Amended in Assembly March 24, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1211

Introduced by Assembly Member Maienschein

February 27, 2015

An act to amend Section begin delete 1569.156 end delete begin insert 1250 end insert of the Health and Safety Code, relating to begin delete residential care facilities for the elderly end delete begin insert health facilities end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 1211, as amended, Maienschein. begin delete Residential care facilities for the elderly: end delete begin insert Health care facilities: congregate living health facility. end insert

begin insert

Existing law provides for the licensure and regulation by the State Department of Public Health of health facilities, including congregate living health facilities. A violation of these provisions is a misdemeanor. For this purpose, existing law defines “congregate living health facility” as a residential home with a capacity of no more than 12 beds, that provides inpatient care and skilled nursing care on a recurring, intermittent, extended, or continuous basis.

end insert begin insert

This bill would include in the definition of congregate living health facility a residential home with a capacity of no more than 18 beds that provides inpatient and skilled nursing care, as specified. By increasing the definition of a crime, this bill would impose a state-mandated local program.

end insert begin insert

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert begin delete

Existing law provides for the licensure of residential care facilities for the elderly by the State Department of Social Services. Existing law requires a residential care facility for the elderly to take certain actions with respect to advance directives, including providing written information, upon admission, about the right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right, under state law, to formulate advance directives and not conditioning the provision of care or otherwise discriminating based on whether or not an individual has executed an advance directive. Existing law defines advance directive, for this purpose, to include advance health care directives or some other form of instruction recognized under state law specifically addressing the provision of health care. Violation of these provisions is a crime.

end delete begin delete

This bill would specifically include in the definition of advance directive a request regarding resuscitative measures, as defined. By expanding the definition of a crime, this bill would impose a state-mandated local program.

end delete begin delete

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

end delete begin delete

This bill would provide that no reimbursement is required by this act for a specified reason.

end delete

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

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 1250 of the end insert begin insert Health and Safety Code end insert begin insert is
amended to read: end insert

1250.  

As used in this chapter, “health facility” means a facility,
place, or building that is organized, maintained, and operated for
the diagnosis, care, prevention, and treatment of human illness,
physical or mental, including convalescence and rehabilitation and
including care during and after pregnancy, or for any one or more
of these purposes, for one or more persons, to which the persons
are admitted for a 24-hour stay or longer, and includes the
following types:

(a) “General acute care hospital” means a health facility having
a duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental
Center may, until June 30, 2007, provide surgery and anesthesia
services through a contract or agreement with another acute care
hospital. Notwithstanding the requirements of this subdivision, a
general acute care hospital operated by the Department of
Corrections and Rehabilitation or the Department of Veterans
Affairs may provide surgery and anesthesia services during normal
weekday working hours, and not provide these services during
other hours of the weekday or on weekends or holidays, if the
general acute care hospital otherwise meets the requirements of
this section.

A “general acute care hospital” includes a “rural general acute
care hospital.” However, a “rural general acute care hospital” shall
not be required by the department to provide surgery and anesthesia
services. A “rural general acute care hospital” shall meet either of
the following conditions:

(1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer Grouping
for Efficiency Comparison, dated December 20, 1982.

(2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982,
and has no more than 76 acute care beds and is located in a census
dwelling place of 15,000 or less population according to the 1980
federal census.

(b) “Acute psychiatric hospital” means a health facility having
a duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care for persons with mental health
disorders or other patients referred to in Division 5 (commencing
with Section 5000) or Division 6 (commencing with Section 6000)
of the Welfare and Institutions Code, including the following basic
services: medical, nursing, rehabilitative, pharmacy, and dietary
services.

(c) (1) “Skilled nursing facility” means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.

(2) “Skilled nursing facility” includes a “small house skilled
nursing facility (SHSNF),” as defined in Section 1323.5.

(d) “Intermediate care facility” means a health facility that
provides inpatient care to ambulatory or nonambulatory patients
who have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.

(e) “Intermediate care facility/developmentally disabled
habilitative” means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer persons with
developmental disabilities who have intermittent recurring needs
for nursing services, but have been certified by a physician and
surgeon as not requiring availability of continuous skilled nursing
care.

(f) “Special hospital” means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.

(g) “Intermediate care facility/developmentally disabled” means
a facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons with
developmental disabilities whose primary need is for
developmental services and who have a recurring but intermittent
need for skilled nursing services.

(h) “Intermediate care facility/developmentally
disabled-nursing” means a facility with a capacity of 4 to 15 beds
that provides 24-hour personal care, developmental services, and
nursing supervision for persons with developmental disabilities
who have intermittent recurring needs for skilled nursing care but
have been certified by a physician and surgeon as not requiring
continuous skilled nursing care. The facility shall serve medically
fragile persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.

(i) (1) “Congregate living health facility” means a residential
home with a capacity, except as provided in paragraph (4), of no
more than begin delete 12 end delete begin insert 18 end insert beds, that provides inpatient care, including the
following basic services: medical supervision, 24-hour skilled
nursing and supportive care, pharmacy, dietary, social, recreational,
and at least one type of service specified in paragraph (2). The
primary need of congregate living health facility residents shall
be for availability of skilled nursing care on a recurring,
intermittent, extended, or continuous basis. This care is generally
less intense than that provided in general acute care hospitals but
more intense than that provided in skilled nursing facilities.

(2) Congregate living health facilities shall provide one begin insert or more end insert
of the following services:

(A) Services for persons who are mentally alert, persons with
physical disabilities, who may be ventilator dependent.

(B) Services for persons who have a diagnosis of terminal
illness, a diagnosis of a life-threatening illness, or both. Terminal
illness means the individual has a life expectancy of six months
or less as stated in writing by his or her attending physician and
surgeon. A “life-threatening illness” means the individual has an
illness that can lead to a possibility of a termination of life within
five years or less as stated in writing by his or her attending
physician and surgeon.

(C) Services for persons who are catastrophically and severely
disabled. A person who is catastrophically and severely disabled
means a person whose origin of disability was acquired through
trauma or nondegenerative neurologic illness, for whom it has
been determined that active rehabilitation would be beneficial and
to whom these services are being provided. Services offered by a
congregate living health facility to a person who is catastrophically
disabled shall include, but not be limited to, speech, physical, and
occupational therapy.

(3) A congregate living health facility license shall specify which
of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.

(4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of
59 beds.

(B) A congregate living health facility not operated by a city
and county servicing persons who are terminally ill, persons who
have been diagnosed with a life-threatening illness, or both, that
is located in a county with a population of 500,000 or more persons,
or located in a county of the 16th class pursuant to Section 28020
of the Government Code, may have not more than 25 beds for the
purpose of serving persons who are terminally ill.

(C) A congregate living health facility not operated by a city
and county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more
than begin delete 12 end delete begin insert 18 end insert beds for the purpose of serving persons who are
catastrophically and severely disabled.

(5) A congregate living health facility shall have a
noninstitutional, homelike environment.

(j) (1) “Correctional treatment center” means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the department, provides inpatient
health services to that portion of the inmate population who do not
require a general acute care level of basic services. This definition
shall not apply to those areas of a law enforcement facility that
houses inmates or wards who may be receiving outpatient services
and are housed separately for reasons of improved access to health
care, security, and protection. The health services provided by a
correctional treatment center shall include, but are not limited to,
all of the following basic services: physician and surgeon,
psychiatrist, psychologist, nursing, pharmacy, and dietary. A
correctional treatment center may provide the following services:
laboratory, radiology, perinatal, and any other services approved
by the department.

(2) Outpatient surgical care with anesthesia may be provided,
if the correctional treatment center meets the same requirements
as a surgical clinic licensed pursuant to Section 1204, with the
exception of the requirement that patients remain less than 24
hours.

(3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.

(4) Physician and surgeon services shall be readily available in
a correctional treatment center on a 24-hour basis.

(5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men’s Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the Department of Corrections and
Rehabilitation from obtaining a correctional treatment center
license at these sites.

(k) “Nursing facility” means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of care
either as a skilled nursing facility in the federal Medicare Program
under Title XVIII of the federal Social Security Act (42 U.S.C.
Sec. 1395 et seq.) or as a nursing facility in the federal Medicaid
Program under Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.), or as both.

(l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, shall not become effective prior to, or if effective, shall
be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.

(m) “Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)” means a homelike
facility with a capacity of four to eight, inclusive, beds that
provides 24-hour personal care, developmental services, and
nursing supervision for persons with developmental disabilities
who have continuous needs for skilled nursing care and have been
certified by a physician and surgeon as warranting continuous
skilled nursing care. The facility shall serve medically fragile
persons who have developmental disabilities or demonstrate
significant developmental delay that may lead to a developmental
disability if not treated. ICF/DD-CN facilities shall be subject to
licensure under this chapter upon adoption of licensing regulations
in accordance with Section 1275.3. A facility providing continuous
skilled nursing services to persons with developmental disabilities
pursuant to Section 14132.20 or 14495.10 of the Welfare and
Institutions Code shall apply for licensure under this subdivision
within 90 days after the regulations become effective, and may
continue to operate pursuant to those sections until its licensure
application is either approved or denied.

(n) “Hospice facility” means a health facility licensed pursuant
to this chapter with a capacity of no more than 24 beds that
provides hospice services. Hospice services include, but are not
limited to, routine care, continuous care, inpatient respite care, and
inpatient hospice care as defined in subdivision (d) of Section
1339.40, and is operated by a provider of hospice services that is
licensed pursuant to Section 1751 and certified as a hospice
pursuant to Part 418 of Title 42 of the Code of Federal Regulations.

begin insert

begin insert SEC. 2. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

end insert

begin delete

SECTION 1.  

Section 1569.156 of the Health and Safety Code
is amended to read:

1569.156.  

(a)  A residential care facility for the elderly shall
do all of the following:

(1)  Not condition the provision of care or otherwise discriminate
based on whether or not an individual has executed an advance
directive, consistent with applicable laws and regulations.

(2)  Provide education to staff on issues concerning advance
directives.

(3)  Provide written information, upon admission, about the
right to make decisions concerning medical care, including the
right to accept or refuse medical or surgical treatment and the right,
under state law, to formulate advance directives.

(4)  Provide written information about policies of the facility
regarding the implementation of the rights described in paragraph
(3).

(b)  For purposes of this section, “advance directive” means an
“advance health care directive,” as defined in Section 4605 of the
Probate Code, or some other form of instruction recognized under
state law specifically addressing the provision of health care,
including a request regarding resuscitative measures, as defined
in Section 4780 of the Probate Code.

end delete

begin delete

SEC. 2.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

end delete