re

quire

d al

l hos

pita

ls, i

nclu

ding

for-

prof

it ho

spita

ls th

at c

hoos

e to

pro

vide

com

mun

ity b

enef

its,

to d

evel

op a

nd im

plem

ent c

omm

unity

ben

efit

plan

s in

a st

anda

rdiz

ed fo

rmat

usi

ng a

uni

form

cal

cula

tion

met

hodo

logy

to q

uant

ify c

omm

unity

ben

efits

info

rmat

ion.

The

bill

als

o w

ould

hav

e re

quire

d co

mm

unity

in

volv

emen

t and

ove

rsig

ht in

pla

n de

velo

pmen

t and

impl

emen

tatio

n (H

eld

in S

enat

e Ap

prop

riat

ions

). A

B 2

298

(Hay

ashi

) wou

ld h

ave

requ

ired

each

hos

pita

l to

allo

cate

at l

east

50%

of m

oney

that

it u

ses t

o im

plem

ent i

ts

com

mun

ity b

enef

its p

lan

to fu

nd sp

ecifi

ed p

rogr

ams t

o el

imin

ate

raci

al, e

thni

c an

d ge

nder

hea

lth d

ispa

ritie

s (H

eld

by a

utho

r in

Asse

mbl

y H

ealth

). A

s am

ende

d, S

B 1

221

(Kue

hl) w

ould

hav

e re

quire

d ho

spita

ls th

at a

pply

to C

HFF

A

and

any

join

t pow

ers a

utho

rity

for f

inan

cing

, to

dem

onst

rate

that

the

faci

lity

perf

orm

s com

mun

ity se

rvic

e (V

etoe

d by

Gov

erno

r). C

HA

pro

vide

d am

endm

ents

to li

mit

the

scop

e of

the

bill

and

elim

inat

e am

bigu

ity. S

ee a

lso

CH

A-

oppo

sed

AB

371

(Huf

fman

) dis

cuss

ed b

elow

und

er W

orkf

orce

Issu

es.

3

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

AB

189

4 am

ende

d to

del

ete

test

ing

man

date

on

ho

spita

ls

sign

ed

AB

220

7 he

ld

X

Follo

w a

s A

men

ded:

AB

189

4

Opp

ose/

A

men

d:

A

B 2

207

Opp

ose:

AB

270

2

Follo

w:

SB 1

738

Leg

isla

tion

Em

erge

ncy

Serv

ices

. CH

A c

ontin

ued

in 2

008

to se

ek a

nd a

dvoc

ate

solu

tions

to th

e em

erge

ncy

serv

ices

cris

is,

incl

udin

g th

e gr

owin

g cr

isis

of c

all-p

anel

phy

sici

an a

vaila

bilit

y fo

r hos

pita

l em

erge

ncy

depa

rtmen

ts. A

s in

trodu

ced,

AB

189

4 (K

reko

rian)

wou

ld h

ave

requ

ired

hosp

itals

that

pro

vide

em

erge

ncy

med

ical

car

e to

off

er

patie

nts t

estin

g fo

r HIV

and

for A

IDS

rega

rdle

ss o

f whe

ther

the

test

ing

is re

late

d to

a p

rimar

y di

agno

sis.

The

bill

was

am

ende

d to

del

ete

the

requ

irem

ent o

n ho

spita

ls a

nd in

stea

d w

ill re

quire

pla

ns a

nd in

sure

rs to

pro

vide

test

ing

for H

IV a

nd A

IDS

rega

rdle

ss o

f whe

ther

the

test

ing

is re

late

d to

a p

rimar

y di

agno

sis (

Sign

ed b

y G

over

nor)

. AB

22

07 (L

ieu)

wou

ld h

ave

requ

ired

each

hos

pita

l to

asse

ss th

e co

nditi

on o

f its

em

erge

ncy

depa

rtmen

t eve

ry 3

hou

rs

and

calc

ulat

e an

d re

cord

a N

EDO

CS

(ove

rcro

wdi

ng) s

core

It a

lso

wou

ld h

ave

requ

ired

hosp

itals

to a

dopt

“fu

ll ca

paci

ty”

prot

ocol

s for

eac

h ca

tego

ry o

f the

NED

OC

S ov

ercr

owdi

ng sc

ale

(Hel

d in

Ass

embl

y Ap

prop

riat

ions

).

AB

270

2 (N

úñez

) will

dilu

te th

e M

addy

EM

S fu

nds a

vaila

ble

to L

os A

ngel

es C

ount

y ph

ysic

ians

by

requ

iring

re

imbu

rsem

ent t

o ph

ysic

ians

who

pro

vide

em

erge

ncy

serv

ices

in q

ualif

ying

urb

an st

andb

y em

erge

ncy

depa

rtmen

ts

(Sig

ned

by G

over

nor)

. SB

173

8 (S

tein

berg

) wou

ld h

ave

crea

ted

the

Freq

uent

Use

rs o

f Hea

lth C

are

Pilo

t Pro

gram

, de

sign

ed to

redu

ce p

artic

ipan

ts’ u

se o

f hos

pita

l em

erge

ncy

depa

rtmen

ts w

hen

mor

e ef

fect

ive

care

can

be

prov

ided

in

less

cos

tly se

tting

s, to

be

impl

emen

ted

only

if fe

dera

l fin

anci

al p

artic

ipat

ion

and

nece

ssar

y fe

dera

l app

rova

ls a

re

obta

ined

(Vet

oed

by G

over

nor)

.

Miti

gate

d:

AB

240

0 am

ende

d si

gned

SB 1

688

drop

ped

by a

utho

r

AB

274

1 he

ld

SB 1

351

veto

ed

SB 1

734

held

by

auth

or

X

Opp

ose:

A

B 2

741

SB 1

688

SB 1

351

SB 1

734

Opp

ose,

then

N

eutr

al a

s am

ende

d:

A

B 2

400

Lis

ted

B

ills

Hos

pita

l Clo

sure

s, C

hang

es in

Ser

vice

s and

Tra

nsfe

rs o

f Ass

ets.

Clo

sure

s, re

duct

ions

in se

rvic

e, a

nd tr

ansf

ers o

f as

sets

con

tinue

d to

pro

voke

legi

slat

ion

in 2

008.

As a

men

ded,

AB

240

0 (P

rice)

will

impo

se n

ew n

otic

e re

quire

men

ts b

efor

e a

hosp

ital c

lose

s a se

rvic

e or

relo

cate

s a su

pple

men

tal s

ervi

ce to

a d

iffer

ent c

ampu

s (Si

gned

by

Gov

erno

r). S

B 1

688

(Rid

ley-

Thom

as) w

ould

hav

e re

quire

d fo

r-pr

ofit

owne

rs o

r ope

rato

rs o

f hos

pita

ls in

spec

ified

ci

rcum

stan

ces t

o m

aint

ain

or in

crea

se le

vels

of c

are

and

serv

ices

of i

ndiv

idua

l hos

pita

ls o

n a

year

-to-y

ear b

asis

(H

eld

by a

utho

r in

Asse

mbl

y Ap

prop

riat

ions

). A

B 2

741

(Tor

rico)

wou

ld h

ave

requ

ired

DPH

, in

eval

uatin

g an

ap

plic

atio

n fo

r lic

ensu

re, t

o ob

tain

a h

ealth

impa

ct a

naly

sis t

o de

term

ine

whe

ther

the

trans

actio

n m

ay c

reat

e a

sign

ifica

nt e

ffec

t on

the

avai

labi

lity

or a

cces

sibi

lity

of h

ealth

car

e se

rvic

es a

nd w

heth

er th

e tra

nsac

tion

is in

the

publ

ic in

tere

st if

the

appl

ican

t did

not

mee

t cer

tain

exi

stin

g st

atut

ory

requ

irem

ents

rela

ting

to th

e sa

le o

r tra

nsfe

r of

the

asse

ts o

f a n

onpr

ofit

corp

orat

ion

that

ope

rate

s or c

ontro

ls a

faci

lity

that

pro

vide

s hea

lth c

are

(Hel

d in

Sen

ate

Appr

opri

atio

ns).

SB 1

351

(Cor

bett)

wou

ld h

ave

impo

sed

mul

tiple

new

rest

rictio

ns a

nd re

quire

men

ts re

latin

g to

the

trans

fer o

f ass

ets f

rom

a h

ealth

car

e di

stric

t to

a no

t-for

-pro

fit o

r for

-pro

fit e

ntity

(Vet

oed

by G

over

nor)

. SB

173

4 (K

uehl

) wou

ld h

ave

proh

ibite

d a

REI

T th

at o

wns

pro

perty

on

whi

ch a

hos

pita

l is s

ituat

ed fr

om ta

king

spec

ified

ac

tions

that

wou

ld re

sult

in a

redu

ctio

n of

car

e. D

PH w

ould

hav

e be

en re

quire

d to

est

ablis

h a

med

iatio

n pr

oces

s to

reso

lve

any

disp

ute

betw

een

the

REI

T an

d th

e op

erat

or o

f the

hos

pita

l, if

the

disp

ute

coul

d re

sult

in h

ospi

tal

clos

ure

(Hel

d in

Ass

embl

y Ap

prop

riat

ions

).

4

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

AB

265

3 he

ld b

y au

thor

AB

155

4 he

ld

AB

291

0 gu

tted

and

am

ende

d by

aut

hor

AB

222

0 ve

toed

AB

139

0 he

ld b

y au

thor

SB 1

300

defe

ated

Miti

gate

d:

AB

120

3 am

ende

d

SB 1

553

sign

ed

X

Opp

ose:

A

B 2

653

AB

155

4

Opp

ose/

Am

end:

SB 1

300

Opp

ose/

Am

end,

then

N

eutr

al a

s am

ende

d:

A

B 1

203

Let

ter

of

Con

cern

, th

en fo

llow

as

amen

ded:

AB

222

0

Supp

ort:

SB 1

553

Follo

w:

AB

115

0

AB

115

5

A

B 1

945

SB 1

553

SB 1

440

AB

254

9

A

B 1

525

App

rove

:

SB 1

522

Follo

w a

s A

men

ded:

AB

291

0

Follo

w a

s A

men

ded:

A

B 1

390

Leg

isla

tion,

re

gula

tory

ad

voca

cy,

and

litig

atio

n

Hea

lth C

are

Cov

erag

e Pr

actic

es a

nd P

lan-

Prov

ider

Rel

atio

nshi

ps. M

any

bills

wer

e in

trodu

ced

on h

ealth

car

e co

vera

ge is

sues

. AB

115

5 (H

uffm

an) w

ould

hav

e im

pose

d ne

w re

quire

men

ts o

n D

MH

C re

gard

ing

unde

rpay

men

ts

by p

lans

to p

rovi

ders

and

unf

air p

aym

ent p

atte

rns (

Veto

ed b

y G

over

nor)

. AB

120

3 (S

alas

) will

pro

hibi

t a

nonc

ontra

ctin

g ho

spita

l fro

m b

illin

g a

cove

red

patie

nt fo

r pos

t-sta

biliz

atio

n ca

re if

the

hosp

ital f

ails

to c

onta

ct th

e pa

tient

’s p

lan

(Sig

ned

by G

over

nor)

. AB

265

3 (G

arci

a) w

ould

hav

e au

thor

ized

a p

lan

parti

cipa

ting

in H

ealth

y Fa

mili

es o

r the

Med

i-Cal

pro

gram

to re

ques

t a “

hosp

ital a

cces

s pas

s” if

the

plan

is u

nabl

e to

reac

h an

agr

eem

ent

with

a h

ospi

tal a

nd w

ould

requ

ire h

ospi

tal s

ervi

ces t

o be

pro

vide

d th

erea

fter a

t rat

es se

t by

CM

AC

(Hel

d in

As

sem

bly

Hea

lth).

AB

155

4 (J

ones

) wou

ld, w

ith so

me

exce

ptio

ns, h

ave

requ

ired

adva

nce

appr

oval

of i

ncre

ases

in

prem

ium

s, co

paym

ents

, ded

uctib

les,

and

othe

r cha

rges

by

a pl

an o

r ins

urer

(Sen

ate

Hea

lth—

not h

eard

). A

B 1

390

(Huf

fman

) wou

ld h

ave

expa

nded

cur

rent

law

lim

iting

a h

ospi

tal’s

abi

lity

to d

eter

min

e or

con

ditio

n m

edic

al st

aff

priv

ilege

s, bu

t the

bill

was

gut

ted

and

amen

ded

to d

eal w

ith a

new

subj

ect m

atte

r of i

nteg

rate

d w

aste

. (R

efer

red

back

to S

enat

e Ru

les)

. AB

222

0 (J

ones

) wou

ld h

ave

enac

ted

sign

ifica

nt n

ew re

gula

tion

of c

ontra

ctua

l rig

hts a

nd

oblig

atio

ns a

mon

g ph

ysic

ians

, phy

sici

an g

roup

s, he

alth

pla

ns a

nd h

ospi

tals

; it w

as a

men

ded

to p

rovi

de fo

r ar

bitra

tion

of c

ontra

ct d

ispu

tes b

etw

een

plan

s and

em

erge

ncy

phys

icia

ns (V

etoe

d by

Gov

erno

r). S

B 1

553

(Low

enth

al) w

ill p

rohi

bit p

lans

from

den

ying

aut

horiz

atio

n fo

r men

tal h

ealth

serv

ices

bas

ed u

pon

whe

ther

the

adm

issi

on w

as v

olun

tary

or i

nvol

unta

ry o

r bas

ed u

pon

the

met

hod

of tr

ansp

orta

tion

to th

e he

alth

faci

lity

(Sig

ned

by G

over

nor)

. AB

291

0 (H

uffm

an) w

ould

hav

e pr

ohib

ited

cons

truin

g ex

istin

g la

w to

relie

ve h

ealth

pla

ns o

f lia

bilit

y fo

r the

med

ical

dec

isio

ns m

ade

by d

eleg

ated

med

ical

gro

ups.

The

bill

had

unin

tend

ed e

ffec

ts o

n M

ICR

A

whi

ch w

ere

disc

usse

d w

ith th

e au

thor

. It w

as g

utte

d an

d am

ende

d by

the

auth

or to

use

for a

diff

eren

t pur

pose

. SB

13

00 (C

orbe

tt) w

ould

hav

e nu

llifie

d co

nfid

entia

lity

prov

isio

ns in

con

tract

s bet

wee

n he

alth

pla

ns a

nd p

rovi

ders

(F

aile

d pa

ssag

e on

Sen

ate

Floo

r). S

B 1

522

(Ste

inbe

rg) w

ould

hav

e re

quire

d pl

ans a

nd in

sure

rs o

ffer

ing

indi

vidu

al

cove

rage

to o

ffer

cov

erag

e in

eac

h of

five

cov

erag

e ca

tego

ries (

Faile

d pa

ssag

e on

Ass

embl

y Fl

oor)

. AB

115

0 (L

ieu)

will

pro

hibi

t spe

cifie

d in

cent

ives

and

pra

ctic

es re

gard

ing

resc

issi

on o

r can

cella

tion

of c

over

age

(Sig

ned

by

Gov

erno

r). A

s am

ende

d, A

B 1

945

(De

La T

orre

) wou

ld h

ave

requ

ired

DM

HC

and

DO

I to

est

ablis

h a

pool

of

appr

oved

app

licat

ion

ques

tions

for i

ndiv

idua

l hea

lth p

lan

cont

ract

s and

indi

vidu

al h

ealth

insu

ranc

e po

licie

s and

w

ould

rest

rict p

lans

and

insu

rers

to u

se o

f tho

se q

uest

ions

in a

pplic

atio

n fo

rms.

The

bill

also

wou

ld h

ave

requ

ired

prio

r app

rova

l bef

ore

resc

indi

ng a

con

tract

or p

olic

y (V

etoe

d by

Gov

erno

r). S

B 1

440

(Kue

hl) w

ould

hav

e re

quire

d at

leas

t 85

perc

ent o

f hea

lth p

lans

’ and

hea

lth in

sure

rs’ a

ggre

gate

due

s, fe

es, p

rem

ium

s and

oth

er p

erio

dic

paym

ents

to b

e sp

ent o

n he

alth

serv

ices

(Vet

oed

by G

over

nor)

. SB

152

5 (K

uehl

) wou

ld h

ave

adde

d a

revi

ew o

f the

pr

oced

ures

for m

akin

g de

term

inat

ions

of m

edic

al n

eces

sity

to e

xist

ing

requ

irem

ents

rega

rdin

g pe

riodi

c on

site

su

rvey

s of h

ealth

pla

ns’ m

edic

al d

eliv

ery

syst

ems,

(Hel

d in

Ass

embl

y Ap

prop

riat

ions

). A

B 2

549

(Hay

ashi

) wou

ld

proh

ibit

plan

s and

insu

rers

from

resc

indi

ng c

over

age

for a

ny re

ason

afte

r 18

mon

ths f

ollo

win

g its

issu

ance

(Hel

d in

Sen

ate

Appr

opri

atio

ns).

5

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

AB

264

4 he

ld b

y au

thor

SB 1

169

sign

ed

AB

247

4 si

gned

AB

214

6 he

ld

Su

ppor

t:

SB 1

169

AB

247

4

Opp

ose:

A

B 2

644

AB

214

6

B

illin

g/R

eim

burs

emen

t Iss

ues.

AB

244

0 (L

aird

) wou

ld h

ave

requ

ired

DH

CS

to u

pdat

e an

d pu

blis

h in

the

Med

i-Cal

pr

ovid

er b

ulle

tin, d

iagn

ostic

and

reim

burs

emen

t cod

es b

y O

ctob

er 1

of t

he y

ear f

or w

hich

the

code

s are

pub

lishe

d by

CM

S (V

etoe

d by

Gov

erno

r). A

B 2

644

(Huf

f) w

ould

hav

e re

quire

d ho

spita

l bill

s to

prov

ide

in p

lain

Eng

lish

a de

scrip

tion

of th

e m

edic

al p

roce

dure

or s

ervi

ces f

or w

hich

a p

atie

nt is

bill

ed (H

eld

by a

utho

r in

Asse

mbl

y H

ealth

). SB

116

9 (R

unne

r) w

ill e

xten

d th

e Ja

n. 1

, 200

9 su

nset

dat

e on

cur

rent

law

rela

ting

to p

aym

ent f

or se

rvic

es re

nder

ed

to p

atie

nts w

ho a

re in

the

cust

ody

of lo

cal l

aw e

nfor

cem

ent a

genc

ies (

Sign

ed b

y G

over

nor)

. (C

urre

nt la

w is

a

com

prom

ise

betw

een

hosp

itals

and

law

enf

orce

men

t age

ncie

s ini

tially

ena

cted

in 2

005.

It a

llow

s she

riffs

and

po

lice

chie

fs to

neg

otia

te c

ontra

cts f

or e

mer

genc

y an

d no

n-em

erge

ncy

care

for p

eopl

e in

thei

r cus

tody

and

requ

ires

that

hos

pita

ls n

ot u

nder

con

tract

be

paid

at a

rate

equ

al to

110

per

cent

of t

he h

ospi

tal’s

act

ual c

osts

.) A

B 2

474

(Gal

gian

i) w

ill c

larif

y th

e Le

gisl

atur

e’s i

nten

t with

rega

rd to

seve

ral p

rovi

sion

s of t

he b

udge

t tra

iler b

ill (S

igne

d by

G

over

nor)

. (Se

e al

so A

B 2

146

(Feu

er),

imm

edia

tely

bel

ow, w

hich

wou

ld h

ave

proh

ibite

d bi

lling

a p

atie

nt o

r in

sure

r for

car

e re

late

d to

an

adve

rse

even

t.)

Miti

gate

d:

SB 1

58

amen

ded

sign

ed

Miti

gate

d:

SB 1

058

amen

ded

sign

ed

AB

296

7 he

ld

AB

214

6 he

ld

AB

203

8 he

ld

O

ppos

e:

A

B 2

967

AB

203

8

Opp

ose/

A

men

d:

AB

214

6

Opp

ose,

then

N

eutr

al a

s am

ende

d:

SB

158

SB

105

8

Lis

ted

bi

lls

OSH

PD

Patie

nt S

afet

y/Q

ualit

y/R

epor

ting/

Dis

clos

ure.

CH

A su

ppor

ts u

nive

rsal

ratio

nal a

nd v

alid

pat

ient

-saf

ety

and

qual

ity

indi

cato

rs a

nd re

porti

ng m

echa

nism

s, an

d is

par

ticip

atin

g in

dev

elop

men

t and

pro

mot

ion

of m

eani

ngfu

l met

rics

and

proc

esse

s, sp

ecifi

cally

, thr

ough

the

Cal

iforn

ia H

ospi

tals

Ass

essm

ent a

nd R

epor

ting

Task

For

ce (C

HA

RT)

. (O

nlin

e at

: Cal

Hos

pita

lCom

pare

.org

). C

HA

supp

orts

ado

ptio

n of

CH

AR

T as

the

sing

le st

anda

rd to

ol b

y w

hich

pl

ans a

nd in

sure

rs w

ould

mea

sure

hos

pita

l qua

lity.

CH

A su

ppor

ts a

ppro

pria

te a

nd m

eani

ngfu

l tra

nspa

renc

y fo

r pr

ices

, pro

cess

es a

nd o

utco

mes

for h

ospi

tals

, phy

sici

ans,

phar

mac

ists

, ins

urer

s, he

alth

pla

ns a

nd o

ther

hea

lth c

are

stak

ehol

ders

. On

May

2, 2

008,

the

CH

A B

oard

app

rove

d th

e de

velo

pmen

t of a

stat

ewid

e ce

ntra

l-lin

e in

fect

ion

redu

ctio

n pr

ogra

m b

y C

HA

/Cal

iforn

ia H

ospi

tal P

atie

nt S

afet

y O

rgan

izat

ion

(CH

PSO

); an

d en

dors

ed in

con

cept

a

stat

ewid

e pa

tient

safe

ty e

duca

tion

prog

ram

. CH

A/C

HPS

O w

orks

in c

oope

ratio

n w

ith th

e R

egio

nal A

ssoc

iatio

ns

and

othe

r sta

keho

lder

s. C

HA

opp

oses

pre

scrip

tive,

redu

ndan

t or e

xces

sive

ly b

urde

nsom

e re

quire

men

ts. A

s am

ende

d, S

B 1

58 (F

lore

z) w

ill re

quire

CD

PH to

est

ablis

h ad

ditio

nal o

vers

ight

of h

ospi

tal-a

cqui

red

infe

ctio

ns

(HA

Is),

as w

ell a

s ena

ctin

g tra

inin

g, e

duca

tion

and

othe

r req

uire

men

ts in

clud

ing

an H

AI a

dvis

ory

com

mitt

ee

(Sig

ned

by G

over

nor)

. As a

men

ded,

SB

105

8 (A

lqui

st) w

ill im

plem

ent H

AI r

epor

ting,

lim

ited

MR

SA te

stin

g an

d ve

ry li

mite

d re

test

ing

befo

re d

isch

arge

, pub

lic re

porti

ng, a

nd fe

es, a

mon

g ot

her p

rovi

sion

s (Si

gned

by

Gov

erno

r).

CH

A w

orke

d w

ith th

e au

thor

, the

adm

inis

tratio

n an

d st

akeh

olde

rs to

cra

ft ac

cept

able

lang

uage

. AB

296

7 (L

iebe

r),

inde

pend

ently

of c

ompr

ehen

sive

hea

lth c

are

refo

rm, w

ould

hav

e es

tabl

ishe

d a

Hea

lth C

are

Cos

t and

Qua

lity

Tran

spar

ency

Com

mitt

ee to

dev

elop

and

impl

emen

ted

a ne

w h

ospi

tal d

ata

repo

rting

syst

em p

aid

for b

y an

ad

ditio

nal f

ee o

n ho

spita

ls (T

o Se

nate

Inac

tive

File

). A

B 2

146

(Feu

er) w

ould

hav

e pr

ohib

ited

a he

alth

car

e pr

ovid

er fr

om b

illin

g a

patie

nt o

r a p

atie

nt’s

insu

rer f

or a

n ad

vers

e ev

ent t

hat o

ccur

s whi

le th

e pa

tient

is in

the

care

of

the

prov

ider

, or f

or th

e ca

re p

rovi

ded

by th

e he

alth

car

e pr

ovid

er to

trea

t or c

orre

ct th

e co

nseq

uenc

es o

f the

ad

vers

e ev

ent (

Hel

d in

Sen

ate

Appr

opri

atio

ns).

AB

203

8 (L

iebe

r) w

ould

hav

e re

writ

ten

the

law

rega

rdin

g re

porti

ng a

nd p

rose

cutio

n of

crim

es a

gain

st d

epen

dent

adu

lts a

nd a

dults

with

dis

abili

ties.

It w

ould

hav

e m

ade

sign

ifica

nt c

hang

es to

abu

se-r

epor

ting

requ

irem

ents

app

licab

le to

long

-term

-fac

ilitie

s and

oth

er c

hang

es to

abu

se-

repo

rting

law

for a

ll he

alth

faci

litie

s (H

eld

in S

enat

e Ap

prop

riat

ions

—Su

spen

se F

ile)

6

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

AB

55

sign

ed

AB

212

0 si

gned

AB

266

1 he

ld b

y au

thor

X

Supp

ort:

AB

55

A

B 2

120

Opp

ose:

AB

266

1

Leg

isla

tion

OSH

PD

Cal

-RH

IO

PSA

B

Cal

OH

II

Hea

lth In

form

atio

n T

echn

olog

y. F

oste

ring

the

deve

lopm

ent a

nd im

plem

enta

tion

of h

ealth

info

rmat

ion

tech

nolo

gy

is th

e su

bjec

t of p

ublic

/priv

ate

effo

rts in

clud

ing

the

Cal

iforn

ia R

egio

nal H

ealth

Info

rmat

ion

Org

aniz

atio

n (C

alR

HIO

) in

whi

ch C

HA

is p

artic

ipat

ing.

Ass

urin

g pr

ivac

y an

d se

curit

y is

ess

entia

l to

the

elec

troni

c ex

chan

ge o

f he

alth

info

rmat

ion.

CH

A p

artic

ipat

es a

s a m

embe

r of t

he P

rivac

y an

d Se

curit

y A

dvis

ory

Boa

rd (C

alPS

AB

), a

priv

ate

and

publ

ic c

olla

bora

tion

to a

ddre

ss a

nd c

oord

inat

e he

alth

info

rmat

ion

exch

ange

priv

acy

and

secu

rity

effo

rts

in C

alifo

rnia

and

wor

ks w

ith th

e C

alifo

rnia

Off

ice

of H

ealth

Info

rmat

ion

Inte

grity

(Cal

OH

II).

CH

A-s

pons

ored

AB

55

(Lai

rd) w

ill b

road

en a

llow

ed te

chno

logy

shar

ing

amon

g ho

spita

ls a

nd p

hysi

cian

s (pr

evio

usly

lim

ited

to e

-pr

escr

ibin

g on

ly) a

nd w

ould

brin

g C

alifo

rnia

law

into

com

plia

nce

with

the

revi

sed

fede

ral l

aw, c

reat

ing

a sa

fe

harb

or fo

r tho

se e

ngag

ing

in IT

shar

ing

(Sig

ned

by G

over

nor)

. AB

212

0 (G

algi

ani)

will

ext

end

the

Jan.

1, 2

009

suns

et d

ate

to Ja

n. 1

, 201

3 on

a st

atut

e th

at a

utho

rizes

the

Med

i-Cal

pro

gram

to re

imbu

rse

for t

eleo

ptha

lmol

ogy

and

tele

derm

atol

ogy

by st

ore

and

forw

ard

(Sig

ned

by G

over

nor)

. A

B 2

661

(Dym

ally

) wou

ld h

ave

mad

e se

vera

l pr

oble

mat

ic c

hang

es to

the

Tele

med

icin

e Pr

actic

e A

ct (H

eld

by a

utho

r in

Asse

mbl

y H

ealth

).

Miti

gate

d:

AB

211

si

gned

Miti

gate

d:

SB 5

41

sign

ed

O

ppos

e/

Am

end,

then

Su

ppor

t:

A

B 2

11

Opp

ose/

A

men

d, th

en

Neu

tral

:

SB 5

41

Follo

w:

SB 1

415

Pa

tient

Pri

vacy

/Med

ical

Rec

ords

. A

s am

ende

d, A

B 2

11 (J

ones

) will

est

ablis

h th

e st

ate

Off

ice

of H

ealth

In

form

atio

n In

tegr

ity (O

HII

) and

wou

ld a

utho

rize

the

OH

II to

levy

subs

tant

ial a

dmin

istra

tive

fines

on

pers

ons o

r no

n-ho

spita

l ent

ities

, lic

ense

d or

unl

icen

sed,

for v

iola

tions

of m

edic

al p

rivac

y la

ws (

Sign

ed b

y G

over

nor)

. As

amen

ded,

SB

541

(Alq

uist

) will

requ

ire h

ealth

faci

litie

s to

prev

ent u

nlaw

ful a

cces

s, us

e, o

r dis

clos

ure

of a

pat

ient

’s

med

ical

info

rmat

ion

and

wou

ld a

utho

rize

CD

PH to

ass

ess,

agai

nst h

ealth

faci

litie

s, su

bsta

ntia

l mon

etar

y pe

nalti

es

for e

ach

impr

oper

acc

ess,

use,

or d

iscl

osur

e. T

he b

ill w

ill a

lso

subs

tant

ially

incr

ease

mon

etar

y pe

nalti

es fo

r “i

mm

edia

te je

opar

dy”

defic

ienc

ies (

Sign

ed b

y G

over

nor)

. SB

141

5 (K

uehl

) wou

ld h

ave

requ

ired

non-

hosp

ital

heal

th c

are

prov

ider

s to

prov

ide

patie

nts,

whe

n an

initi

al p

atie

nt re

cord

is c

reat

ed, a

not

ice

to b

e si

gned

by

the

patie

nt e

xpla

inin

g th

e pr

ovid

er’s

reco

rds r

eten

tion

polic

y an

d w

ould

requ

ire n

otic

e be

fore

reco

rds c

ould

be

dest

roye

d (V

etoe

d by

Gov

erno

r)

AB

251

6 he

ld b

y au

thor

X

Supp

ort:

SB 1

270

Follo

w:

SB 1

307

Opp

ose:

AB

251

6

Lis

ted

bills

Ph

arm

acy/

Phar

mac

eutic

als.

Earli

er in

200

8, th

e st

ate

Phar

mac

y B

oard

vot

ed to

del

ay a

n ex

istin

g dr

ug p

edig

ree

track

ing

requ

irem

ent t

o Ja

n. 1

, 201

1. S

B 1

270

(Ced

illo)

wou

ld h

ave

requ

ired

the

Boa

rd to

est

ablis

h a

task

forc

e to

ad

vise

the

Boa

rd o

n pe

digr

ee tr

acki

ng (H

eld

in A

ssem

bly

Appr

opri

atio

ns).

SB 1

307

(Rid

ley-

Thom

as) w

ill d

efin

e “p

edig

ree”

and

pha

se in

the

pedi

gree

requ

irem

ent s

tarti

ng in

201

1 (S

igne

d by

Gov

erno

r). A

B 2

516

(Men

doza

), co

mm

enci

ng Ja

n. 1

, 201

0, w

ould

hav

e re

quire

d al

l pre

scrib

ers t

o en

sure

that

pre

scrip

tions

be

elec

troni

cally

tra

nsm

itted

to th

e pa

tient

’s p

harm

acy

of c

hoic

e (H

eld

in A

ssem

bly

B&P)

. A

B 1

468

held

AB

364

am

ende

d,

then

hel

d

X

Opp

ose,

then

Su

ppor

t as

amen

ded:

AB

364

Opp

ose:

AB

146

8

Lis

ted

bills

Pa

tient

Tra

nspo

rt/P

atie

nt D

isch

arge

Pol

icie

s. A

s int

rodu

ced,

AB

364

(Ber

g) w

ould

hav

e re

quire

d th

at h

ospi

tal

disc

harg

e po

licy

info

rm p

atie

nts o

f hom

e an

d co

mm

unity

-bas

ed o

ptio

ns p

rior t

o di

scha

rge,

and

wou

ld h

ave

requ

ired

prea

dmis

sion

scre

enin

g be

fore

an

olde

r adu

lt is

tran

sfer

red

to a

ny sk

illed

nur

sing

faci

lity.

The

bill

was

am

ende

d to

repl

ace

the

prea

dmis

sion

scre

enin

g m

anda

te w

ith a

pilo

t pro

gram

, at w

hich

tim

e C

HA

cha

nged

its

posi

tion

to su

ppor

t. (H

eld

in A

ssem

bly

Appr

opri

atio

ns).

CH

A-o

ppos

ed A

B 1

468

(Gar

rick)

wou

ld h

ave

adde

d ci

tizen

ship

stat

us to

the

disc

harg

e ab

stra

ct d

ata

hosp

itals

are

requ

ired

to re

cord

on

each

pat

ient

(Hel

d in

Ass

embl

y H

ealth

).

7

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

SB 1

393

sign

ed

SB 1

621

sign

ed

AB

212

8 si

gned

Su

ppor

t:

A

B 2

375

SB 1

393

SB 1

620

SB 1

621

AB

212

8

Lis

ted

bills

H

ealth

Car

e W

orkf

orce

Sho

rtag

es.

CH

A c

ontin

ued

durin

g 20

08 to

add

ress

hea

lth c

are

wor

kfor

ce sh

orta

ges

thro

ugh

legi

slat

ion,

and

pub

lic a

dvoc

acy.

AB

237

5 (H

erna

ndez

) wou

ld h

ave

requ

ired

OSH

PD to

est

ablis

h a

heal

th

care

wor

kfor

ce ta

sk fo

rce

to a

ssis

t in

the

deve

lopm

ent o

f a h

ealth

car

e w

orkf

orce

mas

ter p

lan

for C

alifo

rnia

(Hel

d in

Sen

ate

Appr

opri

atio

ns).

SB 1

393

(Sco

tt) w

ill c

larif

y ex

istin

g la

w to

pro

hibi

t CSU

S an

d co

mm

unity

col

lege

s fr

om re

quiri

ng re

gist

ered

nur

sing

stud

ents

with

bac

cala

urea

te d

egre

es to

take

cou

rses

not

uni

que

and

excl

usiv

ely

requ

ired

to e

arn

a nu

rsin

g de

gree

(Sig

ned

by G

over

nor)

. SB

162

0 (A

shbu

rn) w

ould

hav

e bo

lste

red

the

num

ber o

f nu

rsin

g in

stru

ctor

s in

Cal

iforn

ia’s

com

mun

ity c

olle

ges b

y al

low

ing

mor

e pa

rt-tim

e in

stru

ctor

s, at

tract

ing

nurs

es

who

pre

fer t

o te

ach

and

prac

tice

(Ass

embl

y Ap

prop

riat

ions

). SB

162

1 (A

shbu

rn) w

ill e

xten

d st

uden

t loa

n fo

rgiv

enes

s to

regi

ster

ed n

urse

s who

are

will

ing

teac

h as

wel

l as p

ract

ice

(Sig

ned

by G

over

nor)

. CH

A-c

ospo

nsor

ed

AB

212

8 (E

mm

erso

n) w

ill e

xpan

d th

e m

echa

nism

s by

whi

ch d

ieta

ry se

rvic

es su

perv

isor

s em

ploy

ed in

skill

ed

nurs

ing

faci

litie

s cou

ld m

eet e

duca

tiona

l and

qua

lific

atio

n re

quire

men

ts (S

igne

d by

Gov

erno

r).

AB

13

veto

ed

AB

371

ve

toed

AB

437

ve

toed

AB

224

4 ve

toed

AB

227

9 ve

toed

SB 1

151

veto

ed

SB 1

721

held

AB

171

1 he

ld

SB 5

29

held

AB

271

6

held

X

Opp

ose:

AB

13

A

B 3

71

AB

171

1

SB

529

A

B 4

37

SB 1

721

AB

271

6

A

B 2

279

Opp

ose/

A

men

d:

SB 1

151

Opp

ose,

then

ne

utra

l as

amen

ded:

A

B 2

244

Follo

w:

SB 1

526

Lis

ted

bills

Reg

ulat

ory

agen

cies

Staf

fing

Req

uire

men

ts a

nd o

ther

Wor

kfor

ce Is

sues

. CH

A o

ppos

es e

xpan

sion

of r

atio

s bey

ond

nurs

es. C

HA

ad

voca

tes h

ospi

tals

’ int

eres

ts o

n la

bor a

nd w

orkf

orce

legi

slat

ion

and

regu

latio

n of

par

ticul

ar in

tere

st to

hos

pita

ls,

and

wor

ks w

ith th

e C

alifo

rnia

Cha

mbe

r of C

omm

erce

, the

Cal

iforn

ia E

mpl

oyer

s Coa

litio

n an

d ot

her o

rgan

izat

ions

on

oth

er le

gisl

atio

n an

d re

gula

tion

of c

once

rn to

Cal

iforn

ia e

mpl

oyer

s. C

HA

-opp

osed

AB

13

(Bro

wnl

ey) w

ould

ha

ve im

pose

d ne

w re

quire

men

ts o

n ho

spita

ls to

ado

pt a

nd c

ompl

y w

ith st

affin

g pl

ans f

or p

rofe

ssio

nal a

nd

tech

nica

l sta

ff o

ther

than

nur

ses (

Veto

ed b

y G

over

nor)

. A

B 2

244

(Pric

e) w

ould

hav

e re

quire

d C

DPH

to c

olle

ct

and

revi

ew n

on-n

ursi

ng st

affin

g pl

ans f

rom

UC

hos

pita

ls (V

etoe

d by

Gov

erno

r). S

B 1

526

(Per

ata)

wou

ld h

ave

enac

ted

the

Poly

som

nogr

aphi

c Te

chno

logi

st A

ct to

pro

vide

for l

icen

sing

and

regu

latio

n of

slee

p la

b te

chni

cian

s by

the

Res

pira

tory

Car

e B

oard

(Vet

oed

by G

over

nor)

. SB

172

1 (Y

ee) w

ould

hav

e re

quire

d ea

ch d

irect

car

e nu

rse

to

com

plet

e an

orie

ntat

ion

to th

e ho

spita

l and

the

unit

in w

hich

he

or sh

e w

ill b

e w

orki

ng a

nd w

ould

hav

e pr

eclu

ded

a nu

rse

who

has

not

com

plet

ed th

e or

ient

atio

n an

d be

en o

bser

ved

for 5

day

s fro

m b

eing

ass

igne

d di

rect

pat

ient

car

e or

bei

ng c

ount

ed to

war

d st

ate-

requ

ired

nurs

e to

pat

ient

ratio

s (H

eld

in A

ssem

bly

Appr

opri

atio

ns).

AB

171

1 (L

evin

e) w

ould

hav

e pr

oble

mat

ical

ly a

men

ded

Labo

r Cod

e Se

ctio

n 51

2 re

gard

ing

mea

l per

iods

(Hel

d in

Sen

ate

Labo

r). S

B 5

29 (C

edill

o) w

ould

hav

e al

low

ed se

lect

uni

oniz

ed in

dust

ries t

o ne

gotia

te m

eal p

erio

d ru

les a

nd

auth

oriz

ed n

on-u

nion

secu

rity

guar

ds to

ent

er in

to o

n-du

ty m

eal p

erio

d ag

reem

ents

(Mov

ed to

Ass

embl

y In

activ

e Fi

le).

SB 1

151

(Per

ata)

wou

ld h

ave

requ

ired

each

hos

pita

l to

adop

t a sa

fe p

atie

nt h

andl

ing

polic

y an

d w

ould

re

quire

hos

pita

ls to

pur

chas

e lif

t equ

ipm

ent a

nd u

se it

exc

ept i

n an

em

erge

ncy

(Vet

oed

by G

over

nor)

. AB

371

(H

uffm

an) w

ould

hav

e re

quire

d ev

ery

hosp

ital t

hat a

pplie

s for

tax-

exem

pt fi

nanc

ing

thro

ugh

the

Cal

if. H

ealth

Fa

cilit

ies F

inan

cing

Aut

horit

y (C

HFF

A) o

r any

oth

er p

ublic

ent

ity to

subm

it its

inju

ry p

reve

ntio

n pr

ogra

m, w

hich

w

ould

be

requ

ired

to in

clud

e a

safe

pat

ient

han

dlin

g po

licy

(Vet

oed

by G

over

nor)

. AB

437

(Jon

es) w

ould

hav

e ef

fect

ivel

y el

imin

ated

the

stat

ute

of li

mita

tions

for C

alifo

rnia

em

ploy

ers’

com

pens

atio

n de

cisi

ons (

Veto

ed b

y G

over

nor)

. AB

271

6 (M

a) w

ould

hav

e re

quire

d al

l em

ploy

ers t

o pr

ovid

e si

ck le

ave

for a

ll em

ploy

ees a

t a ra

te o

f on

e ho

ur fo

r eve

ry 3

0 ho

urs w

orke

d (H

eld

in S

enat

e Ap

prop

riat

ions

). A

B 2

279

(Len

o) w

ould

hav

e pr

ohib

ited

empl

oyer

s fro

m re

fusi

ng to

hire

, dis

char

ging

or d

iscr

imin

atin

g ag

ains

t an

indi

vidu

al b

ecau

se th

ey u

se m

edic

al

mar

ijuan

a (V

etoe

d by

Gov

erno

r).

8

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

SB 9

40

sign

ed

SB 1

103

held

SB 1

717

veto

X

Opp

ose:

SB 1

717

SB 1

103

Opp

ose

until

am

ende

d,

then

neu

tral

:

SB 9

40

Lis

ted

bills

W

orke

rs’ C

ompe

nsat

ion.

SB

171

7 (P

erat

a) w

ould

dou

ble,

by

Jan.

1, 2

011,

per

man

ent d

isab

ility

ben

efits

by

revi

sing

th

e fo

rmul

a fo

r com

putin

g be

nefit

s for

inju

ries t

hat o

ccur

afte

r Jan

.1, 2

009

and

wou

ld re

peal

the

15 p

erce

nt b

ump

up/d

own

for r

etur

n-to

-wor

k-of

fers

(Vet

oed

by G

over

nor)

. SB

110

3 (C

edill

o) w

as a

men

ded

Aug

ust 1

5 to

pro

vide

fo

r a su

pple

men

tal j

ob d

ispl

acem

ent b

enef

it in

the

form

of a

vou

cher

for u

p to

$6,

000

for r

eedu

catio

n an

d sk

ill

enha

ncem

ent s

ervi

ces (

Asse

mbl

y Ru

les)

. SB

940

(Yee

) will

allo

w e

mpl

oyee

s of t

empo

rary

staf

fing

agen

cies

to su

e bo

th th

e te

mp

agen

cy a

nd th

e ho

spita

l whe

re th

ey h

ad te

mpo

rary

ass

ignm

ents

for p

erso

nal i

njur

y if

neith

er th

e ho

spita

l nor

the

tem

p ag

ency

had

wor

kers

’ com

pens

atio

n co

vera

ge fo

r the

em

ploy

ee; t

he b

ill w

as a

men

ded

to

dele

te th

ose

prov

isio

ns. A

s ena

cted

, the

bill

est

ablis

hes a

def

initi

on o

f tem

pora

ry se

rvic

es e

mpl

oyer

whi

ch

excl

udes

a b

ona

fide

nonp

rofit

org

aniz

atio

n an

d pr

ovid

es th

e tim

e fr

ames

for p

aym

ent o

f wag

es fo

r the

ir em

ploy

ees (

Sign

ed b

y G

over

nor)

.

A

B 2

910

gutt

ed a

nd

amen

ded

by a

utho

r

MIC

RA

pr

eser

ved

X

Con

cern

unt

il am

ende

d th

en fo

llow

:

AB

291

0

MIC

RA

lit

igat

ion/

le

gisl

atio

n.

Civ

il ju

stic

e

legi

slat

ion

MIC

RA

/Civ

il Ju

stic

e Is

sues

. CH

A c

ontin

ues t

o w

ork

thro

ugh

Cal

iforn

ians

Alli

ed fo

r Pat

ient

Pro

tect

ion

(CA

PP)

with

oth

er in

tere

sted

par

ties t

o pr

otec

t the

Med

ical

Inju

ry C

ompe

nsat

ion

Ref

orm

Act

(MIC

RA

) leg

isla

tivel

y an

d in

co

urt.

CA

PP a

dvoc

acy

dete

rred

intro

duct

ion

of b

ills t

o am

end

MIC

RA

dur

ing

2008

. CH

A a

lso

cont

inue

s to

supp

ort b

road

er c

ivil

just

ice

refo

rm le

gisl

atio

n an

d op

pose

pro

blem

atic

legi

slat

ion

thro

ugh

parti

cipa

tion

in th

e C

ivil

Just

ice

Ass

ocia

tion

of C

alifo

rnia

(CJA

C).

CA

PP a

nd C

JAC

rais

ed h

ealth

car

e pr

ovid

ers’

con

cern

s with

AB

29

10 (H

uffm

an) (

disc

usse

d ab

ove

unde

r Hea

lth C

are

Cov

erag

e Pr

actic

es a

nd P

lan-

Prov

ider

Rel

atio

nshi

ps

rega

rdin

g th

e po

tent

ial i

mpa

ct o

f the

bill

on

MIC

RA

and

oth

er c

ivil

just

ice

issu

es.)

X

EM

SA

CD

PH

OH

S

OE

S

Dis

aste

r Pr

epar

edne

ss. C

HA

con

tinue

s to

wor

k to

stre

ngth

en h

ospi

tal p

repa

redn

ess.

Dur

ing

the

past

few

yea

rs, t

he

emph

asis

has

bee

n on

bui

ldin

g su

rge

capa

city

and

cap

abili

ty. S

peci

fic fo

cus a

reas

are

: dev

elop

ing

evac

uatio

n an

d sh

elte

r-in

-pla

ce p

lann

ing

guid

es; h

ospi

tal g

uida

nce

for f

atal

ity m

anag

emen

t; as

sist

ing

in th

e de

velo

pmen

t of

mem

oran

da o

f und

erst

andi

ng fo

r the

shar

ing

of p

erso

nnel

, equ

ipm

ent a

nd su

pplie

s. Th

e C

HA

Hos

pita

l Pr

epar

edne

ss P

rogr

am (C

HA

HPP

) reg

iona

l coo

rdin

ator

s pro

vide

dire

ct a

ssis

tanc

e to

hos

pita

l dis

aste

r pla

nner

s. Th

ey c

olla

bora

te w

ith th

e R

egio

nal A

ssoc

iatio

ns a

nd th

eir r

egio

nal v

ice

pres

iden

ts w

here

app

licab

le. S

peci

fic

assi

stan

ce is

dire

cted

tow

ard

mee

ting

the

Join

t Com

mis

sion

em

erge

ncy

man

agem

ent s

tand

ards

and

mee

ting

the

fede

ral H

ospi

tal P

repa

redn

ess g

rant

requ

irem

ents

. Pro

gram

act

ivity

incl

udes

but

is n

ot li

mite

d to

dev

elop

ing

plan

ning

tool

s and

reso

urce

s, id

entif

ying

bes

t pra

ctic

es, p

rovi

ding

HIC

S tra

inin

g, to

ols a

nd g

uida

nce

to im

prov

e ho

spita

l em

erge

ncy

oper

atio

ns p

lans

. CH

A c

oord

inat

es w

ith st

ate

and

fede

ral a

genc

ies i

nclu

ding

the

Emer

genc

y M

edic

al S

ervi

ces A

utho

rity

(EM

SA) t

he C

alifo

rnia

Dep

artm

ent o

f Pub

lic H

ealth

(CD

PH),

the

Gov

erno

r’s O

ffic

e of

Hom

elan

d Se

curit

y (O

HS)

and

the

Off

ice

of E

mer

genc

y Se

rvic

es (O

ES).

CH

A p

artic

ipat

es o

n va

rious

stat

e an

d na

tiona

l com

mitt

ees a

nd w

ork

grou

ps re

pres

entin

g th

e in

tere

sts o

f Cal

iforn

ia H

ospi

tals

.

X

Fe

dera

l: R

AC

cla

ims

revi

ew a

nd

reco

very

Med

ical

Reh

abili

tatio

n Se

rvic

es. C

HA

’s C

ente

r for

Med

ical

Reh

abili

tatio

n Se

rvic

es p

rovi

des f

ocus

ed st

ate

and

fede

ral l

egis

lativ

e an

d re

gula

tory

adv

ocac

y fo

r mem

ber h

ospi

tals

that

pro

vide

inpa

tient

and

out

patie

nt

reha

bilit

atio

n se

rvic

es. H

igh-

prio

rity

issu

es in

clud

e ad

dres

sing

inap

prop

riate

Rec

over

y A

udit

Con

tract

pro

gram

(R

AC

) cla

ims r

evie

w a

nd re

imbu

rsem

ent r

ecov

ery.

9

Prog

ress

Objectives Achieved

Work in Progress

CHA Position

Advocacy Focus

CH

A K

ey S

tate

Iss

ues

SB 1

553

sign

ed

X

Supp

ort:

AB

286

1

AB

188

7

SB

155

3

Leg

isla

tion

Beh

avio

ral H

ealth

. CH

A/C

BH

–spo

nsor

ed A

B 2

861

(Hay

ashi

) wou

ld h

ave

defin

ed th

e te

rm “

psyc

hiat

ric e

mer

genc

y m

edic

al c

ondi

tion”

for p

urpo

ses o

f the

exi

stin

g re

quire

men

t tha

t hos

pita

ls w

ith e

mer

genc

y de

partm

ents

pro

vide

, an

d th

at h

ealth

pla

ns p

ay fo

r, em

erge

ncy

serv

ices

pro

vide

d un

der s

peci

fied

circ

umst

ance

s (V

etoe

d by

Gov

erno

r).

Oth

er h

igh

prio

rity

issu

es in

clud

e m

onito

ring

coun

ty m

enta

l hea

lth fu

ndin

g, M

enta

l Hea

lth S

ervi

ces A

ct

impl

emen

tatio

n, th

e in

tegr

atio

n of

men

tal h

ealth

and

phy

sica

l hea

lth a

nd im

prov

ing

serv

ices

for i

ndiv

idua

ls w

ith

co-o

ccur

ring

diso

rder

s. A

B 1

887

(Bea

ll) w

ould

hav

e br

oade

n pa

rity

diag

nose

s to

incl

ude

any

men

tal d

isor

der

defin

ed in

the

DSM

IV (V

etoe

d by

Gov

erno

r). S

B 1

553

(Low

enth

al) w

ill p

rohi

bit p

lans

from

den

ying

au

thor

izat

ion

for m

enta

l hea

lth se

rvic

es b

ased

upo

n w

heth

er th

e ad

mis

sion

was

vol

unta

ry o

r inv

olun

tary

or b

ased

up

on th

e m

etho

d of

tran

spor

tatio

n to

the

heal

th fa

cilit

y (S

igne

d by

Gov

erno

r). (

See

also

SB

173

8 (S

tein

berg

) to

esta

blis

h a

freq

uent

use

rs o

f hea

lth c

are

pilo

t pro

ject

dis

cuss

ed a

bove

und

er E

mer

genc

y Se

rvic

es.)

X

Su

ppor

t:

A

B 6

61

Stat

e bu

dget

DP/

NF

rate

Rur

al H

ospi

tals

. Top

prio

ritie

s inc

lude

pro

tect

ing

paym

ents

to ru

ral h

ospi

tals

and

clin

ics f

or se

rvic

es p

rovi

ded

to

Med

i-Cal

and

med

ical

ly in

dige

nt p

atie

nts a

nd p

rote

ctin

g C

ritic

al A

cces

s Hos

pita

ls (C

AH

s) a

nd th

e ru

ral h

ospi

tal

safe

ty n

et, i

nclu

ding

exp

ansi

on o

f Med

i-Cal

man

aged

car

e. C

HA

-spo

nsor

ed A

B 6

61 (B

erg)

wou

ld h

ave

requ

ired

that

CA

Hs b

e pa

id M

edi-C

al a

llow

able

cos

ts fo

r out

patie

nt se

rvic

es (H

eld

in A

ssem

bly

Appr

opri

atio

ns).

AB

212

8 si

gned

AB

203

8 he

ld

X

Supp

ort:

AB

212

8

Opp

ose:

AB

203

8

Bud

get

DP/

NF

rate

Post

-Acu

te /S

kille

d N

ursi

ng. C

HA

’s H

ospi

tal S

ervi

ces f

or C

ontin

uing

Car

e (H

SCC

) rep

rese

nts t

he in

tere

sts o

f ho

spita

l-spo

nsor

ed d

istin

ct-p

art s

kille

d nu

rsin

g fa

cilit

ies,

incl

udin

g su

bacu

te fa

cilit

ies,

and

advo

cate

s for

them

on

legi

slat

ive

and

regu

lato

ry is

sues

. Key

issu

es in

clud

e im

plem

enta

tion

of n

urse

staf

f rat

ios,

train

ing

of d

ieta

ry

serv

ices

supe

rvis

ors a

nd a

dvoc

atin

g M

edic

are

and

Med

i-Cal

reim

burs

emen

t. U

nles

s rev

erse

d, sp

ecia

l ses

sion

bu

dget

legi

slat

ion

sign

ed b

y th

e G

over

nor e

arlie

r thi

s yea

r cut

Med

i-Cal

rate

s by

10 p

erce

nt fo

r dis

tinct

-par

t ski

lled

nurs

ing

faci

litie

s, su

bacu

te fa

cilit

ies a

nd a

dult

day

heal

th c

are.

CH

A a

nd o

ther

s are

cha

lleng

ing

that

redu

ctio

n in

co

urt.

On

Jan.

30

CH

A H

SCC

test

ified

bef

ore

DPH

on

emer

genc

y re

gula

tions

file

d by

CD

PH re

gard

ing

skill

ed

nurs

ing

faci

lity

staf

fing

ratio

s and

follo

wed

up

with

writ

ten

com

men

ts. C

HA

-cos

pons

ored

AB

212

8 (E

mm

erso

n)

will

exp

and

the

mec

hani

sms b

y w

hich

die

tary

serv

ices

supe

rvis

ors e

mpl

oyed

in sk

illed

nur

sing

faci

litie

s can

mee

t ed

ucat

iona

l and

qua

lific

atio

n re

quire

men

ts (S

igne

d by

Gov

erno

r). (

See

also

AB

203

8 (L

iebe

r) o

n de

pend

ent a

dult

abus

e re

porti

ng, d

iscu

ssed

abo

ve u

nder

Pat

ient

Saf

ety/

Qua

lity/

Rep

ortin

g/D

iscl

osur

e).

X

Leg

isla

tion

Wom

en’s

and

Chi

ldre

n’s I

ssue

s. C

HA

con

tinue

d to

mon

itor i

ssue

s and

legi

slat

ion

impa

ctin

g w

omen

’s a

nd

child

ren’

s ser

vice

s pro

vide

d in

hos

pita

ls.

SB 1

260

sign

ed

X

Supp

ort:

SB 1

260

Lis

ted

bills

H

ospi

tal-B

ased

Out

patie

nt C

linic

s. SB

126

0 (R

unne

r) w

ill re

quire

DPH

to id

entif

y ho

spita

l-bas

ed o

utpa

tient

clin

ics

on a

hos

pita

l’s li

cens

e (S

igne

d by

Gov

erno

r).

SB 8

91

sign

ed

AB

256

5 si

gned

X

Supp

ort:

SB 8

91

AB

214

Opp

ose/

A

men

d, th

en

Supp

ort:

AB

256

5

Lis

ted

bills

O

ther

. SB

891

(Cor

rea)

will

est

ablis

h th

e El

ectiv

e pe

rcut

aneo

us C

oron

ary

Inte

rven

tion

(PC

I) P

ilot P

rogr

am to

au

thor

ize

up to

6 e

ligib

le a

cute

-car

e ho

spita

ls to

per

form

ele

ctiv

e an

d sc

hedu

led

prim

ary

perc

utan

eous

cor

onar

y in

terv

entio

ns (S

igne

d by

Gov

erno

r). A

B 2

565

(Eng

) will

requ

ire h

ospi

tals

to p

rovi

de a

reas

onab

le p

erio

d of

ac

com

mod

atio

n fo

r fam

ily o

r nex

t of k

in in

the

even

t tha

t a p

atie

nt is

dec

lare

d de

ad b

y ne

urol

ogic

al c

riter

ia

(Sig

ned

by G

over

nor)

. The

aut

hor a

ccep

ted

CH

A’s

am

endm

ents

to th

e bi

ll. A

B 2

14 (F

uent

es) w

ould

hav

e fa

cilit

ated

the

early

reco

gniti

on, t

reat

men

t and

mon

itorin

g of

impa

ired

phys

icia

ns b

y th

e M

edic

al B

oard

(Vet

oed

by

Gov

erno

r).