Amended in Assembly June 23, 2015

Amended in Senate April 21, 2015

Senate Bill No. 675

Introduced by Senator Liu

begin insert

(Coauthor: Senator Wolk)

end insert

February 27, 2015

An act to begin delete add Section 1262.55 to end delete begin insert amend Section 1262.5 of end insert the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL’S DIGEST

SB 675, as amended, Liu. begin delete Health facilities: end delete begin insert Hospitals: end insert family caregivers.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill begin delete would, subject to the federal Health Insurance Portability and Accountability Act of 1996, end delete begin insert would end insert require a hospital to take specified actions relating to family caregivers, including, among others, notifying the family caregiver of the patient’s discharge or transfer to another facility and providing information begin delete or instruction end delete begin insert and counseling end insert regarding the posthospital care needs of the begin delete patient end delete begin insert patient, if the patient has consented to the disclosure of this information end insert . By expanding the scope of a crime, 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:

begin delete

SECTION 1.  

Section 1262.55 is added to the Health and Safety
Code, immediately following Section 1262.5, to read:

1262.55.  

(a) Subject to the provisions of the federal Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C.
Sec. 300gg), a hospital shall do all of the following:

(1) Provide an opportunity for an individual patient who has
been admitted to the hospital as an inpatient to identify one family
caregiver who may assist in posthospital care, and record that
information in the patient’s medical chart.

(A) In the event that the patient is unconscious or otherwise
incapacitated upon admittance to the hospital, the hospital shall
provide the patient or patient’s legal guardian with an opportunity
to designate a caregiver within a specified time period, at the
discretion of the attending physician, following the patient’s
recovery of consciousness or capacity. The hospital shall promptly
document the attempt in the patient’s medical record.

(B) In the event that the patient or legal guardian declines to
designate a caregiver pursuant to this section, the hospital shall
promptly document this declination in the patient’s medical record,
when appropriate.

(2) Notify the patient’s designated family caregiver of the
patient’s discharge or transfer to another facility as soon as possible
and, in any event, upon issuance of a discharge order by the
patient’s attending physician. If the hospital is unable to contact
the designated caregiver, the lack of contact shall not interfere
with, delay, or otherwise affect the medical care provided to the
patient or an appropriate discharge of the patient. The hospital
shall promptly document the attempted notification in the patient’s
medical record.

(3) Provide an opportunity for the patient and his or her
designated family caregiver to engage in the discharge planning
process, which shall include providing information or instruction
regarding the posthospital care needs of the patient, and education
and counseling about the patient’s medications, including dosing
and proper use of medication delivery devices, when applicable.
This instruction shall be provided in a culturally competent manner
and in a language that is comprehensible to the patient and
caregiver, consistent with the requirements of state and federal
law.

(4) Provide contact information for any health care service,
community resource, or other service necessary to successfully
carry out the care plan.

(b) Discharge planning policies adopted by a hospital in
accordance with this section shall ensure that planning is
appropriate to the condition of the patient being discharged from
the hospital and to the discharge destination and meets the needs
and acuity of patients and the abilities of the designated family
caregiver.

(c) This section does not require a hospital to do either of the
following:

(1) Adopt a policy that would delay discharge or transfer of a
patient.

(2) Disclose information if the patient has not provided consent
that meets the standards required by state and federal laws
governing the privacy and security of protected health information.

(d) For the purposes of this section, “family caregiver” means
a relative, friend, or neighbor who provides assistance related to
an underlying physical or mental disability but who is unpaid for
those services.

end delete

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 1262.5 of the end insert begin insert Health and Safety Code end insert begin insert is
amended to read: end insert

1262.5.  

(a) Each hospital shall have a written discharge
planning policy and process.

(b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to begin delete discharge for those
patients who are likely to suffer adverse health consequences upon
discharge if there is no adequate discharge planning. If the hospital
determines that the patient and family members or interested
persons need to be counseled to prepare them for posthospital care,
the hospital shall provide for that counseling. end delete begin insert the discharge of each
patient. end insert

begin insert

(c) As part of the discharge planning process, the hospital shall
provide each patient who has been admitted to the hospital as an
inpatient with an opportunity to identify one family caregiver who
may assist in posthospital care, and shall record this information
in the patient’s medical chart.

end insert begin insert

(A) In the event that the patient is unconscious or otherwise
incapacitated upon admittance to the hospital, the hospital shall
provide the patient or patient’s legal guardian with an opportunity
to designate a caregiver within a specified time period, at the
discretion of the attending physician, following the patient’s
recovery of consciousness or capacity. The hospital shall promptly
document the attempt in the patient’s medical record.

end insert begin insert

(B) In the event that the patient or legal guardian declines to
designate a caregiver pursuant to this section, the hospital shall
promptly document this declination in the patient’s medical record,
when appropriate.

end insert begin insert

(d) The policy required by subdivision (a) shall require that the
patient’s designated family caregiver be notified of the patient’s
discharge or transfer to another facility as soon as possible and,
in any event, upon issuance of a discharge order by the patient’s
attending physician. If the hospital is unable to contact the
designated caregiver, the lack of contact shall not interfere with,
delay, or otherwise affect the medical care provided to the patient
or an appropriate discharge of the patient. The hospital shall
promptly document the attempted notification in the patient’s
medical record.

end insert begin delete

(c)

end delete

begin insert (e) end insert  The process required by subdivision (a) shall require that
the patient begin insert and family caregiver end insert be begin delete informed, orally or in writing, end delete
begin insert informed end insert of the continuing health care requirements following
discharge from the hospital. The right to information regarding
continuing health care requirements following discharge shall begin insert also end insert
apply to the person who has legal responsibility to make decisions
regarding medical care on behalf of the patient, if the patient is
unable to make those decisions for himself or herself. begin delete In addition,
a patient may request that friends or family members be given this
information, even if the patient is able to make his or her own
decisions regarding medical care. end delete begin insert The hospital shall provide an
opportunity for the patient and his or her designated family
caregiver to engage in the discharge planning process, which shall
include providing information and, when appropriate, instruction
regarding the posthospital care needs of the patient. This
information shall include, but is not limited to, education and
counseling about the patient’s medications, including dosing and
proper use of medication delivery devices, when applicable. The
information shall be provided in a culturally competent manner
and in a language that is comprehensible to the patient and
caregiver, consistent with the requirements of state and federal
law, and shall include an opportunity for the caregiver to ask
questions about the posthospital care needs of the patient. end insert

begin delete

(d)

end delete

begin insert (f) end insert  (1) A transfer summary shall accompany the patient upon
transfer to a skilled nursing or intermediate care facility or to the
distinct part-skilled nursing or intermediate care service unit of
the hospital. The transfer summary shall include essential
information relative to the patient’s diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.

(2) A copy of the transfer summary shall be given to the patient
and the patient’s legal representative, if any, prior to transfer to a
skilled nursing or intermediate care facility.

begin delete

(e)

end delete

begin insert (g) end insert  A hospital shall establish and implement a written policy to
ensure that each patient receives, at the time of discharge,
information regarding each medication dispensed, pursuant to
Section 4074 of the Business and Professions Code.

begin delete

(f)

end delete

begin insert (h) end insert  A hospital shall provide every patient anticipated to be in
need of long-term care at the time of discharge with contact
information for at least one public or nonprofit agency or
organization dedicated to providing information or referral services
relating to community-based long-term care options in the patient’s
county of residence and appropriate to the needs and characteristics
of the patient. At a minimum, this information shall include contact
information for the area agency on aging serving the patient’s
county of residence, local independent living centers, or other
information appropriate to the needs and characteristics of the
patient.

begin delete

(g)

end delete

begin insert (i) end insert  A contract between a general acute care hospital and a health
care service plan that is issued, amended, renewed, or delivered
on or after January 1, 2002, may not contain a provision that
prohibits or restricts any health care facility’s compliance with the
requirements of this section.

begin insert

(j) Discharge planning policies adopted by a hospital in
accordance with this section shall ensure that planning is
appropriate to the condition of the patient being discharged from
the hospital and to the discharge destination and meets the needs
and acuity of patients.

end insert begin insert

(k) This section does not require a hospital to do either of the
following:

end insert begin insert

(1) Adopt a policy that would delay discharge or transfer of a
patient.

end insert begin insert

(2) Disclose information if the patient has not provided consent
that meets the standards required by state and federal laws
governing the privacy and security of protected health information.

end insert begin insert

(l) This section does not supersede or modify any privacy and
information security requirements and protections in federal and
state law regarding protected health information or personally
identifiable information, including, but not limited to, the federal
Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. Sec. 300gg).

end insert begin insert

(m) For the purposes of this section, “family caregiver” means
a relative, friend, or neighbor who provides assistance related to
an underlying physical or mental disability but who is unpaid for
those services.

end insert

SEC. 2.  

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