BILL NUMBER: AB 950 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 22, 2009
AMENDED IN ASSEMBLY APRIL 14, 2009
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,
1749.1 and 1749.3 to, the Health and Safety
Code, relating to hospice care.
LEGISLATIVE COUNSEL'S DIGEST
AB 950, as amended, 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 for the chronically ill, and residential
care facilities for the elderly to lease a contiguous space in that
facility for a hospice facility under specified conditions.
Under existing law, any interested person may petition a state
agency requesting the adoption of a regulation. Existing law requires
the state agency to either deny the petition, as prescribed, or
schedule the matter for a public hearing, as prescribed.
This bill would permit the department to avoid drafting
regulations required to implement the bill if the California Hospice
and Palliative Care Association drafts the regulations, as specified,
and submits the draft regulations as a petition for regulation for
the department's review and approval.
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 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
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, 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 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, 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 the adult residential facility that
does not include the number of beds leased to the 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) 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.
(d) Hospice facility patients shall not be subject to the
requirements of paragraph (1) of subdivision (b) of Section 1522.
(e) 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.
(f) 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.
(g) 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 residential care 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 the residential care facility that
does not include the number of beds leased to the 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) 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.
(d) Hospice facility patients shall not be subject to the
requirements of paragraph (2) of subdivision (b) of Section 1568.09.
(e) 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.
(f) 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.
(g) 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 the
residential facility for the elderly that does not include the number
of beds leased to the 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) 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.
(d) Hospice facility patients shall not be subject to the
requirements of subparagraph (B) of paragraph (1) of subdivision (b)
of Section 1569.17.
(e) 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.
(f) 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.
(g) 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. SEC. 4. Section 1746 of the
Health and Safety Code is amended to read:
1746. For 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.
(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.
(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.
(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.
(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 has as its primary purpose 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.
(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.
(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.
(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.
(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.
(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.
SEC. 8. SEC. 5. 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
On or after the effective date of regulations to
implement this section, a hospice provider that provides hospice
services to a patient in a facility that the hospice owns or operates
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.). A hospice facility shall be separately licensed, irrespective
of the location of the facility.
(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
C.F.R. 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) The hospice facility shall meet the On
or after the effective date of regulations to implement this
section, the fire protection standards set forth in federal
Medicare conditions of participation (42 C.F.R. 418 et seq.).
(e) A hospice facility may shall
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 facility. A hospice facility
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.
(f) A hospice facility may be located in all or a portion of an
existing health facility, adult residential facility, residential
care facility for the chronically ill, 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.
(g) A hospice facility that is located in all or a portion of
another health 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 the physical plant of 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.
(4) Notwithstanding any other law, a health 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.
(h) A hospice facility that is located in all or a portion of an
adult residential facility, residential care facility for the
chronically ill, or residential care facility for the elderly 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.
(2) 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 adult residential
facility, residential care facility for the chronically ill, or
residential care facility for the elderly, in which a hospice
facility is located, be responsible for the operations of, or assume
any liability in connection with, the hospice facility.
(i) A person who is 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. SEC. 6. 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) Patient medical records.
(15) Other administrative requirements.
(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 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 protect hospice patients, employees, and visitors, and
reflect coordination with local agencies that are responsible for
disaster preparedness and emergency response.
(4) 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..
(e) The hospice facility shall demonstrate the ability to meet
licensing requirements and shall be fully responsible for meeting all
licensing requirements, regardless of whether those requirements are
met through direct provision by the facility or under contract with
another entity. The hospice facility's reliance on contractors to
meet the licensing requirements does not exempt the hospice facility
or in any way mitigate the hospice facility's responsibilities.
SEC. 10. SEC. 7. Section 128700 of
the Health and Safety Code is amended to read:
128700. As used in this chapter, the following definitions apply:
(a) "Ambulatory surgery procedures" means 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. SEC. 8. 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. SEC. 9. The department is
not required to draft the regulations required under this act if the
California Hospice and Palliative Care Association drafts the
necessary regulations, in consultation with the department and other
state departments and stakeholders, and submits the draft regulations
as a petition for regulation for the department's review and
approval, pursuant to Sections 11340.6 and 11340.7 of the Government
Code.
SEC. 13. SEC. 10. 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.