BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 135|
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THIRD READING
Bill No: SB 135
Author: Hernandez (D), et al.
Amended: 1/23/12
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/27/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 8-0, 1/19/12
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Steinberg
NO VOTE RECORDED: Runner
SUBJECT : Hospice facilities
SOURCE : California Hospice and Palliative Care
Association
DIGEST : This bill establishes hospice facilities as a
facility type and establishes a hospice facility licensing
category that would be administered by the Department of
Public Health.
ANALYSIS :
Existing law:
1. Provides for the licensure and regulation of health
facilities, including hospitals, skilled nursing
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facilities, and congregate living health facilities
(CLHFs) by the Department of Public Health (DPH).
2. Provides for the licensure and regulation by the DPH of
persons or agencies providing hospice services, and
defines hospice as 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 diagnosed with a terminal illness, and to
provide supportive care to the primary caregiver and the
family.
3. Requires, to the extent appropriate, that hospice
services be provided in the patient's home or primary
place of residence, based on the medical needs of the
patient. Also requires hospices to make arrangements
for inpatient care as needed by the patient.
4. Establishes DPH Licensing and Certification program fees
for health facilities, including hospice.
This bill sunsets on January 1, 2015, the 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 requires DPH to:
1. Adopt regulations that define "hospice facility" as
specified, by
January 1, 2016, that would include (a) patient rights; (b)
disaster preparedness plans, compliance with federal
regulations relating to a hospice care; (c) biennial
licensing inspections; and (d) 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.
This bill:
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1. Provides that only a hospice licensed and certified in
California may apply to DPH for a hospice facility
license.
2. Requires each application for a new or renewed hospice
facility license to be accompanied by an annual
Licensing and Certification Program fee.
3. Requires hospice facility licensees to pay the cost of
obtaining a criminal background check for employees,
volunteers, and contractors.
4. Provides 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 same building standards as a CLHF until the
State Fire Marshal develops and adopts building
standards for hospice facilities.
5. Requires a hospice facility to provide specified
services, including skilled nursing services, palliative
care, social and counseling services, and dietary
services.
6. States that 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.
Hospice facilities will 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 increases 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.
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This bill requires the Office of Statewide Health Planning
and Development to develop building standards for hospice
facilities; require a registered nurse to be on duty 24
hours per day, seven days per week; permit an existing
facility to suspend beds in one licensing category and
transition those beds to hospice facility beds; and no
longer phase out the congregate living health facility type
B licensing category.
Background
Hospice . Hospice services include four levels of care -
routine home care, continuous home care, inpatient respite
care, and general inpatient care - that are provided to
patients, caregivers, and family members.
Routine home care and continuous home care can be provided
in the patient's home, and can include a licensed health or
residential care facility through a contract with a hospice
program.
In 2008, there were 1,041,845 hospice patients nationally
and 86,678 hospice patients in California paid for by
Medicare.
Hospice growth . According to the 2009 report, Medicare
Payment Policy, by the Medicare Payment Advisory
Commission, the number of hospice providers nationally has
grown substantially in recent years. From 2001 to 2008,
the total number of hospices increased from 2,300 to 3,400,
a 47 percent increase. For-profit hospices grew by 128
percent compared with one percent in nonprofit hospices and
25 percent in hospices with government ownership.
Freestanding hospices also grew significantly from 2001 to
2008, with an 87 percent growth rate compared to a nine
percent increase in home-health-based hospices and a two
percent decrease in hospital-based hospices. Growth
occurred in both rural and urban areas.
Other facilities . Currently, when a hospice patient needs
inpatient respite care, most hospices must contract with a
licensed health facility such as a hospital, skilled
nursing facility (SNF), CLHF, or with a licensed
residential care facility for the elderly (RCFE), which is
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licensed by the Department of Social Services (DSS) and
which has a Hospice Waiver from DSS in order to provide
these services.
Other states . 35 other states have a separate licensing
category of hospice facility. States without a separate
licensing category reportedly permit hospice services to be
provided in accordance with federal Medicare requirements.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2012-13 2013-14
2014-15 Fund
Adopting licensing $200 $350
Special*
regulations
Ongoing licensing Unknown
Special**
and investigations
Medi-Cal utilization Potential increased
utilization; General/
potential reduced costs
Federal***
* DPH Licensing and Certification Fund
** DPH Licensing and Certification Fund; fully
supported by fees
*** Medi-Cal costs are split 50% General Fund and 50%
federal funds
SUPPORT : (Verified 1/19/12)
California Hospice and Palliative Care Association (source)
Alzheimer's Association
Visiting Nurse and Hospice Care of Santa Barbara
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OPPOSITION : (Verified 1/19/12)
California Nurses Association
ARGUMENTS IN SUPPORT : The bill's sponsor, the California
Hospice and Palliative Care Association, writes that they
are sponsoring this bill because "currently, if a patient
cannot remain safely in his or her own home, they are
frequently moved to a skilled nursing or other facility
even though their symptoms may not warrant that level of
care. Hospice patients have waived seeking or being
provided curative treatment, and are provided palliative
care; thus many elements of the regulations for other
licensed facilities are incongruent to the needs of the
terminally ill. Few hospice programs seek to create or
provide facility-specific care due to the limited and
incompatible licensing requirements for operating hospice
facilities. SB 135 will save patients, their families and
the state money. Hospice is a cost-saving form of health
care to one of the most costly categories in health care
spending, end of life care. As California's population
continues to age, it will be increasingly important to have
resources available to provide services in many different
settings, and SB 135 accomplishes that purpose."
ARGUMENTS IN OPPOSITION : The California Nurses
Association (CNA) questions the necessity of the bill,
given the variety of settings currently available for
hospice patients to receive care. CNA states they are
concerned about the staffing standards established under
the bill, and believe any staffing ratio proposed for
hospice patients should be based on the acuity levels and
minimum staffing needs of hospice patients and not based on
the costs to provide that level of care. CNA further
states that appropriate building standards must be
established to ensure the safety of patients and staff, and
therefore, OSHPD should be responsible for overseeing
hospice facility construction and renovation. Finally, CNA
argues there must be a timeline implementing the
regulations and believes that standards for hospice
facilities should be thoroughly vetted with adequate
stakeholder input and analysis by DPH through the
regulatory process.
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CTW:mw 1/23/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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