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.