BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 135 (Hernandez)
Hearing Date: 5/26/2011 Amended: 5/10/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
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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).
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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.
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
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
CDPH and operated by a licensed and certified provider of
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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
freestanding hospice facility would be required to meet the
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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.
The author's proposed amendments would:
1) Permit a facility that is licensed as a CLHF to be
granted a hospice facility license when its CLHF license is
renewed;
2) Limit the requirement that a hospice facility meet more
stringent building standards to the instances where a
hospice facility is located adjacent to or is physically
connected to another health facility;
3) Permit CDPH, when performing a biennial licensing
inspection, to consider a facility inspection and approval
by a national accrediting body as sufficient to meet the
biennial licensing inspection requirement.
These amendments would have a minor decreasing effect on the
fiscal estimate of these provisions.