The Weekly Articles

The California Department of Public Health (CDPH) issued draft emergency regulations to adopt staffing standards for acute psychiatric hospitals, pursuant to Health and Safety Code section 1276.4, as amended by AB 116 (Stats. 2025, ch. 21, sec. 2). The regulations in part include minimum nurse-to-patient staffing ratios for acute psychiatric hospitals that would be effective January 31, 2026. The draft regulations were issued for public comment on December 22, 2025 through All Facility Letter 25-37, with a public hearing on December 29. Some stakeholders raised concerns that adopting nurse staffing ratios with such a short effective date may result in bed closures while acute psychiatric hospitals work to hire and train additional nursing staff, urging the department to delay the effective date of the new standards. CDPH however, has indicated that, while it “will accept feedback on the draft regulations, … it will not be reflected in the official release of the emergency regulations but will be considered during the subsequent regular rulemaking process.”

In directing CDPH to adopt staffing standards through emergency regulations, AB 116 also exempted the regulations from both review by the Office of Administrative Law and compliance with certain requirements under the Administrative Procedure Act (APA) for emergency regulations, allowing CDPH to issue and adopt these standards with immediate effect without the usual APA guardrails for emergency rulemaking. The initial adoption of the emergency regulations will be effective for 180 days. The statute also authorizes CDPH to readopt the emergency regulations for two 180-day periods (compared to 90 days under the APA).

In its 2025-2026 legislative session, the California legislature enacted Assembly Bill 55 and Senate Bill 669, two bills that increase the availability of perinatal services, particularly in rural counties in which access to hospitals with comprehensive perinatal services is limited. Please see full article by clicking the title for more detail about each bill.

On December 4, 2025, the Ninth Circuit denied a motion by the U.S. Department of Education to stay a preliminary injunction enjoining implementation of the Department’s decision to discontinue funding to public schools for mental health services. State of Washington v. United States Department of Education, Case No. 2:25-cv-01228 (W.D. Wash.) Thus, the case brought by a sixteen state coalition, including California, appears on track to prevail at the trial court level. Check out the full article on CSHA's website by clicking on the title, above.

This latest edition is packed with insights on AI in health care, new CCPA compliance rules, AB 692’s impact on employers, Proposition 35 and the MCO tax, plus California’s NIH grant trends—all in one issue!

To download your electronic copy, click HERE.

Starting January 1, 2026, general acute care hospitals will be required to allow patients with physical, intellectual, developmental, or cognitive disabilities to have a family member or other caregiver present during their stay or visit, including outside regular visiting hours. Signed by Governor Newsom on October 1, 2025, AB 960 added Health and Safety Code section 1261.1 to help ensure patients with disabilities have full and equal access to and benefit from hospital services. The statute expressly includes patients with dementia as being eligible for this visitation right.

There are, however, noted exceptions. Hospitals are allowed to establish reasonable visitation restrictions, such as a limit on the number of visitors or enforcing a masking requirement. Hospitals also retain the ability to exclude visitors who pose a health or safety risk or would impede care. Similarly, the law does not override visitation restrictions during emergency periods designed to prevent the spread of disease. But even under restricted access, the law reinforces that hospitals must still allow visitation to the greatest extent possible for these patients.

California recently enacted legislation modifying the standard of proof in certain elder abuse cases. The Elder Abuse and Dependent Adult Civil Protection Act (EADACPA), established in 1982, affirms the state’s responsibility to protect elders and dependent adults from abuse in settings such as skilled nursing facilities (SNFs) and residential care facilities for the elderly (RCFEs). Under EADACPA, facilities may be held liable for physical abuse, neglect, or abandonment. Historically, victims were required to prove these claims by clear and convincing evidence, whereas financial abuse claims required only a preponderance of evidence. This higher standard has often posed challenges for plaintiffs since key records are controlled by the facility and victims cannot testify due to illness or disability.

Concerns about evidence spoliation prompted legislative efforts beginning in 2017, initially led by Assemblymember Susan Eggman. Early proposals to lower the standard of proof in cases involving destruction or concealment of evidence were unsuccessful. In the 2023–2024 cycle, Assemblymember Ash Kalra introduced Assembly Bill 2773, which was vetoed by Governor Newsom, who recommended a more balanced approach allowing judicial discretion rather than a blanket reduction of the standard.

Responding to that guidance, Assemblymember Kalra introduced Assembly Bill 251, which the Governor signed into law this fall. The new law amends Welfare and Institutions Code Section 15657 and adds Section 15657.02 to EADACPA, permitting courts to adjust the standard of proof in cases involving spoliation of evidence. It also provides a clear definition of spoliation. The legislation was co-sponsored by California Advocates for Nursing Home Reform and Consumer Attorneys of California, with support from organizations representing Ombudsman offices statewide.

CSHA member Jin Hee Park was promoted to Partner at Best Best & Krieger! Jin Hee is in the firm's Business Services and Health Care practice groups and has extensive litigation experience in multiple states representing insurance carriers and health care businesses on matters related to healthcare reimbursement, contract disputes, business disputes, premises liability, and personal injury. Congratulations, Jin Hee!

In Prime Healthcare Centinela, LLC v. United Healthcare Insurance Company, No. B334746, 2025 WL 2950428 (Oct. 20, 2025)*, the California Court of Appeal affirmed the dismissal of claims brought by Prime Healthcare (“Prime”) against United Healthcare (“United”). The case addressed whether health insurance companies regulated under the California Insurance Code have a duty to directly reimburse out-of-network hospitals for the reasonable and customary value of emergency services provided to insured patients. The court held that no such duty exists under the state’s Insurance Code.

Prime alleged that United underpaid for emergency services provided to its insureds at out-of-network facilities. Prime asserted claims for quantum meruit, open book account, and violations of California’s Unfair Competition Law, all premised on United’s alleged failure to pay the reasonable value of the services. The trial court sustained United’s demurrer, finding no statutory basis for a duty to directly reimburse out-of-network providers for the reasonable value of emergency services, and the appellate court agreed.

The court distinguished the Insurance Code from the Knox-Keene Act, which explicitly requires health care service plans to reimburse out-of-network providers for the reasonable value of emergency services. It found no similar provision in the Insurance Code and declined to infer such a duty from statutory language, legislative history, or public policy arguments. The court emphasized that questions of public policy, including whether insurers should be required to directly reimburse out-of-network providers, are for the Legislature to decide.

The decision underscores the distinct regulatory frameworks governing health insurers and health care service plans in California and leaves unresolved the broader policy question of direct reimbursement for emergency services provided at out-of-network hospitals.

*While the decision is currently unpublished, on November 7, 2025, the California Association of Health Plans submitted a request for publication. The California Hospital Association and Prime each submitted oppositions on November 10, 2025. On the same day, the court submitted a memorandum to the California Supreme Court recommending denial of the request for publication pursuant to California Rule of Court 8.1120.

CSHA member and co-editor of the Publications Committee, Kate Broderick, recently started a new role as South Division Senior Corporate Counsel for Providence Health, serving the South Division (CA). In this position, she will support enterprise regulatory strategy, physician contracting, and hospital operations within the South Division. Kate previously served as Senior Corporate Counsel for CommonSpirit Health. When asked how she celebrated her new role, Kate shared that she got a new puppy named Max—some readers may have already seen his surprise cameo in the summer CHLN issue.

Have Member News to Share?
We love to feature updates from our members! If you have news, announcements, or achievements you'd like us to highlight, please email your news to co-editor of the Publications Committee, Andrea Frey, at afrey@hooperlundy.com.

On September 29, 2025, the California Department of Public Health (CDPH) denied two petitions seeking to amend Title 22 hospital licensing regulations to expand eligibility for organized medical staff membership in general acute care hospitals to include “advanced licensed providers” (such as NPs, CRNAs, CNMs, and CNSs). One petition was submitted by the American Nurses Association\California (ANA\C) in 2024 and the other by the California Association of Nurse Anesthesiology (CANA) in 2023. CDPH issued the denials concurrently for substantially similar reasons, finding that the requested expansion in both petitions would conflict with the statutory framework established under Assembly Bill 890 (AB 890) and enacting statutes, Business & Professions Code §§ 2837.103–104.

As a reminder, AB 890 created a new pathway for nurse practitioners who meet specified requirements to apply to be certified by the Board of Registered Nursing to practice independently in hospitals and other settings without standardized procedures, effective January 2023. The related B&P Code provisions also delineate the scope of medical staff eligibility for certified NPs.

CDPH concluded that it lacked authority to make the requested amendments, since doing so would improperly extend medical staff eligibility beyond AB 890’s statutory framework by allowing all advanced licensed providers to become medical staff members – “directly undermining the legislative intent of AB 890 to restrict medical staffing eligibility to select certified nurse practitioners with advanced experience, training, and qualifications.” However, CDPH noted that it may consider future regulatory updates to align Title 22 with AB 890 and encouraged stakeholder participation in any formal rulemaking process.