Health and Safety Code section 1253.4
(a)
(1)A general acute care hospital, as defined in subdivision (a) of Section 1250, seeking to provide skilled nursing services in a distinct part shall submit an application and documentation to the State Department of Public Health. If the distinct part meets the requirements and criteria specified in this section, the department may approve a hospital’s application for a distinct part on a case-by-case basis consistent with Section 1254.(2)
“Distinct part” means an identifiable unit accommodating beds and related facilities, including, but not limited to, contiguous rooms, a wing, a floor, or a building. A skilled nursing distinct part may comprise one or more buildings or designated parts of buildings. The term “distinct part” includes a “composite distinct part” that is not on the hospital’s campus and that meets the definition, requirements, and other criteria specified in this section.(A)
“Composite distinct part” means a distinct part consisting of two or more noncontiguous components that are not located within the same campus.(B)
“Campus” means the physical area immediately adjacent to the hospital’s main buildings or to other areas and structures that are not strictly contiguous to the main buildings.(C)
If the requirements for a “distinct part” and a “composite distinct part” conflict, then the more specific and strict standards shall apply.(b)
A skilled nursing distinct part shall meet and be subject to state licensing statutes and regulations applicable to skilled nursing facilities, unless there is a specific exception or exemption applicable to a distinct part.(c)
(1)A skilled nursing distinct part shall meet all of the following conditions:(A)
Be under the same ownership, control, and governance as the general acute care hospital of which it is a distinct part.(B)
Be wholly owned by the general acute care hospital of which it is a distinct part.(C)
Be subject to the bylaws and operating decisions of the hospital’s governing body.(2)
The general acute care hospital shall have final responsibility for the skilled nursing distinct part’s administrative decisions and personnel policies and procedures.(d)
A general acute care hospital seeking to add a composite distinct part to its license shall submit a proposal to the department demonstrating that a composite distinct part would improve access to care and serve a specific unmet need in the geographical area served by the hospital. If the department determines that the composite distinct part may improve access to care and address a specific unmet need in the geographical area served by the hospital, the general acute care hospital may submit an application with documentation for approval of a composite distinct part.(e)
In deciding whether to approve a general acute care hospital’s application for a composite distinct part, the department may consider the following additional criteria:(1)
Whether the facility is in a rural or underserved area.(2)
The compliance history of the general acute care hospital, the existing distinct part, and the entities and individuals involved with the ownership, administration, operation, and governance of the facilities.(3)
The plan of operation and plan for sharing services with the general acute care hospital and other components of the composite distinct part.(4)
Ability to demonstrate and maintain compliance with the requirements of this section and the licensing statutes and regulations applicable to skilled nursing facilities.(5)
Whether the general acute care hospital and the components of the composite distinct part are so organizationally or geographically separate that it is not feasible to operate and provide safe, quality, and adequate care as a single licensed entity.(6)
Any additional criteria that the department deems relevant or necessary to protect resident safety or ensure quality of care.(f)
Each composite distinct part component that is not located on the general acute care hospital’s campus shall have a dedicated nursing home administrator.(g)
The skilled nursing distinct part shall be integrated with the general acute care hospital of which it is a distinct part. The skilled nursing distinct part shall function as an integral and subordinate part of the hospital of which it is a distinct part, which includes, but is not limited to, common resource usage of buildings, equipment, personnel, and services.(h)
A general acute care hospital shall have a maximum of only one licensed skilled nursing distinct part, which may be a composite distinct part.(1)
A general acute care hospital with a distinct part or composite distinct part shall have only one license number.(2)
The department shall identify on the general acute care hospital’s license each distinct part, including the number of beds, location, and address of each distinct part and components of a composite distinct part.(i)
Each freestanding component of a composite distinct part shall independently meet all of the licensing requirements applicable to a freestanding skilled nursing facility, including staffing requirements and ratios. Staffing exceptions for distinct parts, including, but not limited to, the distinct part exception in Section 1276.65, shall not apply to a freestanding component of a composite distinct part.(j)
The general acute care hospital shall not use composite distinct parts to segregate residents by payment source or on a basis other than care needs.(k)
Existing distinct parts shall meet the requirements of this section before they are approved as a composite distinct part. In deciding whether to approve a consolidation, change of ownership, or other similar restructuring, the department shall consider whether the composite distinct part meets the requirements and satisfies the criteria described in this section.(l)
Notwithstanding any other law, the department may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter (AFL) or similar instruction.
Source:
Section 1253.4, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=1253.4. (updated Jun. 29, 2026; accessed Jul. 13, 2026).
