Amended in Assembly August 19, 2016

Amended in Assembly August 15, 2016

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, 1403, 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, 1409.9, and 1409.10 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 family member or other authorized representative, attorney in fact, 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. The bill would also make it unlawful forbegin delete a medical professional or employeeend deletebegin insert an employee, independent contractor, or other person who is acting on behalfend insert of a governmental agency, hospital, or other health care 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 abegin delete facility.end deletebegin insert facility or licensee.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.

P4    1(c) It is unlawful for any person, association, or corporation to
2establish, conduct, or maintain a referral agency or to refer any
3person for remuneration to any residential care facility for the
4elderly for professional services if that facility does not meet the
5licensing standards established in Chapter 3.2 (commencing with
6Section 1560). The referral agency may satisfy this requirement
7by obtaining and relying on the licensing status information for a
8residential care facility for the elderly that is published on the
9Internet Web site of the State Department of Social Services.

10(d) It is unlawful for any extended care facility, skilled nursing
11home, intermediate care facility, or residential care facility for the
12elderly, or a distinct part of a facility providing extended care,
13skilled nursing home care, or intermediate care to pay a
14commission or fee to a referral agency that does not have a written
15license as provided in this chapter from the State Public Health
16Officer or from an inspection service approved by the State Public
17Health Officer pursuant to Section 1257, from the State Department
18of Social Services, or from both, as appropriate.

19

SEC. 2.  

Section 1401 of the Health and Safety Code is amended
20to read:

21

1401.  

As used in this chapter, “referral agency” means a private,
22profit or nonprofit agency that is engaged in the business of
23referring persons for remuneration to any extended care facility,
24skilled nursing home, intermediate care facility, or residential care
25facility for the elderly, or a distinct part of a facility providing
26extended care, skilled nursing home care, or intermediate care.
27“Referral agency” does not include any of the following:

28(a) A licensed residential care facility for the elderly that does
29either of the following:

30(1) Provides discounts or other remuneration to residents or
31their families for referring new or prospective clients.

32(2) Provides remuneration to staff for marketing or sales offers.

33(b) A resident who refers a new or prospective resident to a
34licensed residential care facility for the elderly and receives a
35discount or other remuneration from the licensed residential care
36facility for the elderly.

37(c) A staff member of the licensed residential care facility for
38the elderly who receives remuneration from the facility for
39professional services, including, but not limited to, sales and
40marketing efforts, on behalf of that facility.

P5    1

SEC. 3.  

Section 1402 is added to the Health and Safety Code,
2to read:

3

1402.  

“Residential care facility for the elderly” has the same
4meaning as set forth in Section 1569.2.

5

SEC. 4.  

Section 1403 of the Health and Safety Code is amended
6to read:

7

1403.  

(a) Each application for a license or renewal of license
8under this chapter shall be accompanied by an annual Licensing
9and Certification Program fee. Each license shall expire 12 months
10from its date of issuance and application for renewal accompanied
11by the fee shall be filed with the director not later than 30 days
12prior to the date of expiration.

13(b) The State Department of Public Health shall set the annual
14Licensing and Certification Program fee in accordance with Section
151266.

16(c) begin insert(1)end insertbegin insertend insertThe State Department of Social Services shall set the
17annual Licensing and Certification Program fee at an amount no
18greater than the amount required to cover the reasonable and actual
19costs of administering the licensing program.

begin insert

20
(2) The State Department of Social Services shall, no later than
21February 1, 2017, and no later than February 1 of each year
22thereafter, submit a proposed fee schedule as part of its budget
23proposal to the Legislature.

end insert
24

SEC. 5.  

Section 1404 of the Health and Safety Code is amended
25to read:

26

1404.  

No licensee under this chapter shall have a direct or
27indirect financial interest in any facility doing business with the
28licensee.

29

SEC. 6.  

Section 1404.5 of the Health and Safety Code is
30amended to read:

31

1404.5.  

A license application shall be submitted to either or
32both licensing departments, as appropriate, whenever any of the
33following circumstances occur:

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

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

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

37

SEC. 7.  

Section 1405 of the Health and Safety Code is amended
38to read:

39

1405.  

Any person, partnership, firm, corporation, or association
40desiring to obtain a license to refer persons to extended care
P6    1facilities, skilled nursing homes, or intermediate care facilities, or
2a distinct part of a facility providing extended care, skilled nursing
3home care, or intermediate care, shall file with the State
4Department of Public Health an application on forms furnished
5by the State Department of Public Health. Any person, partnership,
6firm, corporation, or association desiring to obtain a license to
7refer persons to residential care facilities for the elderly shall file
8with the State Department of Social Services an application on
9forms furnished by the State Department of Social Services. The
10applications shall contain all of the following:

11(a) Name of applicant, and if an individual, whether the applicant
12has attained the age of 18 years.

13(b) Name of referral agency.

14(c) The location of the referral agency.

15(d) The business or occupation engaged in by each applicant,
16and by each partner, officer, and director, for at least two years
17immediately preceding the filing of the application. In addition,
18each such person shall submit a statement setting forth whether
19he or she has previously engaged in the operation of a referral
20agency, whether he or she has been involved in, or the subject of,
21a refusal or revocation of a referral agency license, and whether
22he or she has been convicted of a crime other than a minor traffic
23offense.

24(e) If the applicant is a corporation, the name and principal
25business address of each officer and director of the corporation;
26and for nonpublic corporations, the name and business address of
27each stockholder owning 10 percent or more of the stock and the
28name and business address of any corporation member who has
29responsibility in the operation of the facility.

30(f) If the applicant is a partnership, the name and principal
31business address of each partner.

32(g) Evidence of the right to occupy the premises where the
33referral agency is to be located.

34(h) A copy of the partnership agreement or the Articles of
35Incorporation, if applicable.

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

37(j) A schedule of fees to be charged and collected by the referral
38agency, and a statement of the method by which each fee is to be
39computed or determined.

P7    1(k) A declaration that the licensee will not have any financial
2interest in any health facility doing business with the referral
3agency.

4(l) Evidence satisfactory to the licensing department that the
5applicant demonstrates reputable and responsible character and
6the capability to comply with this chapter.

7(m) For a licensee to refer persons to residential care facilities
8for the elderly, both of the following:

9(1) A declaration that the licensee will either conduct a
10suitability determination of each person who seeks a referral from
11the licensee and who is referred to a facility or facilities, or will
12comply with the requirements of paragraph (3) of subdivision (b)
13of Section 1409.4. For purposes of this subdivision, “a suitability
14determination” means a determination made by the licensee that
15the facility offers services to meet the needs of the person seeking
16a referral because of the following considerations:

17(A) The level of care requested by the person seeking the
18referral.

19(B) The cost of the facility and the ability of the financial means
20of the person seeking the referral.

21(C) The social needs and preferences of the person seeking the
22referral.

23(D) The geographic location of the facility and the geographic
24preference of the person seeking the referral.

25(2) A declaration that the licensee trains all employees who
26make referrals to residential care facilities for the elderly regarding
27all of the following issues:

28(A) All of the provisions of this chapter that apply to a referral
29agency, including, but not limited to, instruction on how to comply
30with all of those provisions.

31(B) State governance and administrative functions of agency
32operations, including resident assessment and admission
33procedures.

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

35(D) Community supports, cultural competency and sensitivity
36to residents’ needs.

37

SEC. 8.  

Section 1407 of the Health and Safety Code is amended
38to read:

39

1407.  

(a) Any licensee desiring to voluntarily surrender his
40or her license for cancellation or temporary suspension shall notify
P8    1the licensing department in writing as soon as possible and, in all
2cases, at least 30 days prior to the effective date of cancellation or
3temporary suspension of the license.

4(b) Any license placed in temporary suspension pursuant to this
5section may be reinstated by the licensing department within 12
6months of the date of the voluntary suspension on receipt of an
7application and evidence showing compliance with licensing
8requirements.

9

SEC. 9.  

Section 1408 of the Health and Safety Code is amended
10to read:

11

1408.  

(a)  Upon verification of compliance with this chapter
12and with the approval of the licensing department, the licensing
13department shall issue the license to the applicant.

14(b) When issuing a license to a referral agency that provides
15referrals to residential care facilities for the elderly, the State
16Department of Social Services is not required to conduct an onsite
17licensing inspection as a condition of verifying compliance with
18this chapter.

19(c) As a condition of verifying compliance with this chapter,
20the licensing department may require an applicant to submit a copy
21or example of the disclosures required by Section 1409.4.

22(d) If the applicant is not in compliance with this chapter, the
23licensing department shall deny the applicant a license.
24Immediately upon the denial of any license, the licensing
25department shall notify the applicant in writing. Within 20 days
26of receipt of the notice, the applicant may present his or her written
27petition for a hearing to the licensing department. Proceedings
28conducted by the State Department of Public Health shall be
29conducted in accordance with Section 100171.

30(e) For purposes of compliance with this chapter, an applicant
31is not required to have a physical place of business within the state.

32

SEC. 10.  

Section 1409.3 of the Health and Safety Code is
33amended to read:

34

1409.3.  

(a) The licensee shall notify either or both licensing
35departments, as appropriate, within 10 days in writing when a
36change of stockholder owning 10 percent or more of the nonpublic
37corporate stock occurs. The writing shall include the name and
38principal mailing addresses of the new stockholder.

39(b) When a change of agency manager occurs, either or both
40licensing departments, as appropriate, shall be notified in writing
P9    1within 10 days by the licensee. The notification shall include the
2name of the new agency manager.

3(c) Each licensee shall notify either or both licensing
4departments, as appropriate, within 10 days in writing of any
5change of the mailing address of the licensee. The writing shall
6include the new mailing address of the licensee.

7(d) When a change occurs in the principal officer of a corporate
8licensee, chairperson, president, or general manager, either or both
9licensing departments, as appropriate, shall be notified within 10
10days in writing by the licensee. The writing shall include the name
11and principal business address of the officer.

12

SEC. 11.  

Section 1409.4 is added to the Health and Safety
13Code
, to read:

14

1409.4.  

(a) Before referring a person to any facility, a licensee
15shall disclose all of the following to the person:

16(1) Whether the licensee has an agreement or contract with the
17facility to which the person is being referred.

18(2) Whether a commission or fee will be received by the licensee
19from the facility as a result of the referral.

20(3) Any gift or exchange of monetary value between the facility
21and the licensee that is in addition to, or in lieu of, a commission
22or fee.

23(4) Any fee charged to the person or persons by the licensee.
24The notice shall include a description of the services being rendered
25for that fee and the licensee’s refund policy.

26(5) The licensee’s contact information, including address and
27telephone number, and the licensee’s privacy policy. The privacy
28policy may be provided as an Internet Web site link consistent
29 with provisions set forth in Section 22575 of the Business and
30Professions Code.

31(6) The contact information, including address and telephone
32number, of the State Department of Social Services or State
33Department of Public Health, as appropriate, and the contact
34information for filing consumer complaints, including contact
35information for the local long-term care ombudsman. If the
36disclosure statement is provided electronically, the contact
37information for each department and the local long-term care
38ombudsman may be provided as a hyperlink.

39(b) Contemporaneous with a referral, the licensee shall provide
40the person with the following information about the facility:

P10   1(1) The date of the licensee’s most recent tour or visit to the
2facility, if any, verification that the facility is licensed and in good
3standing, and a hyperlink to, or copy of, the most recent evaluation
4report for the facility which the person is being referred, prepared
5pursuant to Section 1569.33 and published by the State Department
6of Social Services, if an evaluation report has been prepared in the
7previous 24 months.

8(2) Information regarding the facility and the services offered
9by the facility.

10(3) (A) Subject to the provisions of subdivision (m) of Section
111405, a suitability advisory, to be written on the disclosure form,
12or read aloud, as follows:

13“State law does not require that we determine whether facilities
14to which we refer you are suitable for you based upon your care
15and social needs, financial means, and location. We cannot and
16are not required to make this decision for you and your family.
17We cannot be sure whether a facility has an opening or whether it
18is still available when you need it. You should contact the facility
19yourself to verify whether an opening is available.”

20(B) Nothing shall require a licensee who declares, pursuant to
21subdivision (m) of Section 1405, that the licensee will conduct a
22suitability determination of each person who seeks a referral from
23the licensee, to comply with the requirements of this paragraph.

24(c) (1) The disclosures and the suitability advisory, if provided,
25shall be dated and shall contain, in addition to the requirements of
26subdivisions (a) and (b), the name of the person being referred and
27the name of the employee making the referral.

28(2) If the disclosures are provided in written form, they shall be
29printed in 16-point bold type.

30(3) If the disclosures are provided electronically, they shall be
31provided in a manner that is consistent with provisions set forth
32in Title 2.5 (commencing with Section 1633.1) of Part 2 of Division
333 of the Civil Code, and shall be displayed on a secured Web page
34in a larger type than the surrounding text.

35(4) The licensing department may develop standard disclosure
36forms and a suitability advisory that conform to the requirements
37of this section. Nothing in this paragraph precludes licensees from
38the ability to give disclosures orally, as set forth herein.

P11   1(d) The licensee shall make the disclosures pursuant to
2subdivisions (a) and (b) in the same language in which the licensee
3negotiates any referral services with the person receiving services.

4(e) The disclosures shall be signed or otherwise acknowledged
5by the person being referred, or his or her conservator, guardian,
6authorized family member or other authorized representative,
7 attorney in fact, or agent under a power of attorney, stating that
8the disclosures required by this section were received. The
9acknowledgment shall be evidenced in one of the following ways:

10(1) The signature of the person being referred, or his or her
11conservator, guardian, authorized family member or other
12authorized representative, attorney in fact, or agent under a power
13of attorney on the document containing the required disclosures.

14(2) An electronic signature that is consistent with standards set
15forth in Title 2.5 (commencing with Section 1633.1) of Part 2 of
16Division 3 of the Civil Code and includes the date, time, and
17Internet provider address and displays the required disclosures.

18(3) A faxed confirmation that includes the date, time, and fax
19number and displays the required disclosures.

20(4) A telephonic, oral acknowledgment of the person being
21referred, or his or her conservator, guardian, authorized family
22member or other authorized representative, attorney in fact, or
23agent under power of attorney, which shall be recorded, with that
24person’s consent, consistent with Sections 632 and 632.7 of the
25Penal Code. This paragraph does not authorize an in-person oral
26acknowledgment.

27(f) Evidence of the dated disclosure acknowledgment shall be
28retained for a period of no less than three years.

29(g) (1) If the disclosures, or any other referral-related document,
30are provided electronically, the licensee shall provide a written
31copy, in 16-point bold type, to the person being referred, or his or
32her conservator, guardian, authorized family member or other
33authorized representative, attorney in fact, or agent under power
34of attorney following any referral. This written copy may be
35provided by fax, email, or other means of electronic
36communication, if appropriate.

37(2) Recorded telephonic acknowledgments shall, upon request,
38be provided in a reasonably accessible format to the person being
39referred or the licensing department within five days of the request.

P12   1(h) For the purposes of this section, the following terms have
2the followingbegin delete meaning:end deletebegin insert meanings:end insert

3(1) “Facility” means a residential care facility for the elderly as
4set forth in Section 1569.2.

5(2) “Licensee” means a referral agency that is licensed pursuant
6to Section 1405.

7

SEC. 12.  

Section 1409.5 is added to the Health and Safety
8Code
, to read:

9

1409.5.  

Owners, operators, and employees of a referral agency
10licensed pursuant to Section 1405 are mandated reporters of elder
11or dependent adult abuse pursuant to Section 15630 of the Welfare
12and Institutions Code.

13

SEC. 13.  

Section 1409.6 is added to the Health and Safety
14Code
, to read:

15

1409.6.  

(a) It is unlawful for a licensee to share any personal
16information, including, but not limited to, the name, address, age,
17gender, or medical information of the person receiving services
18from the licensee, with any unauthorized person or third-party
19affiliate of the licensee, unless authorized pursuant to subdivision
20(b).

21(b) A referral agency that refers a person to any facility or
22facilities shall obtain from the person being referred, or his or her
23conservator, guardian, authorized family member or other
24authorized representative, attorney in fact, or agent under power
25of attorney, prior to making the referral, authorization allowing
26the referral agency to share the referred person’s personal
27information, as well as the name and a description of the care or
28services needed by the individual being referred, with a facility or
29facilities for purposes of the referral. The personal information, or
30other information shared, shall be limited to only that information
31which is necessary to complete the referral process. The
32authorization shall be obtained in either of the following ways:

33(1) As a separate authorization form that clearly discloses that
34the individual is consenting to the disclosure of his or her personal
35information to a facility or facilities for which they are being
36referred. This authorization form shall include the name and
37location of the facility or facilities that may receive the personal
38information, and shall be executed in the manner described in
39 subdivision (e) of Section 1409.4.

P13   1(2) As part of the disclosures required by Section 1409.4, if the
2acknowledgment required by subdivision (e) of Section 1409.4
3clearly indicates that the individual being referred, or his or her
4conservator, guardian, authorized family member or other
5authorized representative, attorney in fact, or agent under power
6of attorney, consents to the referral agency’s disclosure of his or
7her personal information to a facility or facilities for which he or
8she is being referred. The licensee shall provide to the individual
9being referred the name and location of the facility or facilities
10that will receive the personal information, as applicable.

11(c) The licensee shall not share the contact information of an
12individual who has not provided his or her authorization pursuant
13to subdivision (b).

14(d) For the purposes of this section, the following terms have
15the following meanings:

16(1) “Facility” means a residential care facility for the elderly as
17set forth in Section 1569.2.

18(2) “Licensee” means a referral agency that is licensed pursuant
19to Section 1405.

20

SEC. 14.  

Section 1409.7 is added to the Health and Safety
21Code
, to read:

22

1409.7.  

It is unlawful for a referral agency licensed pursuant
23to Section 1405 to hold any power of attorney for a person
24receiving placement referral services from that licensee, or to
25receive or hold a client’s property in any capacity.

26

SEC. 15.  

Section 1409.8 is added to the Health and Safety
27Code
, to read:

28

1409.8.  

On and after July 1, 2017, all persons, associations, or
29corporations licensed pursuant to Section 1405 shall maintain
30liability insurance coverage in an amount of at least one million
31dollars ($1,000,000) per person occurrence and three million dollars
32($3,000,000) in the total annual aggregate, for negligent acts or
33omissions by the licensee.

34

SEC. 16.  

Section 1409.9 is added to the Health and Safety
35Code
, to read:

36

1409.9.  

A licensee shall display the licensee’s name and license
37number on all advertising, promotional or marketing material, and
38Internet Web sites paid for or operated by the licensee.

39

SEC. 17.  

Section 1409.10 is added to the Health and Safety
40Code
, to read:

P14   1

1409.10.  

(a) It is unlawful forbegin delete a medical professional or
2employeeend delete
begin insert an employee, independent contractor, or other person
3who is acting on behalfend insert
of a government agency, hospital, or other
4health care institution, including, but not limited to,begin insert medical
5professionals,end insert
physicians, nurses, social workers, discharge
6planners, therapists, and geriatric care managers, to offer, provide,
7or accept a payment, rebate, refund, commission, preference, or
8discount, whether in the form of money or other consideration, as
9payment, compensation, or inducement for referring patients,
10clients, or customers to abegin delete facility.end deletebegin insert facility or licensee.end insert

11(b) For the purposes of this section, the following terms have
12the following meanings:

13(1) “Facility” means a residential care facility for the elderly as
14set forth in Section 1569.2.

15(2) “Licensee” means a referral agency that is licensed pursuant
16to Section 1405.

17

SEC. 18.  

Section 1410 of the Health and Safety Code is
18amended to read:

19

1410.  

The licensing department may suspend or revoke a
20license issued under this chapter for violation of any provisions
21of this chapter or any rules and regulations promulgated hereunder.
22In addition, the licensing department shall assess a civil penalty
23in the amount of fees received by a licensee as a result of a
24violation of any provisions of this chapter or rules and regulations
25promulgated hereunder. Proceedings to suspend or revoke a license
26conducted by the State Department of Public Health shall be
27conducted pursuant to Section 100171.

28

SEC. 19.  

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

30

15630.  

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

31(1) A person who has assumed full or intermittent responsibility
32for the care or custody of an elder or dependent adult, whether or
33not he or she receives compensation, including administrators,
34supervisors, and any licensed staff of a public or private facility
35that provides care or services for elder or dependent adults.

36(2) An elder or dependent adult care custodian.

37(3) A health practitioner.

38(4) A clergy member.

39(5) An employee of a county adult protective services agency.

40(6) An employee of a local law enforcement agency.

P15   1(7) An owner, operator, or employee of a referral agency
2licensed under Article 1 (commencing with Section 1400) of
3Chapter 2.3 of Division 2 of the Health and Safety Code.

4(b) (1) Any mandated reporter who, in his or her professional
5capacity, or within the scope of his or her employment, has
6observed or has knowledge of an incident that reasonably appears
7to be physical abuse, as defined in Section 15610.63, abandonment,
8abduction, isolation, financial abuse, or neglect, or is told by an
9elder or dependent adult that he or she has experienced behavior,
10including an act or omission, constituting physical abuse, as defined
11in Section 15610.63, abandonment, abduction, isolation, financial
12abuse, or neglect, or reasonably suspects that abuse, shall report
13the known or suspected instance of abuse by telephone or through
14a confidential Internet reporting tool, as authorized by Section
1515658, immediately or as soon as practicably possible. If reported
16by telephone, a written report shall be sent, or an Internet report
17shall be made through the confidential Internet reporting tool
18established in Section 15658, within two working days.

19(A) If the suspected or alleged abuse is physical abuse, as
20defined in Section 15610.63, and the abuse occurred in a long-term
21care facility, except a state mental health hospital or a state
22developmental center, the following shall occur:

23(i) If the suspected abuse results in serious bodily injury, a
24telephone report shall be made to the local law enforcement agency
25immediately, but also no later than within two hours of the
26mandated reporter observing, obtaining knowledge of, or
27suspecting the physical abuse, and a written report shall be made
28to the local ombudsman, the corresponding licensing agency, and
29the local law enforcement agency within two hours of the mandated
30reporter observing, obtaining knowledge of, or suspecting the
31physical abuse.

32(ii) If the suspected abuse does not result in serious bodily injury,
33a telephone report shall be made to the local law enforcement
34agency within 24 hours of the mandated reporter observing,
35obtaining knowledge of, or suspecting the physical abuse, and a
36written report shall be made to the local ombudsman, the
37corresponding licensing agency, and the local law enforcement
38agency within 24 hours of the mandated reporter observing,
39obtaining knowledge of, or suspecting the physical abuse.

P16   1(iii) When the suspected abuse is allegedly caused by a resident
2with a physician’s diagnosis of dementia, and there is no serious
3bodily injury, as reasonably determined by the mandated reporter,
4drawing upon his or her training or experience, the reporter shall
5report to the local ombudsman or law enforcement agency by
6telephone, immediately or as soon as practicably possible, and by
7written report, within 24 hours.

8(iv) When applicable, reports made pursuant to clauses (i) and
9(ii) shall be deemed to satisfy the reporting requirements of the
10federal Elder Justice Act of 2009, as set out in Subtitle H of the
11federal Patient Protection and Affordable Care Act (Public Law
12111-148), Section 1418.91 of the Health and Safety Code, and
13Section 72541 of Title 22 of the California Code of Regulations.
14When a local law enforcement agency receives an initial report of
15suspected abuse in a long-term care facility pursuant to this
16subparagraph, the local law enforcement agency may coordinate
17efforts with the local ombudsman to provide the most immediate
18and appropriate response warranted to investigate the mandated
19report. The local ombudsman and local law enforcement agencies
20may collaborate to develop protocols to implement this
21subparagraph.

22(B) Notwithstanding the rulemaking provisions of Chapter 3.5
23(commencing with Section 11340) of Part 1 of Division 3 of Title
242 of the Government Code, or any other law, the department may
25implement subparagraph (A), in whole or in part, by means of
26all-county letters, provider bulletins, or other similar instructions
27without taking regulatory action.

28(C) If the suspected or alleged abuse is abuse other than physical
29abuse, and the abuse occurred in a long-term care facility, except
30a state mental health hospital or a state developmental center, a
31telephone report and a written report shall be made to the local
32ombudsman or the local law enforcement agency.

33(D) With regard to abuse reported pursuant to subparagraph
34(C), the local ombudsman and the local law enforcement agency
35shall, as soon as practicable, except in the case of an emergency
36or pursuant to a report required to be made pursuant to clause (v),
37in which case these actions shall be taken immediately, do all of
38the following:

39(i) Report to the State Department of Public Health any case of
40known or suspected abuse occurring in a long-term health care
P17   1facility, as defined in subdivision (a) of Section 1418 of the Health
2and Safety Code.

3(ii) Report to the State Department of Social Services any case
4of known or suspected abuse occurring in a residential care facility
5for the elderly, as defined in Section 1569.2 of the Health and
6Safety Code, or in an adult day program, as defined in paragraph
7(2) of subdivision (a) of Section 1502 of the Health and Safety
8Code.

9(iii) Report to the State Department of Public Health and the
10California Department of Aging any case of known or suspected
11abuse occurring in an adult day health care center, as defined in
12subdivision (b) of Section 1570.7 of the Health and Safety Code.

13(iv) Report to the Bureau of Medi-Cal Fraud and Elder Abuse
14any case of known or suspected criminal activity.

15(v) Report all cases of known or suspected physical abuse and
16financial abuse to the local district attorney’s office in the county
17where the abuse occurred.

18(E) (i) If the suspected or alleged abuse or neglect occurred in
19a state mental hospital or a state developmental center, and the
20suspected or alleged abuse or neglect resulted in any of the
21following incidents, a report shall be made immediately, but no
22later than within two hours of the mandated reporter observing,
23obtaining knowledge of, or suspecting abuse, to designated
24investigators of the State Department of State Hospitals or the
25State Department of Developmental Services, and also to the local
26law enforcement agency:

27(I) A death.

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

29(III) An assault with a deadly weapon, as described in Section
30245 of the Penal Code, by a nonresident of the state mental hospital
31or state developmental center.

32(IV) An assault with force likely to produce great bodily injury,
33as described in Section 245 of the Penal Code.

34(V) An injury to the genitals when the cause of the injury is
35undetermined.

36(VI) A broken bone when the cause of the break is
37undetermined.

38(ii) All other reports of suspected or alleged abuse or neglect
39that occurred in a state mental hospital or a state developmental
40center shall be made immediately, but no later than within two
P18   1hours of the mandated reporter observing, obtaining knowledge
2of, or suspecting abuse, to designated investigators of the State
3Department of State Hospitals or the State Department of
4Developmental Services, or to the local law enforcement agency.

5(iii) When a local law enforcement agency receives an initial
6report of suspected or alleged abuse or neglect in a state mental
7hospital or a state developmental center pursuant to clause (i), the
8local law enforcement agency shall coordinate efforts with the
9designated investigators of the State Department of State Hospitals
10or the State Department of Developmental Services to provide the
11most immediate and appropriate response warranted to investigate
12the mandated report. The designated investigators of the State
13Department of State Hospitals or the State Department of
14Developmental Services and local law enforcement agencies may
15collaborate to develop protocols to implement this clause.

16(iv) Except in an emergency, the local law enforcement agency
17shall, as soon as practicable, report any case of known or suspected
18criminal activity to the Bureau of Medi-Cal Fraud and Elder Abuse.

19(v) Notwithstanding any other law, a mandated reporter who is
20required to report pursuant to Section 4427.5 shall not be required
21to report under clause (i).

22(F) If the abuse has occurred in any place other than a long-term
23care facility, a state mental hospital, or a state developmental
24center, the report shall be made to the adult protective services
25agency or the local law enforcement agency.

26(2) (A) A mandated reporter who is a clergy member who
27acquires knowledge or reasonable suspicion of elder or dependent
28adult abuse during a penitential communication is not subject to
29paragraph (1). For purposes of this subdivision, “penitential
30communication” means a communication that is intended to be in
31confidence, including, but not limited to, a sacramental confession
32made to a clergy member who, in the course of the discipline or
33practice of his or her church, denomination, or organization is
34authorized or accustomed to hear those communications and under
35the discipline tenets, customs, or practices of his or her church,
36denomination, or organization, has a duty to keep those
37communications secret.

38(B) This subdivision shall not be construed to modify or limit
39a clergy member’s duty to report known or suspected elder and
40dependent adult abuse if he or she is acting in the capacity of a
P19   1care custodian, health practitioner, or employee of an adult
2protective services agency.

3(C) Notwithstanding any other provision in this section, a clergy
4member who is not regularly employed on either a full-time or
5part-time basis in a long-term care facility or does not have care
6or custody of an elder or dependent adult shall not be responsible
7for reporting abuse or neglect that is not reasonably observable or
8discernible to a reasonably prudent person having no specialized
9training or experience in elder or dependent care.

10(3) (A) A mandated reporter who is a physician and surgeon,
11a registered nurse, or a psychotherapist, as defined in Section 1010
12of the Evidence Code, shall not be required to report, pursuant to
13paragraph (1), an incident if all of the following conditions exist:

14(i) The mandated reporter has been told by an elder or dependent
15adult that he or she has experienced behavior constituting physical
16abuse, as defined in Section 15610.63, abandonment, abduction,
17isolation, financial abuse, or neglect.

18(ii) The mandated reporter is not aware of any independent
19evidence that corroborates the statement that the abuse has
20occurred.

21(iii) The elder or dependent adult has been diagnosed with a
22mental illness or dementia, or is the subject of a court-ordered
23conservatorship because of a mental illness or dementia.

24(iv) In the exercise of clinical judgment, the physician and
25surgeon, the registered nurse, or the psychotherapist, as defined
26in Section 1010 of the Evidence Code, reasonably believes that
27the abuse did not occur.

28(B) This paragraph shall not be construed to impose upon
29mandated reporters a duty to investigate a known or suspected
30incident of abuse and shall not be construed to lessen or restrict
31any existing duty of mandated reporters.

32(4) (A) In a long-term care facility, a mandated reporter shall
33not be required to report as a suspected incident of abuse, as defined
34in Section 15610.07, an incident if all of the following conditions
35exist:

36(i) The mandated reporter is aware that there is a proper plan
37of care.

38(ii) The mandated reporter is aware that the plan of care was
39properly provided or executed.

P20   1(iii) A physical, mental, or medical injury occurred as a result
2of care provided pursuant to clause (i) or (ii).

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

5(B) This paragraph shall not be construed to require a mandated
6reporter to seek, nor to preclude a mandated reporter from seeking,
7information regarding a known or suspected incident of abuse prior
8to reporting. This paragraph shall apply only to those categories
9of mandated reporters that the State Department of Public Health
10determines, upon approval by the Bureau of Medi-Cal Fraud and
11Elder Abuse and the state long-term care ombudsman, have access
12to plans of care and have the training and experience necessary to
13determine whether the conditions specified in this section have
14been met.

15(c) (1) Any mandated reporter who has knowledge, or
16reasonably suspects, that types of elder or dependent adult abuse
17for which reports are not mandated have been inflicted upon an
18elder or dependent adult, or that his or her emotional well-being
19is endangered in any other way, may report the known or suspected
20instance of abuse.

21(2) If the suspected or alleged abuse occurred in a long-term
22care facility other than a state mental health hospital or a state
23developmental center, the report may be made to the long-term
24care ombudsman program. Except in an emergency, the local
25ombudsman shall report any case of known or suspected abuse to
26the State Department of Public Health and any case of known or
27suspected criminal activity to the Bureau of Medi-Cal Fraud and
28Elder Abuse, as soon as is practicable.

29(3) If the suspected or alleged abuse occurred in a state mental
30health hospital or a state developmental center, the report may be
31made to the designated investigator of the State Department of
32State Hospitals or the State Department of Developmental Services
33or to a local law enforcement agency. Except in an emergency,
34the local law enforcement agency shall report any case of known
35or suspected criminal activity to the Bureau of Medi-Cal Fraud
36and Elder Abuse, as soon as is practicable.

37(4) If the suspected or alleged abuse occurred in a place other
38than a place described in paragraph (2) or (3), the report may be
39made to the county adult protective services agency.

P21   1(5) If the conduct involves criminal activity not covered in
2subdivision (b), it may be immediately reported to the appropriate
3law enforcement agency.

4(d) If two or more mandated reporters are present and jointly
5have knowledge or reasonably suspect that types of abuse of an
6elder or a dependent adult for which a report is or is not mandated
7have occurred, and there is agreement among them, the telephone
8report or Internet report, as authorized by Section 15658, may be
9made by a member of the team selected by mutual agreement, and
10a single report may be made and signed by the selected member
11of the reporting team. Any member who has knowledge that the
12member designated to report has failed to do so shall thereafter
13make the report.

14(e) A telephone report or Internet report, as authorized by
15Section 15658, of a known or suspected instance of elder or
16dependent adult abuse shall include, if known, the name of the
17person making the report, the name and age of the elder or
18dependent adult, the present location of the elder or dependent
19adult, the names and addresses of family members or any other
20adult responsible for the elder’s or dependent adult’s care, the
21nature and extent of the elder’s or dependent adult’s condition, the
22date of the incident, and any other information, including
23information that led that person to suspect elder or dependent adult
24abuse, as requested by the agency receiving the report.

25(f) The reporting duties under this section are individual, and
26no supervisor or administrator shall impede or inhibit the reporting
27duties, and no person making the report shall be subject to any
28sanction for making the report. However, internal procedures to
29facilitate reporting, ensure confidentiality, and apprise supervisors
30and administrators of reports may be established, provided they
31are not inconsistent with this chapter.

32(g) (1) Whenever this section requires a county adult protective
33services agency to report to a law enforcement agency, the law
34enforcement agency shall, immediately upon request, provide a
35copy of its investigative report concerning the reported matter to
36that county adult protective services agency.

37(2) Whenever this section requires a law enforcement agency
38to report to a county adult protective services agency, the county
39adult protective services agency shall, immediately upon request,
P22   1provide to that law enforcement agency a copy of its investigative
2report concerning the reported matter.

3(3) The requirement to disclose investigative reports pursuant
4to this subdivision shall not include the disclosure of social services
5records or case files that are confidential, nor shall this subdivision
6be construed to allow disclosure of any reports or records if the
7disclosure would be prohibited by any other provision of state or
8federal law.

9(h) Failure to report, or impeding or inhibiting a report of,
10physical abuse, as defined in Section 15610.63, abandonment,
11abduction, isolation, financial abuse, or neglect of an elder or
12dependent adult, in violation of this section, is a misdemeanor,
13punishable by not more than six months in a county jail, by a fine
14of not more than one thousand dollars ($1,000), or by both that
15fine and imprisonment. Any mandated reporter who willfully fails
16to report, or impedes or inhibits a report of, physical abuse, as
17defined in Section 15610.63, abandonment, abduction, isolation,
18financial abuse, or neglect of an elder or dependent adult, in
19violation of this section, if that abuse results in death or great bodily
20injury, shall be punished by not more than one year in a county
21jail, by a fine of not more than five thousand dollars ($5,000), or
22by both that fine and imprisonment. If a mandated reporter
23intentionally conceals his or her failure to report an incident known
24by the mandated reporter to be abuse or severe neglect under this
25section, the failure to report is a continuing offense until a law
26enforcement agency specified in paragraph (1) of subdivision (b)
27of Section 15630 discovers the offense.

28(i) For purposes of this section, “dependent adult” shall have
29the same meaning as in Section 15610.23.

30

SEC. 20.  

No reimbursement is required by this act pursuant to
31Section 6 of Article XIII B of the California Constitution because
32the only costs that may be incurred by a local agency or school
33district will be incurred because this act creates a new crime or
34infraction, eliminates a crime or infraction, or changes the penalty
35for a crime or infraction, within the meaning of Section 17556 of
36the Government Code, or changes the definition of a crime within
37the meaning of Section 6 of Article XIII B of the California
38Constitution.



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