Senate Bill No. 816

Introduced by Committee on Health (Senators Hernandez (Chair), Anderson, Beall, DeSaulnier, Monning, Nielsen, Pavley, and Wolk)

March 11, 2013

An act to amend Sections 1339.40 and 1339.43 of the Health and Safety Code, and to amend Section 4512 of the Welfare and Institutions Code, relating to health and human services.

LEGISLATIVE COUNSEL’S DIGEST

SB 816, as introduced, Committee on Health. Hospice facilities: developmental disabilities: intellectual disability.

(1) Existing law provides for the licensure and regulation of health facilities, including hospice facilities, by the State Department of Public Health. A violation of those provisions is a crime. Existing law requires a freestanding hospice facility to meet specified requirements relating to the physical environment of the facility until the Office of Statewide Health Planning and Development, in consultation with the Office of the State Fire Marshal, develops and adopts building standards for hospice facilities.

This bill would instead require the Office of the State Fire Marshal to develop and adopt the building standards for hospice facilities in consultation with the Office of Statewide Health Planning and Development and would make other technical changes.

(2) Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities, defined to include mental retardation and disabling conditions related to, or requiring treatment similar to, mental retardation.

This bill would revise this definition of developmental disabilities to instead include intellectual disability and disabling conditions closely related to, or requiring treatment similar to, intellectual disability.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1339.40 of the Health and Safety Code
is amended to read:

1339.40.  

For the purposes of this article, the following
definitions apply:

(a) “Bereavement services” has the same meaning as defined
in subdivision (a) of Section 1746.

(b) “Hospice care” means 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 who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the following criteria:

(1) Considers the patient and the patient’s family, in addition
to the patient, as the unit of care.

(2) Utilizes an interdisciplinary team to assess the physical,
medical, psychological, social, and spiritual needs of the patient
and the patient’s family.

(3) Requires the interdisciplinary team to develop an overall
plan of care and to provide coordinated care that emphasizes
supportive services, including, but not limited to, home care, pain
control, and limited inpatient services. Limited inpatient services
are intended to ensure both continuity of care and appropriateness
of services for those patients who cannot be managed at home
because of acute complications or the temporary absence of a
capable primary caregiver.

(4) Provides for the palliative medical treatment of pain and
other symptoms associated with a terminal disease, but does not
provide for efforts to cure the disease.

(5) Provides for bereavement services following death to assist
the family in coping with social and emotional needs associated
with the death of the patient.

(6) Actively utilizes volunteers in the delivery of hospice
services.

(7) To the extent appropriate, based on the medical needs of the
patient, provides services in the patient’s home or primary place
of residence.

(c) “Hospice facility” means a health facility as defined in
subdivision (n) of Section 1250.

(d) “Inpatient hospice care” means hospice care that is provided
to patients in a hospice facility, including routine, continuous and
inpatient care directly as specified in Section begin delete 418.10 end delete begin insert 418.110 end insert of
Title 42 of the Code of Federal Regulations, and may include
short-term inpatient respite care as specified in Section 418.108
of Title 42 of the Code of Federal Regulations.

(e) “Interdisciplinary team” has the same meaning as defined
in subdivision (g) of Section 1746.

(f) “Medical direction” has the same meaning as defined in
subdivision (h) of Section 1746.

(g) “Palliative care” has the same meaning as defined in
subdivision (j) of Section 1746.

(h) “Plan of care” has the same meaning as defined in
subdivision (l) of Section 1746.

(i) “Skilled nursing services” has the same meaning as defined
in subdivision (n) of Section 1746.

(j) “Social services/counseling services” has the same meaning
as defined in subdivision (o) of Section 1746.

(k) “Terminal disease” or “terminal illness” has the same
meaning as defined in subdivision (p) of Section 1746.

(l) “Volunteer services” has the same meaning as defined in
subdivision (q) of Section 1746.

SEC. 2.  

Section 1339.43 of the Health and Safety Code is
amended to read:

1339.43.  

(a) A hospice facility shall provide a home-like
environment that is comfortable and accommodating to both the
patient and patient’s visitors.

(b) Building standards for hospice facilities adopted pursuant
to this chapter relating to fire and panic safety, and other
regulations for hospice facilities adopted pursuant to this chapter,
shall apply uniformly throughout the state. No city, county, city
and county, including a charter city or charter county, or fire
protection district shall adopt or enforce any ordinance or local
rule or regulation relating to fire and panic safety in buildings or
structures subject to this section that is inconsistent with the rules
and regulations for hospice facilities adopted pursuant to this
chapter.

(c) The hospice facility shall meet the fire protection standards
set forth in the federal Medicare conditions of participation (42
C.F.R. Part 418 et seq.).

(d) A hospice facility may operate as a freestanding health
facility.

(1) Until the Office of begin delete Statewide Health Planning and
Development end delete begin insert the State Fire Marshal end insert , in consultation with the
Office of begin delete the State Fire Marshal end delete begin insert Statewide Health Planning and
Development end insert , develops and adopts building standards for hospice
facilities, a freestanding hospice facility shall meet applicable
building standards and requirements relating to the physical
environment of the facility as specified in Section begin delete 418.100 end delete begin insert 418. end insert begin insert 110 end insert
of Title 42 of the Code of Federal Regulations. The building
standards developed shall, at a minimum, maintain the requirements
specified in that section.

(2) A freestanding hospice facility shall be under the jurisdiction
of the local building department. As part of the license application,
the prospective licensee shall submit evidence of compliance with
applicable building standards for hospice facilities.

(3) The physical environment of the hospice facility shall be
adequate to provide the level of care and service required by the
residents of the facility as determined by the department.

(e) A hospice facility may be located within the physical plant
of another health facility.

(1) Notwithstanding subdivision (d) and paragraphs (8) and (9)
of subdivision (b) of Section 129725, a hospice facility located
within the physical plant of another licensed health facility that is
under the jurisdiction of the Office of Statewide Health Planning
and Development, shall meet the building standards for that
category of health facility within which the hospice facility is
located, and plans shall be submitted to the office for review of
any new construction or renovation of these hospice facilities. As
part of the license application, the prospective licensee shall submit
evidence of compliance with the building codes enforced by the
Office of Statewide Health Planning and Development.

(2) The physical environment of the facility shall be adequate
to provide the level of care and service required by the residents
of the facility as determined by the department.

(3) In the event the space used by the hospice facility reverts
back to the facility with which the hospice facility shared the space,
the building standards applicable to the former shared space, as
identified by date of enactment of the standards, shall not change
due solely to the reversion.

(4) A hospice facility that provides inpatient hospice care and
is located within, adjacent to or physically connected to another
health facility shall provide all of the following:

(A) A designated nursing station.

(B) Adequate space for the preparation of drugs with lockable,
secure storage that is accessible only by authorized personnel.

(C) Signage that shall clearly demarcate the hospice facility
area from the facility with which the hospice facility shares space.

(D) Doors for every exit and entrance to the hospice facility.

(E) Contiguous beds within the designated area set aside for the
hospice facility.

(f) If a freestanding hospice facility is located on the site of or
is physically connected to a health facility that is under the
jurisdiction of the Office of Statewide Health Planning and
Development or both, the hospice facility shall submit plans for
any new construction or renovation of the hospice facility to the
office for plan review and approval. The Office of Statewide Health
Planning and Development shall review the hospice facility plans
to identify any impacts to the health facility under the office’s
jurisdiction that may compromise the health facility’s continued
compliance with applicable laws and regulations.

SEC. 3.  

Section 4512 of the Welfare and Institutions Code is
amended to read:

4512.  

As used in this division:

(a) “Developmental disability” means a disability that originates
before an individual attains begin delete age end delete 18 begin delete years, end delete begin insert years of age; end insert continues,
or can be expected to continue, begin delete indefinitely, end delete begin insert indefinitely; end insert and
constitutes a substantial disability for that individual. As defined
by the Director of Developmental Services, in consultation with
the Superintendent of Public Instruction, this term shall include
begin delete mental retardation end delete begin insert intellectual disability end insert , cerebral palsy, epilepsy,
and autism. This term shall also include disabling conditions found
to be closely related to begin insert intellectual disability end insert or to require treatment
similar to that required for individuals with begin delete mental retardation end delete begin insert an
intellectual disability end insert , but shall not include other handicapping
conditions that are solely physical in nature.

(b) “Services and supports for persons with developmental
disabilities” means specialized services and supports or special
adaptations of generic services and supports directed toward the
alleviation of a developmental disability or toward the social,
personal, physical, or economic habilitation or rehabilitation of an
individual with a developmental disability, or toward the
achievement and maintenance of independent, productive, normal
lives. The determination of which services and supports are
necessary for each consumer shall be made through the individual
program plan process. The determination shall be made on the
basis of the needs and preferences of the consumer or, when
appropriate, the consumer’s family, and shall include consideration
of a range of service options proposed by individual program plan
participants, the effectiveness of each option in meeting the goals
stated in the individual program plan, and the cost-effectiveness
of each option. Services and supports listed in the individual
program plan may include, but are not limited to, diagnosis,
evaluation, treatment, personal care, day care, domiciliary care,
special living arrangements, physical, occupational, and speech
therapy, training, education, supported and sheltered employment,
mental health services, recreation, counseling of the individual
with a developmental disability and of his or her family, protective
and other social and sociolegal services, information and referral
services, follow-along services, adaptive equipment and supplies,
advocacy assistance, including self-advocacy training, facilitation
and peer advocates, assessment, assistance in locating a home,
child care, behavior training and behavior modification programs,
camping, community integration services, community support,
daily living skills training, emergency and crisis intervention,
facilitating circles of support, habilitation, homemaker services,
infant stimulation programs, paid roommates, paid neighbors,
respite, short-term out-of-home care, social skills training,
specialized medical and dental care, supported living arrangements,
technical and financial assistance, travel training, training for
parents of children with developmental disabilities, training for
parents with developmental disabilities, vouchers, and
transportation services necessary to ensure delivery of services to
persons with developmental disabilities. Nothing in this subdivision
is intended to expand or authorize a new or different service or
support for any consumer unless that service or support is contained
in his or her individual program plan.

(c) Notwithstanding subdivisions (a) and (b), for any
organization or agency receiving federal financial participation
under the federal Developmental Disabilities Assistance and Bill
of Rights Act of 2000, as amended, “developmental disability”
and “services for persons with developmental disabilities” mean
the terms as defined in the federal act to the extent required by
federal law.

(d) “Consumer” means a person who has a disability that meets
the definition of developmental disability set forth in subdivision
(a).

(e) “Natural supports” means personal associations and
relationships typically developed in the community that enhance
the quality and security of life for people, including, but not limited
to, family relationships, friendships reflecting the diversity of the
neighborhood and the community, associations with fellow students
or employees in regular classrooms and workplaces, and
associations developed through participation in clubs,
organizations, and other civic activities.

(f) “Circle of support” means a committed group of community
members, who may include family members, meeting regularly
with an individual with developmental disabilities in order to share
experiences, promote autonomy and community involvement, and
assist the individual in establishing and maintaining natural
supports. A circle of support generally includes a plurality of
members who neither provide nor receive services or supports for
persons with developmental disabilities and who do not receive
payment for participation in the circle of support.

(g) “Facilitation” means the use of modified or adapted
materials, special instructions, equipment, or personal assistance
by an individual, such as assistance with communications, that
will enable a consumer to understand and participate to the
maximum extent possible in the decisions and choices that effect
his or her life.

(h) “Family support services” means services and supports that
are provided to a child with developmental disabilities or his or
her family and that contribute to the ability of the family to reside
together.

(i) “Voucher” means any authorized alternative form of service
delivery in which the consumer or family member is provided with
a payment, coupon, chit, or other form of authorization that enables
the consumer or family member to choose his or her own service
provider.

(j) “Planning team” means the individual with developmental
disabilities, the parents or legally appointed guardian of a minor
consumer or the legally appointed conservator of an adult
consumer, the authorized representative, including those appointed
pursuant to subdivision (d) of Section 4548 and subdivision (e) of
Section 4705, one or more regional center representatives,
including the designated regional center service coordinator
pursuant to subdivision (b) of Section 4640.7, any individual,
including a service provider, invited by the consumer, the parents
or legally appointed guardian of a minor consumer or the legally
appointed conservator of an adult consumer, or the authorized
representative, including those appointed pursuant to subdivision
(d) of Section 4548 and subdivision (e) of Section 4705, and
including a minor’s, dependent’s, or ward’s court-appointed
developmental services decisionmaker appointed pursuant to
Section 319, 361, or 726.

(k) “Stakeholder organizations” means statewide organizations
representing the interests of consumers, family members, service
providers, and statewide advocacy organizations.

(l) “Substantial disability” means the existence of significant
functional limitations in three or more of the following areas of
major life activity, as determined by a regional center, and as
appropriate to the age of the person:

(1) Self-care.

(2) Receptive and expressive language.

(3) Learning.

(4) Mobility.

(5) Self-direction.

(6) Capacity for independent living.

(7) Economic self-sufficiency.

Any reassessment of substantial disability for purposes of
continuing eligibility shall utilize the same criteria under which
the individual was originally made eligible.