BILL NUMBER: AB 2821	CHAPTERED  09/21/04

	CHAPTER  661
	FILED WITH SECRETARY OF STATE  SEPTEMBER 21, 2004
	APPROVED BY GOVERNOR  SEPTEMBER 21, 2004
	PASSED THE ASSEMBLY  AUGUST 27, 2004
	PASSED THE SENATE  AUGUST 23, 2004
	AMENDED IN SENATE  AUGUST 10, 2004
	AMENDED IN SENATE  JUNE 23, 2004
	AMENDED IN ASSEMBLY  APRIL 26, 2004

INTRODUCED BY   Assembly Member Daucher

                        FEBRUARY 20, 2004

   An act to amend Section 1400 of, and to add Section 14019.7 to,
the Welfare and Institutions Code, relating to health care services.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2821, Daucher.  Care facilities:  referrals:  Medi-Cal payment
for noncovered services.
   (1) Existing law prohibits any person, association, or corporation
from establishing, conducting, or maintaining a referral agency or
to refer any person for remuneration to any extended care, skilled
nursing home, or intermediate care facility or a distinct part of a
facility providing extended care, skilled nursing home care, or
intermediate care, without first having obtained a written license
from the Director of Health Services or from an inspection service
approved by the director.
   This bill would prohibit any person, association, or corporation
from establishing, conducting, or maintaining a referral agency or to
refer any person for remuneration to any person or agency outside a
long-term health care facility for professional services for which
the facility does not employ a qualified professional person to
furnish a specific service, unless the facility complies with current
federal and state law regarding the provision of these services and
other requirements are met.
   (2) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Services, pursuant to
which medical benefits are provided to public assistance recipients
and certain other low-income persons.  Existing law prohibits a
provider of health services from seeking reimbursement or payment
from a Medi-Cal beneficiary for covered services.
   This bill would provide that, if permitted by federal law, a
relative of a skilled nursing facility resident who is a Medi-Cal
beneficiary may pay an additional amount to the facility to enable
the resident to obtain requested noncovered services, as described in
the bill.  The bill would prohibit the charge for these services
from exceeding the charges to private pay residents for the same
services.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1400 of the Health and Safety Code is amended
to read:
   1400.  (a) It is unlawful for any person, association, or
corporation to establish, conduct or maintain a referral agency or to
refer any person for remuneration to any extended care, skilled
nursing home or intermediate care facility or a distinct part of a
facility providing extended care, skilled nursing home care, or
intermediate care, without first having obtained a written license
therefor as provided in this chapter from the director or from an
inspection service approved by the director pursuant to Section 1257.

   (b) It is unlawful for any person, association, or corporation to
establish, conduct, or maintain a referral agency or to refer any
person for remuneration to any person or agency outside a long-term
health care facility, as defined in Section 1418, for professional
services for which the long-term health care facility does not employ
a qualified professional person to furnish a specific service,
including, but not limited to, laboratory, diagnostic, or therapy
services, unless the long-term health care facility complies with
current federal and state laws regarding the provision of these
services and all of the following conditions are met:
   (1) The services will be provided in accordance with professional
standards applicable to the provision of these services in a
long-term health care facility.
   (2) The long-term health care facility assumes responsibility for
timeliness of the services.
   (3) Services are provided or obtained only when ordered by the
attending physician and a notation is made in the resident's medical
chart reflecting that the service has been provided to the resident.

  SEC. 2.  Section 14019.7 is added to the Welfare and Institutions
Code, to read:
   14019.7.  (a) Notwithstanding Section 14019.4 and if permitted by
federal law, a relative of a skilled nursing facility resident who is
a beneficiary under this chapter may pay an additional amount to the
facility to enable the resident to obtain requested noncovered
services, such as a private room, telephone, or television, or for
bed hold days that exceed a period paid for under the state plan.
   (b) The additional charge for requested noncovered services shall
not exceed the amount charged to private pay residents.  The
additional charge for bed hold days shall not exceed the rate paid
for by the Medi-Cal program for a covered bed hold day.  The
additional charge for a private room shall not exceed the difference
between the private pay rate for a semiprivate room and a private
room.
   (c) Prior to accepting supplemental payment for holding a bed for
a resident in a facility, a facility shall disclose to the relative
the resident's right under federal law to be readmitted without
charge upon the first availability of a bed in a semiprivate room in
that facility, other state and federal laws regarding bed hold
rights, the average number of bed vacancies at that facility for the
past month, and the current number of bed vacancies.  Written
information regarding bed vacancies shall be provided to the relative
at the first available opportunity.
   (d) The ability of a resident's relative to pay an additional
amount for noncovered services shall not be a condition of admission.