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: 8/24/12
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
SENATE FLOOR : 31-2, 1/26/12
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Correa, De León, DeSaulnier, Dutton, Emmerson,
Evans, Fuller, Gaines, Harman, Hernandez, Huff, Kehoe, La
Malfa, Lieu, Negrete McLeod, Padilla, Price, Rubio,
Simitian, Steinberg, Strickland, Vargas, Walters, Wolk,
Wright
NOES: Lowenthal, Yee
NO VOTE RECORDED: Corbett, Hancock, Leno, Liu, Pavley,
Runner, Wyland
ASSEMBLY FLOOR : Not available
SUBJECT : Hospice facilities
SOURCE : California Hospice and Palliative Care
Association
CONTINUED
SB 135
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DIGEST : This bill establishes a new health facility
licensing category of hospice facility, and permits a
licensed and certified hospice services provider to provide
inpatient hospice services through the operation of a
hospice facility, either as a free-standing health
facility, or adjacent to, physically connected to, or on
the building grounds of another health facility or a
residential care facility.
Assembly Amendments address chaptering out concerns, and
substantive concerns raised by the Department of Public
Health (DPH). The substantive amendments ensure that the
new hospice licensing category adheres to existing
patients' rights regulations, sets applicable staffing
standards, and conforms the new licensing category to
Medicare hospice conditions of participation.
ANALYSIS :
Existing law:
1. Provides for the licensure and regulation of health
facilities, including hospitals, skilled nursing
facilities, and congregate living health facilities
(CLHFs) by DPH.
2. Provides for the 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 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.
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4. Establishes DPH Licensing and Certification program fees
for health facilities, including hospice.
This bill:
1. Establishes a new licensing category of "hospice
facility" defined as a health facility with a capacity
of no more than 24 beds that is licensed by DPH, and
provides hospice services including, but not limited to
(a) routine care; (b) continuous care; (c) inpatient
respite care and inpatient hospice care as defined in
existing law; and (d) is operated by a provider of
hospice services that is licensed pursuant to existing
law and certified pursuant to federal Medicare
Conditions of Participation (MCP).
2. Requires a hospice facility to be separately licensed,
irrespective of the location of the facility. Permits a
hospice facility to operate as a freestanding health
facility, and also to be located adjacent to, physically
connected to, or on the building grounds of another
health facility or residential care facility. Permits
DPH to issue a provisional license to a hospice facility
for a period of up to one year.
3. Requires DPH to establish a licensure fee for hospice
facilities. Requires in the first year of licensure for
hospice providers, the licensure fee to be equivalent to
the licensure fee for CLHFs during the same year.
Requires, thereafter, the licensure fee for hospice
providers to be established pursuant to the provisions
of this bill.
4. Requires hospice facilities to report data elements such
as assets, liabilities, a statement of income, revenue
by payer, and other data elements defined in current
statute.
5. Requires hospice facilities to comply with federal
Centers for Medicare and Medicaid Services (CMS) hospice
regulations. Permits DPH, until it adopts regulations
to implement this bill's provisions, to use CMS hospice
care regulations for the hospice facility licensure
requirements.
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6. Defines "inpatient hospice care" to mean hospice care
that is provided to patients in a hospice facility,
including routine, continuous and inpatient care
directly as specified by MCP. Permits short-term
inpatient respite care, as specified by existing law, to
be included in this definition.
7. Prohibits a person, governmental agency, or political
subdivision of the state from being licensed as a
hospice facility unless the person or entity is a
provider of hospice services licensed under existing law
and is certified by MCP.
8. Establishes DPH application requirements and other
administrative procedures for hospice facility
licensure.
9. Permits a hospice facility that participates in the
Medicare and Medicaid programs to obtain initial
certification from a CMS-approved accreditation
organization.
10.Clarifies building and physical environment requirements
for hospice facilities, both freestanding, and those
that operate within, adjacent to, physically connected
to, or on the grounds of another facility.
11.Requires a freestanding hospice facility to meet the
fire protection standards set forth in MCP, until the
Office of Statewide Health Planning and Development
(OSHPD), in consultation with the Office of the State
Fire Marshall, develops and adopts building standards
for hospice facilities. Requires a hospice facility
located within the physical plant of another licensed
health facility to meet building standards for that
category of health facility within which the hospice
facility is located.
12.Prohibits a private or public organization, including,
but not limited to, a partnership, corporation, or
political subdivision of the state, or other
governmental agency within the state, to do any of the
following without a license issued pursuant to the
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provisions of this bill:
A. Represent itself to be a hospice facility by its
name or advertisement, soliciting, or any other
presentments to the public, or in the context of
services within the scope of the provisions of this
bill imply that it is licensed to provide those
services or to make any reference to employee bonding
in relation to those services;
B. Use the words "hospice facility," "hospice home,"
"hospice-facility," or any combination of those
terms, within its name; or,
C. Use words to imply that it is licensed as a
hospice facility to provide those services.
13.Requires the hospice facility to be responsible for
obtaining criminal background checks for employees,
volunteers, and contractors in accordance with MCP and
in accordance with state law. Requires the hospice
facility licensee to pay the costs of obtaining a
criminal background check.
14.Requires a hospice facility to provide a home-like
environment that is comfortable and accommodating to
both the patient and patient's visitors, and to continue
to provide services to family and friends after the
patient's stay in the hospice facility in accordance
with the patient's plan of care.
15.Establishes the services and requirements required by a
hospice program to be licensed as a hospice facility.
16.Defines "inpatient hospice care" to mean hospice care
that is provided to patients in a hospice facility,
including routine, continuous and inpatient care
directly as specified by the MCP. Permits short-term
inpatient respite care, as specified by existing law, to
be included in this definition.
17.Establishes minimum staffing standards that require at
least one registered nurse to be on duty 24 hours a day
and a maximum of six patients assigned at any given time
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per direct caregiver.
18.Defines "direct caregiver" other than a registered nurse
to mean a licensed vocational nurse and a certified
nurse assistant.
19.Adopts for hospice facilities patient rights provisions,
mirroring the patients' rights information provided to
skilled nursing facilities (SNFs) and intermediate care
facilities to ensure that patients are advised of their
fundamental rights and the obligations of the facility.
20.Excludes from the definition in existing law for
"hospital building" any freestanding building used, or
designed to be used, as a CLHF or hospice facility.
21.Makes conforming changes to avoid chaptering out
problems with SB 1228 (Alquist, 2012) regarding
licensure for small house SNFs.
22.Makes other technical and clarifying changes.
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
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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
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 Assembly Appropriations Committee, this
bill will result in the following costs:
1. One-time fee-supported special fund costs (L&C Fund) of
$500,000 over three years to DPH to promulgate
regulations and develop standards and protocols for
hospice facilities.
2. $200,000 (L&C Fund) in one-time fee-supported special
fund costs for Information Technology modifications to
accommodate a new licensure category.
3. Annual workload costs related to facility licensure will
depend on the number of licenses issued by DPH, but will
be likely be at least $200,000 (L&C Fund).
4. Costs for OSHPD to review and develop hospice-specific
building standards should be minor and absorbable.
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SUPPORT : (Verified 8/28/12)
California Hospice and Palliative Care Association (source)
Alzheimer's Association
Visiting Nurse and Hospice Care of Santa Barbara
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."
CTW:m 8/28/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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