Health care districts: employment.

Removed amendment history dates and coauthor names from the header; added final passage dates showing the Assembly passed on August 26, 2026 and the Senate passed on August 25, 2026.

Removed all line numbers (line 1 through line 40) that were present in the amended version for legislative tracking purposes.

Changed the digest attribution from 'AB 2311, as amended, Schiavo' to 'AB 2311, Schiavo', removing the 'as amended' designation now that the bill is in its final form.

Removed the vote/appropriation/fiscal committee summary line ('Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.') which is not carried into enrolled bills.

Added standard enrolled bill elements at the end: a Governor receipt date/time block and an approval signature line with 'Governor' designation.

Coauthors changed: Assembly Members Ortega and Pellerin removed, Assembly Member Sharp-Collins added. Senator Becker removed from coauthor list, Senators Grove and Valladares added as Senate coauthors.

Fixed duplicate lettering in Section 2400(f)(1) conditions. The old version had redundant letters (e.g., (A) appeared twice, (B) appeared twice, etc.). The new version uses a clean sequence: (A), (B), (C), (D), (E).

Section 2400(f)(2) reporting requirement restructured from a single paragraph into subparts (A) covering the publication obligation and (B) covering the required report contents. No change to the actual requirements or timeline.

New condition (A) in subdivision (f)(1) requires the hospital to be a licensed acute care hospital AND either (i) have been awarded a loan under the Distressed Hospital Loan Program before January 1, 2025, or (ii) have a combined Medicare and Medi-Cal payor mix greater than 75 percent as calculated from DHCAI annual financial disclosure data as of January 1, 2025. For the payor mix test, both the hospital and its parent health care system must independently exceed the 75 percent threshold.

The existing conditions (medical staff concurrence, non-interference with professional judgment, positions in addition to existing ones, offer of contract option) were renumbered from (A)-(D) to (B)-(E) to accommodate the new hospital eligibility condition as (A).

Coauthors changed: Assembly Member Sharp-Collins added and Senator Valladares added alongside Senator Becker.

The health care district employment exemption is now temporary, expiring January 1, 2037 (inoperative July 1, 2037, repealed January 1, 2038). Previously the exemption had no expiration date.

New condition (A): Medical staff must concur by affirmative vote under bylaws that the licensee's employment is in the best interest of communities served by the hospital.

New condition (C): Licensee positions must be in addition to, and not supplant, existing medical staff positions as of January 1, 2026. Mutual contract amendments are still permitted.

New condition (D): The health care district or nonprofit must affirmatively offer a prospective employee the option to contract with the facility instead of being employed.

The prohibition on interfering with professional judgment now explicitly extends to any hospital under the ownership or control of the health care district or nonprofit corporation, not just the district itself.

A new Section 2401 is added that becomes operative July 1, 2037. It preserves exemptions for university teaching clinics, Section 1206(p) clinics, narcotic treatment programs, pediatric subspecialty hospitals, and critical access hospitals, but does NOT include the health care district exemption, effectively ending it after sunset.

Starting January 1, 2028, qualifying entities must publish an annual report on their website by July 1 each year, including data on ability to recruit and retain physicians, total recruited/retained since January 1, 2027, broken out by employment versus contracted positions.