BILL ANALYSIS
AB 950
Page 1
ASSEMBLY THIRD READING
AB 950 (Hernandez)
As Amended June 2, 2009
Majority vote
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De Leon, | |Charles Calderon, Davis, |
| |Emmerson, Hall, Hayashi, | |Duvall, Fuentes, Hall, |
| |Hernandez, Bonnie | |Harkey, Miller, |
| |Lowenthal, Nava, V. | |John A. Perez, Price, |
| |Manuel Perez, Salas, | |Skinner, Solorio, Audra |
| | Audra Strickland | |Strickland, Torlakson, |
| | | |Krekorian |
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SUMMARY : Establishes a new health facility licensing category
of hospice facility (HF), as specified. Specifically, this
bill :
1)Establishes the HF as a new type of health facility, defined
as a freestanding health facility, which has been licensed by
the Department of Public Health (DPH) as a hospice facility
for the provision of all levels of hospice care, including
routine care, continuous care, inpatient respite care, and
general inpatient care, and as a hospice program, under
existing law.
2)Requires a hospice provider who provides short-term inpatient
respite or inpatient care directly in the hospice provider's
own facility to apply for licensure.
3)Establishes minimum services and requirements that a HF must
meet as follows:
a) Medical direction/staff;
b) Skilled nursing services;
c) Palliative care;
d) Social services/counseling services;
e) Bereavement services;
f) Volunteer services;
g) Dietary services;
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h) Pharmaceutical services;
i) Physical therapy, occupational therapy, and
speech-language therapy;
j) Patient rights;
aa) Disaster preparedness;
bb) An adequate, safe, and sanitary physical environment;
cc) Housekeeping;
dd) Patient medical records; and,
ee) Other administrative requirements.
4)Requires DPH to adopt regulations for HFs and to prescribe
standards for the provision of services outlined in 3) above.
5)Requires the HF regulations adopted by DPH to include, but not
be limited to:
a) Minimum staffing standards that require at least one
licensed nurse to be on duty 24 hours per day and that
prohibit direct care staff from taking care of more than
six patients at any given time;
b) Patient rights so that each patient is:
i) Fully informed of his or her total health status and
the options for end-of-life care;
ii) Provided care that reflects individual preferences
regarding end-of-life care, including the right to refuse
any treatment or procedure;
iii) Treated with consideration, respect, and full
recognition of dignity and individuality, including
privacy in treatment and in the care of personal needs;
and,
iv) Entitled to visitors of his or her own choosing, at
any time the patient chooses, and ensured privacy for
those visits.
c) Disaster preparedness for both internal and external
disasters that protect hospice patients, employees, and
visitors, and reflects coordination with local agencies
that are responsible for disaster preparedness and
emergency response; and,
d) Additional qualifications and requirements for
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licensure.
6)Requires a HF to obtain and to pay the costs of, criminal
background checks for employees, volunteers, and contractors
in compliance with the Medicare conditions of participation
(COP) and as may be required in state law.
7)Requires a licensed HF to provide a home-like environment that
is comfortable and accommodating to both the patient and the
patient's visitors and to continue to provide services to
family and friends after the patient's stay in the HF, in
accordance with the patient's plan of care. Authorizes the
hospice program operating the HF to provide the follow-up
services to the family.
8)Requires a HF to demonstrate the ability to meet licensing
requirements and to be fully responsible for meeting all
licensing requirements, regardless of whether those
requirements are met through direct provision by the HF or
under contract with another entity. Specifies that a HF's
reliance on contractors to meet the licensing requirements
does not exempt the HF or in any way mitigate the HF's
responsibilities.
9)Requires a HF to meet the same building standards as a
congregate living health facility, as described in existing
law.
10)Authorizes a HF to be located adjacent to, physically
connected to, or on the building grounds of another health
facilities or residential care facility.
11)Requires an HF to submit evidence, as part of the application
for licensure submitted to DPH, that the HF is in compliance
with local building codes and that the physical environment of
the HF is adequate to provide the level of care and service
required by the residents of the HF, as determined by DPH.
12)Requires a HF to meet the fire protection standards set forth
in the Medicare COP for hospice services.
13)Requires building standards adopted by DPH relating to fire
and panic safety, and other HF regulations, to apply uniformly
throughout the state, and prohibits local jurisdictions from
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adopting or enforcing any ordinance or local rule or
regulation relating to fire and panic safety in HF buildings
or structures that is inconsistent with the rules and
regulations for HFs adopted by DPH.
14)Exempts a HF from having to submit construction plans to the
Office of Statewide Health Planning and Development for new
construction or renovation.
15)Eliminates the requirement for DPH to draft regulations
required by this bill if the California Hospice and Palliative
Care Association (CHAPCA) drafts the necessary regulations, in
consultation with DPH, other state departments, and
stakeholders, and submits the draft regulations as a petition
for regulation pursuant to the Administrative Procedures Act
(APA).
16)Makes legislative findings and declarations related to the
need for and importance of hospice services to provide
supportive care to terminally ill patients, their primary
caregivers and families. Finds that 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 with United State
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.
17)Expresses legislative intent 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.
18)Makes other technical and clarifying changes.
EXISTING LAW :
1)Provides for licensure and regulation by DPH of persons or
agencies providing hospice services, and defines hospice as a
specialized form of interdisciplinary health care that is
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designed to provide palliative care; alleviate the physical,
emotional, social, and spiritual discomforts of a terminally
ill individual; and provide supportive care to caregivers and
family members, according to specified criteria.
2)Requires licensed hospice providers to provide, or make
provision for, specified basic services, including skilled
nursing services, inpatient care, home health aide services,
social services and counseling, bereavement, medical
direction, and volunteer services.
3)Includes hospice care as a covered benefit under Medicare and
Medi-Cal, under specified conditions, including that an
individual is certified as terminally ill and his or her life
expectancy is six months or less.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time fee-supported special fund costs of $250,000 to DPH
to promulgate regulations and to license 5 to 10 free-standing
hospice facilities. Annual costs will depend on the number of
initial and renewal licenses issued by DPH.
2)Unknown potential savings to Medi-Cal to the extent patients
shift from inpatient medical intervention-heavy settings to
hospice which reduces and eliminates medical intervention per
patient and family wishes. Research shows expenditures are 50%
lower in the last month of life and 30% lower in the last year
of life for patients in hospice vs. non-hospice care.
COMMENTS : According to the author, this bill will improve the
options patients and their families have to obtain hospice
services. According to CHAPCA, the sponsor of this bill,
hospice providers must currently contract with other licensed
facilities to provide inpatient hospice which can create
conflicts in regulations and philosophies of care. CHAPCA
points out that 95% of all hospice care is provided to patients
in their own home, but when a patient can no longer remain
safely at home, hospices need the flexibility to provide their
services in facilities that are as home-like and residential as
possible, as in the new licensing category of HF proposed in
this bill.
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Under current California law, hospice is a licensed service and
not a facility type. DPH evaluates hospice programs and
certifies that they meet federal COP for Medicare and Medicaid
(Medi-Cal in California). Health facilities may arrange for the
provision of hospice services in settings such as: general acute
care beds; skilled nursing facility beds; and, congregate living
health facility beds through an agreement with a licensed
hospice provider who will provide the hospice services. Those
facilities, however, must still follow the regulations for which
the facility bed is licensed. This bill allows for the creation
of HFs which would presumably be dedicated specifically to the
provision of hospice services and designed and staffed to meet
the specialized needs of dying patients and their families.
CHAPCA, the sponsor of this bill, states that this bill will
expand the choices available to terminally ill patients and
their families. CHAPCA contends this bill will also save money
for patients, families, and the state. CHAPCA points out that
currently when hospice patients cannot remain safely at home,
they often move to a skilled nursing facility even though their
symptoms and plan of care may not warrant that level of care.
The Alliance for Catholic Health Care writes in support that
this bill would address concerns relative to the current
limitations on hospice care, such as conflicting regulations and
philosophies of care, lack of adequate staffing levels to meet
hospice COP requirements, and increasing difficulty in obtaining
contracts for hospice care.
Service Employees International Union (SEIU) is opposed unless
this bill is amended. SEIU is opposed because this bill
eliminates the public process for developing regulations under
the APA and instead substitutes draft regulations to be proposed
by the industry to be regulated. SEIU objects to industry
self-regulation. SEIU suggests that after the debacles in the
banking industry, as well as the long sorry history of the Joint
Commission on the Accreditation of Health Organizations, the
lesson has been learned that industries cannot be trusted to
regulate themselves.
Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097
FN: 0001369