San Francisco County Municipal Code Art. 3 Hospitals

Sec. 111. Institutions. Sec. 112. Emergency Medical Services. Sec. 113. Functions. Sec. 114. Mental Health Service. Sec. 115. Admission to Hospitals, Allied Institutional Facilities or Services of City and County. Sec. 115.1. Priority of Admission to Institutions of the Department of Public Health. Sec. 116. Unit Cost. Sec. 118. Controller to Prescribe Forms, Etc. Sec. 119. Investigation of Patients. Sec. 120. Billing. Sec. 120.1. Fees for Emergency Medical Services Waived. Sec. 121. Billing to County of Residence. Sec. 122. Billing to Retirement System. Sec. 123. Penalty. Sec. 124. Reimbursement for Aid Granted. Sec. 124.1. Value of Aid Rendered. Sec. 124.2. Agreement to Reimburse. Sec. 124.3. Evaluation of Institutional Care – Laguna Honda Hospital. Sec. 124.4. Liens. Sec. 124.5. Liens on Actions Against Third Party. Sec. 125. Chief Administrative Officer Authorized to Contract with Other Hospitals. Sec. 126. Professional Fee of Physicians and Dentists. Sec. 127. Disposal of Unclaimed Personal Property at Laguna Honda Hospital. Sec. 128. Patient Rates. Sec. 128.1. Patient Rates/Fire Department EMS Services. Sec. 129. Charity Care Policy Reporting and Notice Requirement. Sec. 130. Definitions. Sec. 131. Reporting to the Department of Public Health. Sec. 132. Notification. Sec. 133. Authority to Adopt Rules and Regulations. Sec. 134. Enforcement. Sec. 135. City Undertaking Limited to Promotion of General Welfare. Sec. 136. Severability. Sec. 137. Preemption. Sec. 138. Annual Report to the Health Commission. Sec. 139. Written Informed Consent and Pre-Test Counseling Prior to HIV Testing. Sec. 140. Findings. Sec. 140.1. Definitions. Sec. 140.2. Reporting to the Department of Public Health. Sec. 140.3. Promotion of the General Welfare.

SEC. 111. INSTITUTIONS. The Department of Public Health is hereby authorized and directed to maintain the institutions to be known as Hassler Hospital, formerly known as Hassler Health Home, Laguna Honda Hospital (for Rehabilitation and Chronic Care), formerly known as Laguna Honda Home, and San Francisco General Hospital, formerly known as San Francisco Hospital. (Added by Ord. 75-66, App. 4/11/66) SEC. 112. EMERGENCY MEDICAL SERVICES. The Fire Department is hereby authorized to provide emergency medical services with the approval of the Health Commission and subject to such conditions and requirements as the Health Commission may establish pursuant to Charter Section 4.110. The Department of Public Health shall determine which Fire Department personnel may provide emergency medical services and shall determine the standards, policies and medical protocols that shall govern the Fire Department in its operations with respect to these services. Nothing herein is intended to affect the authority granted to the San Francisco Emergency Medical Services Agency, which serves as the local emergency medical services agency under State law. (Added by Ord. 171-97, App. 5/2/97) SEC. 113. FUNCTIONS. The functions of the institutions may include, but are not limited to, the following: (1) care of the sick and injured as in-patients, or out-patients, (2) prevention of disease and disability, (3) care of certain persons for public health necessity, (4) promotion of health, (5) education of medical personnel, nurses, and paramedical personnel, (6) advancement of research and scientific medicine. (Added by Ord. 75-66, App. 4/11/66) SEC. 114. MENTAL HEALTH SERVICE. A Community Mental Health Service in the City and County shall be administered by the Director of Public Health for the City and County, pursuant to the provisions of Division 8 of the Welfare and Institutions Code of the State (the Short-Doyle Act) and Chapter 15 of the San Francisco Administrative Code. The Department of Public Health is hereby authorized and directed to establish and maintain psychiatric services wherever necessary and feasible, in accordance with this Section. Such services may be established and maintained whether they are reimbursable under the Short-Doyle Act or not. Patients shall be charged in whole or in part for services and treatment given them as provided in this Section and in accordance with their ability to pay as determined by the Director of Public Health after investigation. Maximum charges shall be as proposed by the Chief Administrative Officer, concurred in by the controller, and adopted in a resolution by the Board of Supervisors. (Added by Ord. 75-66, App. 4/11/66) SEC. 115. ADMISSION TO HOSPITALS, ALLIED INSTITUTIONAL FACILITIES OR SERVICES OF CITY AND COUNTY. There shall be admitted to the institutions defined in Section 111 the following: (1) An indigent sick person or a dependent poor person of the City and County of San Francisco who possesses the required residence qualifications, upon application and after investigation and approval by the Director of Public Health. (2) A narcotic addict or habitual inebriate temporarily in custody.

(3) A physically defective and physically handicapped person under the age of 21 years when the parents or guardian of such person are not financially able to secure proper care or treatment and when such person's admission and treatment has been duly authorized in the manner provided by law. (4) A prisoner confined to the City and County Jail who requires medical or surgical treatment necessitating hospitalization where such treatment cannot be furnished or supplied at such jail when any court of the City and County shall have ordered the removal of such prisoner to the San Francisco General Hospital. (5) A person in need of immediate hospitalization on account of accident or sudden sickness or injury or mental disorder or by reason of sickness or injury caused by or arising in a public emergency or calamity or disaster. (6) A person who has or who is suspected of having any communicable disease, or a person who is or who is suspected of being a carrier or other potential source of infectious disease. (7) A person to be isolated in the San Francisco General Hospital by order of the Health Officer because he has or is suspected of having a communicable or infectious disease or because he is or is suspected of being a carrier of such a disease. (8) An expectant mother who is unable to pay for her necessary care. (9) An indigent sick person or dependent poor person from another county whose care is reimbursable by the county of residence, as provided in Section 1475 of the Health and Safety Code of the State. (10) A City and County employee who is judged by the Retirement Board to have suffered an injury arising out of and in the course of his employment by the City and County, when hospitalization is reasonably required to cure and relieve the effects of such injury. (11) Members of the San Francisco Disaster Corps who are determined under the provisions of the State Labor Code to have suffered an injury arising out of and in the course of performance of duties as members of the San Francisco Disaster Corps, when hospitalization is reasonably required to cure and relieve the effects of such injury. (12) Any authorized volunteer or trainee assigned by the Director of Public Health, or Administrator of an institution and (a) assisting in the care and treatment of patients in any of the said institutions, or (b) assisting under supervision in any Bureau, Division, or Service of the Department of Public Health, who is judged by the Retirement Board to have suffered injury while actually serving as such volunteer in any of such services, when hospitalization is reasonably required to cure or relieve the effects of such injury. (13) Any juvenile committed to Log Cabin Ranch School or in custody in the Youth Guidance Center who requires medical or surgical treatment which cannot be furnished in such facility and who is adjudged by the Retirement Board to have suffered injury while actually performing duties assigned by the Chief Probation Officer of the Juvenile Court when hospitalization is reasonably required to cure or relieve the effects of such injury. (14) Any authorized volunteer including student interns assigned by the Chief Probation Officer of the Juvenile Court and rendering volunteer service at the Youth Guidance Center or Log Cabin Ranch School who is adjudged by the Retirement Board to have suffered injury while actually performing volunteer service, when hospitalization is reasonably required to cure or relieve the effect of such injury. (15) Any juvenile committed to Log Cabin Ranch School or in custody of Youth Guidance Center who requires medical or surgical treatment which cannot be furnished in such facility when the Juvenile Court shall have ordered removal of such juvenile person. (16) A person sent by an Agency of the United States Government under conditions as may be contracted for between the Director of Public Health and the United States Government. (17) A person recommended for admission to special investigative units operated solely with funds of State and/or Federal Government, pursuant to agreement therewith, and such persons shall not be subjected to a financial investigation and shall not be required to have residential qualifications. (18) A person in need of services not readily available elsewhere in the City and County of San Francisco. (19) Any patient who becomes mentally ill while in the San Francisco General Hospital may be transferred to the Psychiatric In- patient Service, with the approval of the Chief of that Service or his duly authorized representative. (20) Any person suspected of being mentally ill who is in the City Prison or County Jail. Such person may be examined in those places or in any appropriate facility of the Department upon an order of any judge of the Superior and Municipal Courts for observation, examination or treatment and for return to the Prison or Jail as medically indicated. (21) Any resident of the City and County of San Francisco suffering from mental illness may be admitted as a voluntary patient to the Psychiatric Service. Financial investigation shall be made under the rules and regulations of the Department of Public Health. Such a patient must be, at the time of making application for admission, in such a state of mind as to render him competent to make such application. Any person so received and detained shall be deemed a voluntary patient. Such patient shall not be detained in said Psychiatric Service for more than seven days after having given notice in writing of his desire to leave to the person in charge, and in no case shall a patient remain for a period longer than 90 days. (22) Any mentally disturbed person brought into the Psychiatric Service by the police, City ambulance, relatives or friends, transferred from any of the institutions of the City and County

d Psychiatric Service for more than seven days after having given notice in writing of his desire to leave to the person in charge, and in no case shall a patient remain for a period longer than 90 days. (22) Any mentally disturbed person brought into the Psychiatric Service by the police, City ambulance, relatives or friends, transferred from any of the institutions of the City and County may be accepted for temporary hospitalization on the certification by the Chief of Psychiatric Service, or his duly authorized representative, that emergency detention is necessary. The person may be cared for and treated for a period not to exceed 72 hours, excluding Sundays and nonjudicial days at which time such person shall be discharged unless a petition of mental illness is presented to a judge of the Superior Court and the Court issues an order for detention of such person, or unless he requests treatment pursuant to Subsection (21) above.

Provided, nothing in Subsections (1) to (22) inclusive hereof shall be construed as restraining the Director of Public Health from obeying or carrying out or giving effect to any law that may exist or be hereafter passed, relating to the hospitalization of patients in County institutions. (Added by Ord. 75-66, App. 4/11/66)

PUBLIC HEALTH. Notwithstanding any other provision of this Code, any sick, disabled, or injured person may be admitted to the institutions of the Director of Public Health of the City and County of San Francisco as an in-patient or out-patient. The Director of Public Health shall give preference in the admission of patients in the following order of priority.

1. Sick or injured persons in need of emergency care.
2. Sick, medically indigent residents of the City and County of San Francisco.
3. Sick persons certified by the San Francisco Department of Social Services as eligible for benefits under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14500) of Part 3 of Division 9 of the Welfare and Institutions Code.
4. Sick residents of the City and County of San Francisco.
5. The determination of residence under this Article shall be made in accordance with the provisions of Sections 17100 through 17105 of the Welfare and Institutions Code. (Added by Ord. 75-66, App. 4/11/66) SEC. 116. UNIT COST. The Director of Public Health each year shall compute the unit cost of maintaining, treating, and caring for each type of patient at the institutions and their out-patient services, the definition or classification of types of patients to be determined by the Director of Public Health. The method of said computation of unit cost with respect to each type of patient cared for in each institution shall be as approved by the Controller of the City and County of San Francisco. The unit cost so determined shall be approved by the Chief Administrative Officer and the Board of Supervisors. Sec. 117. (Added by Ord. 75-66, App. 4/11/66; repealed by Ord. 106-03, File No. 030624, App. 5/23/2003) SEC. 118. CONTROLLER TO PRESCRIBE FORMS, ETC. Pursuant to Section 64 of the Charter, the Controller shall prescribe the forms, methods, and procedure to be followed in billing said persons or their relatives under Sections 115 to 122 inclusive of this Article. (Added by Ord. 75-66, App. 4/11/66) SEC. 119. INVESTIGATION OF PATIENTS. All persons admitted or committed to the Hassler Hospital, Laguna Honda Hospital, or San Francisco General Hospital of the City and County of San Francisco, or who receive prehospital emergency medical services from the San Francisco Fire Department, except under provisions of Subsections (10) to (14) inclusive and (17) of Section 115 hereof, or persons who are recipients of public assistance, shall be investigated by the Director of Public Health or the San Francisco Fire Department for those who receive prehospital emergency medical services, who shall determine the financial ability of such persons to pay, in whole or in part, either directly or through relatives legally obligated to pay in whole or in part for the institutional or prehospital emergency medical service rendered. The spouse and every relative who may be legally obligated to support an applicant or recipient of indigent aid shall furnish, within 10

days of request by the Director of Public Health and/or the San Francisco Fire Department on forms provided by the Department, information necessary to the determination of the liability of said spouse and relative, or either of them to support said applicant or recipient of aid. Provided, however, that whenever any person admitted to the Hassler Hospital or Laguna Honda Hospital receives a total monthly income in an amount less than the actual cost of his care and from which income no personal allowance is made as a condition or term thereof, the Director of Public Health shall permit such person to retain from his said total income each month a reasonable amount to be used for his personal and incidental needs. If the source of monthly income is aid to needy disabled or old age aid or blind aid, as provided in the Welfare and Institutions Code, the amount to be retained for personal and incidental needs shall be the same as allowed by the regulations of the State of California Social Welfare Department for such personal and incidental needs. Any person admitted to any institution who shall own a life insurance policy or policies having an actual cash surrender value of $500 or more may be required by said Director of Public Health to assign by proper written instruments said policy or policies to the City and County of San Francisco. No provisions of this code shall constitute a waiver of the right of the City and County of San Francisco to recover the full cost of care from any person or persons able to pay therefor or from the estates of such person, where such ability is subsequently shown. (Added by Ord. 75-66, App. 4/11/66; amended by Ord. 106-03, File No. 030624, App. 5/23/2003) SEC. 120. BILLING. The Director of Public Health shall bill every person legally obligated to pay for institutional service rendered, and the San Francisco Fire Department shall bill every person legally obligated to pay for prehospital emergency medical services provided by Fire Department personnel, on the basis of the rates to be established as provided in Section 128 and 128.1 hereof, and to the extent of his ability to pay, in whole or in part, either directly or through relatives legally obligated to pay in whole or in part, as determined under Sections 116 to 122, inclusive, hereof. Billing to patients at the Institutions may consist of a direct charge against the patient's Home Trust Fund Account or Patient's Account in the amount established by his ability to pay as provided in Section 119. Such billing shall include costs and fees application under the provisions of Section 5201 of the Welfare and Institutions Code of the State of California relative to proceedings and medical examiners' fees for the mentally ill. (Added by Ord. 75-66, App. 4/11/66; amended by Ord. 106-03, File No. 030624, App. 5/23/2003)

(a) The San Francisco Fire Department shall waive its fee for Emergency Medical Services if the patient and/or any other person legally obligated to pay provides the Department with reliable information that: 1. The patient and/or any other persons who are legally obligated to pay have insufficient annual income to pay the bill without undue hardship. The Fire Department shall define "insufficient income" but may not define it at a rate less than 300% of the Federal Poverty Level as set forth in the Federal Register; and 2. The patient is not covered by an insurance that would pay for the services and cannot obtain MediCal or MediCare. (b) The Fire Department has the sole authority to determine whether the information provided supports a waiver of the fee. (Added by Ord. 185-05, File No. 050993, App. 7/29/2005) SEC. 121. BILLING TO COUNTY OF RESIDENCE. The care of all persons admitted to the several institutions enumerated herein under the provisions of Section 115(9) hereof, shall be billed under provisions of the Health and Safety Code of the State of California, Section 1475, unless a reciprocal agreement between the County of Residence and City and County of San Francisco is in existence pursuant to Section 1475 of the State Health and Safety Code. (Added by Ord. 75-66, App. 4/11/66)

SEC. 122. BILLING TO RETIREMENT SYSTEM. The care of all persons admitted to the several institutions enumerated herein under the provisions of Subsections (10) to (14), inclusive of Section 115, hereof, shall be billed to the City and County of San Francisco Employees' Retirement System. (Added by Ord. 75-66, App. 4/11/66) SEC. 123. PENALTY. Every person who knowingly, fraudulently and designedly conceals or withholds any information concerning his financial condition or means or ability to pay or concerning other conditions, or who knowingly makes or causes to be made, either directly or indirectly or through any agency whatsoever, any false statement in writing, with intent that it shall be relied upon, respecting the financial condition or means or ability to pay of himself or any other person in whom he is interested, or for whom he is acting, for the purpose of gaining admission to and receiving care and treatment in the institutions, shall be guilty of a misdemeanor, punishable by a fine of not more than $500, or by imprisonment in the County Jail for not more than six months, or by both such fine and imprisonment. Said person, in addition the penalties hereinabove set forth, shall be billed by the institution rendering said services for the full amount of the cost of such institutional care and treatment, thus fraudulently obtained, in accordance with the basic rates, legally established and determined therefor. (Added by Ord. 75-66, App. 4/11/66) SEC. 124. REIMBURSEMENT FOR AID GRANTED. Every person; except persons enumerated in Subsections (10) to (14) inclusive, and Section (17) of Section 115 hereof, and persons found to be exempt from liability for benefits under the provisions of Chapter 7 or Chapter 8, Part 3, Division 9 of the Welfare and Institutions Code of the State of California, who is given or shall receive aid directly or indirectly from public monies drawn through the Treasury of the City and County of San Francisco, shall be liable to the extent of his ability to pay as determined by Section 119 hereof, for the value of said aid so allowed, granted, or given, and if any of said aid granted to said person is for injury sustained by reason of an accident or wrongful act, the value of aid shall, if said person or other persons entitled to bring such action asserts or maintains a claim against another for damages on account of his or her injury or because of his or her death, constitute a lien upon the damages recovered, or to be recovered, either by judgment, settlement or compromise by said person, or by his or her heirs or personal representative in case of his or her death, or other persons lawfully entitled to a cause of action because of his or her death. (Amended by Ord. 304-80, App. 6/27/80; Ord. 355-90, App. 10/17/90)

The actual cost of the aid shall constitute its value. The rates established by the Board of Super-visors pursuant to Section 128 and 128.1 hereof for aid granted or given to persons at the institutions or by the San Francisco Fire Department shall constitute prima facie evidence of the reasonableness of said charge and the resulting amount which shall be due to the City and County of San Francisco. (Added by Ord. 75-66, App. 4/11/66; amended by Ord. 106-03, File No. 030624, App. 5/23/2003)

As a consideration for the allowing, granting or giving of aid, the officer, board, or commission shall take from every person receiving aid except for persons enumerated in Subsections (10) to (14), inclusive, and (17) of Section 115, hereof the following agreement: "AGREEMENT TO REIMBURSE "In consideration of the granting of aid to me by the City and County of San Francisco, I hereby pledge, promise and agree to reimburse and repay said City and County all sums of money actually expended in my behalf or aid granted or given by the City and

County of San Francisco for my care and maintenance, provided I am able to pay for the same in whole or in part, and I further agree that if any of said aid consists of care and treatment for injury sustained by me by reason of accident or wrongful act, the value of such aid shall be, if I assert or maintain a claim against another for damages on account of said injury, a lien upon any damages recovered, or to be recovered, either by judgment, settlement or compromise by myself, or by my heirs or personal representative in case of my death. "I further agree that if and when I enter Laguna Honda Hospital or Hassler Hospital as a patient therein, I shall deposit in the Home Trust Fund an amount not less than the sum fixed for payment by toward cost of such institutional care as determined by my ability so to pay, and which sum I hereby expressly agree to pay; and I further agree that a direct charge against my Home Trust Fund account in that amount may be made by the said hospital at the completion of each month or portion of a month during the time I remain therein to discharge this obligation to pay, as aforesaid. "For valuable consideration, I hereby assign to the San Francisco General Hospital the amount equal to the total cost of care rendered to me (or the total amount due to me if the amount thus due be less than the total amount of the cost of care rendered to me) from any monies due or to become due to me under my insurance policies, including any hospital benefits payable from the California State Disability Program or any private carrier in lieu thereof, and hereby authorize you to make such payment directly to said San Francisco General Hospital. "This agreement is binding upon myself, my heirs, executors, administrators and assigns. "The foregoing agreement is executed on the express condition, and with the understanding that it shall be binding on the applicant only in the event that he (or she) is found to be exempt from liability for such benefits under the provisions of Chapter 7 or Chapter 8, Part 3, Division 9, Welfare and Institutions Code of the State of California and that it shall be null and void if the applicant is found to be exempt from liability for such benefits. Dated this ____________ day of 197____________ Witness ____________ Witness ____________ Signature of Applicant in full ____________"

The Controller of the City and County of San Francisco shall prescribe the procedure governing the evaluation of institutional care at the Laguna Honda Hospital, the auditing, accounting, reporting and collecting of all obligations arising under Sections 124 to 124.4, inclusive, hereof in accordance with the provisions of Section 64 and 75 of the Charter. (Added by Ord. 75-66, App. 4/11/66)

Any lien created by the provisions of Section 124 of this Article upon damages recovered, or to be recovered by a recipient of aid, shall be referred to the Bureau of Delinquent Revenue for collection pursuant to the provisions of Chapter 10, Article V, of the San Francisco Code. (Amended by Ord. 155- 68; App. 6/13/68; Ord. 386-89, App. 10/25/89)

(a) As used in this section: (1) "Recipient" means any person who has received medical care or hospitalization or will be provided medical care or hospitalization rendered by the San Francisco Department of Public Health or the San Francisco Fire Department because of an injury for which another person may be liable. This term includes the recipient's guardian, conservator, other personal representative, estate, or survivors, including any heir, as defined in California Code of Civil Procedure Section 377, who is a party in a cause of action arising out of the death of the person who received the medical care or hospitalization. (2) "Action" means any cause of action demanding payment of damages filed in any court, or with any public agency, including but not limited to any application for compensation under the Workers Compensation Act of the California Labor Code, or with a private

adjudicator, including but not limited to a private arbitrator or mediator, arising out of the injuries that resulted in the medical care or hospitalization of the recipient. This term also includes any cause of action arising out of the death of the recipient from such injuries. (3) "Claim" means any demand by the recipient for damages against another, including but not limited to any written demand by the recipient for payment under the provisions of any insurance contract providing for payment to injured persons, including payment from the recipient's insurance carrier or the third party's insurance carrier or both carriers. (b) When any recipient, as defined in Subsection (a)(1) of this section, asserts an action or claim for damages against a third party or insurance carrier based upon an injury requiring medical care, the cost of the medical care shall constitute a lien in favor of the City and County of San Francisco upon any such recovery received by the recipient. (c) When any recipient who has been billed for the cost of medical care rendered by the San Francisco Department of Public Health or the San Francisco Fire Department fails to pay in full for such care and asserts an action or claim for damages against a third party or insurance carrier, the recipient's attorney retained to assert the action or claim shall provide written notice of such action or claim by personal delivery or first-class mail to the Bureau of Delinquent Revenue Collection in the Office of the Treasurer-Tax Collector within 10 days of asserting such action or claim. Such notice by the retained attorney to the Bureau of Delinquent Revenue Collection shall adequately identify the recipient, and his or her action or claim, including the name of the insurance carrier against which claim has been made, or the court or state or local agency in which the action or claim is asserted, in order to allow the Bureau of Delinquent Revenue Collection to prepare and file the lien as authorized by Subsection B of this section. In addition, if the recipient as defined in Subsection (a)(1) of this section does not retain an attorney to assert the action or claim, he or she shall give the same notice as described in this subsection. A mailed billing statement sent by the San Francisco Department of Public Health, the San Francisco Fire Department or the Bureau of Delinquent Revenue Collection to the address of the recipient as given on the medical records shall constitute prima facie evidence of knowledge by the recipient of such billing for medical care. (d) When the Bureau of Delinquent Revenue Collection has perfected a lien upon a judgment, award, or settlement in favor of a recipient against any third party or third-party insurance carrier for an injury for which the recipient has received medical care from the San Francisco Department of Public Health or the San Francisco Fire Department, the Bureau of Delinquent Revenue Collection as lien claimant shall be entitled to foreclose its lien against any proceeds from such judgment, award, or settlement to enforce payment of the lien against the third party or third-party insurance carrier, with interest at the legal rate. If the amount of such judgment, award, or settlement so recovered has been paid to the recipient, as defined in Subsection (a)(1) of this section, or to his or her attorney retained to assert the action or claim, the Bureau of Delinquent Revenue Collection shall be entitled to foreclose its lien against the proceeds received by such recipient, recipient's agent, recipient's transferee, or against the retained attorney if he or she has received such payment, to the extent of the San Francisco Department of Public Health's or the San Francisco Fire Department's or the Bureau of Delinquent Revenue Collection's lien, with interest at the legal rate. (e) The failure by the attorney retained by the recipient, as defined in Subsection (a)(1) of this section, to give notice to the Bureau of Delinquent Revenue Collection in the Office of the Treasurer-Tax Collector regarding the recipient's action or claim for damages against a third party or insurance carrier after the recipient has received a billing for medical care from the San Francisco Department of Public Health, the San Francisco Fire Department or the Bureau of Delinquent Revenue Collection shall constitute fraud and deceit by the retained attorney. Likewise, the failure by any recipient, as defined in Subsection (a)(1) of this section, to give such notice as described in this subsection after receiving a billing for medical care from the San Francisco Department of Public Health or by the recipient. In addition, either the recipient or the recipient's attorney retained to assert such action or claim who receives any payment from the third party or insurance carrier resulting from the assertion of such action or claim and who fails to apply such payment toward the satisfaction of the outstanding bill for medical care shall be liable as a constructive trustee for all damages that may be awarded by any court to the City and County of San Francisco for breach of constructive trustee duties and responsibilities. (f) Commencing 30 days after the enactment of this ordinance, the affected medical facilities of the San Francisco Department of Public Health and the San Francisco Fire Department shall make every reasonable effort where feasible to include a statement in English, Spanish, and Chinese with every billing setting out the notice requirement, as described in Subsection (c) of this section, imposed on the recipient's retained attorney, or if there is no retained attorney, imposed on the recipient, regarding any action or claim for recovery asserted against a third party or insurance carrier. The statement shall read: "IMPORTANT: If your attorney or you alone demand money from another person or insurance company because of your injuries and you have not paid this bill

this section, imposed on the recipient's retained attorney, or if there is no retained attorney, imposed on the recipient, regarding any action or claim for recovery asserted against a third party or insurance carrier. The statement shall read: "IMPORTANT: If your attorney or you alone demand money from another person or insurance company because of your injuries and you have not paid this bill in full, your attorney or you must notify: The Bureau of Delinquent Revenue Collection, City Hall, Room 107, San Francisco, California 94102. Failure to notify the Bureau within 10 days of making your demand may result in civil liability for your attorney or you. S.F. Health Code Section 124.5." (Added by Ord. 355-90, App. 10/17/90; amended by Ord. 106-03, File No. 030624, App. 5/23/2003) SEC. 125. CHIEF ADMINISTRATIVE OFFICER AUTHORIZED TO CONTRACT WITH OTHER HOSPITALS. When adequate facilities are not available in any of the institutions enumerated in Section 111 of this Article, the Chief Administrative Officer may contract with other hospitals for the admission and care of persons enumerated in Section 115 of this Article, for in-patient or out-patient care. The Chief Administrative Officer shall not enter into any such agreement until after the Board of Supervisors has made an appropriation to provide funds for the payment to such hospitals, and the rates agreed to be paid such hospitals in any such agreement for in-patient care shall not exceed the cost of maintaining and caring for like classes of person at the San Francisco General

Hospital. In any such agreement for out-patient care other than psychiatric care the rates agreed to be paid each hospital shall not exceed said hospital's actual costs or $12, whichever is the lesser as determined and approved by the Controller of the City and County of San Francisco. In any such agreement for out-patient psychiatric care the rates agreed to be paid each hospital shall not exceed said hospital's actual costs or $16, whichever is the lesser as determined and approved by the Controller of the City and County of San Francisco. (Amended by Ord. 149-66, App. 6/22/66) SEC. 126. PROFESSIONAL FEE OF PHYSICIANS AND DENTISTS. Any licensed physician or dentist who is a member of the medical or dental staff of any of the institutions maintained by the Department of Public Health, except an intern or resident, may charge and collect professional fees for direct medical or dental care furnished by him to any patient in an institution of the Department of Public Health, provided said patient is able to pay or carries sickness or accident insurance or medical expense indemnity insurance or is eligible for health care and related remedial or preventive service care under Public Law 89-97 of the United States (the 1965 Amendment to the Social Security Act) or Chapters 7 and 8 of Part 3 of Division 9 of the Welfare and Institutions Code, except as provided in Section 150 of the Charter. (Added by Ord. 247-66, App. 9/19/66) SEC. 127. DISPOSAL OF UNCLAIMED PERSONAL PROPERTY AT LAGUNA HONDA HOSPITAL. (a) Definition Unclaimed Property. Personal property left at Laguna Honda Hospital for a period of more than 90 days after the patient has left the Hospital shall be considered unclaimed personal property. (b) Disposition of Unclaimed Personal Property. Such unclaimed personal property shall be disposed of according to the following procedure: (1) Notice shall be sent by certified mail to the former patient at his last known address advising that such unclaimed personal property must be claimed within 30 days. (2) Such unclaimed personal property as remains after 30 days' notice to reclaim it shall be disposed of as follows: A. Any sums of money which remain over and above Laguna Honda's charges shall be transmitted to the Controller of the City and County of San Francisco for deposit in the General Fund. B. Other unclaimed personal property shall be delivered to the Purchaser of Supplies for disposition as provided for in Section 7.100 of the Charter of the City and County of San Francisco. C. Proceeds derived from the sale of unclaimed property are to be deposited with the City Treasurer and used exclusively for such items that may be of general benefit for the patients of Laguna Honda Hospital and which are not provided for them by any other appropriation. (Added by Ord. 277-73, App. 7/13/73) SEC. 128. PATIENT RATES. (a) The Board of Supervisors of the City and County of San Francisco does hereby determine and fix the proper reasonable amounts to be charged to persons for services furnished by the Department of Public Health (“Department”) as follows, which rates shall be effective for services delivered as of July 1, 2025, through June 30, 2027. The County Clerk’s Office may charge the amounts listed herein for services rendered relating to vital records. TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 San Francisco Health Network TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 San Francisco Health Network

The San Francisco Health Network is the Department of Public Health s system of care, which includes Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), Laguna Honda Hospital and Rehabilitation Center, and the network of Community Primary Care Clinics. Patient Rates listed under this section, labeled San Francisco Health Network, apply to all providers that fall under the San Francisco Health Network. Clinical Lab, Supplies & Drugs The fees relating to clinical lab, supplies, and drugs may be set by the Director of Health or the Director s designee based on increases or decreases to procurement cost of the individual supplies and medications. The list of such fees, which is posted on the California Department of Health Care Access and Information website in the Hospital Chargemasters file (https://data.chhs.ca.gov/dataset/chargemasters) or is available upon request from DPH, is incorporated by reference as if set forth herein. General Clinic

Initial Patient

Evaluation & Management (E/M) Expanded Exam Visit 721 741 E/M Detailed Exam Visit 823 846 E/M Comprehensive Exam Visit 1,102 1,133 E/M Complex Exam Visit 1,375 1,414 Established Patient E/M Brief Exam Visit 336 345 E/M Focused Exam Visit 399 410 E/M Expanded Exam Visit 525 540 E/M Detailed Exam Visit 745 766 E/M Comprehensive Exam Visit 1,161 1,194 Consultation E/M Expanded Consult Visit 699 719 E/M Detailed Consult Visit 784 806 E/M Comprehensive Consult Visit 1,036 1,065 E/M Complex Consult Visit 1,227 1,262 E/M Add On Prolong E/M Service 15 minutes 92 95 Complex E/M Service Add on Visit 42 43 Home Patient Visits Initial Patient E/M Brief Exam Visit 161 166 E/M Low Severity Exam Visit 231 238 E/M Moderate Severity Exam Visit 541 556 E/M High Severity Exam Visit 658 677 Established Patient E/M Brief Exam Visit 161 166 E/M Low to Moderate Severity Exam Visit 249 256 E/M Moderate to High Severity Exam Visit 380 391 E/M High Severity Exam Visit 530 545

TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) Diagnostic Radiology Anatomic Pathology All Other Special Services The fees relating to diagnostic radiology, anatomic pathology, and other special services may be set by the Director of Health or the Director s designee. The list of such fees, which is posted on the California Department of Health Care Access and Information website in the Hospital Chargemasters file (https://data.chhs.ca.gov/dataset/chargemasters) or is available upon request from DPH, is incorporated by reference as if set forth herein. In-Patient Care

Medical Surgical Day 9,769 9,769 Intensive Care Day 22,460 22,460 Intensive Care - Trauma Day 22,460 22,460 Coronary Care Day 22,460 22,460 Stepdown Units Day 14,103 14,103

Pediatrics Day 9,343 9,343 Obstetrics Day 7,645 7,645 Nursery New Born Day 4,177 4,177 Semi-Intensive Care Day 14,901 14,901 Intensive Care Day 22,459 22,459 Labor/Delivery Hours of Stay Hour 363 363 Psychiatric Inpatient Day 7,645 7,645 Psychiatric Forensic Inpatient - 7L Day 7,645 7,645 Security Unit - 7D Day 7,645 7,645 Skilled Nursing Facility Day 3,059 3,059 Mental Rehab Unit Day 2,528 2,528 Adult Residential Facility Day 510 510 Respiratory Therapy O2 Therapy per 24 hours 418 430 Surgical Services Minor Surgery I (Come & Go) 1st Hour 7,717 7,935 Minor Surgery I (Come & Go) Add l Hour or portion 3,859 3,968 Minor Surgery II 1st Hour 8,424 8,662 Minor Surgery II Add l Hour or portion 4,212 4,331 Major Surgery I 1st Hour 12,688 13,046 Major Surgery I Add l Hour or portion 5,071 5,214 Major Surgery II 1st Hour 14,286 14,689 Major Surgery II Add l Hour or portion 5,721 5,882 Major Surgery III 1st Hour 15,899 16,347 Major Surgery III Add l Hour or portion 6,361 6,540 Surgery (3 Teams) 1st Hour 26,213 26,952 Surgery (3 Teams) Add l Hour or portion 10,487 10,783 Major Trauma I 1st Hour 14,944 15,365 Major Trauma I Add l Hour or portion 5,981 6,150 Interventional Radiology 1st Hour 6,873 7,067 Interventional Radiology Add l Hour or portion 3,436 3,533 Recovery Room 1st Hour 4,914 5,053 Recovery Room Each Add l Hour or portion 2,457 2,526 Anesthesia 1st Hour 11,040 11,351 Anesthesia Add l Hour or portion 5,510 5,665 Trauma Care Trauma Activation - 900 Visit 29,924 29,924 Trauma Activation - 911 Visit 17,602 17,602 Trauma Critical Care 1st 1-74 minutes 9,371 9,371 Trauma Critical Care Each add l 30 min. or portion 2,342 2,342 ED Level 5 Team Trauma Visit 17,602 17,602 Emergency Clinic Level I Room 556 556 Level II Room 1,665 1,665 Level III Room 3,563 3,563 Level IV Room 5,869 5,869 Level V Room 11,846 11,846 Resuscitation 8,208 8,208 Psychiatric Emergency Services Psych Crisis Level 1 ER Room Room 1,135 1,135 Psych Crisis Level 2 ER Room Room 2,637 2,637 Psych Crisis Level 3 ER Room Room 4,143 4,143 Psych Crisis Level 4 ER Room Room 5,648 5,648 Psych Crisis Level 5 ER Room Room 7,156 7,156 Psych Crisis Level 6 ER Room Room 8,662 8,662 Medication Svs./Min. per minute 27 27 Community Primary Care Dental Services Initial Complete Exam Visit 215 221

Periodic Exam Visit 215 221 Prophylaxis - Adult Visit 297 305 Prophylaxis - Child Visit 283 291 Extract Single Tooth Visit 427 439 One Surface, Permanent Tooth Visit 344 354 Home Health Services Skilled Nursing Visit 748 769 Home Health Aide Services Visit 397 408 Medical Social Services Visit 1,032 1,061 Physical Therapy Visit 820 843 Occupational Therapy Visit 820 843 Speech Therapy Visit 820 843

TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Laguna Honda Hospital and Rehabilitation Center In-Patient Care

Regular Hospital Rates

Acute

Day 7,047 7,047 Rehabilitation Day 7,047 7,047 Skilled Nursing Facility Day 1,508 1,508

TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Community Behavioral Health Services TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Community Behavioral Health Services Outpatient Mental Health and Drug Medi-Cal Organized Delivery System Psychiatrist/Contracted Psychiatrist/Physician Hour or portion 2,109.13 2,168.61 Physician s Assistant Hour or portion 945.93 972.61 Nurse Practitioner Hour or portion 1,048.82 1,078.40 Registered Nurse Hour or portion 856.70 880.86 Certified Nurse Specialist Hour or portion 1,048.82 1,078.40 Alcohol and Drug Counselor Hour or portion 455.30 468.14 Licensed Vocational Nurse Hour or portion 450.05 462.74 Pharmacist Hour or portion 1,009.59 1,038.06 Licensed Psychiatric Technician Hour or portion 385.82 396.70 Psychologist/Pre-licensed Psychologist Hour or portion 848.22 872.14 Licensed Practitioner of the Healing Arts (MFT, LCSW, LPCC)/Intern or Waivered Licensed Practitioner of the Healing Arts (MFT, LCSW, LPCC) Hour or portion 548.91 564.39 Occupational Therapist Hour or portion 730.68 751.29 Mental Health Rehabilitation Specialist Hour or portion 412.97 424.62 Peer Support Specialist Hour or portion 433.62 445.85 Medical Assistant Hour or portion 309.37 318.09 Other Qualified Providers Hour or portion 412.97 424.62 Community Health Worker Hour or portion 423.30 435.24 Interactive Complexity Occurrence 18.89 19.42 Sign Language or Oral Interpretive Services Per 15 minutes 31.88 32.78 Mobile Crisis Mobile Crisis Per encounter 3,143.81 3,232.47 Transportation, mileage Per mile 0.69 0.71 Transportation, staff time Per 15 minutes 120.24 123.63

Mental Health

24-Hour Services

Hospital Inpatient Day 7,645 7,645 Skilled Nursing Day 302.02 310.54 Adult Crisis Residential Day 744.64 765.64 Adult Residential Day 568.32 584.35 Therapeutic Foster Care (TFC) Service Model Day 634.24 652.13 Day Services Day Rehabilitation Day 376 386.60 Day Rehabilitation Half Day 250.67 257.74 Day Treatment Intensive Day 805.96 828.69 Day Treatment Intensive Half Day 537.31 552.46 Crisis Stabilization Hour 363.04 373.28 Socialization Hour 152.17 156.46 Clubhouse Day 301.04 309.53 Monthly Services Assertive Community Treatment Full Month 5,074.69 5,217.80 Assertive Community Treatment Partial Month 3,383.13 3,478.53 Forensic Assertive Community Treatment Full Month 5,252.30 5,400.41 Forensic Assertive Community Treatment Partial Month 3,501.53 3,600.27 Coordinated Specialty Care Full Month 4,160.06 4,277.37 Coordinated Specialty Care Partial Month 1,386.68 1,425.78 Multi Systemic Therapy Full Month 9,542.05 9,811.14 Multi Systemic Therapy Partial Month 6,361.36 6,540.75 Supported Employment Full Month 1,913.52 1,967.48 Supported Employment Partial Month 956.76 983.74 Substance Use Disorder (SUD) Opioid Replacement Therapy (OTP)/Narcotic Treatment Program (NTP) Methadone Daily 38.62 39.71 Buprenorphine Naloxone Combo Daily 52.24 53.71 Buprenorphine Mono Daily 51.67 53.13 Disulfiram Perinatal Daily 13.99 14.38 Buprenorphine Injectable (Sublocade) Monthly 2,200.77 2,262.83 Naltrexone Injectable (Vivitrol) Monthly 7,408.86 7,617.79 Naloxone HCL 2 pack (Generic) Per pack of 2 112.72 115.90 Naloxone HCL 2 pack (Narcan) Per pack of 2 153.83 158.17 24-Hour Service (Residential) Level 3.2 Residential Withdrawal Management Day 213.86 219.89 Level 3.1 Residential Day 331.20 340.54 Level 3.3 Residential Day 197.32 202.88 Level 3.5 Residential Day 214.42 220.47

TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 TYPE OF SERVICE UNIT AMOUNT 2025-26 2026-27 Population Health & Prevention Vital Records Birth Certificate Per Certificate Rates Per California Health and Safety Code Section 103625 Death Certificate Per Certificate Rates Per California Health and Safety Code Section 103625 Permit - Disposition of Human Remains Per Permit Rates Per California Health and Safety Code Sections 103065, 103675 to 103685, inclusive, and 103692 Out-of-County Cross File Fee Per Certificate Rates Per California Health and Safety Code Section 103065 Letter of Non-Contagious Disease Per Letter 15 15 Expedited Registration of Vital Event Per Event 42 42

Expedited Documents Per Delivery 30 30 After Hours Registration of Vital Event Per Event 42 42 Reproduction of Documents Per Page 2 2 Medical Marijuana ID Card Medical Marijuana ID Card 100 100 Adult Immunization Clinic Travel Health Visit (THV1) Per Visit 70 70 Travel Health Visit (THV2) Under Age 18 with Parent THV1 Per Visit 70 70 Registered Nurse Visit Off-Site Location Per Visit 200 200 Vaccines and Testing Per Injection/Dose The fees relating to vaccines and testing may be set the Director of Health or the Director s designee. The list is posted on the City and County of San Francisco s website (https://www.sf.gov/information--aitc-services-and- prices) or is available upon request from DPH and is incorporated by reference as if set forth herein.

(b) The Department of Public Health may waive or reduce the fees listed in subsection (a) of this Section 128 if a patient or any other person legally obligated to pay meets the eligibility requirements established by the Department as part of a program adopted by the Department to meet the needs of low-income patients, including but not limited to charity care and discount payment programs. The Department has the sole authority to determine whether a patient or other person legally obligated to pay is eligible for a waiver or reduction in fees. (Added by Ord. 313-96, App. 8/8/96; amended by Ord. 332-97, App. 8/19/97; Ord. 278-98, App. 8/28/98; Ord. 236-99, File No. 991389, App. 8/27/99; Ord. 20-00, File No. 000043, App. 2/11/2000; Ord. 218-00, File No. 001337, App. 9/8/2000; Ord. 13-01, File No. 002148, App. 1/26/2001; Ord. 173-01, File No. 011220, App. 8/10/2001; Ord. 151- 02, File No. 021073, App. 7/12/2002; Ord. 34-03, File No. 030167, App. 3/13/2003; Ord. 189-03, File No. 030986, App. 7/25/2003; Ord. 185-04, File No. 040748, App. 7/22/2004; Ord. 178-05, File No. 050985, App. 7/29/2005; Ord. 197-06, File No. 060782, App. 7/21/2006; Ord. 195-07, File No. 070810, App. 8/3/2007; Ord. 164-08, File No. 080761, App. 7/30/2008; Ord. 153-09, File No. 090701, App. 7/15/2009; Ord. 177-10, File No. 100719, App. 7/23/2010; Ord. 157-11 , File No. 110708, App. 8/1/2011, Eff. 8/31/11; Ord. 167-12 , File No. 120604, App. 7/27/2012, Eff. 8/26/2012; Ord. 93-13 , File No. 130261, App. 5/31/13, Eff. 6/30/13 [retroactive]; Ord. 172-13 , File No. 130547, App. 8/2/2013, Eff. 9/1/2013; Ord. 170-14 , File No. 140628, App. 7/31/2014, Eff. 8/30/2014; Ord. 86-15 , File No. 150184, App. 6/18/2015, Eff. 7/18/2015 [retroactive]; Ord. 145-15 , File No. 150570, App. 8/6/2015, Eff. 9/5/2015; Ord. 152-16 , File No. 160635, App. 8/1/2016, Eff. 8/31/2016; Ord. 173-17, File No. 170681, App. 7/27/2017, Eff. 8/26/2017, Retro. 7/1/2017; Ord. 186-18, File No. 180586, App. 8/1/2018, Eff. 9/1/2018, Retro. 7/1/2017 and 7/1/2018*; Ord. 180-20, File No. 200844, App. 10/1/2020, Eff. 11/1/2020; Ord. 124-21, File No. 210646, App. 8/4/2021, Eff. 9/4/2021; Ord. 185-22, File No. 220686, App. 8/4/2022, Eff. 9/4/2022; Ord. 177-23, File No. 230662, App. 7/28/2023, Eff. 8/28/2023; Ord. 195-24, File No. 240600, App. 7/31/2024, Eff. 8/31/2024; Ord. 141-25, File No. 250607, App. 8/1/2025, Eff. 9/1/2025) *Editor’s note: Section 3(b) of Ord. 186-18 states: “new rates established in this ordinance for Fiscal Year 2017-2018 shall be retroactive to July 1, 2017, and new rates established in this ordinance for Fiscal Year 2018-2019 shall be retroactive to July 1, 2018.”

(a) The Board of Supervisors approves the following fee schedule for Fire Department emergency medical services: (1) Treatment without Transportation, a base rate fee of $365.00 per call. (2) Basic Life Service, including transportation, a base rate fee of $1,642 per call. (3) Advanced Life Service, including transportation, a base rate fee of $1,642 per call. (4) Mileage if transported, an additional fee above the base rate of $31.00 per mile. (b) Beginning with Fiscal Year 2011-2012, the fees set in this section may be amended without further action by the Board of Supervisors, to reflect changes in the Medical Consumer Price Index as determined by the Controller. No later than April 15th of each year, the Fire Department shall submit its current fee schedule to the Controller, who shall apply the price index adjustment to produce a new fee schedule for the following year. (c) No later than May 15th of each year, the Controller shall file a report with the Board of Supervisors reporting the new fee schedule and certifying that: (a) the fees produce sufficient revenue to support the costs of providing the services for which each fee is assessed, and (b) the fees do not produce revenue which is significantly more than the costs of providing the services for which each fee is assessed. (Added by Ord. 106-03, File No. 030624, App. 5/23/2003; amended by Ord. 185-05, File No. 050993, App. 7/29/2005; Ord. 165-08, File No. 080759, 7/30/2008; Ord. 170-09, File No. 090706, 7/21/2009; Ord. 174-10, File No. 100714, App. 7/23/2010) SEC. 129. CHARITY CARE POLICY REPORTING AND NOTICE REQUIREMENT.

Declaration of policy. It is the policy of the City and County of San Francisco that charity care-medical care provided to those who cannot afford to pay and without expectation of reimbursement-is a vital portion of community health care services. While San Francisco General Hospital is the primary provider of charity care services in San Francisco, private hospitals also have a responsibility to serve uninsured and poor patients. Nonprofit hospitals in particular have an obligation to provide community benefits in the public interest in exchange for favorable tax treatment by the government. It is essential that, on an ongoing basis, the City and County of San Francisco evaluate the need for charity care in the community given the City's responsibility to provide care to indigents. To plan for the continuing fulfillment of this responsibility, the City needs information from the hospitals in San Francisco on each hospital's policies on the availability of and criteria for charity care. For planning purposes, the City also needs information on the amount of charity care provided by each hospital. Upon receipt of such information, the City can better fulfill its mandate to provide care to indigents and fashion an appropriate response to unmet needs for charity care including the recommendation of budgetary, regulatory or other action at the State and Federal levels. To maximize the access to charity care within the community and to enhance the health of the public by informing individuals of the availability of charity care, it is further the policy of the City and County of San Francisco that each hospital notify patients of that hospital's policies on charity care. Such notice shall include visually prominent multilingual postings explaining the hospital's policy on charity care. It shall also be the policy of the City and County of San Francisco to require hospitals, when practicable, to verbally notify patients at the time of admission as to the availability of charity care and the process for applying or qualifying for such care. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 130. DEFINITIONS. For purposes of Sections 129-137 of Article 3, certain words and phrases shall be construed as hereafter defined. Words in the singular include the plural, and words in the plural shall include the singular. Words in the present tense shall include the future. Masculine pronouns include feminine meaning and are not gender-specific. (a) Bad Debt. The term "Bad Debt" means the unpaid accounts of any person who has received medical care or is financially responsible for the cost of care provided to another, where such person has the ability to pay but is unwilling to pay. (b) Charity Care. The term "Charity Care" means emergency, inpatient or outpatient medical care, including ancillary services, provided to those who cannot afford to pay and without expectation of reimbursement and that qualifies for inclusion in the line item "Charity-Other" in the reports referred to in Section 128740(a) of the California Health and Safety Code, after reduction by the Ratio of Costs-to-Charges. (c) Cost. The term "Cost" means the actual amount of money a hospital spends to provide each service, but not the full list price charged by the hospital for that service. (d) Department. The term "Department" means the Department of Public Health of the City and County of San Francisco. (e) Director of Health. The term "Director of Health" includes the Director of Health or a designee. (f) Hospital. The term "Hospital" includes every entity in San Francisco licensed as a general acute care hospital, as defined by Section 1250(a) of the California Health and Safety Code, other than hospitals exempt from taxation under Section 6.8-1 of the San Francisco Business and Tax Regulations Code. For purposes of Section 131, the term "Hospital" shall also not include hospitals owned and operated by a nonprofit system that does not provide a significant level of service on a fee-for-service basis and whose annual financial statement is consolidated with a nonprofit health maintenance organization, filed with the California Department of Managed Health Care. (g) Policies. The term "policies" means the hospital's criteria and procedures on the provision of charity care including any criteria and procedures for patient and community notification of charity care availability, the application or eligibility process, the criteria for determinations on eligibility for charity care and the appeal process on such determinations, and the hospital's internal accounting procedures for charity care. (h) Ratio of Cost-to-Charge. The term "Cost-to-Charge" shall have the same meaning as that given by the Office of Statewide Health Planning and Development in the reports referred to in Section 128740(a) of the California Health and Safety Code and describes the relationship between the hospital's cost of providing services and the charge assessed by the hospital for the service. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 131. REPORTING TO THE DEPARTMENT OF PUBLIC HEALTH. (a) Hospitals shall disclose to the Department of Public Health the following information in the form of reports to be filed annually with the Department within 120 days after the end of each hospital's fiscal year. 1. The dollar amount of charity care provided during the prior year as specified by the Department, after adjustment by the Cost-to-

Charge ratio. Each hospital shall file a calculation of its Ratio of Costs-to-Charges with its report. Figures representing bad debt shall not be included in the amount reported. 2. The total number of applications, patient and third party requests for charity care, and the total number of hospital acceptances and denials for charity care received and decided during the prior year; the zip code of each patient's residence on each such acceptance and denial, and the number of individuals seeking, applying, or otherwise eligible for charity care who were referred to other medical facilities along with the identification of the facility to which the individuals were referred. 3. The total number of patients who received hospital services within the prior year reported as being charity care and whether those services were for emergency, inpatient or outpatient medical care, or for ancillary services. 4. All charity care policies, including but not limited to explanations regarding the availability of charity care and the time periods and procedures for eligibility, application, determination, and appeal; any application or eligibility forms used, and the hospital locations and hours at which the information may be obtained by the general public. 5. Such other information as the Department shall require. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 132. NOTIFICATION. (a) During the admission process whenever practicable, hospitals shall provide patients with verbal notification as to the hospital's policies describing the availability of charity care and any process necessary to apply for charity care. (b) Hospitals shall post multilingual notices as to any policies on charity care in several prominent locations within the hospital, including but not limited to the emergency department, billing office, waiting rooms for purposes of admissions, the outpatient area, and the inpatient area. Said notices shall be published in at least the following languages-English, Spanish, and Chinese; and shall be clearly visible to the public from the location where they are posted. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 133. AUTHORITY TO ADOPT RULES AND REGULATIONS. The Director may issue and amend rules, regulations, standards, or conditions to implement this ordinance. The Director is authorized to implement the provisions of this ordinance, including any rules, regulations, standards, or conditions issued hereunder. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 134. ENFORCEMENT. Any hospital which fails to comply with the reporting or notification requirements specified in this ordinance or in the rules and regulations of the Department may be liable for a civil penalty, in an amount not to exceed $500 for each day the violation continues. The penalty shall be assessed and recovered in a civil action brought on behalf of the City and County of San Francisco. Any monies recovered pursuant to this section shall be deposited in the Treasury of the City and County of San Francisco and appropriated for use by the Department of Public Health. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 135. CITY UNDERTAKING LIMITED TO PROMOTION OF GENERAL WELFARE. In undertaking the adoption and enforcement of this ordinance, the City and County is assuming an undertaking only to promote the general welfare. It is not assuming, nor is it imposing on its officers and employees, an obligation for breach of which it is liable in money damages to any person who claims that such breach proximately caused injury. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001)

SEC. 136. SEVERABILITY. If any part or provision of this ordinance, or the application thereof to any person or circumstances, is held invalid, the remainder of the ordinance, including the application of such part or provision to the other persons, or circumstances, shall not be affected thereby and shall continue in full force and effect. To this end, provisions of this ordinance are severable. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 137. PREEMPTION. Nothing in these sections shall be interpreted or applied so as to create any power, duty or obligation in conflict with any Federal or State law. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 138. ANNUAL REPORT TO THE HEALTH COMMISSION. The Department shall make a report on an annual basis to the Health Commission on the information obtained from the hospitals for use including but not limited to future planning on the Department's provision of care to the community. (Added by Ord. 163-01, File No. 010142, App. 7/20/2001) SEC. 139. WRITTEN INFORMED CONSENT AND PRE-TEST COUNSELING PRIOR TO HIV TESTING. (a) The Board of Supervisors encourages the San Francisco Department of Pubic Health to modify the San Francisco General Hospital Medical Center's policies and procedures to require that providers obtain written informed consent from and provide pre-test counseling to patients consistent with State and Federal law, before administering an HIV antibody test to such patients. (b) Written informed patient consent may consist of documentation by the provider in the patient's medical record if such consent satisfies State and Federal law. (Added by Ord. 144-06, File No. 060702, App. 6/22/2006) SEC. 140. FINDINGS. San Francisco has a shortage of subacute skilled nursing care beds in the City, which often necessitates transferring patients from general acute care hospitals in the City to subacute skilled nursing care facilities outside of the City. Some City residents who receive subacute skilled nursing care at facilities outside of the City, and their families, face hardships associated with traveling to, and receiving care at, these facilities. As the City strives to increase the number of subacute skilled nursing care beds in San Francisco, it is necessary to understand the full scope of the need for both subacute and general skilled nursing care beds based on the number of patients who qualify for either subacute or general skilled nursing care in an acute care hospital or hospital-based skilled nursing facility and are either transferred outside of the City or remain in the City in an acute care hospital or hospital-based skilled nursing facility. Accordingly, Section 140.2 requires public and private general acute care hospitals and hospital-based skilled nursing facilities in the City to report the number of and aggregated demographic information regarding qualified subacute and general skilled nursing care patients to the Department of Public Health. (Added by Ord. 77-22, File No. 220410, App. 5/13/2022, Eff. 6/13/2022)

For purposes of Sections 140 through 140.3 the following terms have the following meanings: “City” means the City and County of San Francisco. “Department” means the Department of Public Health. “Director” means the Director of Health or the Director’s designee. “Out-of-County Health Facility” means a health facility located outside of the City, whether public or private, licensed as a general acute care hospital or skilled nursing facility, as those two terms are defined by Section 1250 of the California Health and Safety Code, as amended from time to time, and providing Skilled Nursing Care. “Reporting Health Facility” means every health facility in the City, whether public or private, licensed as a general acute care hospital or hospital-based skilled nursing facility, as those two terms are defined by Section 1250 of the California Health and Safety Code, as amended from time to time. “Skilled Nursing Care” means general skilled nursing care including but not limited to adult subacute care as defined by Section 14132.25 of the California Welfare and Institutions Code, as amended from time to time, which is a level of care designed for patients who have an acute illness, injury, or exacerbation of a disease process, and pediatric subacute care, which is a level of care for patients under 21 years of age who use a medical technology that compensates for the loss of a vital bodily function. (Added by Ord. 77-22, File No. 220410, App. 5/13/2022, Eff. 6/13/2022)

(a) Reporting Health Facilities owned by the City or private entities shall disclose to the Department the following information in the form of a report to be submitted annually to the Department by January 31 for the preceding calendar year, except that the submission deadline for calendar year 2021 shall be October 1, 2022. The Department shall request such information from Reporting Health Facilities owned by non-City public entities. The report shall present patient information in aggregate, de-identified form consistent with state and federal laws governing the confidentiality of medical information. (1) The total number of patients who were City residents and the total number of patients who were not City residents, transferred by the Reporting Health Facility to an Out-of-County Health Facility for the purpose of receiving Skilled Nursing Care. (2) The total number of patients who were City residents and the total number of patients who were not City residents, who qualified for Skilled Nursing Care while admitted to the Reporting Health Facility but were not transferred by the Reporting Health Facility to an Out-of-County Health Facility. (3) The following aggregate demographic information for each category of patient: age, race/ethnicity, gender (as well as sexual orientation and gender identity, if normally collected by the Reporting Health Facility), patient’s insurance provider (by way of example but not limitation, Medi-Cal, Medicare, or the specific private insurance provider), and housing status (by way of example but not limitation, people experiencing homelessness, marginally housed, or permanently housed). (b) The Director may issue rules or guidelines regarding the information required by this Section 140.2 including the format by which Reporting Health Facilities will transmit the report. (c) The Department shall make a report on an annual basis to the Health Commission based on the annual reports submitted by the Reporting Health Facilities to the Department. The Department’s report to the Health Commission shall include not only statistical information but also such future plans and/or recommendations, as the Department deems appropriate, for provision of Skilled Nursing Care in the City. (Added by Ord. 77-22, File No. 220410, App. 5/13/2022, Eff. 6/13/2022)

In enacting and implementing Sections 140–140.2, the City is assuming an undertaking only to promote the general welfare. It is not assuming, nor is it imposing on its officers and employees, an obligation for breach of which it is liable in money damages to any person who claims that such breach proximately caused injury. (Added by Ord. 77-22, File No. 220410, App. 5/13/2022, Eff. 6/13/2022)