BILL NUMBER: AB 691 CHAPTERED
BILL TEXT
CHAPTER 36
FILED WITH SECRETARY OF STATE APRIL 30, 2004
APPROVED BY GOVERNOR APRIL 29, 2004
PASSED THE ASSEMBLY APRIL 19, 2004
PASSED THE SENATE APRIL 16, 2004
AMENDED IN SENATE FEBRUARY 26, 2004
AMENDED IN SENATE SEPTEMBER 3, 2003
AMENDED IN SENATE JULY 1, 2003
AMENDED IN ASSEMBLY MAY 27, 2003
AMENDED IN ASSEMBLY APRIL 10, 2003
INTRODUCED BY Assembly Member Daucher
(Coauthors: Assembly Members Chu and Lieber)
FEBRUARY 19, 2003
An act to add Chapter 1.6 (commencing with Section 120392) to Part
2 of Division 105 of the Health and Safety Code, relating to
immunizations.
LEGISLATIVE COUNSEL'S DIGEST
AB 691, Daucher. Nursing facilities: vaccines.
Under existing law, the State Department of Health Services is
responsible for the licensure and regulation of health facilities,
including skilled nursing facilities and intermediate care
facilities, as defined.
Under existing law, the department also has responsibilities
relating to the prevention and control of communicable diseases by
various means, including requiring immunization by vaccine for
various populations.
This bill would require a skilled nursing facility, an
intermediate care facility, or a nursing facility, as defined, to
offer immunizations for influenza and pneumococcal disease to its
residents, aged 65 years or older, between October 1 and April 1 of
each year, and to offer pneumococcal vaccine to all new admittees.
The bill would require that the facility be reimbursed the standard
Medi-Cal rate for vaccines provided to Medi-Cal recipients, except
under specified circumstances. The bill would require the facility
to obtain informed consent for the immunization services from the
resident or, if the person lacks the capacity to make medical
decisions, for the person legally authorized to make medical
decisions on the resident's behalf.
This bill would specify circumstances under which the
immunizations may not be administered to a resident, and
circumstances under which the facility shall not be required to
provide the immunization services required by the bill. The bill
would provide that if a health care facility fails to offer an
immunization pursuant to the bill due to lack of availability of
vaccine, or due to the physician's or resident's refusal or lack of
cooperation, the failure shall not be the basis for issuing a
deficiency or citation against the facility's license. The bill
would authorize the department to issue a deficiency or citation for
failure to comply with provisions of the bill relating to resident
evaluation and consent procedures.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Chapter 1.6 (commencing with Section 120392) is added
to Part 2 of Division 105 of the Health and Safety Code, to read:
CHAPTER 1.6. INFLUENZA AND PNEUMOCOCCAL IMMUNIZATIONS
120392. For purposes of this chapter, the following definitions
apply:
(a) "Health care facility" means a skilled nursing facility as
defined in subdivision (c) of Section 1250, an intermediate care
facility as defined in subdivision (d) of Section 1250, or a nursing
facility as defined in subdivision (k) of Section 1250. This chapter
shall not apply to hospital-based skilled nursing facilities.
(b) "Medically contraindicated" means that the administration of
the influenza or pneumococcal vaccines to a person, because of a
medical condition of that person, would be detrimental to the person'
s health if the person receives either or both of the vaccines.
120392.2. (a) Each year, commencing October 1 to the following
April 1, inclusive, every health care facility, as defined in
subdivision (a) of Section 120392, shall offer, pursuant to Section
120392.4, immunizations for influenza and pneumococcal disease to
residents, aged 65 years or older, receiving services at the
facility, based upon the latest recommendations of the Advisory
Committee on Immunization Practices (ACIP) of the Centers for Disease
Control and Prevention, and the latest recommendations of
appropriate entities for the prevention, detection, and control of
influenza outbreaks in California long-term care facilities.
(b) Each health care facility, as defined in subdivision (a) of
Section 120392, shall offer, pursuant to Section 120392.4,
pneumococcal vaccine to all new admittees to the health care
facility, based on the latest recommendations of the ACIP.
(c) The facility shall be reimbursed the standard Medi-Cal rate
for an immunization provided to a Medi-Cal recipient, unless he or
she is also a Medicare recipient whose coverage includes
reimbursement for the immunization.
120392.4. (a) A resident who receives services at a health care
facility during the period of October 1 to April 1 shall have his or
her status for influenza and pneumococcal immunization determined by
his or her physician or facility medical director, and, if
appropriate, the facility shall offer to make the immunizations
available, unless the facility, through written policies and
procedures and using standardized nursing procedures, offers to make
the immunizations available without limitation as to the period when
the residents receive services at the facility.
(b) A health care facility shall obtain from a resident who
requests immunization services, or, if the person lacks the capacity
to make medical decisions, from the person legally authorized to make
medical decisions on the resident's behalf, informed consent for the
resident to be immunized by vaccination against influenza or
pneumococcal disease, or both, to be conducted by the facility while
the resident is receiving services at the facility.
(c) A health care facility shall comply with Section 1418.8 with
respect to a resident who lacks the capacity to make health care
decisions, and there is no person with legal authority to make these
decisions on behalf of the resident.
(d) The health care facility shall document in a resident's
medical record whether the resident has been offered the influenza
vaccine or the pneumococcal vaccine.
120392.6. No person who has been offered the vaccine as required
under this chapter may receive either an influenza vaccine or
pneumococcal vaccine pursuant to this chapter if any of the following
conditions exists:
(a) The vaccine is medically contraindicated, as described in the
product labeling approved by the federal Food and Drug Administration
or by the recommendations established by the Advisory Committee on
Immunization Practice (ACIP) of the Centers for Disease Control and
Prevention that are in effect at the time of vaccination.
(b) Receipt of the vaccine is against the resident's personal
beliefs.
(c) Receipt of the vaccine is against the resident's wishes, or,
if the person lacks the capacity to make medical decisions, is
against the wishes of the person legally authorized to make medical
decisions on the resident's behalf.
120392.8. (a) Notwithstanding any other provision of this
chapter, a health care facility shall not be required to offer
immunizations for influenza and pneumococcal disease under either of
the following circumstances:
(1) The facility is unable to obtain the vaccine due to a shortage
of the supply of vaccine.
(2) The resident refuses to pay for the vaccine and there is no
other funding source available to pay for the cost of the vaccine.
(b) If a health care facility, as defined in subdivision (a) of
Section 120392, fails to offer an immunization pursuant to this
chapter due to lack of availability of vaccine, a physician's refusal
to assess the resident or cooperate with the recommendations of the
provisions of this chapter, or lack of resident cooperation, the
failure shall not be the basis for issuing a deficiency or citation
against the facility's license.
(c) This chapter is intended to encourage immunizations for
residents in health care facilities, and the department shall
consider a facility's efforts to prevent a violation of this chapter
prior to issuing a deficiency or citation. The department may issue
a deficiency or citation for failure to comply with Section 120392.4.