Rural hospitals: standby perinatal services.

Senator McGuire, along with several principal and coauthors, advances a rural-health policy by authorizing a 10-year pilot to establish standby perinatal services at up to five rural critical access hospitals, beginning no later than mid-2026. Standby perinatal services are defined as obstetric and neonatal care provided in a designated space that can receive patients within 30 minutes, with physician, midwifery, and nursing coverage maintained at all times. The pilot concentrates attention on Humboldt and Plumas counties, with the first two participating hospitals required to be nonprofit and located in those counties, and provisions allowing additional sites only if workforce representation considerations are met or there is no exclusive employee representative.

Key mechanisms establish the structure and criteria for participation and evaluation. The department would identify up to five qualifying critical access hospitals, evaluate applicants against standards for standby perinatal space and capacity to deliver basic surgical and anesthesia services, timely laboratory support, the ability to prepare premixed infusions, and appropriate emergency medical service capabilities. Participating hospitals must implement designated standby spaces, maintain timelines for on-site coverage, and develop contracts and policies governing maternal and neonatal transfer, telemedicine, consultation with higher-level neonatal and perinatal services, and standardized care protocols. A data-collection framework would record safety, outcomes, utilization, and populations served, with the department compiling and submitting an evaluative report to the Legislature and making it publicly available; quarterly data would also be required. The department may grant program flexibility to accommodate local capacity needs, subject to defined conditions, and can enforce compliance through licensing provisions.

Implementation, enforcement, and regulatory context shape how the pilot would function. Approved standby perinatal services would remain subject to existing licensing enforcement authorities, with the department empowered to suspend or revoke participation for noncompliance or patient-safety concerns. The standards align with national guidelines for maternal and well-newborn care and with existing California regulatory frameworks, including requirements for on-call physician, nurse, and special-physician rosters, ongoing training, and equipment inventories maintained to professional standards. Hospitals seeking participation must appoint a responsible physician on the medical staff to oversee the standby services, ensure proper contracts and procedures, and maintain documentation and transfer capabilities for care beyond the standby scope. The proposal also clarifies that no statewide appropriation is requested and that local costs could arise for capital upgrades, staffing, and data reporting, with the program presented as a time-bound, evaluative test rather than a broad mandate.

Viewed in policy context, the bill creates a tightly regulated, pilot-based approach to expanding access to perinatal care in rural California. The framework links to existing standards for levels of maternal and neonatal care, reimbursement and transfer obligations, and nurse staffing regulations, while enabling department-directed flexibility through administrative guidance. By requiring a formal evaluation and public reporting, the proposal seeks to inform future decisions about sustaining or expanding standby perinatal services beyond the pilot and to clarify the implications for rural health access and hospital operations, including potential capital and workforce considerations for participating facilities and the communities they serve.