BILL NUMBER: AB 950 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Hernandez
FEBRUARY 26, 2009
An act to amend Sections 1250, 1250.1, 1746, 128700, and 128755
of, and to add Sections 1520.6, 1568.043, 1569.173, 1749.1, and
1749.3 to, the Health and Safety Code, relating to hospice care.
LEGISLATIVE COUNSEL'S DIGEST
AB 950, as introduced, Hernandez. Hospice providers: licensed
hospice facilities.
Under existing law, the State Department of Public Health licenses
and regulates health care facilities, including adult residential
facilities, residential care facilities, and residential care
facilities for the elderly. Under existing law, the department also
licenses and regulates hospices and the provision of hospice
services. Violation of these provisions is a crime.
This bill would create as a new category for, and require the
department to license and regulate, hospice facilities, as defined.
The bill would allow adult residential facilities, residential care
facilities, and residential care facilities for the elderly to lease
a contiguous space in that facility for a hospice facility under
specified conditions.
Because this bill would create a new crime, it 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Hospice is a special type of health care service designed to
provide palliative care and to alleviate the physical, emotional,
social, and spiritual discomforts of an individual who is
experiencing the last phases of life due to terminal illness.
(b) Hospice services provide supportive care to the primary
caregiver and family of the patient.
(c) Hospice services are provided primarily in the home, but can
also be provided in residential care or in health facility inpatient
settings.
(d) Persons who do not have family or caregivers who are able to
provide care in the home should be able to have care provided in a
home-like environment, rather than in an institutional setting, if
that is their preference.
(e) Permitting the establishment of licensed hospice facilities
provides additional care and treatment options for persons who are at
the end of life.
(f) The establishment of licensed hospice facilities is permitted
under federal law and by many other states.
(g) Permitting the establishment of licensed hospice facilities is
consistent with federal legal affirmations of the right of an
individual to refuse life-sustaining treatment and that each person's
preferences about his or her end-of-life care should be considered.
(h) Permitting the establishment of licensed hospice facilities is
also consistent with the decision of the United States Supreme Court
in Olmstead v. L.C. by Zimring (1999) 527 U.S. 581, which held that
persons with disabilities have the right to live in the most
integrated setting possible with appropriate access to care and
choice of community-based services and placement options.
(i) It is the intent of the Legislature to permit the licensure of
hospice inpatient facilities in order to improve access to care, to
provide additional care options, and to provide for a home-like
environment within which to provide care and treatment for persons
who are experiencing the last phases of life.
SEC. 2. Section 1250 of the Health and Safety Code is amended to
read:
1250. As used in this chapter, "health facility" means any
facility, place, or building that is organized, maintained, and
operated for the diagnosis, care, prevention, and treatment of human
illness, physical or mental, including convalescence and
rehabilitation and including care during and after pregnancy, or for
any one or more of these purposes, for one or more persons, to which
the persons are admitted for a 24-hour stay or longer, and includes
the following types:
(a) "General acute care hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental Center
may, until June 30, 2007, provide surgery and anesthesia services
through a contract or agreement with another acute care hospital.
Notwithstanding the requirements of this subdivision, a general acute
care hospital operated by the Department of Corrections and
Rehabilitation or the Department of Veterans Affairs may provide
surgery and anesthesia services during normal weekday working hours,
and not provide these services during other hours of the weekday or
on weekends or holidays, if the general acute care hospital otherwise
meets the requirements of this section .
A "general acute care hospital" includes a "rural general acute
care hospital." However, a "rural general acute care hospital" shall
not be required by the department to provide surgery and anesthesia
services. A "rural general acute care hospital" shall meet either of
the following conditions:
(1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982.
(2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982, and has
no more than 76 acute care beds and is located in a census dwelling
place of 15,000 or less population according to the 1980 federal
census.
(b) "Acute psychiatric hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff
that who provides 24-hour inpatient care for
mentally disordered, incompetent, or other patients referred to in
Division 5 (commencing with Section 5000) or Division 6 (commencing
with Section 6000) of the Welfare and Institutions Code, including
the following basic services: medical, nursing, rehabilitative,
pharmacy, and dietary services.
(c) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
(d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
(e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer developmentally disabled
persons who have intermittent recurring needs for nursing services,
but have been certified by a physician and surgeon as not requiring
availability of continuous skilled nursing care.
(f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that who provides inpatient or
outpatient care in dentistry or maternity.
(g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to developmentally
disabled clients whose primary need is for developmental services and
who have a recurring but intermittent need for skilled nursing
services.
(h) "Intermediate care facility/developmentally disabled--nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for developmentally disabled persons who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons who have developmental disabilities or demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
(i) (1) "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than 12 beds, that provides inpatient care, including the following
basic services: medical supervision, 24-hour skilled nursing and
supportive care, pharmacy, dietary, social, recreational, and at
least one type of service specified in paragraph (2). The primary
need of congregate living health facility residents shall be for
availability of skilled nursing care on a recurring, intermittent,
extended, or continuous basis. This care is generally less intense
than that provided in general acute care hospitals but more intense
than that provided in skilled nursing facilities.
(2) Congregate living health facilities shall provide one of the
following services:
(A) Services for persons who are mentally alert, physically
disabled persons, who may be ventilator dependent.
(B) Services for persons who have a diagnosis of terminal illness,
a diagnosis of a life-threatening illness, or both. Terminal illness
means the individual has a life expectancy of six months or less as
stated in writing by his or her attending physician and surgeon. A
"life-threatening illness" means the individual has an illness that
can lead to a possibility of a termination of life within five years
or less as stated in writing by his or her attending physician and
surgeon.
(C) Services for persons who are catastrophically and severely
disabled. A catastrophically and severely disabled person means a
person whose origin of disability was acquired through trauma or
nondegenerative neurologic illness, for whom it has been determined
that active rehabilitation would be beneficial and to whom these
services are being provided. Services offered by a congregate living
health facility to a catastrophically disabled person shall include,
but not be limited to, speech, physical, and occupational therapy.
(3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
(4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
(B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons may
have not more than 25 beds for the purpose of serving terminally ill
persons.
(C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving catastrophically and severely
disabled persons.
(5) A congregate living health facility shall have a
noninstitutional, homelike environment.
(j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections and Rehabilitation
, the Department of the Youth Authority, or
a county, city, or city and county law enforcement agency that, as
determined by the state department, provides inpatient health
services to that portion of the inmate population who do not require
a general acute care level of basic services. This definition shall
not apply to those areas of a law enforcement facility that houses
inmates or wards that who may be
receiving outpatient services and are housed separately for reasons
of improved access to health care, security, and protection. The
health services provided by a correctional treatment center shall
include, but are not limited to, all of the following basic services:
physician and surgeon, psychiatrist, psychologist, nursing,
pharmacy, and dietary. A correctional treatment center may provide
the following services: laboratory, radiology, perinatal, and any
other services approved by the state department.
(2) Outpatient surgical care with anesthesia may be provided, if
the correctional treatment center meets the same requirements as a
surgical clinic licensed pursuant to Section 1204, with the exception
of the requirement that patients remain less than 24 hours.
(3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.
(4) Physician and surgeon services shall be readily available in a
correctional treatment center on a 24-hour basis.
(5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men's Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the Department of Corrections and
Rehabilitation from obtaining a correctional treatment center
license at these sites.
(k) "Nursing facility" means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of
care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act or as a
nursing facility in the federal Medicaid Program under Title XIX of
the federal Social Security Act, or as both.
() Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation ,
or the Department of the Youth Authority, shall
not become effective prior to, or if effective, shall be inoperative
until January 1, 1996, and until that time these correctional
facilities are exempt from any licensing requirements.
(m) "Hospice facility" means a facility licensed pursuant to
Sections 1749.1 and 1749.3.
SEC. 3. Section 1250.1 of the Health and Safety Code is amended to
read:
1250.1. (a) The state department shall adopt regulations that
define all of the following bed classifications for health
facilities:
(1) General acute care.
(2) Skilled nursing.
(3) Intermediate care-developmental disabilities.
(4) Intermediate care--other.
(5) Acute psychiatric.
(6) Specialized care, with respect to special hospitals only.
(7) Chemical dependency recovery.
(8) Intermediate care facility/developmentally disabled
habilitative.
(9) Intermediate care facility/developmentally disabled nursing.
(10) Congregate living health facility.
(11) Pediatric day health and respite care facility, as defined
in Section 1760.2.
(12) Correctional treatment center. For correctional treatment
centers that provide psychiatric and psychological services provided
by county mental health agencies in local detention facilities, the
State Department of Mental Health shall adopt regulations specifying
acute and nonacute levels of 24-hour care. Licensed inpatient beds in
a correctional treatment center shall be used only for the purpose
of providing health services.
(13) Hospice facility. The department shall consult with the State
Department of Social Services, the Office of Statewide Health
Planning and Development, and the Office of the State Fire Marshal
when drafting regulations pursuant to this section.
(b) Except as provided in Section 1253.1, beds classified as
intermediate care beds, on September 27, 1978, shall be reclassified
by the state department as intermediate care--other. This
reclassification shall not constitute a "project" within the meaning
of Section 127170 and shall not be subject to any requirement for a
certificate of need under Chapter 1 (commencing with Section 127125)
of Part 2 of Division 107, and regulations of the state department
governing intermediate care prior to the effective date shall
continue to be applicable to the intermediate care--other
classification unless and until amended or repealed by the state
department.
SEC. 4. Section 1520.6 is added to the Health and Safety Code, to
read:
1520.6. (a) (1) An adult residential facility, as defined in
paragraph (5) of subdivision (a) of Section 80001 of Title 22 of the
California Code of Regulations, licensed pursuant to this chapter,
may lease contiguous beds or space to a licensed hospice facility, as
defined in subdivision (m) of Section 1250, in accordance with this
section. The adult residential facility shall obtain written approval
from the department at least 30 days before the effective date of
the lease. For purposes of this section, "contiguous beds or space"
means a separate unit, wing, floor, building, or grouping of beds,
offices, or rooms that are used exclusively for the purposes of
operating a licensed hospice facility and does not contain any space
used by the adult residential facility.
(2) Not more than 25 percent of the adult residential facility's
total bed capacity shall be used for purposes of a hospice facility,
unless the department issues an exemption.
(3) Notwithstanding paragraph (2), the department may issue
regulations that increase the maximum percentage of total bed
capacity used for a hospice facility.
(b) When a portion of an adult residential facility is leased for
the purpose described in subdivision (a), the department shall issue
a new license to the licensee of an adult residential facility that
does not include the number of beds leased to a hospice facility. The
department may request a new plan of operation from the licensee
that demonstrates the licensee's ability to meet all licensing
requirements within the proximity of the hospice facility.
(c) Notwithstanding any other law, an adult residential facility
may place all or a portion of its licensed bed capacity in voluntary
suspension in order to lease that space to a licensed hospice
facility. The health facility shall obtain written approval from the
department and provide written notification to the Office of
Statewide Health Planning and Development at least 30 days prior to
the effective date of the lease. The period of voluntary suspension
shall coincide with the duration of the hospice facility license.
Upon termination of the lease agreements, termination, temporary
suspension, revocation, or cancellation of the license, termination
of Medicare or Medicaid certification, or voluntary surrender of the
hospice facility or hospice program license, the bed capacity shall
be removed from voluntary suspension and reinstated to the health
facility within which the hospice facility was located.
(d) Nothing in this subdivision shall prohibit staff from being
employees of both the adult residential facility and the hospice
facility. The staff of the adult residential facility shall not
simultaneously provide care or services to residents of both
facilities.
(e) Hospice facility patients shall not be subject to the
requirements of paragraph (1) of subdivision (b) of Section 1522.
(f) Common areas used by residents of the adult residential
facility shall not be routinely used as common areas for hospice
patients, except as provided by mutual agreement between the
facilities.
(g) Nothing in this section shall prohibit residents of the adult
residential facility or patients of the hospice facility from
visiting each other, provided all licensing requirements for visitors
are met.
(h) A licensed hospice facility that is located within an existing
licensed adult residential facility shall assume full and complete
responsibility for complying with all applicable licensing and
certification requirements when providing hospice care to patients
within the hospice facility, whether hospice services are provided
directly by, or under contract with, the licensee. Unless specified
by contract, in no event shall a licensed adult residential facility
be responsible for the operations of, or assume any liability in
connection with, the hospice facility.
SEC. 5. Section 1568.043 is added to the Health and Safety Code,
to read:
1568.043. (a) (1) A residential care facility that is licensed
pursuant to this chapter may lease contiguous beds or space to a
licensed hospice facility, as defined in subdivision (m) of Section
1250, in accordance with this section. The residential care facility
shall obtain written approval from the department at least 30 days
before the effective date of the lease. For purposes of this section,
"contiguous beds or space" means a separate unit, wing, floor,
building, or grouping of beds, offices, or rooms that are used
exclusively for the purposes of operating a licensed hospice facility
and does not contain any space used by the residential care
facility.
(2) Not more than 25 percent of the adult residential facility's
total bed capacity shall be used for purposes of a hospice facility,
unless the department issues an exemption.
(3) Notwithstanding paragraph (2), the department may issue
regulations that increase the maximum percentage of total bed
capacity used for a hospice facility.
(b) When a portion of a residential care facility is leased for
the purpose described in subdivision (a), the department shall issue
a new license to the licensee of a residential care facility that
does not include the number of beds leased to a hospice facility. The
department may request a new plan of operation from the licensee
that demonstrates the licensee's ability to meet all licensing
requirements within the proximity of the hospice facility.
(c) Notwithstanding any other law, a residential care facility may
place all or a portion of its licensed bed capacity in voluntary
suspension in order to lease that space to a licensed hospice
facility. The health facility shall obtain written approval from the
department and provide written notification to the Office of
Statewide Health Planning and Development at least 30 days prior to
the effective date of the lease. The period of voluntary suspension
shall coincide with the duration of the hospice facility license.
Upon termination of the lease agreements, termination, temporary
suspension, revocation, or cancellation of the license, termination
of Medicare or Medicaid certification, or voluntary surrender of the
hospice facility or hospice program license, the bed capacity shall
be removed from voluntary suspension and reinstated to the health
facility within which the hospice facility was located.
(d) Nothing in this subdivision shall prohibit staff from being
employees of both the residential care facility and the hospice
facility. The staff of the residential care facility shall not
simultaneously provide care or services to residents of both
facilities.
(e) Hospice facility patients shall not be subject to the
requirements of paragraph (2) of subdivision (b) of Section 1568.09.
(f) Common areas used by residents of the residential care
facility shall not be routinely used as common areas for hospice
patients, except as provided by mutual agreement between the
facilities.
(g) Nothing in this section shall prohibit residents of the
residential care facility or patients of the hospice facility from
visiting each other, provided that all licensing requirements for
visitors are met.
(h) A licensed hospice facility that is located within an existing
licensed residential care facility shall assume full and complete
responsibility for complying with all applicable licensing and
certification requirements when providing hospice care to patients
within the hospice facility, whether hospice services are provided
directly by, or under contract with, the licensee. Unless specified
by contract, in no event shall a licensed residential care facility
be responsible for the operations of, or assume any liability in
connection with, the hospice facility.
SEC. 6. Section 1569.173 is added to the Health and Safety Code,
to read:
1569.173. (a) (1) A residential care facility for the elderly
licensed pursuant to this chapter may lease contiguous beds or space
to a licensed hospice facility, as defined in subdivision (m) of
Section 1250, in accordance with this section. The residential care
facility for the elderly shall obtain prior written approval from the
department at least 30 days before the effective date of the lease.
For purposes of this section, "contiguous beds or space" means a
separate unit, wing, floor, building, or grouping of beds, offices,
or rooms that are used exclusively for the purposes of operating a
licensed hospice facility.
(2) Not more than 25 percent of the residential care facility for
the elderly's total bed capacity shall be used for purposes of a
licensed hospice facility, unless the department issues an exemption.
(3) Notwithstanding paragraph (2), the department may issue
regulations that increase the maximum percentage of total bed
capacity used for a hospice facility.
(b) When a portion of a residential care facility for the elderly
is leased for the purpose described in subdivision (a), the
department shall issue a new license to the licensee of a residential
facility for the elderly that does not include the number of beds
leased to a hospice facility. The department may request a new plan
of operation from the licensee that demonstrates the licensee's
ability to meet all licensing requirements within the proximity of
the hospice facility.
(c) Notwithstanding any other law, a residential care facility for
the elderly may place all or a portion of its licensed bed capacity
in voluntary suspension in order to lease that space to a licensed
hospice facility. The health facility shall obtain written approval
from the department and provide written notification to the Office of
Statewide Health Planning and Development at least 30 days prior to
the effective date of the lease. The period of voluntary suspension
shall coincide with the duration of the hospice facility license.
Upon termination of the lease agreements, termination, temporary
suspension, revocation, or cancellation of the license, termination
of Medicare or Medicaid certification, or voluntary surrender of the
hospice facility or hospice program license, the bed capacity shall
be removed from voluntary suspension and reinstated to the health
facility within which the hospice facility was located.
(d) Nothing in this subdivision shall prohibit staff from being
employees of both the residential care facility for the elderly and
the hospice facility. The staff of the residential care facility
shall not simultaneously provide care or services to residents of
both facilities.
(e) Hospice facility patients shall not be subject to the
requirements of subparagraph (B) of paragraph (1) of subdivision (b)
of Section 1569.17.
(f) Common areas used by residents of the residential care
facility for the elderly shall not be routinely used as common areas
for hospice patients, except as provided by mutual agreement between
the facilities.
(g) Nothing in this section shall prohibit residents of the
residential care facility for the elderly or patients of the hospice
facility from visiting each other, provided that all licensing
requirements for visitors are met.
(h) A licensed hospice facility that is located within an existing
licensed residential care facility for the elderly shall assume full
and complete responsibility for complying with all applicable
licensing and certification requirements when providing hospice care
to patients within the hospice facility, whether hospice services are
provided directly by, or under contract with, the licensee. Unless
specified by contract, in no event shall a licensed residential care
facility for the elderly be responsible for the operations of, or
assume any liability in connection with, the hospice facility.
SEC. 7. 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) "Home health aide" has the same
meaning as set forth in subdivision (c) of Section 1727.
(c) "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.
(b)
(d) "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.
(e) "Hospice facility" means a health facility that has been
licensed pursuant to Sections 1749.1 and 1749.3 by the department for
the provision of hospice care, including routine care, continuous
care, inpatient respite care, and general inpatient care. Hospice
facility licensure shall be granted only to licensed and certified
hospices licensed in California.
(c)
(f) "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.
(g) "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.
(d)
(h) "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.
(i) "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.
(j) "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.
(k) "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.
(f)
(l) "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.
(m) "Preliminary services" means those services authorized
pursuant to subdivision (d) of Section 1749.
(g)
(n) "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)
(o) "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)
(p) "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)
(q) "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.
() "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. 8. Section 1749.1 is added to the Health and Safety Code, to
read:
1749.1. (a) Hospices licensed and certified in California may
apply for a hospice facility license. A hospice facility shall be
both licensed, and certified to participate as a provider of hospice
care in the federal Medicare program under Title XVIII of the federal
Social Security Act (42 U.S.C. Sec. 1395 et seq.).
(b) Hospice facility licensees shall be responsible for obtaining
criminal background checks for employees, volunteers, and contractors
in accordance with federal Medicare conditions of participation (42
CFR 418 et seq.) and as may be required in accordance with state law.
The hospice facility licensee shall pay the costs of obtaining a
criminal background check.
(c) Building standards adopted pursuant to this section relating
to fire and panic safety, and other regulations adopted pursuant to
this section, shall apply uniformly throughout the state. No city,
county, city and county, including a charter city or charter county,
or fire protection district shall adopt or enforce any ordinance or
local rule or regulation relating to fire and panic safety in
buildings or structures subject to this section that is inconsistent
with the rules and regulations adopted pursuant to this section.
(d) A hospice facility may operate as a freestanding facility, but
may also be located adjacent to, physically connected to, or on the
building grounds of another health facility or residential care
facility. Freestanding hospice facilities shall not be required to
submit construction plans to the Office of Statewide Health Planning
and Development for new construction or renovation. As part of the
application for licensure, the prospective licensee shall submit
evidence of compliance with local building codes. In addition, the
physical environment of the facility shall be adequate to provide the
level of care and service required by the residents of the facility
as determined by the department.
(e) Irrespective of location, hospice facilities shall be
separately licensed.
(f) The hospice facility shall meet the fire protection standards
set forth in federal Medicare conditions of participation (42 CFR 418
et seq.).
(g) A separately-licensed hospice facility may be located in all
or a portion of an existing health facility, adult residential
facility, residential care facility, or residential care facility for
the elderly and may lease space from that facility. The area leased
by the hospice facility shall be made up of contiguous beds in a
separate unit or floor within the leasing facility. The hospice
facility shall be identifiable as a separately-operating health
facility and shall have separate signage.
(h) A hospice facility that is located in all or a portion of
another facility shall be subject to all of the following:
(1) The hospice facility shall not be required to submit
construction plans to the Office of Statewide Health Planning and
Development for new construction or renovation, unless the hospice
facility is located within a health facility that is otherwise
required to submit plans to the Office of Statewide Health Planning
and Development.
(2) As part of the application for licensure, the prospective
licensee shall submit evidence of compliance with local building
codes. In addition, the physical environment of the facility shall be
adequate to provide the level of care and service required by the
residents of the facility as determined by the department.
(3) The hospice facility shall assume full and complete
responsibility for complying with all applicable licensing and
certification requirements when providing hospice care to patients
within the hospice facility, whether hospice services are provided
directly by, or under contract with, the licensee. Unless specified
by contract, in no event shall the licensed health facility in which
a hospice facility is located be responsible for the operations of,
or assume any liability in connection with, the hospice facility.
(i) In addition to the other provisions of this section, persons
excluded under Section 1558, 1568.092, or 1569.58 shall not be a
member of a hospice facility board of directors, or a licensee,
contractor, volunteer, or employee of a hospice facility located in a
portion of a residential care facility.
SEC. 9. Section 1749.3 is added to the Health and Safety Code, to
read:
1749.3. (a) In order for a hospice program to be licensed as a
hospice facility, it shall provide, or make provision for, all of the
following services and requirements:
(1) Medical direction and adequate staff.
(2) Skilled nursing services.
(3) Palliative care.
(4) Social services and counseling services.
(5) Bereavement services.
(6) Volunteer services.
(7) Dietary services.
(8) Pharmaceutical services.
(9) Physical therapy, occupational therapy, and speech-language
therapy.
(10) Patient rights.
(11) Disaster preparedness.
(12) An adequate, safe, and sanitary physical environment.
(13) Housekeeping services.
(14) Adequate and secure administrative and patient medical
records.
(b) The department shall adopt regulations that establish
standards for the provision of the services in subdivision (a). These
regulations shall include, but are not limited to, all of the
following:
(1) Minimum staffing standards that require at least one licensed
nurse to be on duty 24 hours per day and a maximum of six patients at
any given time per direct care staffperson.
(2) Patients rights provisions that require that provide each
patient with all of the following:
(A) Full information regarding his or her health status and
options for end-of-life care.
(B) Care that reflects individual preferences regarding
end-of-life care, including the right to refuse any treatment or
procedure.
(C) Treatment with consideration, respect, and full recognition of
dignity and individuality, including privacy in treatment and care
of personal needs.
(D) Entitlement to visitors of his or her choosing, at any time
the patient chooses, and ensured privacy for those visits.
(3) Disaster preparedness plans for both internal and external
disasters that protects hospice patients, employees, and visitors,
and reflect coordination with local agencies that are responsible for
disaster preparedness and emergency response.
(4) Any additional qualifications and requirements for licensure
above the requirements of this section and Section 1749.1.
(c) The hospice facility shall provide a home-like environment
that is comfortable and accommodating to both the patient and the
patient's visitors.
(d) The hospice facility shall continue to provide services to
family and friends after the patient's stay in the hospice facility
in accordance with the patient's plan of care. These services may be
provided by the hospice program that operates the hospice facility.
SEC. 10. Section 128700 of the Health and Safety Code is amended
to read:
128700. As used in this chapter, the following terms mean:
(a) "Ambulatory surgery procedures" mean those procedures
performed on an outpatient basis in the general operating rooms,
ambulatory surgery rooms, endoscopy units, or cardiac catheterization
laboratories of a hospital or a freestanding ambulatory surgery
clinic.
(b) "Commission" means the California Health Policy and Data
Advisory Commission.
(c) "Emergency department" means, in a hospital licensed to
provide emergency medical services, the location in which those
services are provided.
(d) "Encounter" means a face-to-face contact between a patient and
the provider who has primary responsibility for assessing and
treating the condition of the patient at a given contact and
exercises independent judgment in the care of the patient.
(e) "Freestanding ambulatory surgery clinic" means a surgical
clinic that is licensed by the state under paragraph (1) of
subdivision (b) of Section 1204.
(f) "Health facility" or "health facilities" means all health
facilities required to be licensed pursuant to Chapter 2 (commencing
with Section 1250) of Division 2.
(g) "Hospital" means all health facilities except skilled nursing,
intermediate care, hospice facilities, and congregate
living health facilities.
(h) "Office" means the Office of Statewide Health Planning and
Development.
(i) "Risk-adjusted outcomes" means the clinical outcomes of
patients grouped by diagnoses or procedures that have been adjusted
for demographic and clinical factors.
SEC. 11. Section 128755 of the Health and Safety Code is amended
to read:
128755. (a) (1) Hospitals shall file the reports required by
subdivisions (a), (b), (c), and (d) of Section 128735 with the office
within four months after the close of the hospital's fiscal year
except as provided in paragraph (2).
(2) If a licensee relinquishes the facility license or puts the
facility license in suspense, the last day of active licensure shall
be deemed a fiscal year end.
(3) The office shall make the reports filed pursuant to this
subdivision available no later than three months after they were
filed.
(b) (1) Skilled nursing facilities, intermediate care facilities,
intermediate care facilities/developmentally disabled, hospice
facilities, and congregate living facilities, including nursing
facilities certified by the state department to participate in the
Medi-Cal program, shall file the reports required by subdivisions
(a), (b), (c), and (d) of Section 128735 with the office within four
months after the close of the facility's fiscal year, except as
provided in paragraph (2).
(2) (A) If a licensee relinquishes the facility license or puts
the facility licensure in suspense, the last day of active licensure
shall be deemed a fiscal year end.
(B) If a fiscal year end is created because the facility license
is relinquished or put in suspense, the facility shall file the
reports required by subdivisions (a), (b), (c), and (d) of Section
128735 within two months after the last day of active licensure.
(3) The office shall make the reports filed pursuant to paragraph
(1) available not later than three months after they are filed.
(4) (A) Effective for fiscal years ending on or after December 31,
1991, the reports required by subdivisions (a), (b), (c), and (d) of
Section 128735 shall be filed with the office by electronic media,
as determined by the office.
(B) Congregate living health facilities are exempt from the
electronic media reporting requirements of subparagraph (A).
(c) A hospital shall file the reports required by subdivision (g)
of Section 128735 as follows:
(1) For patient discharges on or after January 1, 1999, through
December 31, 1999, the reports shall be filed semiannually by each
hospital or its designee not later than six months after the end of
each semiannual period, and shall be available from the office no
later than six months after the date that the report was filed.
(2) For patient discharges on or after January 1, 2000, through
December 31, 2000, the reports shall be filed semiannually by each
hospital or its designee not later than three months after the end of
each semiannual period. The reports shall be filed by electronic
tape, diskette, or similar medium as approved by the office. The
office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the date that the report
is approved.
(3) For patient discharges on or after January 1, 2001, the
reports shall be filed by each hospital or its designee for report
periods and at times determined by the office. The reports shall be
filed by online transmission in formats consistent with national
standards for the exchange of electronic information. The office
shall approve or reject each report within 15 days of receiving it.
If a report does not meet the standards established by the office, it
shall not be approved as filed and shall be rejected. The report
shall be considered not filed as of the date the facility is notified
that the report is rejected. A report shall be available from the
office no later than 15 days after the date that the report is
approved.
(d) The reports required by subdivision (a) of Section 128736
shall be filed by each hospital for report periods and at times
determined by the office. The reports shall be filed by online
transmission in formats consistent with national standards for the
exchange of electronic information. The office shall approve or
reject each report within 15 days of receiving it. If a report does
not meet the standards established by the office, it shall not be
approved as filed and shall be rejected. The report shall be
considered not filed as of the date the facility is notified that the
report is rejected. A report shall be available from the office no
later than 15 days after the report is approved.
(e) The reports required by subdivision (a) of Section 128737
shall be filed by each hospital or freestanding ambulatory surgery
clinic for report periods and at times determined by the office. The
reports shall be filed by online transmission in formats consistent
with national standards for the exchange of electronic information.
The office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the report is approved.
(f) Facilities shall not be required to maintain a full-time
electronic connection to the office for the purposes of online
transmission of reports as specified in subdivisions (c), (d), and
(e). The office may grant exemptions to the online transmission of
data requirements for limited periods to facilities. An exemption may
be granted only to a facility that submits a written request and
documents or demonstrates a specific need for an exemption.
Exemptions shall be granted for no more than one year at a time, and
for no more than a total of five consecutive years.
(g) The reports referred to in paragraph (2) of subdivision (a) of
Section 128730 shall be filed with the office on the dates required
by applicable law and shall be available from the office no later
than six months after the date that the report was filed.
(h) The office shall post on its Internet Web site and
make available to any person a copy of any report referred to in
subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision
(a) of Section 128736, subdivision (a) of Section 128737, Section
128740, and, in addition, shall make available in electronic formats
reports referred to in subdivision (a), (b), (c), (d), or (g) of
Section 128735, subdivision (a) of Section 128736, subdivision (a) of
Section 128737, Section
128740, and subdivisions (a) and (c) of Section 128745, unless the
office determines that an individual patient's rights of
confidentiality would be violated. The office shall make the reports
available at cost.
SEC. 12. 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.