BILL NUMBER: AB 1299	CHAPTERED  09/28/04

	CHAPTER  825
	FILED WITH SECRETARY OF STATE  SEPTEMBER 28, 2004
	APPROVED BY GOVERNOR  SEPTEMBER 28, 2004
	PASSED THE ASSEMBLY  AUGUST 25, 2004
	PASSED THE SENATE  AUGUST 24, 2004
	AMENDED IN SENATE  AUGUST 23, 2004
	AMENDED IN SENATE  AUGUST 9, 2004
	AMENDED IN SENATE  MAY 27, 2004
	AMENDED IN SENATE  APRIL 22, 2004
	AMENDED IN SENATE  JUNE 24, 2003
	AMENDED IN ASSEMBLY  JUNE 3, 2003

INTRODUCED BY   Assembly Member Daucher

                        FEBRUARY 21, 2003

   An act to amend Sections 1368.2, 1746, and 1749 of the Health and
Safety Code, relating to health facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1299, Daucher.  Hospices.
   The California Hospice Licensure Act of 1990 provides for the
licensure of hospices by the State Department of Health Services in
order to ensure the health and safety of patients experiencing the
last phases of life due to the existence of a terminal disease, and
to permit qualified persons, political subdivisions of the state, and
governmental agencies to comply with requirements of federal law
regarding the provision of hospice care.
   Existing law requires every group health care service plan
contract, except a specialized health care service plan contract,
that is issued, amended, or renewed, to include a provision for
hospice care.  Existing law requires the hospice care to, at a
minimum, be equivalent to hospice care provided by the federal
Medicare program.
   This bill would provide that the hospice care is not required to
include preliminary services, as defined.  However, the bill would
require an enrollee who receives those preliminary services to remain
eligible for coverage of curative treatment by a health care service
plan during the course of preliminary services and prior to the
election of hospice services.
   This bill would authorize the provision of additional preliminary
services, as defined, to persons who have not elected to become a
hospice patient if those services are determined to be needed, and
would make these additional services and related definitions
inapplicable to group health care service plans.
   Existing law requires licensed hospice services to comply with the
"Standards for Quality Hospice Care, 1996" of the California State
Hospice Association.  Existing law makes violation of hospice
licensure provisions a crime.
   The bill would, instead, require licensed hospice services to
comply with the "Standards for Quality Hospice Care, 2003" of the
California Hospice and Palliative Care Association.  By changing the
definition of a crime, this bill would impose a state-mandated local
program.
  The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state.  Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.


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


  SECTION 1.  Section 1368.2 of the Health and Safety Code is amended
to read:
   1368.2.  (a) On and after January 1, 2002, every group health care
service plan contract, except a specialized health care service plan
contract, which is issued, amended, or renewed, shall include a
provision for hospice care.
   (b) The hospice care shall at a minimum be equivalent to hospice
care provided by the federal Medicare program pursuant to Title XVIII
of the Social Security Act.
   (c) The hospice care provided under this section is not required
to include preliminary services set forth in subdivision (d) of
Section 1749. However, an enrollee who receives those preliminary
services shall remain eligible for coverage of curative treatment by
a health care service plan during the course of preliminary services
and prior to the election of hospice services.
   (d) The following are applicable to this section and to paragraph
(7) of subdivision (b) of Section 1345:
   (1) The definitions in Section 1746, except for subdivisions (o)
and (p) of that section.
   (2) The "federal regulations" which means the regulations adopted
for hospice care under Title XVIII of the Social Security Act in
Title 42 of the Code of Federal Regulations, Chapter IV, Part 418,
except Subparts A, B, G, and H, and any amendments or successor
provisions thereto.
   (e) The director no later than January 1, 2001, shall adopt
regulations to implement this section.  The regulations shall meet
all of the following requirements:
   (1) Be consistent with all material elements of the federal
regulations that are not by their terms applicable only to eligible
Medicare beneficiaries. If there is a conflict between a federal
regulation and any state regulation, other than those adopted
pursuant to this section, the director shall adopt the regulation
that is most favorable for plan subscribers, members or enrollees to
receive hospice care.
   (2) Be consistent with any other applicable federal or state laws.

   (3) Be consistent with the definitions of Section 1746, except for
subdivisions (o) and (p) of that section.
   (f) This section is not applicable to the subscribers, members, or
enrollees of a health care service plan who elect to receive hospice
care under the Medicare program.
   (g) The director, commencing on January 15, 2002, and on each
January 15th thereafter, shall report to the Advisory Committee on
Managed Health Care any changes in the federal regulations that
differ materially from the regulations then in effect for this
section.  The director shall include with the report written text for
proposed changes to the regulations then in effect for this section
needed to meet the requirements of subdivision  (e).
  SEC. 2.  Section 1746 of the Health and Safety Code is amended to
read:
   1746.  For the purposes of this chapter, the following definitions
apply:
   (a) "Bereavement services" means those services available to the
surviving family members for a period of at least one year after the
death of the patient, including an assessment of the needs of the
bereaved family and the development of a care plan that meets these
needs, both prior to and following the death of the patient.
   (b) "Hospice" means a specialized form of interdisciplinary health
care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the following criteria:
   (1) Considers the patient and the patient's family, in addition to
the patient, as the unit of care.
   (2) Utilizes an interdisciplinary team to assess the physical,
medical, psychological, social, and spiritual needs of the patient
and the patient's family.
   (3) Requires the interdisciplinary team to develop an overall plan
of care and to provide coordinated care that emphasizes supportive
services, including, but not limited to, home care, pain control, and
limited inpatient services.  Limited inpatient services are intended
to ensure both continuity of care and appropriateness of services
for those patients who cannot be managed at home because of acute
complications or the temporary absence of a capable primary
caregiver.
   (4) Provides for the palliative medical treatment of pain and
other symptoms associated with a terminal disease, but does not
provide for efforts to cure the disease.
   (5) Provides for bereavement services following death to assist
the family in coping with social and emotional needs associated with
the death of the patient.
   (6) Actively utilizes volunteers in the delivery of hospice
services.
   (7) To the extent appropriate, based on the medical needs of the
patient, provides services in the patient's home or primary place of
residence.
   (c) "Inpatient care arrangements" means arranging for those short
inpatient stays that may become necessary to manage acute symptoms or
because of the temporary absence, or need for respite, of a capable
primary caregiver.  The hospice shall arrange for these stays,
ensuring both continuity of care and the appropriateness of services.

   (d) "Medical direction" means those services provided by a
licensed physician and surgeon who is charged with the responsibility
of acting as a consultant to the interdisciplinary team, a
consultant to the patient's attending physician and surgeon, as
requested, with regard to pain and symptom management, and a liaison
with physicians and surgeons in the community.
   (e) "An interdisciplinary team" means the hospice care team that
includes, but is not limited to, the patient and patient's family, a
physician and surgeon, a registered nurse, a social worker, a
volunteer, and a spiritual caregiver.  The team shall be coordinated
by a registered nurse and shall be under medical direction.  The team
shall meet regularly to develop and maintain an appropriate plan of
care.
   (f) "Plan of care" means a written plan developed by the attending
physician and surgeon, the medical director or physician and surgeon
designee, and the interdisciplinary team that addresses the needs of
a patient and family admitted to the hospice program.  The hospice
shall retain overall responsibility for the development and
maintenance of the plan of care and quality of services delivered.
   (g) "Skilled nursing services" means nursing services provided by
or under the supervision of a registered nurse under a plan of care
developed by the interdisciplinary team and the patient's physician
and surgeon to a patient and his or her family that pertain to the
palliative, supportive services required by patients with a terminal
illness.  Skilled nursing services include, but are not limited to,
patient assessment, evaluation and case management of the medical
nursing needs of the patient, the performance of prescribed medical
treatment for pain and symptom control, the provision of emotional
support to both the patient and his or her family, and the
instruction of caregivers in providing personal care to the patient.
Skilled nursing services shall provide for the continuity of
services for the patient and his or her family.  Skilled nursing
services shall be available on a 24-hour on-call basis.
   (h) "Social services/counseling services" means those counseling
and spiritual care services that assist the patient and his or her
family to minimize stresses and problems that arise from social,
economic, psychological, or spiritual needs by utilizing appropriate
community resources, and maximize positive aspects and opportunities
for growth.
   (i) "Terminal disease" or "terminal illness" means a medical
condition resulting in a prognosis of life of one year or less, if
the disease follows its natural course.
   (j) "Volunteer services" means those services provided by trained
hospice volunteers who have agreed to provide service under the
direction of a hospice staff member who has been designated by the
hospice to provide direction to hospice volunteers.  Hospice
volunteers may be used to provide support and companionship to the
patient and his or her family during the remaining days of the
patient's life and to the surviving family following the patient's
death.
   (k) "Multiple location" means a location or site from which a
hospice makes available basic hospice services within the service
area of the parent agency.  A multiple location shares
administration, supervision, policies and procedures, and services
with the parent agency in a manner that renders it unnecessary for
the site to independently meet the licensing requirements.
   (l) "Home health aide" has the same meaning as set forth in
subdivision (c) of Section 1727.
   (m) "Home health aide services" means those services described in
subdivision (d) of Section 1727 that provide for the personal care of
the terminally ill patient and the performance of related tasks in
the patient's home in accordance with the plan of care in order to
increase the level of comfort and to maintain personal hygiene and a
safe, healthy environment for the patient.
   (n) "Parent agency" means the part of the hospice that is licensed
pursuant to this chapter and that develops and maintains
administrative controls of multiple locations.  All services provided
by the multiple locations and parent agency are the responsibility
of the parent agency.
   (o) "Palliative" refers to medical treatment, interdisciplinary
care, or consultation provided to the patient or family members, or
both, that have as its primary purposes preventing or relieving
suffering and enhancing the quality of life, rather than curing the
disease, as described in subdivision (b) of Section 1339.31, of a
patient who has an end-stage medical condition.
   (p) "Preliminary services" means those services authorized
pursuant to subdivision (d) of Section 1749.
  SEC. 3.  Section 1749 of the Health and Safety Code is amended to
read:
   1749.  (a) To qualify for a license under this chapter, an
applicant shall satisfy all of the following:
   (1) Be of good moral character.  If the applicant is a franchise,
franchisee, firm, association, organization, partnership, business
trust, corporation, company, political subdivision of the state, or
governmental agency, the person in charge of the hospice for which
the application for a license is made shall be of good moral
character.
   (2) Demonstrate the ability of the applicant to comply with this
chapter and any rules and regulations promulgated under this chapter
by the state department.
   (3) File a completed application with the state department that
was prescribed and furnished pursuant to Section 1748.
   (b) In order for a person, political subdivision of the state, or
other governmental agency to be licensed as a hospice it shall
satisfy the definition of a hospice contained in Section 1746, and
also provide, or make provision for, the following basic services:
   (1) Skilled nursing services.
   (2) Social services/counseling services.
   (3) Medical direction.
   (4) Bereavement services.
   (5) Volunteer services.
   (6) Inpatient care arrangements.
   (7) Home health aide services.
   (c) The services required to be provided pursuant to subdivision
(b) shall be provided in compliance with the "Standards for Quality
Hospice Care, 2003," as available from the California Hospice and
Palliative Care Association, until the state department adopts
regulations establishing alternative standards pursuant to
subdivision (e).
   (d) (1) Notwithstanding any provision of law to the contrary, to
meet the unique needs of the community, licensed hospices may
provide, in addition to hospice services authorized in this chapter,
any of the following preliminary services for any person in need of
those services, as determined by the physician and surgeon, if any,
in charge of the care of a patient, or at the request of the patient
or family:
   (A) Preliminary palliative care consultations.
   (B) Preliminary counseling and care planning.
   (C) Preliminary grief and bereavement services.
   (2) Preliminary services authorized pursuant to this subdivision
may be provided concurrently with curative treatment to a person who
does not have a terminal prognosis or who has not elected to receive
hospice services only by licensed and certified hospices.  These
services shall be subject to the schedule of benefits under the
Medi-Cal program, pursuant to subdivision (w) of Section 14132 of the
Welfare and Institutions Code.
   (e) The state department may adopt regulations establishing
standards for any or all of the services required to be provided
under subdivision (b).  The regulations of the state department
adopted pursuant to this subdivision shall supersede the standards
referenced in subdivision (c) to the extent the regulations duplicate
or replace those standards.
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.