SB 669

SB669:v92#DOCUMENT

Bill Start

Senate Bill No. 669

CHAPTER 603

An act to add Sections 1256.05 and 1256.06 to the Health and Safety Code, relating to perinatal health care.

[ Approved by Governor October 11, 2025. Filed with Secretary of State October 11, 2025. ]

LEGISLATIVE COUNSEL'S DIGEST

SB 669, McGuire. Rural hospitals: standby perinatal services.

Existing law finds and declares that prenatal care, delivery service, postpartum care, and neonatal and infant care are essential services necessary to assure maternal and infant health, and that these services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. Existing law requires the State Department of Public Health to develop and maintain a statewide community-based comprehensive perinatal services program, as specified, to deliver services in medically underserved areas or areas with demonstrated need.

Existing law provides for the licensure of health facilities, including general acute care hospitals, by the department. Existing law generally makes a violation of those licensing provisions a crime. Existing law sets forth provisions for critical access hospitals, as designated by the department and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program.

This bill would require the department, by July 1, 2026, to establish a 10-year pilot project within up to 5 critical access hospitals to allow participating hospitals, on an application basis, to establish standby perinatal services, as defined. Under the bill, the first 2 hospitals selected, if qualified, would be nonprofit and located in the County of Humboldt and the County of Plumas. The bill would set forth various criteria for the selection of the participating hospitals with regard to standards and resources.

The bill would require the department to develop a template to collect and evaluate data on safety, outcomes, utilization, and populations served under the pilot project, as specified. The bill would require the department to prepare and submit an evaluation to the Legislature and to make the evaluation publicly available.

Under the bill, an approved standby perinatal service would be subject to all relevant licensing enforcement provisions, as specified. The bill would set forth provisions relating to suspension or revocation for noncompliance and to a hospital’s request for program flexibility.

The bill would require a hospital requesting approval to establish a standby perinatal service to implement and maintain certain requirements relating to, among other things, compliance with professional standards and recommendations, having specified equipment and supplies, defining the responsibility of the medical staff and administration, implementing contracts, and developing a quality improvement program. The bill would set forth specific requirements for a physician who has responsibility of the standby perinatal services.

Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program.

This bill would make legislative findings and declarations as to the necessity of a special statute for the County of Humboldt and the County of Plumas.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Digest Key

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES

Bill Text

The people of the State of California do enact as follows:

SECTION 1.

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

(1) Over the past decade, rural hospitals with low volumes of deliveries have been closing their perinatal services largely because of workforce and funding challenges.

(2) These perinatal unit closures mean that large areas of rural California have no hospitals providing perinatal services, requiring long distances of travel to access an open perinatal unit.

(3) Studies in the United States and other developed countries show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital perinatal unit, and that the outcomes are progressively worse with each additional hour of travel time.

(4) New models are needed to meet birthing persons’ needs in rural areas without hospital perinatal services.

(b) It is the intent of the Legislature to create a pilot project to test a new category of perinatal service, called standby perinatal services, in critical access hospitals in rural areas with limited access to comprehensive perinatal services.

SEC. 2.

Section 1256.05 is added to the Health and Safety Code, immediately following Section 1256.01, to read:

1256.05.

(a) For purposes of this section and Section 1256.06, the following definitions apply:

(1) “Critical access hospital” means a hospital designated by the State Department of Public Health as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medicare Rural Hospital Flexibility Program.

(2) “Department” means the State Department of Public Health, unless otherwise specified.

(3) “Standardized order sets” means predefined groups of orders that support clinical decisions, including, but not limited to, appropriate treatments, medications, and dosages, for specific conditions or procedures and that are developed using relevant evidence-based guidelines.

(4) “Standby perinatal services” means the provision of obstetric and neonatal medical care to patients who are transferred from an alternative birth center, or who present to the hospital’s emergency department with an urgent or emergent obstetric issue, in a specifically designated area of the hospital that is equipped and maintained at all times to receive patients and capable of providing physician, midwifery, and nursing services within a reasonable time not to exceed 30 minutes.

(b) The department shall do all of the following:

(1) By July 1, 2026, establish a 10-year pilot project within up to five critical access hospitals to allow participating hospitals to establish standby perinatal services. If qualified, the first two hospitals selected shall be nonprofit and located in the County of Humboldt and the County of Plumas. Up to three additional critical access hospitals may be selected at any time if the application includes a signed agreement from the exclusive employee representatives of the workforce that the proposed pilot project site would not adversely impact the workforce or includes an attestation that there is no existing exclusive employee representative.

(2) Within a reasonable time, determine whether hospitals requesting to participate meet applicable statutory requirements, including, but not limited to, all of the following:

(A) Ability to meet the standards of the standby perinatal service, as described in Section 1256.06.

(B) Provide surgery and anesthesia as basic services of the hospital.

(C) Maintain capability for obtaining or performing timely blood gas, pH, and microbiologic analyses.

(D) Provide ability to maintain premixed infusions.

(E) Maintain a basic emergency medical service, comprehensive emergency medical service, or standby emergency medical service licensed as a supplemental service.

(F) (i) Have a designated room or rooms for the standby perinatal service space. A hospital may designate an existing room or rooms with a licensed general acute care bed as the standby perinatal service space. If a hospital designates an existing room or rooms for the standby perinatal service space, the hospital may continue to provide general acute care services in that room or rooms when the room or rooms are not in use by the standby perinatal services only if all remaining general acute care beds are occupied or a plan for management of perinatal patients using alternate space is approved by the department.

(ii) The operating room may serve as the delivery room in hospitals having a licensed bed capacity of 25 or less, but the operating room shall not serve as the sole standby perinatal service space.

(G) In consultation with stakeholders, establish any additional requirements that the department deems necessary to protect patient safety or to ensure quality of care under the pilot project.

(3) (A) Develop a template to collect and evaluate data on safety, outcomes, utilization, and populations served under the pilot project using stratified demographic data, to the extent statistically reliable data are available and comply with medical privacy laws and practices. The department may, in consultation with relevant stakeholders, establish additional requirements for participating hospitals to collect and report any additional data under the pilot project that the department deems necessary.

(B) Compile the data collected pursuant to subparagraph (A), prepare and submit an evaluation to the Legislature, and make the evaluation publicly available. The department shall submit the evaluation to the Legislature on or before two years after the completion of the pilot project. Data-collection requests shall be provided in a timely manner to enable the pilot hospital to collect and report the data before the deadline. The evaluation to be submitted to the Legislature pursuant to this subparagraph shall be submitted in compliance with Section 9795 of the Government Code.

(4) Consult with relevant state departments and stakeholders on the matter of meeting the requirements of this subdivision. Stakeholders shall include representatives of hospitals, consumers, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Nurse-Midwives, health plans, labor, and other health care professionals who provide pediatric and pregnancy-related services, including, but not limited to, registered nurses, certified nurse-midwives, and licensed midwives.

(c) A hospital seeking to participate in the pilot project shall submit an application to the department.

(d) An approved standby perinatal service shall be subject to all relevant licensing enforcement provisions as established under this chapter and Chapter 1 (commencing with Section 70001) of Division 5 of Title 22 of the California Code of Regulations.

(e) If, at any time, a hospital with a standby perinatal service fails to meet the requirements set forth in this section or Section 1256.06, or fails to ensure patient health and safety, as determined by the department, the department may suspend or revoke its approval of the hospital’s participation in the pilot project.

(f) (1) Notwithstanding any other law or regulation, a hospital participating in the pilot project may, in consultation with the medical and any other relevant staff, request program flexibility for the statutory requirements of this section or Section 1256.06, in order to meet the particular capacities and needs of the hospital and community.

(2) If the department approves the request described in paragraph (1), the department’s approval shall provide for the terms and conditions under which the program flexibility is granted.

(3) To request program flexibility for the statutory requirements of this section or Section 1256.06, the hospital shall follow existing procedures established by the department for program flexibility requests pursuant to subdivision (b) of Section 1276.

(g) Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section and Section 1256.06 by means of an All Facilities Letter (AFL) or similar instruction.

SEC. 3.

Section 1256.06 is added to the Health and Safety Code, immediately following Section 1256.05, to read:

1256.06.

A hospital requesting approval to establish a standby perinatal service pursuant to Section 1256.05 shall implement and maintain all of the following requirements:

(a) (1) Comply with the most recent standards and recommendations for Level I (Basic Care) of the Levels of Maternal Care and Level 1 (Well Newborn Nursery) of the Neonatal Levels of Care, within the Guidelines for Perinatal Care developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

(2) Have the capacity for operative delivery, including caesarean section, and neonatal resuscitation and stabilization at all times.

(3) Have the ability, equipment, and supplies necessary to provide care for mothers and infants needing emergency or immediate life support measures to sustain life up to 12 hours or to prevent major disability, including, but not limited to, all of the following services:

(A) Administration of intravenous or intramuscular antibiotics.

(B) Administration of intravenous or intramuscular uterotonic drugs, including oxytocin.

(C) Administration of intravenous or intramuscular anticonvulsants.

(D) Administration of antihypertensives.

(E) Manual removal of the placenta.

(F) Removal of retained products of conception.

(G) Basic neonatal resuscitation.

(H) Surgery, including caesarean sections.

(I) Blood transfusions.

(J) Additional services specified by the department, in consultation with relevant stakeholders.

(4) Have capabilities for risk identification and determination of conditions necessitating consultation, referral, and transfer.

(5) Have capabilities, including necessary equipment, for stabilization and the ability to facilitate transfer or transport to a higher level of care at all times.

(6) (A) Have the equipment and supplies specified in Section 70551 of Title 22 of the California Code of Regulations, or its successor.

(B) In addition to the items required under subparagraph (A), have all of the following equipment and supplies:

(i) A fetal heart rate monitor that includes both the ability to monitor multiple gestation pregnancies using internal monitors, including fetal scalp electrodes and intrauterine pressure catheters, and maternal pulse integrated to ensure monitoring of fetal pulse and not maternal pulse.

(ii) Provision for oxygen and suction for the mother and infant, including, but not limited to, specialized supplies needed for neonatal resuscitation and breathing support.

(iii) A ventilatory assistance bag and infant masks of assorted sizes for infants of different gestational ages.

(iv) A postpartum hemorrhage kit, including a uterine tamponade device.

(v) Neonatal resuscitation supplies, including supplies for umbilical access for medications.

(vi) Maternal steroid medications available for initial administration in the case of preterm labor while awaiting transport.

(vii) A refrigerated medication storage unit in the standby perinatal service for uterotonic medications requiring refrigerated storage to be immediately accessible in emergencies.

(viii) A suction device appropriate for neonatal resuscitation.

(b) (1) In consultation with the medical staff, define the responsibilities of the medical staff and administration associated with the standby perinatal services.

(2) (A) Ensure that a provider that provides services pursuant to this section in the hospital meets all applicable requirements set forth in both of the following:

(i) The medical staff bylaws.

(ii) Rules, regulations, and policies of that facility.

(B) Nothing in this section shall be construed to require changes to the medical staff bylaws or policies regarding credentialing or privileges.

(c) (1) Ensure that a physician who is certified, or eligible for certification, by the American Board of Obstetrics and Gynecology, the American Board of Pediatrics, or the American Board of Family Medicine, and who is a member of the medical staff of the facility, has overall responsibility of the standby perinatal services.

(2) The physician described in paragraph (1) shall be responsible for ensuring that contracts and agreements are in place as applicable and for the development of policies and procedures for all of the following:

(A) Developing policies and procedures specified in paragraphs (1) through (28) of subdivision (b) of Section 70547 of Title 22 of the California Code of Regulations that align with the standards specified in paragraph (1) of subdivision (a).

(B) Admission policies for infants transferred from an alternative birth center.

(C) Consultations, including, but not limited to, real-time telemedicine services, between the standby perinatal service and health care personnel from an intensive care newborn nursery and from a perinatal service, qualified and available at all times to provide maternal fetal medicine consultation.

(D) Formal arrangements for consultation or transfer of an infant to an intensive newborn nursery and a mother to a hospital with the necessary services for medical problems beyond the capability of the standby perinatal services.

(E) Current state newborn screening requirements.

(F) Standby perinatal service activation protocols.

(G) Condition-specific management protocols outlining best practices.

(H) Emergency codes.

(I) Monitoring and checkoff to ensure that equipment stays in the standby perinatal service and does not outdate.

(J) Documentation standards for antepartum, intrapartum, postpartum, and newborn care.

(K) Surgery and anesthesia services readily available at all times.

(L) Arrangements for incidents of more than one patient requiring the use of the designated standby perinatal service space.

(M) Care management for mothers, fetuses, and neonates in alignment with the standards specified in this section.

(N) Development by an appropriate committee of the medical staff of standardized obstetric and newborn nursing procedures and standardized order sets for pregnant patients presenting to the emergency department and for the standby perinatal service, and for neonates. Standardized order sets shall be annually reviewed and updated as necessary.

(O) Convening of an appropriate obstetric and neonatal or pediatric committee that, at a minimum annually, evaluates the services provided and makes appropriate recommendations to the executive committee of the medical staff and administration.

(d) In consultation with the physician described in subdivision (c) and with other appropriate health care professionals, do all of the following:

(1) Implement and maintain contracts, and transfer agreements as applicable, and develop and implement policies and procedures for any maternal or neonatal care outside the scope of the standby perinatal service, including, but not limited to, all of the following services:

(A) Transfer of mothers and neonates to appropriate higher levels of care, including a reliable, accurate, and comprehensive communication system between hospitals initiating and hospitals receiving a patient transfer from a standby perinatal service, hospital personnel, and transport teams.

(B) A blood bank, if the facility might need additional blood.

(C) Ambulance transport and rescue services.

(2) Develop a system for ensuring coverage to provide care for both the mother and the neonate, on call 24 hours a day for the standby perinatal service, including, but not limited to, both of the following:

(A) Physician and nursing staff coverage onsite within 30 minutes.

(B) A roster of physicians and certified nurse-midwives who have an agreement or contract with the hospital, and their immediate contact information, who are available to provide emergency perinatal services.

(3) Have a registered nurse immediately available within the hospital to provide nursing care, including emergency maternal fetal triage and infant resuscitation.

(4) Develop a roster of specialty physicians who have an agreement or contract with the hospital, and their immediate contact information, who are available for consultation at all times.

(5) Conduct monitoring and checkoff to ensure that equipment stays in the standby perinatal service and does not outdate.

(6) Ensure continuing education for the medical staff.

(7) Establish, and document compliance with, continuing education and training program requirements for nursing staff in perinatal nursing and infection control, including, but not limited to, all of the following:

(A) Biennial, week-long rotations at a Level II, III, or IV maternal or neonatal care facility.

(B) Participation in simulation-based training to reinforce response to obstetric emergencies.

(C) All other continuing education and training programs that are necessary to ensure the safe provision of care for both mothers and neonates in the standby perinatal service.

(8) (A) Annually verify and document all nursing competencies, including, but not limited to, maternal care, fetal and newborn care, postdelivery care, and emergency condition competencies.

(B) Maintain evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control, including all of the following:

(i) Documented current registered nurse license.

(ii) Current Basic Life Support (BLS) certification.

(iii) Current Advanced Cardiovascular Life Support (ACLS) certification.

(iv) Electronic fetal monitoring certification.

(v) S.T.A.B.L.E. neonatal education program certification.

(vi) Neonatal resuscitation program certification.

(e) Require a physician, certified-nurse midwife, or registered nurse to attend to patients, within the scope of their licensure, under the effect of anesthesia or regional anesthesia, when in active labor, during delivery, or in the immediate postpartum period.

(f) Initiate and sustain an education program and develop a quality improvement program to maximize patient safety, in collaboration with facility partners that provide higher levels of care.

(g) Comply with the existing licensed nurse-to-patient ratios for a combined labor/delivery/postpartum area of perinatal services. This subdivision does not alter or amend the effect of any regulation adopted pursuant to Section 1276.4.

(h) Report the data required by Section 1256.05 quarterly and in the manner and method required by the department.

(i) Maintain compliance with federal Medicare obstetrical services conditions of participation, if applicable.

SEC. 4.

The Legislature finds and declares that a special statute is necessary and that a general statute cannot be made applicable within the meaning of Section 16 of Article IV of the California Constitution because of the unique circumstances of the County of Humboldt and the County of Plumas with regard to access to perinatal services. Residents of those counties do not have adequate access to perinatal services, but they could have access to hospitals with capacity to provide services using a standby perinatal model. A special statute applied to those counties would expedite implementation of that model.

SEC. 5.

No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.