BILL NUMBER: AB 950 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 25, 2010
AMENDED IN ASSEMBLY JUNE 2, 2009
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 1749.1 and 1749.3 to,
1265.7, 1267.13, and 1267.15 of 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
skilled nursing facilities, intermediate care facilities, and
congregate living facilities . 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 a new health facility licensing
category for, and require the department to license and regulate,
hospice facilities congregate living health
facility-hospices , as defined. It would impose various
requirements on these fa cilities.
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.
( l ) 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.
(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 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. 5. Section 1749.1 is added to the Health
and Safety Code, to read:
1749.1. (a) (1) Only a hospice licensed and certified in
California may apply for a hospice facility license.
(2) On or after the effective date of regulations to implement
this section, a hospice provider that seeks to provide short-term
inpatient respite or inpatient care directly in the
hospice provider's own facility shall
submit an application for licensure as a hospice facility.
(3) A hospice provider who provides short-term inpatient respite
or inpatient care directly in the hospice provider's own facility
prior to the effective date of regulations to implement this section
may also continue to be licensed as a specialty hospital, skilled
nursing facility, or congregate living health facility.
(4) Each application for a new or renewed hospice facility license
under this chapter shall be accompanied by an annual Licensing and
Certification Program fee set in accordance with Section 1266.
(5) 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 fire protection standards
set forth in federal Medicare conditions of participation (42 C.F.R.
418 et seq.). A hospice facility shall meet the same building
standards as a congregate living health facility as described in
subparagraph (B) of paragraph (2) of subdivision (i) of Section 1250.
(e) A hospice facility shall operate as a freestanding health
facility, but may also be located adjacent to, physically connected
to, or on the building grounds of, another health facility or
residential care 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.
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. 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. 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. 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. 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
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 persons with developmental
disabilities 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 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 persons with
developmental disabilities 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 persons with developmental disabilities 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 with developmental disabilities or who 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, persons with
physical disabilities, 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 person who is catastrophically and severely disabled
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 person who is catastrophically disabled
shall include, but not be limited to, speech, physical, and
occupational therapy.
(D) Services for persons who have a diagnosis of a terminal
illness, or are eligible for hospice services, palliative, or
preliminary care, as permitted under state law.
(i) A facility that provides these services shall be known as a
congregate living health facility-hospice.
(ii) A congregate living health facility-hospice shall be owned by
and licensed to a hospice licensed and certified in California to
provide routine and continuous care, as defined by the federal
Centers for Medicare and Medicaid Services.
(iii) A congregate living health facility-hospice may also provide
short-term respite care, inpatient care directly, or other optional
services, pursuant to subparagraph (F) of paragraph (2) of
subdivision (n) of Section 1267.13.
(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 persons who are
terminally ill.
(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 persons who are catastrophically
and severely disabled.
(D) A congregate living health
facility-hospice may have a capacity of 36 beds.
(5) A congregate living health facility shall have a
noninstitutional, homelike home-
like environment.
(j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, 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 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.
(l) 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 Corrections and Rehabilitation, Division of Juvenile
Facilities, 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) "Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)" means a homelike facility
with a capacity of four to eight, inclusive, beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
continuous needs for skilled nursing care and have been certified by
a physician and surgeon as warranting 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.
ICF/DD-CN facilities shall be subject to licensure under this chapter
upon adoption of licensing regulations in accordance with Section
1275.3. A facility providing continuous skilled nursing services to
persons with developmental disabilities pursuant to Section 14132.20
or 14495.10 of the Welfare and Institutions Code shall apply for
licensure under this subdivision within 90 days after the regulations
become effective, and may continue to operate pursuant to those
sections until its licensure application is either approved or
denied.
SEC. 3. Section 1265.7 of the Health
and Safety Code is amended to read:
1265.7. (a) (1) The state department shall
adopt regulations for the licensure of congregate living health
facilities. The regulations shall include minimum standards of
adequacy, safety, and sanitation of the physical plant and equipment,
minimum standards for staffing with duly qualified personnel, and
training of the staff, and minimum standards for providing the
services offered.
(2) Regulations for facilities approved to provide services for
persons who may be ventilator dependent shall ensure that residents
of these facilities are assured appropriate supportive health
services in the most normal, least restrictive physical and
rehabilitative environment appropriate to individual resident needs.
(3) Regulations for facilities approved to provide services for
persons who are terminally ill, who have a diagnosis of a
life-threatening illness, who are catastrophically and severely
disabled, persons who are provided care in a congregate living
health facility-hospice or any combination of those persons,
shall ensure that residents of these facilities receive supportive
health services, based on individual resident acuity levels in the
most normal, least restrictive physical environment for individual
resident needs.
(b) Pending adoption of the regulations pursuant to paragraphs (2)
and (3) of subdivision (a), an entity shall be licensed as a
congregate living health facility serving persons who are terminally
ill, persons who are catastrophically and severely disabled, persons
who are mentally alert but physically disabled, persons who are
provided care in a congregate living health facility-hospice,
or any combination of these persons, by the state
department beginning July 1, 1988, if it meets the requirements
identified in subdivision (i) of Section 1250 and in Section 1267.13.
SEC. 4. Section 1267.13 of the Health
and Safety Code is amended to read:
1267.13. Pursuant to paragraph (3) of subdivision (a) and
subdivision (b) of Section 1265.7, this section shall be effective
until the adoption of permanent regulations. Notwithstanding, the
state department has authority to make reasonable accommodation for
exceptions to the standards in this section, providing the health,
safety, and quality of patient care is not compromised. No exceptions
shall be made for building standards. Prior written approval
communicating the terms and conditions under which the exception is
granted shall be required. Applicants shall request the exception in
writing accompanied by detailed, supporting documentation.
Congregate living health facilities serving persons who are
terminally ill, persons who are catastrophically and severely
disabled, persons who are mentally alert but physically disabled,
persons who are provided care in a congregate living health
facility-hospice, or any combination of these persons, shall
conform to the following:
(a) Facilities shall obtain and maintain a valid fire clearance
from the appropriate authority having jurisdiction over the facility,
based on compliance with state regulations concerning fire and life
safety, as adopted by the State Fire Marshal.
(b) The State Fire Marshal, with the advice of the State Board of
Fire Services, shall adopt regulations on or before January 1, 1991,
following a public hearing, establishing minimum requirements for the
protection of life and property for congregate living health
facilities serving terminally ill persons, catastrophically and
severely disabled persons, persons who are mentally alert but
physically disabled, or any combination of these persons. These
minimum requirements shall recognize the residential and
noninstitutional setting of congregate living health facilities
serving terminally ill persons, catastrophically and severely
disabled persons, persons who are mentally alert but physically
disabled, or any combination of these persons.
(c) Facilities shall be in a homelike residential setting. Living
accommodations and grounds shall be related to the facility's
function and clientele. Facilities shall provide sufficient space for
comfortable living accommodations and privacy for residents, staff,
and others who may reside in the facility.
(d) Common rooms, including, but not limited to, living rooms,
dining rooms, and dens or other recreation or activity rooms, shall
be provided and shall have sufficient space, separation, or both to
promote and facilitate the program of activities and to prevent these
activities from interfering with other functions. Accommodations
shall ensure adequate space for residents to have visitors and for
privacy during visits, if desired.
(e) Resident bedrooms shall have adequate space to allow easy
passage throughout; permit comfortable usage of furnishings; promote
ease of nursing care; and accommodate use of assistive devices,
including, but not limited to, wheelchairs, walkers, and patient
lifts, when needed.
(f) No room commonly used for other purposes, including, but not
limited to, a hall, stairway, attic, garage, storage area, shed, or
similar detached building, shall be used as a sleeping room for any
resident.
(g) No resident bedroom shall be used as a passageway to another
room, bath, or toilet.
(h) Not more than two residents shall share a bedroom.
(i) Equipment and supplies necessary for personal care and
maintenance of adequate hygiene shall be readily available to all
residents.
(j) Toilets and bathrooms shall be conveniently located. At least
one toilet and washbasin shall be provided per six residents. At
least one bathtub or shower shall be provided per 10 residents.
Individual privacy shall be provided in all toilet, bath and shower
areas. Separate toilet, washbasin, and bathtub or shower
accommodations shall be provided for staff.
(k) Sufficient room shall be available throughout the facility to
accommodate and serve all persons in comfort and safety. The premises
shall be maintained in good repair and shall provide a safe, clean,
and healthful environment.
( l ) Facilities shall have equipment and supplies
appropriate to meet the routine and specialized needs of all
residents.
(m) All persons shall be protected from hazards throughout the
premises:
(1) Stairways, inclines, ramps, open porches, and other areas of
potential hazard to residents with poor balance or eyesight shall be
made inaccessible unless well lighted and equipped with sturdy hand
railings.
(2) Night lights shall be maintained in hallways and passages to
nonprivate bathrooms.
(3) All indoor and outdoor passageways and stairways shall be kept
free of obstructions.
(4) Fireplaces, woodstoves, and open-faced heaters shall be
adequately screened.
(5) Facilities shall assure the inaccessibility of fishponds,
wading pools, hot tubs, swimming pools, or similar bodies of water or
other areas of potential hazard when not in active use.
(n) (1) Facilities serving persons who are
terminally ill, catastrophically and severely disabled, mentally
alert but physically disabled, or any combination of these persons,
shall, in addition to the requirements of this chapter and until
specific regulations governing their operation are filed, conform to
regulations contained in Chapter 3 of Division 5 of Title 22 of the
California Code of Regulations of April 1, 1988, with the exception
of the following sections or portions of sections: 72007, 72053,
72073, subdivision (a) of Section 72077, 72097, 72099, 72103, 72203,
subdivision (a) of Section 72205, 72301, 72305, subdivision (a) of
Section 72325, 72327, 72329, 72331, 72337, subdivisions (b), (g), and
(h) of Section 72351, 72353, subdivision (a) of Section 72367,
72373, subdivision (b) of Section 72375, 72401, 72403, 72405, 72407,
72409, 72411, 72413, 72415, 72417, 72419, 72421, 72423, 72425, 72427,
72429, 72431, 72433, 72435, 72437, 72439, 72441, 72443, 72445,
72447, 72449, 72451, 72453, 72455, 72457, 72459, 72461, 72463, 72465,
72467, 72469, 72471, 72473, 72475, 72503, paragraph (2) of
subdivision (a) of Section 72513, 72520, 72535, 72555, 72557,
subdivisions (a) and (b) of Section 72601, subdivision (d) of Section
72607, subdivisions (a) and (d) of Section 72609, 72611, 72615,
72617, 72629, 72631, 72633, 72635, subdivisions (b), (c), and (d) of
Section 72639, 72641, and 72665.
(2) (A) A congregate living health facility-hospice shall comply
with the requirements of this section, except for Section 1439.2, and
except for Section 72315(h), (i), (j), and (k), Section 72323(d),
Section 72335(a)(1), Section 72341(a), Sections 72379 to 72389,
inclusive, and Section 72525 of Chapter 3 of Division 5 of Title 22
of the California Code of Regulations.
(B) An activity plan shall be developed and implemented for, and
reflect the personal preferences of, each resident. The activity plan
shall be integrated with the individual interdisciplinary patient
care plan.
(C) Chemicals may be used as a substitute for the methods
specified in Section 72323(c) of Division 5 of Title 22 of the
California Code of Regulations, if the product used is specifically
designed to be used as a substitute and is used in accordance with
the manufacturer's requirements.
(D) The hospice interdisciplinary team shall perform the functions
of the required committees as specified by Section 72525 of Division
5 of Title 11 of the California Code of Regulations.
(E) The department shall not count temporary sleeping
accommodations provided to permit family and friends to stay with the
residents of a congregate living health facility-hospice in the
number of licensed beds for purposes of compliance with Section 1250,
or Section 72607 of Division 5 of Title 22 of the California Code of
Regulations.
(F) A facility is not required to provide optional services.
(i) "Optional service" means a service of a congregate living
health facility-hospice that is organized, staffed, and equipped to
provide specific types of patient care.
(ii) A congregate living health facility-hospice may provide,
pursuant to federal law, including Section 418 of Title 42 of the
Code of Federal Regulations, the following types of optional
services:
(I) Direct inpatient care, including fire/life safety
requirements.
(II) Optional services approved by the department.
(iii) A facility desiring approval for an optional service shall
file an application on a form furnished by the department for this
purpose.
(iv) The department shall approve each optional service within the
facility and list on the facility's license each optional service
for which the department has granted approval.
(o) (1) Facilities serving persons who are terminally ill,
catastrophically and severely disabled, mentally alert but physically
disabled, persons who are provided care in a congregate living
health facility-hospice, or any combination of these persons,
shall have an administrator who is responsible for the day-to-day
operation of the facility. The administrator may be either a licensed
registered nurse, a nursing home administrator, or the licensee. The
administrator shall be present at the facility a sufficient number
of hours to ensure the smooth operation of the facility. If the
administrator is also the registered nurse fulfilling the duties
specified in paragraph (2), the administrator shall not be
responsible for more than one facility. In all other circumstances,
the administrator shall not be responsible for more than three
facilities with an aggregate total of 75 beds and these facilities
shall be within one hour's surface travel time of each other.
(2) (A) For each congregate living health facility of more than
six beds serving persons who are terminally ill, catastrophically and
severely disabled, mentally alert but physically disabled, or any
combination of these persons, there shall be, at a minimum, a
registered nurse or licensed vocational nurse awake and on duty at
all times. A registered nurse shall be awake and on duty eight hours
a day, five days a week.
(B) For each congregate living health facility of six or fewer
beds serving persons who are terminally ill, catastrophically and
severely disabled, mentally alert but physically disabled, or any
combination of these persons, a registered nurse shall visit each
patient at least twice a week for approximately two hours, or more as
patient care requires.
(C) For all congregate living health facilities serving persons
who are terminally ill, catastrophically and severely disabled,
mentally alert but physically disabled, or any combination of these
persons, a registered nurse shall be available for consultation and
able to come into the facility within 30 minutes, if necessary, when
no registered nurse is on duty. In addition, certified nurse
assistants, or persons with similar training and experience as
determined by the department, shall be awake and on duty in the
facility in at least the following ratios: facilities with six beds
or less, one per shift; facilities with 7 to 12 beds, two per shift;
facilities with 13 to 25 beds, three per day and evening shifts and
two per nocturnal shift. No nursing services personnel shall be
assigned housekeeping or dietary duties.
(D) A congregate living health facility-hospice shall provide
24-hour nursing services that meet the nursing needs of all patients
and are furnished in accordance with each patient's plan of care.
(i) Each patient shall receive all nursing services as prescribed
in the patient's plan of care and shall be kept comfortable, clean,
well-groomed, and protected from accident, injury, and infection.
(ii) Each shift shall have at least one registered nurse or
licensed vocational nurse awake and on duty.
(iii) Each shift shall include a registered nurse who provides
direct patient care when at least one patient is receiving general
inpatient care.
(iv) No registered nurse, licensed vocational nurse, certified
nurse assistant, or home health aide may care for more than six
residents.
(v) The facility shall document the level of care provided to each
resident and the staffing levels at each shift.
(3) Notwithstanding the provisions of this subdivision, the
facility shall provide appropriately qualified staff in sufficient
numbers to meet patient care needs.
(4) Nursing service personnel shall be employed and on duty in at
least the number and with the qualifications determined by the
department to provide the necessary nursing services for patients
admitted for care. The department may require a facility to provide
additional professional, administrative, or supportive personnel
whenever the state department determines through a written
evaluation, that additional personnel are needed to provide for the
health and safety of patients.
(5) All staff members shall receive orientation regarding care
appropriate for the patients' diagnoses and individual resident
needs. Orientation shall include a minimum of 16 hours during the
first 40 hours of employment.
(6) Nothing in this chapter shall prevent the use of volunteers;
however, volunteers shall not be used as substitutes for the
personnel required in the above sections. Volunteers providing
patient care services shall:
(A) Be provided clearly defined roles and written job
descriptions.
(B) Receive orientation and training equivalent to that provided
paid staff.
(C) Possess education and experience equal to that required of
paid staff performing similar functions.
(D) Conform to the facility's policies and procedures.
(E) Receive periodic performance evaluations.
(p) In addition to the requirements of this section, a congregate
living health facility-hospice shall comply with the following:
(1) Meet all standards for providing routine or continuous care to
residents of the facility, in full compliance with Section 418 of
Title 42 of the Code of Federal Regulations, as required by the
federal Centers for Medicare and Medicaid Services.
(2) Provide each patient with all of the following:
(A) Full information regarding the patient's health status and
options for end-of-life care.
(B) Care that reflects a patient's preferences regarding
end-of-life care, including the right to refuse any treatment or
procedure.
(C) Treatment with consideration, respect, and full recognition of
the patient's dignity and individuality, including privacy in
treatment and care of personal needs.
(D) Entitlement to visitors of the patient's choosing, at any time
the patient chooses, and with ensured privacy for those visits.
(3) Draft and implement disaster preparedness plans for both
internal and external disasters that protect the facility's patients,
employees, and visitors, and reflect coordination with local
agencies that are responsible for disaster preparedness and emergency
response.
(4) Continue to provide services to family and friends after the
patient's stay in the facility in accordance with the patient's plan
of care. Continuing services may be provided by the hospice program
that operates the facility.
(p)
(q) The interim standards prescribed by this section
shall become inoperative upon the filing of the regulations with the
Secretary of State.
SEC. 5. Section 1267.15 of the Health
and Safety Code is amended to read:
1267.15. Congregate (a)
A congregate living health facilities
facility shall be freestanding, but this does not preclude
their location the facility from being
located on the premises of a hospital. Congregate
living health facilities shall be separately licensed.
(b) The provisions of subdivision (a) shall not apply to a
congregate living health facility-hospice.
(1) A congregate living health facility-hospice may be located
adjacent to, physically connected to, within the physical plant of,
or on the building grounds of, another health facility.
(2) A congregate living health facility-hospice may lease space
from another hospital for purposes of obtaining a separate license,
and the lease shall be considered a change of ownership for that
space. Units or wings of another health facility leased and
separately licensed to a congregate living health facility-hospice
shall be deemed to be continuously licensed for purposes of meeting
California building code requirements. Units or wings of another
health facility leased and separately licensed to a congregate living
health facility-hospice shall not be considered a change in use,
unless renovations made by the congregate living health
facility-hospice would result in a failure to comply with health
facility building code standards, as required prior to the change of
ownership. Upon termination of the lease agreement, or revocation of
the congregate living health facility-hospice license, the space
previously occupied by the congregate living health facility-hospice
shall be placed back on the license of the health facility that
leased the space.
(3) A congregate living health facility-hospice shall demonstrate
its ability to meet licensing and Medicare certification
requirements, and shall be fully responsible for meeting these
requirements, regardless of whether the requirements are met through
direct provision by the facility, or through a contract with another
health facility or entity. Reliance on contractors to meet the
licensing requirements, including contracting with another health
facility, does not exempt from or lessen the congregate living health
facility-hospice's legal responsibilities.
(4) The department shall hold the congregate living health
facility-hospice accountable for a violation of licensing or
certification requirements under Section 418 of Title 42 of the Code
of Federal Regulations, regardless of whether the violation occurred
as a result of services provided under contract with another health
facility or entity, or the services were provided directly by the
congregate living health facility-hospice.
(5) Nothing shall preclude the department from holding accountable
the health facility providing services under contract to the
congregate living health facility-hospice, if the department
determines that the facts also present a separate violation for the
health facility providing services under contract.
(c) A congregate living health facility shall be separately
licensed.
SEC. 10. SEC. 6. 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.