Amended in Assembly June 30, 2016

Amended in Assembly June 22, 2016

Amended in Senate January 26, 2016

Amended in Senate January 5, 2016

Amended in Senate May 5, 2015

Amended in Senate April 20, 2015

Amended in Senate April 7, 2015

Senate BillNo. 648


Introduced by Senator Mendoza

(Coauthor: Assembly Member Levine)

February 27, 2015


An act to amend Sections 1400, 1401, 1404, 1404.5, 1405, 1407, 1408, 1409.3, and 1410 of, and to add Sections 1402, 1409.4, 1409.5, 1409.6, 1409.7, 1409.8,begin delete and 1409.9end deletebegin insert 1409.9, and 1409.10end insert to, the Health and Safety Code, and to amend Section 15630 of the Welfare and Institutions Code, relating to health and care facilities.

LEGISLATIVE COUNSEL’S DIGEST

SB 648, as amended, Mendoza. Health and care facilities: referral agencies.

Existing law requires a referral agency to obtain a license from the State Department of Public Health in order to refer a person to any extended care facility, skilled nursing home, or intermediate care facility. Existing law exempts a local public agency performing referral services without cost from these provisions. Under existing law, a violation of these provisions is subject to a civil penalty and suspension or revocation of the license.

This bill would additionally require a referral agency to obtain a license from the State Department of Social Services in order to refer a person to a residential care facility for the elderly. The bill would prohibit an extended care facility, skilled nursing home, intermediate care facility, or residential care facility for the elderly from paying a commission or fee to a referral agency that is not licensed, as specified. The bill would prohibit a referral agency from holding any power of attorney or any other property of a person receiving referral services, or from disclosing any personal information of a person receiving services, unless authorized to do so. The bill would require a referral agency to disclose specified information to each person receiving its services, and to retain, for 3 years, an acknowledgment from the person being referred, or his or her conservator, guardian, authorized familybegin delete member,end deletebegin insert member or other authorized representative, attorney in fact,end insert or agent under a power of attorney, stating that the disclosures had been made. The bill would also require referral agencies to maintain liability insurance in specified amounts.begin insert The bill would also make it unlawful for a medical professional or employee of a governmental agency, hospital, or other healthcare institution to offer, provide, or accept a payment, rebate, refund, commission, preference, or discount as payment, compensation, or inducement for referring patients, clients, or customers to a facility.end insert

Existing law makes specified persons mandated reporters of elder or dependent adult abuse, including administrators, supervisors, and licensed staff of a facility that provide care or services for elder or dependent adults. Under existing law, failure to report physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult is a misdemeanor.

The bill would include on the list of mandated reporters owners, operators, and employees of a referral agency. By expanding the crime of failure to report elder or dependent adult abuse, this bill would impose a state-mandated local program.

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.

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

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

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

P3    1

SECTION 1.  

Section 1400 of the Health and Safety Code is
2amended to read:

3

1400.  

(a) It is unlawful for any person, association, or
4corporation to establish, conduct, or maintain a referral agency or
5to refer any person for remuneration to any extended care facility,
6skilled nursing home, intermediate care facility, or residential care
7facility for the elderly, or a distinct part of a facility providing
8extended care, skilled nursing home care, or intermediate care,
9without first having obtained a written license as provided in this
10chapter from the State Public Health Officer or from an inspection
11service approved by the State Public Health Officer pursuant to
12Section 1257, from the State Department of Social Services, or
13from both, as appropriate.

14(b) It is unlawful for any person, association, or corporation to
15establish, conduct, or maintain a referral agency or to refer any
16person for remuneration to any person or agency outside a
17long-term health care facility, as defined in Section 1418, for
18professional services for which the long-term health care facility
19does not employ a qualified professional person to furnish a
20specific service, including, but not limited to, laboratory,
21diagnostic, or therapy services, unless the long-term health care
22facility complies with current federal and state laws regarding the
23provision of these services and all of the following conditions are
24met:

25(1) The services will be provided in accordance with
26professional standards applicable to the provision of these services
27in a long-term health care facility.

28(2) The long-term health care facility assumes responsibility
29for timeliness of the services.

30(3) Services are provided or obtained only when ordered by the
31attending physician and a notation is made in the resident’s medical
32chart reflecting that the service has been provided to the resident.

33(c) It is unlawful for any person, association, or corporation to
34establish, conduct, or maintain a referral agency or to refer any
35person for remuneration to any residential care facility for the
P4    1elderly for professional services if that facility does not meet the
2licensing standards established in Chapter 3.2 (commencing with
3Section 1560). The referral agency may satisfy this requirement
4by obtaining and relying on the licensing status information for a
5residential care facility for the elderly that is published on the
6Internet Web site of the State Department of Social Services.

7(d) It is unlawful for any extended care facility, skilled nursing
8home, intermediate care facility, or residential care facility for the
9elderly, or a distinct part of a facility providing extended care,
10skilled nursing home care, or intermediate care to pay a
11commission or fee to a referral agency that does not have a written
12license as provided in this chapter from the State Public Health
13Officer or from an inspection service approved by the State Public
14Health Officer pursuant to Section 1257, from the State Department
15of Social Services, or from both, as appropriate.

16

SEC. 2.  

Section 1401 of the Health and Safety Code is amended
17to read:

18

1401.  

As used in this chapter, “referral agency” means a private,
19profit or nonprofit agency that is engaged in the business of
20referring persons for remuneration to any extended care facility,
21skilled nursing home, intermediate care facility, or residential care
22facility for the elderly, or a distinct part of a facility providing
23extended care, skilled nursing home care, or intermediate care.
24“Referral agency” does not include any of the following:

25(a) A licensed residential care facility for the elderly that does
26either of the following:

27(1) Provides discounts or other remuneration to residents or
28their families for referring new or prospective clients.

29(2) Provides remuneration to staff for marketing or sales offers.

30(b) A resident who refers a new or prospective residentbegin insert to a
31licensed residential care facility for the elderlyend insert
and receives a
32discount or other remuneration frombegin delete aend deletebegin insert theend insert licensed residential care
33facility for the elderly.

34(c) Abegin delete licensed residential care facilityend delete staff memberbegin insert of the
35licensed residential care facility for the elderlyend insert
who receives
36remuneration from the facility forbegin delete sales or marketing efforts.end delete
37
begin insert professional services, including, but not limited to, sales and
38marketing efforts, on behalf of that facility.end insert

39

SEC. 3.  

Section 1402 is added to the Health and Safety Code,
40to read:

P5    1

1402.  

“Residential care facility for the elderly” has the same
2meaning as set forth in Section 1569.2.

3

SEC. 4.  

Section 1404 of the Health and Safety Code is amended
4to read:

5

1404.  

No licensee under this chapter shall have a direct or
6indirect financial interest in any facility doing business with the
7licensee.

8

SEC. 5.  

Section 1404.5 of the Health and Safety Code is
9amended to read:

10

1404.5.  

A license application shall be submitted to either or
11both licensing departments, as appropriate, whenever any of the
12following circumstances occur:

13(a) Change of ownership of the referral agency.

14(b) Change of name of the referral agency.

15(c) Change of location of the referral agency.

16

SEC. 6.  

Section 1405 of the Health and Safety Code is amended
17to read:

18

1405.  

Any person, partnership, firm, corporation, or association
19desiring to obtain a license to refer persons to extended care
20facilities, skilled nursing homes, or intermediate care facilities, or
21a distinct part of a facility providing extended care, skilled nursing
22home care, or intermediate care, shall file with the State
23Department of Public Health an application on forms furnished
24by the State Department of Public Health. Any person, partnership,
25firm, corporation, or association desiring to obtain a license to
26refer persons to residential care facilities for the elderly shall file
27with the State Department of Social Services an application on
28forms furnished by the State Department of Social Services. The
29applications shall contain all of the following:

30(a) Name of applicant, and if an individual, whether the applicant
31has attained the age of 18 years.

32(b) Name of referral agency.

33(c) The location of the referral agency.

34(d) The business or occupation engaged in by each applicant,
35and by each partner, officer, and director, for at least two years
36immediately preceding the filing of the application. In addition,
37each such person shall submit a statement setting forth whether
38he or she has previously engaged in the operation of a referral
39agency, whether he or she has been involved in, or the subject of,
40a refusal or revocation of a referral agency license, and whether
P6    1he or she has been convicted of a crime other than a minor traffic
2offense.

3(e) If the applicant is a corporation, the name and principal
4business address of each officer and director of the corporation;
5and for nonpublic corporations, the name and business address of
6each stockholder owning 10 percent or more of the stock and the
7name and business address of any corporation member who has
8responsibility in the operation of the facility.

9(f) If the applicant is a partnership, the name and principal
10business address of each partner.

11(g) Evidence of the right to occupy the premises where the
12referral agency is to be located.

13(h) A copy of the partnership agreement or the Articles of
14Incorporation, if applicable.

15(i) A copy of the current organization chart.

16(j) A schedule of fees to be charged and collected by the referral
17agency, and a statement of the method by which each fee is to be
18computed or determined.

19(k) A declaration that the licensee will not have any financial
20interest in any health facility doing business with the referral
21agency.

22(l) Evidence satisfactory to the licensing department that the
23applicant demonstrates reputable and responsible character and
24the capability to comply with this chapter.

begin insert

25
(m) For a licensee to refer persons to residential care facilities
26for the elderly, both of the following:

end insert
begin insert

27
(1) A declaration that the licensee will either conduct a
28suitability determination of each person who seeks a referral from
29the licensee and who is referred to a facility or facilities, or will
30comply with the requirements of paragraph (3) of subdivision (b)
31of Section 1409.4. For purposes of this subdivision, “a suitability
32determination” means a determination made by the licensee that
33the facility offers services to meet the needs of the person seeking
34a referral because of the following considerations:

end insert
begin insert

35
(A) The level of care requested by the person seeking the
36referral.

end insert
begin insert

37
(B) The cost of the facility and the ability of the financial means
38of the person seeking the referral.

end insert
begin insert

39
(C) The social needs and preferences of the person seeking the
40referral.

end insert
begin insert

P7    1
(D) The geographic location of the facility and the geographic
2preference of the person seeking the referral.

end insert
begin insert

3
(2) A declaration that the licensee trains all employees who
4make referrals to residential care facilities for the elderly
5regarding all of the following issues:

end insert
begin insert

6
(A) All of the provisions of this chapter that apply to a referral
7agency, including but not limited to, instruction on how to comply
8with all of those provisions.

end insert
begin insert

9
(B) State governance and administrative functions of agency
10operations, including resident assessment and admission
11procedures.

end insert
begin insert

12
(C) The psychosocial and physical needs of the elderly.

end insert
begin insert

13
(D) Community supports, cultural competency and sensitivity
14to residents’ needs.

end insert
15

SEC. 7.  

Section 1407 of the Health and Safety Code is amended
16to read:

17

1407.  

(a) Any licensee desiring to voluntarily surrender his
18or her license for cancellation or temporary suspension shall notify
19the licensing department in writing as soon as possible and, in all
20cases, at least 30 days prior to the effective date of cancellation or
21temporary suspension of the license.

22(b) Any license placed in temporary suspension pursuant to this
23section may be reinstated by the licensing department within 12
24months of the date of the voluntary suspension on receipt of an
25application and evidence showing compliance with licensing
26requirements.

27

SEC. 8.  

Section 1408 of the Health and Safety Code is amended
28to read:

29

1408.  

(a)  Upon verification of compliance with this chapter
30and with the approval of the licensing department, the licensing
31department shall issue the license to the applicant.

32(b) Whenbegin delete licensing referral agencies that provideend deletebegin insert issuing a
33license to a referral agency that providesend insert
referrals to residential
34care facilities for the elderly, the State Department of Social
35Services is not required to conduct an onsite licensing inspection
36as a condition of verifying compliance with this chapter.

37(c) As a condition of verifying compliance with this chapter,
38the licensing department may require an applicant to submit a copy
39or example of the disclosures required by Section 1409.4.

P8    1(d) If the applicant is not in compliance with this chapter, the
2licensing department shall deny the applicant a license.
3Immediately upon the denial of any license, the licensing
4department shall notify the applicant in writing. Within 20 days
5of receipt of the notice, the applicant may present his or her written
6petition for a hearing to the licensing department. Proceedings
7conducted by the State Department of Public Health shall be
8conducted in accordance with Section 100171.

9(e) For purposes of compliance with this chapter, an applicant
10is not required to have a physical place of business within the state.

11

SEC. 9.  

Section 1409.3 of the Health and Safety Code is
12amended to read:

13

1409.3.  

(a) The licensee shall notify either or both licensing
14departments, as appropriate, within 10 days in writing when a
15change of stockholder owning 10 percent or more of the nonpublic
16corporate stock occurs. The writing shall include the name and
17principal mailing addresses of the new stockholder.

18(b) When a change of agency manager occurs, either or both
19licensing departments, as appropriate, shall be notified in writing
20within 10 days by the licensee. The notification shall include the
21name of the new agency manager.

22(c) Each licensee shall notify either or both licensing
23departments, as appropriate, within 10 days in writing of any
24change of the mailing address of the licensee. The writing shall
25include the new mailing address of the licensee.

26(d) When a change occurs in the principal officer of a corporate
27licensee, chairperson, president, or general manager, either or both
28licensing departments, as appropriate, shall be notified within 10
29days in writing by the licensee. The writing shall include the name
30and principal business address of the officer.

31

SEC. 10.  

Section 1409.4 is added to the Health and Safety
32Code
, to read:

33

1409.4.  

(a) Before referring a person to any facility, a licensee
34shall disclose all of the following to the person:

35(1) Whether the licensee has an agreement or contract with the
36facility to which the person is being referred.

37(2) Whether a commission or fee will be received by the licensee
38from the facility as a result of the referral.

P9    1(3) Any gift or exchange of monetary value between the facility
2and the licensee that is in addition to, or in lieu of, a commission
3or fee.

4(4) Any fee charged to the person or persons by the licensee.
5The notice shall include a description of the services being rendered
6for that fee and the licensee’s refund policy.

7(5) The licensee’s contact information, including address and
8telephone number, and the licensee’s privacy policy. The privacy
9policy may be provided as an Internet Web site link consistent
10 with provisions set forth in Section 22575 of the Business and
11Professions Code.

12(6) The contact information, including address and telephone
13number, of the State Department of Social Services or State
14Department of Public Health, as appropriate, and the contact
15information for filing consumer complaints, including contact
16information for the local long-term care ombudsman. If the
17disclosure statement is provided electronically, the contact
18information for each department and the local long-term care
19ombudsman may be provided as a hyperlink.

20(b) Contemporaneous with a referral, the licensee shall provide
21the person with the following information about the facility:

22(1) The date of the licensee’s most recent tour or visit to the
23begin delete facility andend deletebegin insert facility, if any,end insert verification that the facility is licensed
24and in good standing, and a hyperlink to, or copy of, the most
25recent evaluation report forbegin delete a residential care facility for the elderly
26toend delete
begin insert the facilityend insert which the person is being referred, prepared pursuant
27to Section 1569.33 and published by the State Department of Social
28Services, if an evaluation report has been prepared in the previous
2924 months.

30(2) Information regarding thebegin delete type ofend delete facility and the services
31offered by the facility.

begin insert

32
(3) (A) Subject to the provisions of subdivision (m) of Section
331405, a suitability advisory, to be written on the disclosure form,
34or read aloud, as follows:

end insert
begin insert

35
“State law does not require that we determine whether facilities
36to which we refer you are suitable for you based upon your care
37and social needs, financial means, and location. We cannot and
38are not required to make this decision for you and your family.”

end insert
begin insert

P10   1
“We cannot be sure whether a facility has an opening or whether
2it is still available when you need it. You should contact the facility
3yourself to verify whether an opening is available.”

end insert
begin insert

4
(B) Nothing shall require a licensee who declares, pursuant to
5subdivision (m) of Section 1405, that the licensee will conduct a
6suitability determination of each person who seeks a referral from
7the licensee, to comply with the requirements of this paragraph.

end insert

8(c) (1) The disclosuresbegin insert and the suitability advisory, if provided,end insert
9 shall be dated and shall contain, in addition to the requirements of
10subdivisions (a) and (b), the name of the person beingbegin delete referred.end delete
11
begin insert referred and the name of the employee making the referral.end insert

12(2) If the disclosures are provided in written form, they shall be
13printed in 16-point bold type.

14(3) If the disclosures are provided electronically, they shall be
15provided in a manner that is consistent with provisions set forth
16in Title 2.5 (commencing with Section 1633.1) of Part 2 of Division
173 of the Civil Code, and shall be displayed on a secured Web page
18in a larger type than the surrounding text.

begin insert

19
(4) The licensing department may develop standard disclosure
20forms and a suitability advisory that conform to the requirements
21of this section. Nothing in this paragraph precludes licensees from
22the ability to give disclosures orally, as set forth herein.

end insert

23(d) The licensee shall make the disclosures pursuant to
24subdivisions (a) and (b) in the same language in which the licensee
25negotiates any referral services with the person receiving services.

26(e) The disclosures shall be signed or otherwise acknowledged
27by the person being referred, or his or her conservator, guardian,
28authorized familybegin delete member,end deletebegin insert member or other authorized
29representative, attorney in fact,end insert
or agent under a power of attorney,
30stating that the disclosures required by this section were received.
31The acknowledgment shall be evidenced in one of the following
32ways:

33(1) The signature of the person being referred, or his or her
34conservator, guardian, authorized familybegin delete member,end deletebegin insert member or other
35authorized representative, attorney in fact,end insert
or agent under a power
36of attorney on the document containing the required disclosures.

37(2) An electronic signature that is consistent with standards set
38forth in Title 2.5 (commencing with Section 1633.1) of Part 2 of
39Division 3 of the Civil Code and includes the date, time, and
40Internet provider address and displays the required disclosures.

P11   1(3) A faxed confirmation that includes the date, time, and fax
2number and displays the required disclosures.

3(4) A telephonic, oral acknowledgment of the person being
4referred, or his or her conservator, guardian, authorized family
5begin delete member,end deletebegin insert member or other authorized representative, attorney in
6fact,end insert
or agent under power of attorney, which shall be recorded,
7with that person’s consent, consistent with Sections 632 and 632.7
8of the Penal Code. This paragraph does not authorize anbegin delete inperson,end delete
9begin insert in-personend insert oral acknowledgment.

10(f) Evidence of the dated disclosure acknowledgment shall be
11retained for a period of no less than three years.

12(g) (1) If the disclosures, or any other referral-related document,
13are provided electronically, the licensee shall provide a written
14copy, in 16-point bold type, to the person being referred, or his or
15her conservator, guardian, authorized familybegin delete member,end deletebegin insert member or
16other authorized representative, attorney in fact,end insert
or agent under
17power of attorney following any referral. This written copy may
18be provided by fax, email, or other means of electronic
19communication, if appropriate.

20(2) Recorded telephonic acknowledgments shall, upon request,
21be provided inbegin delete an easilyend deletebegin insert a reasonablyend insert accessible format to the
22person being referred or the licensing department within five days
23of the request.

begin insert

24
(h) For the purposes of this section, the following terms have
25the following meaning:

end insert
begin insert

26
(1) “Facility” means a residential care facility for the elderly
27as set forth in Section 1569.2.

end insert
begin insert

28
(2) “Licensee” means a referral agency that is licensed pursuant
29to Section 1405.

end insert
30

SEC. 11.  

Section 1409.5 is added to the Health and Safety
31Code
, to read:

32

1409.5.  

Owners, operators, and employees of abegin delete licenseeend deletebegin insert referral
33agency licensed pursuant to Section 1405end insert
are mandated reporters
34of elder or dependent adult abuse pursuant to Section 15630 of the
35Welfare and Institutions Code.

36

SEC. 12.  

Section 1409.6 is added to the Health and Safety
37Code
, to read:

38

1409.6.  

(a) It is unlawful for a licensee to share any personal
39information, including, but not limited to, the name, address, age,
40gender, or medical information of the person receiving services
P12   1from the licensee, with any unauthorized person or third-party
2affiliate of the licensee, unless authorized pursuant to subdivision
3(b).

4(b) A referral agencybegin delete shall not referend deletebegin insert that refersend insert a person to any
5facility or facilitiesbegin delete unlessend deletebegin insert shall obtain fromend insert the person being
6referred, or his or her conservator, guardian,begin insert authorizedend insert family
7begin delete member,end deletebegin insert member or other authorized representative, attorney in
8fact,end insert
or agent under power of attorney,begin delete authorizes the licenseeend deletebegin insert prior
9to making the referral, authorization allowing the referral agencyend insert

10 to share the referred person’s personal information, as well as the
11name and a description of the care or services needed by the
12individual being referred, with a facility or facilities for purposes
13of the referral. The personal information, or other information
14shared, shall be limited to only that information which is necessary
15to complete the referral process. The authorization shall be obtained
16in either of the following ways:

17(1) As a separate authorization form that clearly discloses that
18the individual is consenting to the disclosure of his or her personal
19information to a facility or facilities for which they are being
20referred. This authorization form shall include the name and
21location of the facility or facilities thatbegin delete willend deletebegin insert mayend insert receive the
22personal information, and shall be executed in the manner described
23in subdivision (e) of Section 1409.4.

24(2) As part of the disclosures required by Section 1409.4, if the
25acknowledgment required by subdivision (e) of Section 1409.4
26clearly indicates that the individual being referred, or his or her
27conservator, guardian, authorized familybegin delete member,end deletebegin insert member or other
28authorized representative, attorney in fact,end insert
or agent under power
29of attorney,begin delete is consentingend deletebegin insert consentsend insert to the referral agency’s
30 disclosure of his or her personal information to a facility or
31facilities for which he or she is being referred. The licensee shall
32provide to the individual being referred the name and location of
33the facility or facilities that will receive the personal information,
34as applicable.

35(c) The licensee shall not share the contact information of an
36individual who has not provided his or her authorization pursuant
37to subdivision (b).

begin insert

38
(d) For the purposes of this section, the following terms have
39the following meaning:

end insert
begin insert

P13   1
(1) “Facility” means a residential care facility for the elderly
2as set forth in Section 1569.2.

end insert
begin insert

3
(2) “Licensee” means a referral agency that is licensed pursuant
4to Section 1405.

end insert
5

SEC. 13.  

Section 1409.7 is added to the Health and Safety
6Code
, to read:

7

1409.7.  

It is unlawful for abegin delete licenseeend deletebegin insert referral agency licensed
8pursuant to Section 1405end insert
to hold any power of attorney for a person
9receiving placement referral services from that licensee, or to
10receive or hold a client’s property in any capacity.

11

SEC. 14.  

Section 1409.8 is added to the Health and Safety
12Code
, to read:

13

1409.8.  

On and after July 1, 2017, all persons, associations, or
14corporations licensed pursuant tobegin delete this chapterend deletebegin insert Section 1405end insert shall
15maintain liability insurance coverage in an amount of at least one
16million dollars ($1,000,000) per person occurrence and three
17million dollars ($3,000,000) in the total annual aggregate, for
18negligent acts or omissions by the licensee.

19

SEC. 15.  

Section 1409.9 is added to the Health and Safety
20Code
, to read:

21

1409.9.  

A licensee shall display the licensee’s name and license
22number on all advertising, promotional or marketing material, and
23Internet Web sites paid for or operated by the licensee.

24begin insert

begin insertSEC. 16.end insert  

end insert

begin insertSection 1409.10 is added to the end insertbegin insertHealth and Safety
25Code
end insert
begin insert, to read:end insert

begin insert
26

begin insert1409.10.end insert  

(a) It is unlawful for a medical professional or
27employee of a government agency, hospital, or other healthcare
28institution, including, but not limited to, physicians, nurses, social
29workers, discharge planners, therapists, and geriatric care
30managers, to offer, provide, or accept a payment, rebate, refund,
31commission, preference, or discount, whether in the form of money
32or other consideration, as payment, compensation, or inducement
33for referring patients, clients, or customers to a facility.

34
(b) For the purposes of this section, the following terms have
35the following meanings:

36
(1) “Facility” means a residential care facility for the elderly
37as set forth in Section 1569.2.

38
(2) “Licensee” means a referral agency that is licensed pursuant
39to Section 1405.

end insert
P14   1

begin deleteSEC. 16.end delete
2
begin insertSEC. 17.end insert  

Section 1410 of the Health and Safety Code is
3amended to read:

4

1410.  

The licensing department may suspend or revoke a
5license issued under this chapter for violation of any provisions
6of this chapter orbegin insert anyend insert rules and regulations promulgated hereunder.
7In addition, the licensing department shall assess a civil penalty
8in the amount of fees received by a licensee as a result of a
9violation of any provisions of this chapter or rules and regulations
10promulgated hereunder. Proceedings to suspend or revoke a license
11conducted by the State Department of Public Health shall be
12conducted pursuant to Section 100171.

13

begin deleteSEC. 17.end delete
14
begin insertSEC. 18.end insert  

Section 15630 of the Welfare and Institutions Code
15 is amended to read:

16

15630.  

(a) All of the following persons are mandated reporters:

17(1) A person who has assumed full or intermittent responsibility
18for the care or custody of an elder or dependent adult, whether or
19not he or she receives compensation, including administrators,
20supervisors, and any licensed staff of a public or private facility
21that provides care or services for elder or dependent adults.

22(2) An elder or dependent adult care custodian.

23(3) A health practitioner.

24(4) A clergy member.

25(5) An employee of a county adult protective services agency.

26(6) An employee of a local law enforcement agency.

27(7) An owner, operator, or employee of a referral agency
28licensed under Article 1 (commencing with Section 1400) of
29Chapter 2.3 of Division 2 of the Health and Safety Code.

30(b) (1) Any mandated reporter who, in his or her professional
31capacity, or within the scope of his or her employment, has
32observed or has knowledge of an incident that reasonably appears
33to be physical abuse, as defined in Section 15610.63, abandonment,
34abduction, isolation, financial abuse, or neglect, or is told by an
35elder or dependent adult that he or she has experienced behavior,
36including an act or omission, constituting physical abuse, as defined
37in Section 15610.63, abandonment, abduction, isolation, financial
38abuse, or neglect, or reasonably suspects that abuse, shall report
39the known or suspected instance of abuse by telephone or through
40a confidential Internet reporting tool, as authorized by Section
P15   115658, immediately or as soon as practicably possible. If reported
2by telephone, a written report shall be sent, or an Internet report
3shall be made through the confidential Internet reporting tool
4established in Section 15658, within two working days.

5(A) If the suspected or alleged abuse is physical abuse, as
6defined in Section 15610.63, and the abuse occurred in a long-term
7care facility, except a state mental health hospital or a state
8developmental center, the following shall occur:

9(i) If the suspected abuse results in serious bodily injury, a
10telephone report shall be made to the local law enforcement agency
11immediately, but also no later than within two hours of the
12mandated reporter observing, obtaining knowledge of, or
13suspecting the physical abuse, and a written report shall be made
14to the local ombudsman, the corresponding licensing agency, and
15the local law enforcement agency within two hours of the mandated
16reporter observing, obtaining knowledge of, or suspecting the
17physical abuse.

18(ii) If the suspected abuse does not result in serious bodily injury,
19a telephone report shall be made to the local law enforcement
20agency within 24 hours of the mandated reporter observing,
21obtaining knowledge of, or suspecting the physical abuse, and a
22written report shall be made to the local ombudsman, the
23corresponding licensing agency, and the local law enforcement
24agency within 24 hours of the mandated reporter observing,
25obtaining knowledge of, or suspecting the physical abuse.

26(iii) When the suspected abuse is allegedly caused by a resident
27with a physician’s diagnosis of dementia, and there is no serious
28bodily injury, as reasonably determined by the mandated reporter,
29drawing upon his or her training or experience, the reporter shall
30report to the local ombudsman or law enforcement agency by
31telephone, immediately or as soon as practicably possible, and by
32written report, within 24 hours.

33(iv) When applicable, reports made pursuant to clauses (i) and
34(ii) shall be deemed to satisfy the reporting requirements of the
35federal Elder Justice Act of 2009, as set out in Subtitle H of the
36federal Patient Protection and Affordable Care Act (Public Law
37111-148), Section 1418.91 of the Health and Safety Code, and
38Section 72541 of Title 22 of California Code of Regulations. When
39a local law enforcement agency receives an initial report of
40suspected abuse in a long-term care facility pursuant to this
P16   1subparagraph, the local law enforcement agency may coordinate
2efforts with the local ombudsman to provide the most immediate
3and appropriate response warranted to investigate the mandated
4report. The local ombudsman and local law enforcement agencies
5may collaborate to develop protocols to implement this
6subparagraph.

7(B) Notwithstanding the rulemaking provisions of Chapter 3.5
8(commencing with Section 11340) of Part 1 of Division 3 of Title
92 of the Government Code, or any other law, the department may
10implement subparagraph (A), in whole or in part, by means of
11all-county letters, provider bulletins, or other similar instructions
12without taking regulatory action.

13(C) If the suspected or alleged abuse is abuse other than physical
14abuse, and the abuse occurred in a long-term care facility, except
15a state mental health hospital or a state developmental center, a
16telephone report and a written report shall be made to the local
17ombudsman or the local law enforcement agency.

18(D) With regard to abuse reported pursuant to subparagraph
19(C), the local ombudsman and the local law enforcement agency
20shall, as soon as practicable, except in the case of an emergency
21or pursuant to a report required to be made pursuant to clause (v),
22in which case these actions shall be taken immediately, do all of
23the following:

24(i) Report to the State Department of Public Health any case of
25known or suspected abuse occurring in a long-term health care
26facility, as defined in subdivision (a) of Section 1418 of the Health
27and Safety Code.

28(ii) Report to the State Department of Social Services any case
29of known or suspected abuse occurring in a residential care facility
30for the elderly, as defined in Section 1569.2 of the Health and
31Safety Code, or in an adult day program, as defined in paragraph
32(2) of subdivision (a) of Section 1502 of the Health and Safety
33Code.

34(iii) Report to the State Department of Public Health and the
35California Department of Aging any case of known or suspected
36abuse occurring in an adult day health care center, as defined in
37subdivision (b) of Section 1570.7 of the Health and Safety Code.

38(iv) Report to the Bureau of Medi-Cal Fraud and Elder Abuse
39any case of known or suspected criminal activity.

P17   1(v) Report all cases of known or suspected physical abuse and
2financial abuse to the local district attorney’s office in the county
3where the abuse occurred.

4(E) (i) If the suspected or alleged abuse or neglect occurred in
5a state mental hospital or a state developmental center, and the
6suspected or alleged abuse or neglect resulted in any of the
7following incidents, a report shall be made immediately, but no
8later than within two hours of the mandated reporter observing,
9obtaining knowledge of, or suspecting abuse, to designated
10investigators of the State Department of State Hospitals or the
11State Department of Developmental Services, and also to the local
12law enforcement agency:

13(I) A death.

14(II) A sexual assault, as defined in Section 15610.63.

15(III) An assault with a deadly weapon, as described in Section
16245 of the Penal Code, by a nonresident of the state mental hospital
17or state developmental center.

18(IV) An assault with force likely to produce great bodily injury,
19as described in Section 245 of the Penal Code.

20(V) An injury to the genitals when the cause of the injury is
21undetermined.

22(VI) A broken bone when the cause of the break is
23undetermined.

24(ii) All other reports of suspected or alleged abuse or neglect
25that occurred in a state mental hospital or a state developmental
26center shall be made immediately, but no later than within two
27hours of the mandated reporter observing, obtaining knowledge
28of, or suspecting abuse, to designated investigators of the State
29Department of State Hospitals or the State Department of
30Developmental Services, or to the local law enforcement agency.

31(iii) When a local law enforcement agency receives an initial
32report of suspected or alleged abuse or neglect in a state mental
33hospital or a state developmental center pursuant to clause (i), the
34local law enforcement agency shall coordinate efforts with the
35designated investigators of the State Department of State Hospitals
36or the State Department of Developmental Services to provide the
37most immediate and appropriate response warranted to investigate
38the mandated report. The designated investigators of the State
39Department of State Hospitals or the State Department of
P18   1Developmental Services and local law enforcement agencies may
2collaborate to develop protocols to implement this clause.

3(iv) Except in an emergency, the local law enforcement agency
4shall, as soon as practicable, report any case of known or suspected
5criminal activity to the Bureau of Medi-Cal Fraud and Elder Abuse.

6(v) Notwithstanding any other law, a mandated reporter who is
7required to report pursuant to Section 4427.5 shall not be required
8to report under clause (i).

9(F) If the abuse has occurred in any place other than a long-term
10care facility, a state mental hospital, or a state developmental
11center, the report shall be made to the adult protective services
12agency or the local law enforcement agency.

13(2) (A) A mandated reporter who is a clergy member who
14acquires knowledge or reasonable suspicion of elder or dependent
15adult abuse during a penitential communication is not subject to
16paragraph (1). For purposes of this subdivision, “penitential
17communication” means a communication that is intended to be in
18confidence, including, but not limited to, a sacramental confession
19made to a clergy member who, in the course of the discipline or
20practice of his or her church, denomination, or organization is
21authorized or accustomed to hear those communications and under
22the discipline tenets, customs, or practices of his or her church,
23denomination, or organization, has a duty to keep those
24communications secret.

25(B) This subdivision shall not be construed to modify or limit
26a clergy member’s duty to report known or suspected elder and
27dependent adult abuse if he or she is acting in the capacity of a
28care custodian, health practitioner, or employee of an adult
29protective services agency.

30(C) Notwithstanding any other provision in this section, a clergy
31member who is not regularly employed on either a full-time or
32part-time basis in a long-term care facility or does not have care
33or custody of an elder or dependent adult shall not be responsible
34for reporting abuse or neglect that is not reasonably observable or
35discernible to a reasonably prudent person having no specialized
36training or experience in elder or dependent care.

37(3) (A) A mandated reporter who is a physician and surgeon,
38a registered nurse, or a psychotherapist, as defined in Section 1010
39of the Evidence Code, shall not be required to report, pursuant to
40paragraph (1), an incident if all of the following conditions exist:

P19   1(i) The mandated reporter has been told by an elder or dependent
2adult that he or she has experienced behavior constituting physical
3abuse, as defined in Section 15610.63, abandonment, abduction,
4isolation, financial abuse, or neglect.

5(ii) The mandated reporter is not aware of any independent
6evidence that corroborates the statement that the abuse has
7occurred.

8(iii) The elder or dependent adult has been diagnosed with a
9mental illness or dementia, or is the subject of a court-ordered
10conservatorship because of a mental illness or dementia.

11(iv) In the exercise of clinical judgment, the physician and
12surgeon, the registered nurse, or the psychotherapist, as defined
13in Section 1010 of the Evidence Code, reasonably believes that
14the abuse did not occur.

15(B) This paragraph shall not be construed to impose upon
16mandated reporters a duty to investigate a known or suspected
17incident of abuse and shall not be construed to lessen or restrict
18any existing duty of mandated reporters.

19(4) (A) In a long-term care facility, a mandated reporter shall
20not be required to report as a suspected incident of abuse, as defined
21in Section 15610.07, an incident if all of the following conditions
22exist:

23(i) The mandated reporter is aware that there is a proper plan
24of care.

25(ii) The mandated reporter is aware that the plan of care was
26properly provided or executed.

27(iii) A physical, mental, or medical injury occurred as a result
28of care provided pursuant to clause (i) or (ii).

29(iv) The mandated reporter reasonably believes that the injury
30 was not the result of abuse.

31(B) This paragraph shall not be construed to require a mandated
32reporter to seek, nor to preclude a mandated reporter from seeking,
33information regarding a known or suspected incident of abuse prior
34to reporting. This paragraph shall apply only to those categories
35of mandated reporters that the State Department of Public Health
36determines, upon approval by the Bureau of Medi-Cal Fraud and
37Elder Abuse and the state long-term care ombudsman, have access
38to plans of care and have the training and experience necessary to
39determine whether the conditions specified in this section have
40been met.

P20   1(c) (1) Any mandated reporter who has knowledge, or
2reasonably suspects, that types of elder or dependent adult abuse
3for which reports are not mandated have been inflicted upon an
4elder or dependent adult, or that his or her emotional well-being
5is endangered in any other way, may report the known or suspected
6instance of abuse.

7(2) If the suspected or alleged abuse occurred in a long-term
8care facility other than a state mental health hospital or a state
9developmental center, the report may be made to the long-term
10care ombudsman program. Except in an emergency, the local
11ombudsman shall report any case of known or suspected abuse to
12the State Department of Public Health and any case of known or
13suspected criminal activity to the Bureau of Medi-Cal Fraud and
14Elder Abuse, as soon as is practicable.

15(3) If the suspected or alleged abuse occurred in a state mental
16health hospital or a state developmental center, the report may be
17made to the designated investigator of the State Department of
18State Hospitals or the State Department of Developmental Services
19or to a local law enforcement agency. Except in an emergency,
20the local law enforcement agency shall report any case of known
21or suspected criminal activity to the Bureau of Medi-Cal Fraud
22and Elder Abuse, as soon as is practicable.

23(4) If the suspected or alleged abuse occurred in a place other
24than a place described in paragraph (2) or (3), the report may be
25made to the county adult protective services agency.

26(5) If the conduct involves criminal activity not covered in
27subdivision (b), it may be immediately reported to the appropriate
28law enforcement agency.

29(d) If two or more mandated reporters are present and jointly
30have knowledge or reasonably suspect that types of abuse of an
31elder or a dependent adult for which a report is or is not mandated
32have occurred, and there is agreement among them, the telephone
33report or Internet report, as authorized by Section 15658, may be
34made by a member of the team selected by mutual agreement, and
35a single report may be made and signed by the selected member
36of the reporting team. Any member who has knowledge that the
37member designated to report has failed to do so shall thereafter
38make the report.

39(e) A telephone report or Internet report, as authorized by
40Section 15658, of a known or suspected instance of elder or
P21   1dependent adult abuse shall include, if known, the name of the
2person making the report, the name and age of the elder or
3dependent adult, the present location of the elder or dependent
4adult, the names and addresses of family members or any other
5adult responsible for the elder’s or dependent adult’s care, the
6nature and extent of the elder’s or dependent adult’s condition, the
7date of the incident, and any other information, including
8information that led that person to suspect elder or dependent adult
9abuse, as requested by the agency receiving the report.

10(f) The reporting duties under this section are individual, and
11no supervisor or administrator shall impede or inhibit the reporting
12duties, and no person making the report shall be subject to any
13sanction for making the report. However, internal procedures to
14facilitate reporting, ensure confidentiality, and apprise supervisors
15and administrators of reports may be established, provided they
16are not inconsistent with this chapter.

17(g) (1) Whenever this section requires a county adult protective
18services agency to report to a law enforcement agency, the law
19enforcement agency shall, immediately upon request, provide a
20copy of its investigative report concerning the reported matter to
21that county adult protective services agency.

22(2) Whenever this section requires a law enforcement agency
23to report to a county adult protective services agency, the county
24adult protective services agency shall, immediately upon request,
25provide to that law enforcement agency a copy of its investigative
26report concerning the reported matter.

27(3) The requirement to disclose investigative reports pursuant
28to this subdivision shall not include the disclosure of social services
29records or case files that are confidential, nor shall this subdivision
30be construed to allow disclosure of any reports or records if the
31disclosure would be prohibited by any other provision of state or
32federal law.

33(h) Failure to report, or impeding or inhibiting a report of,
34physical abuse, as defined in Section 15610.63, abandonment,
35abduction, isolation, financial abuse, or neglect of an elder or
36dependent adult, in violation of this section, is a misdemeanor,
37punishable by not more than six months in the county jail, by a
38fine of not more than one thousand dollars ($1,000), or by both
39that fine and imprisonment. Any mandated reporter who willfully
40fails to report, or impedes or inhibits a report of, physical abuse,
P22   1as defined in Section 15610.63, abandonment, abduction, isolation,
2financial abuse, or neglect of an elder or dependent adult, in
3violation of this section, if that abuse results in death or great bodily
4injury, shall be punished by not more than one year in a county
5jail, by a fine of not more than five thousand dollars ($5,000), or
6by both that fine and imprisonment. If a mandated reporter
7intentionally conceals his or her failure to report an incident known
8by the mandated reporter to be abuse or severe neglect under this
9section, the failure to report is a continuing offense until a law
10enforcement agency specified in paragraph (1) of subdivision (b)
11of Section 15630 discovers the offense.

12(i) For purposes of this section, “dependent adult” shall have
13the same meaning as in Section 15610.23.

14

begin deleteSEC. 18.end delete
15
begin insertSEC. 19.end insert  

No reimbursement is required by this act pursuant to
16Section 6 of Article XIII B of the California Constitution because
17the only costs that may be incurred by a local agency or school
18district will be incurred because this act creates a new crime or
19infraction, eliminates a crime or infraction, or changes the penalty
20for a crime or infraction, within the meaning of Section 17556 of
21the Government Code, or changes the definition of a crime within
22the meaning of Section 6 of Article XIII B of the California
23Constitution.



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