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<ns0:Description>
<ns0:Id>20250AB__192399INT</ns0:Id>
<ns0:VersionNum>99</ns0:VersionNum>
<ns0:History>
<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-12</ns0:ActionDate>
</ns0:Action>
</ns0:History>
<ns0:LegislativeInfo>
<ns0:SessionYear>2025</ns0:SessionYear>
<ns0:SessionNum>0</ns0:SessionNum>
<ns0:MeasureType>AB</ns0:MeasureType>
<ns0:MeasureNum>1923</ns0:MeasureNum>
<ns0:MeasureState>INT</ns0:MeasureState>
</ns0:LegislativeInfo>
<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Soria</ns0:AuthorText>
<ns0:AuthorText authorType="PRINCIPAL_COAUTHOR_ORIGINATING">(Principal coauthors: Assembly Members Gipson and Ransom)</ns0:AuthorText>
<ns0:AuthorText authorType="COAUTHOR_ORIGINATING">(Coauthors: Assembly Members Bonta, Mark González, Haney, and Rogers)</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Soria</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>PRINCIPAL_COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Gipson</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>PRINCIPAL_COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Ransom</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Bonta</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Mark González</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Haney</ns0:Name>
</ns0:Legislator>
<ns0:Legislator>
<ns0:Contribution>COAUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Rogers</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title> An act to amend Sections 129380, 129383, 129384, 129385, and 129387 of the Health and Safety Code, relating to hospitals, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately.</ns0:Title>
<ns0:RelatingClause>hospitals, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Distressed Hospital Loan Program.</ns0:Subject>
</ns0:GeneralSubject>
<ns0:DigestText>
<html:p>Existing law requires the Department of Health Care Access and Information to administer the Distressed Hospital Loan Program, until January 1, 2032, which provides loans to not-for-profit hospitals and public hospitals in significant financial distress or to governmental entities representing a closed hospital to prevent the closure of, or facilitate the reopening of, those hospitals. Existing law requires the department to develop a methodology to evaluate an at-risk hospital’s potential eligibility for state assistance from the program, and authorizes the methodology for determining financial distress to consider the hospital’s prior and projected performance on financial metrics, as specified. Existing law requires a hospital or a closed hospital applying for aid under this program to provide, among other things, the California Health Facilities Financing Authority and the department
with financial information demonstrating the hospital’s need for financial assistance due to financial hardship. Existing law requires the department to issue the loan award to a qualifying hospital as soon as reasonably practicable following its eligibility determination. Existing law prohibits not-for-profit hospitals and public hospitals that belong to integrated health care systems with more than 2 separately licensed hospital facilities from being eligible for state assistance under the program.</html:p>
<html:p>This bill would make any hospital, regardless of ownership type or system affiliation, eligible for state assistance under the program for awards provided on or after the effective date of this act, as specified, if it meets the applicable criteria for significant financial distress as established by the department and the authority. The bill would require the projections that determine financial distress to account for impacts of federal and state policy changes
affecting hospital reimbursement or health care coverage, including, but not limited to, the federal One Big Beautiful Bill Act. </html:p>
<html:p>Existing law requires the department to provide loan forgiveness or modification of loan terms to an applicant based upon criteria determined by the department and subject to the approval of the department and the authority. Existing law requires the department to establish the terms and conditions associated with accepting loan forgiveness or modification of loan terms, subject to approval of the Department of Finance.</html:p>
<html:p>This bill would require the evaluation for loan forgiveness incorporate projections of future financial performance in addition to a hospital’s point-in-time financial condition. The bill would also, in place of the current criteria, require the department to provide loan forgiveness to any participant of the program who received a loan award before the effective date of this act,
as specified, if the department and authority determine the participant has demonstrated a good faith effort to comply with program requirements through January 1, 2026, and the financial projections demonstrate that the participant will become financially distressed as a result of loan repayments under the program or other outside factors, including, but not limited to, the impacts of the federal One Big Beautiful Bill Act.</html:p>
<html:p>Existing law establishes the Distressed Hospital Loan Program Fund, which is administered by the department. Existing law authorizes the Department of Finance to transfer up to $150,000,000 from the General Fund to the Distressed Hospital Loan Program Fund between state fiscal years 2022–23 and 2023–24 to implement these provisions. Existing law requires any funds transferred to be available for encumbrance or expenditure until December 31, 2034, and abolishes the fund on December 31, 2031.</html:p>
<html:p>This bill
would appropriate $300,000,000 from the General Fund to the Distressed Hospital Loan Program Fund to provide additional rounds of funding to hospitals in financial distress. The bill would require any funds transferred to be available for encumbrance or expenditure until December 31, 2034, and would abolish the fund on December 31, 2034. The bill would repeal these provisions on January 1, 2035.</html:p>
<html:p>This bill would declare that it is to take effect immediately as an urgency statute.</html:p>
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<ns0:DigestKey>
<ns0:VoteRequired>TWO_THIRDS</ns0:VoteRequired>
<ns0:Appropriation>YES</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
<ns0:LocalProgram>NO</ns0:LocalProgram>
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<ns0:ImmediateEffect>YES</ns0:ImmediateEffect>
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<ns0:Urgency>YES</ns0:Urgency>
<ns0:TaxLevy>NO</ns0:TaxLevy>
<ns0:Election>NO</ns0:Election>
<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
<ns0:BudgetBill>NO</ns0:BudgetBill>
<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
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</ns0:Description>
<ns0:Bill id="bill">
<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_2213C310-837F-4F1E-A25C-47B30E62EF5E">
<ns0:Num>SECTION 1.</ns0:Num>
<ns0:Content>
<html:p>The Legislature finds and declares all of the following:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Hospitals are essential health care infrastructure. Every year, California’s hospitals save countless lives, restore patients’ health, and provide livelihoods for hundreds of thousands of workers.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Timely access to hospital care is critical to saving lives and preventing avoidable harm. Hospital closures or significant reductions in services increase travel times, delay diagnosis and treatment, and heighten risks for patients experiencing time-sensitive medical conditions, including heart attack, stroke, sepsis, respiratory distress, and obstetric emergencies.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Hospitals across the state are in severe financial distress. Nearly half of California hospitals are operating in the red. Now, as a result of the looming impacts of the federal One Big Beautiful Bill Act (Public Law No. 119-21), many more hospitals face a precarious financial outlook.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Hospitals experiencing financial distress disproportionately provide care to underserved communities, including Medi-Cal beneficiaries, uninsured patients, and patients with complex medical and social needs. They play a vital role as safety net providers and are central to advancing health equity in California.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Hospital closures and service reductions have significant ripple effects on communities, including job losses, reduced local economic activity, increased emergency medical transport times, and the loss of clinical training
sites that are necessary to sustain the health care workforce.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
The state has a compelling interest in preserving access to hospital services where closures or service reductions would threaten the adequacy of health care access for a community, particularly for underserved and high-need populations.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The Distressed Hospital Loan Program administered by the Department of Health Care Access and Information has proven remarkably successful in addressing short-term liquidity challenges, covering extraordinary or unanticipated costs that otherwise jeopardized the continued operation of an otherwise viable hospital. To date, the program has helped 15 hospitals keep their doors open, and 1 hospital to reopen entirely.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
Notwithstanding the success of the program, there is an acute and growing need for a second
round of loans. These needs are driven by the volatile economic and policy environment causing rising prices and falling reimbursement. Loans provided through the Distressed Hospital Loan Program will provide sustainability while promoting accountability. They will support hospitals as they implement corrective action plans, pursue operational and financial restructuring, engage in affiliations or transactions, address facility or infrastructure needs, and stabilize services necessary to maintain patient access to care.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Providing loans through the Distressed Hospital Loan Program is essential to prevent avoidable hospital closures, reduces downstream costs to the state associated with delayed or higher cost care, and supports the efficient use of public resources.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
It is therefore the intent of the Legislature to reinvigorate and strengthen the Distressed Hospital Loan
Program administered by the Department of Health Care Access and Information in order to preserve essential hospital services, protect access to care for Californians, and promote the long-term stability of the state’s hospital delivery system.
</html:p>
</ns0:Content>
</ns0:BillSection>
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 129380 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_99DFC8FB-7A15-4584-B972-A2D41E831895">
<ns0:Num>129380.</ns0:Num>
<ns0:LawSectionVersion id="id_9B721D4F-E710-4C4E-8E15-CE6983913BCA">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
This program shall be known, and may be cited, as the Distressed Hospital Loan Program.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The purpose of this program is to provide interest-free cashflow loans to not-for-profit hospitals and public hospitals in significant financial distress or to governmental entities representing a closed hospital, except as otherwise provided, to prevent the closure of, or facilitate the reopening of, those hospitals.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The purpose of the program also includes providing interest-free cashflow loans or other relief as authorized by this chapter to any hospital, regardless of ownership type or system affiliation, that meets
the applicable criteria for significant financial distress as established by the department and the authority.
</html:p>
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<ns0:BillSection id="id_9F4118C9-5857-4A79-9944-371A5D37C7ED">
<ns0:Num>SEC. 3.</ns0:Num>
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Section 129383 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_799087CD-F514-4D52-8041-D71037DE9DB6">
<ns0:Num>129383.</ns0:Num>
<ns0:LawSectionVersion id="id_44E6BA18-FBCD-4215-BE35-584EC0CAAD01">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
In collaboration with the State Department of Health Care Services, the Department of Managed Health Care, and the State Department of Public Health, the department shall develop a methodology to evaluate an at-risk hospital’s potential eligibility for state assistance from the program.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The methodology shall consider factors, including, but not limited to, whether the hospital is in financial distress, as solely determined by the department, whether the hospital is small, rural, a critical access hospital, a trauma center, an urban hospital providing access for an underserved area, a hospital that serves a disproportionate share of Medicaid patients, or serving a rural catchment area, whether closure of the hospital would
significantly impact access to services in the region, and whether the hospital is publicly owned.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The methodology for determining financial distress may consider such factors as the hospital’s prior and projected performance on financial metrics, including the amount of cash on hand, and whether the hospital has, or is projected to experience, negative operating margins. Projections shall account for impacts of federal and state policy changes affecting hospital reimbursement or health care coverage, including, but not limited to, the federal One Big Beautiful Bill Act (Public Law No. 119-21).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The methodology shall also be used for identification and monitoring of hospitals at risk of financial distress.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A hospital or a closed hospital applying for aid under this program shall provide the authority and the department with financial information, in a format determined by the authority and the department, demonstrating the hospital’s need for financial assistance due to financial hardship.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Before receiving state assistance under this program, an eligible hospital shall submit a plan to the authority, which it shall share with the department, with projections detailing the uses of the proposed loan and strategies proposed by the hospital’s governing body to regain financial viability and continue to operate.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Before issuing a loan under this chapter, the department shall review the plan submitted by an eligible hospital and make a determination that the plan is viable and there is a reasonable likelihood that the hospital will be able
to regain financial viability and continue to operate as a hospital. The department shall not issue a loan award if the department is unable to make this determination.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The department shall issue the loan award to a qualifying hospital as soon as reasonably practicable following its eligibility determination.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
For awards provided under this chapter before the effective date of the act that added paragraph (2), not-for-profit hospitals and public hospitals that belong to integrated health care systems with more than two separately licensed hospital facilities shall be ineligible for state assistance under the program.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
For awards provided under this chapter after the effective date of the act that added this paragraph, any hospital, regardless of ownership type or system affiliation, shall be eligible for state assistance under the program if it meets the applicable criteria for significant financial distress as established by the department and the authority.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
The department shall, in consultation with the authority, determine the application process, underwriting review, and methodology for approval and distribution of the loans under the program.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The department shall have the authority to determine service provision requirements in approving, and for the duration of, loans to eligible hospitals. In making its determination, the department shall consider the impact of any changes to the hospital’s
service delivery on access to necessary medical care, particularly for beneficiaries of the Medi-Cal program.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
The department shall make the methodology publicly accessible on its internet website.
</html:p>
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<ns0:Num>SEC. 4.</ns0:Num>
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Section 129384 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_04D41279-A7BE-47C5-98D8-8AC0AD66CCAD">
<ns0:Num>129384.</ns0:Num>
<ns0:LawSectionVersion id="id_B73C35A5-1E65-4F9F-9345-A2C2BAC00677">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
Notwithstanding Sections 15432 and 15451.5 of the Government Code, unless subdivision (c) applies, a hospital shall be required to begin making monthly repayments of the loan after the first 18 months and shall discharge the loan within 72 months of the date of the loan.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Notwithstanding any other law and to the extent permissible under federal rules, security for the cashflow loans in this chapter shall be Medi-Cal reimbursements due to the hospital from the State Department of Health Care Services. The department’s or authority’s recoupment of these cashflow loans shall not exceed 20 percent of the hospital’s respective Medi-Cal checkwrite payments until the loan amount has been satisfied. In the event that a 20-percent withhold will not result in full
repayment of the loan within a 72-month period, the department may extend the repayment term of the loan.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The department, in consultation with the authority, and upon approval of the Department of Finance, shall develop an application and approval process for loan forgiveness or modification of the terms of the loan, including a delay of the beginning of the loan repayment period or an extension of the 72-month loan repayment term, or both. The process shall include, but is not limited to, eligibility criteria for an applicant for loan forgiveness or modification, including which portion of a loan may be forgiven or modified. The criteria shall incorporate projections of future financial performance in addition to a hospital’s point-in-time financial condition.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The department shall provide loan forgiveness or modification of loan terms to an applicant based upon criteria determined by the department and subject to the approval of the department and the authority. The department shall provide loan forgiveness to any participant of the program who received a loan under this chapter before the effective date of the act that added subparagraphs (A) and (B), if the department and authority determine the participant meets both of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The participant has demonstrated a good faith effort to comply with program requirements through January 1, 2026.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Financial projections demonstrate that the participant will become financially distressed as a result of loan repayments under the program or other outside factors, including, but not limited to, the impacts of the federal One Big Beautiful Bill Act (Public Law No. 119-21).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Before any action on a request for forgiveness or modification of any loan that would result in the extension of the payback
period by more than one year, and again not later than 60 days after final approval or denial of the forgiveness or modification, the department shall submit to the Joint Legislative Budget Committee and relevant policy and fiscal committees of the Legislature notice of the request and the subsequent action, including a summary of the request and reason for the denial, approval, or modification.
</html:p>
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<ns0:Num>SEC. 5.</ns0:Num>
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Section 129385 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_F66A1150-74BB-4BA4-82F6-AC27CB98D149">
<ns0:Num>129385.</ns0:Num>
<ns0:LawSectionVersion id="id_3EF98FF0-55EA-4732-A416-B7E8E02676E1">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Distressed Hospital Loan Program Fund is hereby established in the State Treasury. The fund shall be administered by the department consistent with this chapter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Notwithstanding Section 13340 of the Government Code, all moneys in the fund are continuously appropriated, without regard to fiscal years, for the department and the authority to implement this chapter.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The authority shall make secured loans from the Distressed Hospital Loan Program Fund to a hospital or to a governmental entity representing a closed hospital, for purposes of preventing the closure, or facilitating the reopening, of the hospital.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The
department may allocate an amount not to exceed 5 percent of total program funds to administer the program, including, but not limited to, administrative costs to the authority. Any funds transferred shall be available for encumbrance or expenditure until December 31, 2034.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The Department of Finance may transfer up to one hundred fifty million dollars ($150,000,000) from the General Fund to the Distressed Hospital Loan Program Fund between state fiscal years 2022–23 and 2023–24 to implement this chapter.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The Department of Finance may transfer, subject to Section 14105.200 of the Welfare and Institutions Code, up to one hundred fifty million dollars
($150,000,000) from the Medi-Cal Provider Payment Reserve Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2023–24 to implement this chapter.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The Department of Finance shall transfer three hundred million dollars ($300,000,000) from the General Fund to the Distressed Hospital Loan Program Fund in state fiscal year 2025–26 to provide additional rounds of funding to hospitals in financial distress.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
All moneys accruing to the authority and the department under this chapter from any source shall be deposited into the fund.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
The Treasurer may invest moneys in the fund that are not required for its current needs in eligible securities specified in Section 16430 of the Government Code
and may transfer moneys in the fund to the Surplus Money Investment Fund for investment pursuant to Article 4 (commencing with Section 16470) of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government Code.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
Notwithstanding Section 16305.7 of the Government Code, all interest or other increment resulting from the investment or deposit of moneys from the fund shall be deposited in the fund.
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<html:p>
(i)
<html:span class="EnSpace"/>
Moneys in the fund shall not be subject to transfer to any other funds pursuant to any provision of Part 2 (commencing with Section 16300) of Division 4 of Title 2 of the Government Code, except to the Surplus Money Investment Fund.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
Effective December 31,
2034, the Distressed Hospital Loan Program Fund in the State Treasury, created pursuant to this chapter, is hereby abolished. After accounting for all final program transactions, any remaining Distressed Hospital Loan Program Fund reserves shall be returned to the source of origin, in the amounts of up to one hundred fifty million dollars ($150,000,000) to the General Fund, and up to one hundred fifty million dollars ($150,000,000) to the Medi-Cal Provider Payment Reserve Fund. Any other remaining balance, assets, liabilities, and encumbrances of the Distressed Hospital Loan Program Fund shall revert to the General Fund. The department shall deposit all subsequent loan repayments or Medi-Cal reimbursements withheld for due cause pursuant to subdivision (b) of Section 129384 to the Treasurer, to the credit of the General Fund.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
The department and the authority may require any hospital receiving a loan
under this chapter to provide the department and the authority with an independent financial audit of the hospital’s operations for any fiscal year in which a loan is outstanding.
</html:p>
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<ns0:BillSection id="id_0271E0B4-4034-4897-BB5D-FF7B139E02F4">
<ns0:Num>SEC. 6.</ns0:Num>
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Section 129387 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_D67D639B-4629-48BC-A6FA-813A50D00FCD">
<ns0:Num>129387.</ns0:Num>
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<ns0:Content>
<html:p>This chapter shall remain in effect only until January 1, 2035, and as of that date is repealed.</html:p>
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</ns0:LawSection>
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</ns0:BillSection>
<ns0:BillSection id="id_C890EE13-54B6-4551-A2F5-8B48F18B1FF3">
<ns0:Num>SEC. 7.</ns0:Num>
<ns0:Content>
<html:p>This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:</html:p>
<html:p>In order to prevent further hospital closures and reductions to health care access in vulnerable communities, it is necessary that this act take effect immediately. </html:p>
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