BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          SB 135 (Hernandez)
          
          Hearing Date: 5/23/2011         Amended: 5/10/2011
          Consultant: Katie Johnson       Policy Vote: Health 9-0
          _________________________________________________________________
          ____
          BILL SUMMARY: SB 135 would establish hospice facilities as a 
          facility type and would establish a hospice facility licensing 
          category that would be administered by the California Department 
          of Public Health (CDPH).
          _________________________________________________________________
          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2011-12      2012-13       2013-14     Fund
           CDPH regulations and   $200       $350        $0        Special*
          automation system updates

          Ongoing CDPH licensing,unknown, potentially significant,** 
          Special*
          certification, and investigations  commencing FY 2013-2014

          Increase in Medi-Cal   unknown, potentially minor to    
          General/***
          hospice inpatient capacity        significant costs or cost 
          avoidance              Federal

          *State Department of Public Health Licensing and Certification 
          Program Fund
          **Fully supported by licensing fees
          ***Medi-Cal costs shared 50 percent General Fund, 50 percent 
          federal funds.
          _________________________________________________________________
          ____

          STAFF COMMENTS: This bill meets the criteria for referral to the 
          Suspense File
          Existing law provides for the licensure of hospices, but does 
          not define "hospice facilities" or provide for their licensure.

          This bill would add "hospice facility" to the types of "health 
          facilities" enumerated in statute and would define it as a 
          facility with a capacity of up to 24 beds that is licensed by 








          SB 135 (Hernandez)
          Page 1


          CDPH and operated by a licensed and certified provider of 
          hospice services. Hospice services include routine care, 
          continuous care, inpatient respite care, and general inpatient 
          care.

          This bill would sunset on January 1, 2015, the congregate living 
          health facility (CLHF-B) type that provides services for persons 
          who have a diagnosis of terminal or life-threatening illness. 
          There are 11 such facilities in California currently.

          This bill would require CDPH to:
             1)   Adopt regulations that define "hospice facility" as 
               specified, by January 1, 2016, that would include a) 
               minimum staffing standards that require a nurse to be on 
               duty 24 hours per day and a maximum of six patients at any 
               given time per direct care staff person; b) patient rights, 
               c) disaster preparedness plans, compliance with federal 
               regulations relating to a hospice care; d) biennial 
               licensing inspections; e) penalties in the same amount as 
               those for CLHFs;
             2)   Permit the licensure fee for the first year of licensure 
               of hospice facilities to be equivalent to that of CLHFs;
             3)   Develop a hospice facility-specific licensing fee;

          Costs to CDPH to provide for a nurse and an attorney to develop 
          regulations and to update its automated systems to accommodate a 
          new licensure category would be approximately $200,000 in FY 
          2011-2012 and $350,000 in FY 2012-2013 from the State Department 
          of Public Health Licensing and Certification Program Fund. 
          Ongoing licensure costs would be fully-supported by fees 
          developed and imposed on applicants by the department.

          This bill would:
             1)   Provide that only a hospice licensed and certified in 
               California may apply to CDPH for a hospice facility 
               license;
             2)   Require each application for a new or renewed hospice 
               facility license to be accompanied by an annual Licensing 
               and Certification Program fee;
             3)   Require hospice facility licensees to pay the cost of 
               obtaining a criminal background check for employees, 
               volunteers, and contractors;
             4)   Provide that hospice facilities must meet the fire 
               protection standards set forth in Medicare law and that a 








          SB 135 (Hernandez)
          Page 2


               freestanding hospice facility would be required to meet the 
               same building standards as a CLHF until the State Fire 
               Marshal develops and adopts building standards for hospice 
               facilities; 
             5)   Require a hospice facility to provide specified 
               services, including skilled nursing services, palliative 
               care, social and counseling services, and dietary services.

          Hospice facilities would be required to report specified 
          financial data to the Office of Statewide Health Planning and 
          Development (OSHPD). Any costs to OSHPD to develop regulations 
          related to this bill would be minor and absorbable. 

          Any costs to the State Fire Marshal to develop and adopt 
          building standards would be minor and absorbable since similar 
          standards already exist for CLHFs.

          Since this bill would increase the number of beds available to 
          hospice patients, there could be minor to significant costs or 
          cost avoidance to Medi-Cal to the extent that a patient chooses 
          to utilize these beds and that these beds are either more or 
          less expensive than another appropriate setting such as a 
          hospital or skilled nursing facility.