BILL NUMBER: AB 1731 CHAPTERED
BILL TEXT
CHAPTER 451
FILED WITH SECRETARY OF STATE SEPTEMBER 15, 2000
APPROVED BY GOVERNOR SEPTEMBER 14, 2000
PASSED THE SENATE AUGUST 23, 2000
PASSED THE ASSEMBLY AUGUST 23, 2000
CONFERENCE REPORT NO. 1
PROPOSED IN CONFERENCE AUGUST 11, 2000
AMENDED IN SENATE JUNE 15, 2000
AMENDED IN ASSEMBLY MAY 31, 2000
AMENDED IN ASSEMBLY APRIL 24, 2000
INTRODUCED BY Assembly Members Shelley, Alquist, and Honda
(Principal coauthor: Senator Vasconcellos)
(Coauthors: Assembly Members Bates, Bock, Cardoza, Dutra, Keeley,
Knox, Kuehl, Lowenthal, Romero, Scott, Steinberg, Strom-Martin,
Wayne, and Wildman)
(Coauthors: Senators Alarcon, Alpert, Chesbro, Dunn, Escutia,
Ortiz, and Speier)
JANUARY 5, 2000
An act to amend Sections 1250, 1253, 1265, 1267, 1267.5, 1294,
1298, 1331, 1333, 1336.2, 1337.1, 1337.3, 1417.2, 1417.3, 1417.4,
1420, 1421.1, 1421.2, 1422, 1422.5, 1424, 1428, 1428.1, 1438, and
1599.1 of, to add Sections 1276.7, 1325.5, 1417.15, 1418.91, 1422.6,
1423.5, 1424.5, 1429.1, and 1437.5 to, and to repeal Sections 1430.5,
1435, and 1435.5 of, the Health and Safety Code, to amend Section
14124.7 of, and to add Section 14126.02 to, the Welfare and
Institutions Code, relating to health facilities, and making an
appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
AB 1731, Shelley. Long-term health care facilities.
Existing law provides for the licensure and regulation of health
facilities, including nursing facilities, by the State Department of
Health Services. Existing law defines a nursing facility for
purposes of these provisions.
This bill would revise the definition of nursing facility to mean
a health facility licensed under state law that is certified to
participate as a provider of care as a skilled nursing facility in
the federal Medicare program or as a nursing facility in the federal
medicaid program, or as both.
Existing law prohibits the operation, establishment, management,
conduct, or maintenance of a health facility without having first
obtained a license, or the continued operation, conduct, or
maintenance of an existing health facility without having obtained a
license. Existing law also authorizes the court to appoint a
receiver to temporarily operate an existing long-term health care
facility under certain conditions.
This bill would expressly except the court-appointed receiver from
the prohibition against operating a long-term health care facility
without having obtained a license.
Existing law requires the filing of an application with the
department for licensure as a health facility or for approval to
provide a special service at a health facility. Under existing law
the application must contain certain information, including any
information required by the department for the proper administration
and enforcement of these provisions. Existing law requires that the
information provided to the department under this provision be made
available to the public upon request.
This bill would require the filing of an application for approval
to manage a currently licensed skilled nursing facility or
intermediate care facility under circumstances in which an
application to operate the facility has not been filed by the
applicant. This bill also would prohibit an individual's social
security number from being made public pursuant to these provisions.
Existing law provides that a license for a health facility expires
12 months from the date of its issuance.
This bill would except from this provision the license of a
long-term care facility operated by a court-appointed receiver. The
bill, instead, would provide that this license shall not expire
during the period of the receivership and 30 days thereafter.
Existing law requires each applicant for a license to operate a
skilled nursing facility or intermediate care facility to make
certain disclosures regarding ownership and officers to the
department.
This bill would revise these disclosure requirements. The bill
also would require that the information required by these disclosure
provisions be included in the department's automated certification
licensing administration information management system.
Existing law authorizes the department to suspend or revoke a
license or special permit issued to the health facility.
This bill would add the violation by a facility of designated
federal statutes or regulations to the circumstances under which the
department may suspend or revoke a license or special permit of
certain nursing facilities.
Existing law authorizes the Director of Health Services to file a
petition in the superior court for appointment of a receiver for any
long-term health care facility whenever certain conditions exist.
This bill would authorize the director to appoint a temporary
manager, as provided under the bill, to operate the facility and
would establish procedures whereby a licensee could contest the
appointment.
Existing law sets forth procedures under which the court may
terminate the court-ordered receiver management of a long-term health
care facility upon consideration of designated factors, under which
the management of the facility may be returned to the licensee if
certain conditions are met, and under which the state is reimbursed
for funds advanced for expenses in connection with the receivership.
This bill would revise the factors the court is required to
consider to terminate court-ordered receiver management. The bill
would recast the provisions for return of management of the facility.
The bill would revise the method of determining the state's
reimbursement.
Existing law requires a long-term health care facility to submit a
proposed relocation plan for affected patients to the department for
comment if 10 or more patients are likely to be transferred due to
any voluntary change in the status of the license or operation of a
facility.
This bill would also require these facilities to submit the
proposed relocation plan if 10 or more patients are likely to be
transferred due to any involuntary change in the status of the
license or operation of the facility.
Existing law requires that moneys collected as a result of civil
penalties imposed against long-term health care facilities be
deposited in the Health Facilities Citation Penalties Account in the
Special Deposit Fund and prohibits the balance in the account from
exceeding $10,000,000.
This bill would make a technical, nonsubstantive change to this
provision.
Existing law requires the department to promote quality in
long-term health care facility services through specified activities.
This bill would revise this provision to require the department to
promote quality of care and quality of life for persons in these
facilities. This bill would add to the specified activities of the
department to achieve this goal.
Existing law requires the department to establish the Quality
Awards Program to recognize skilled nursing facilities that provide
exemplary care to residents.
This bill would make technical, nonsubstantive changes to this
provision.
Existing law requires the department to adopt regulations setting
forth the minimum number of equivalent nursing hours, as defined, per
patient required in skilled nursing and intermediate care
facilities. Existing law provides that the minimum number of actual
nursing hours per patient required in a skilled nursing facility
shall be 3.2 hours.
This bill would declare the intent of the Legislature to increase
the minimum number of direct care nursing hours per patient day in
skilled nursing facilities. The bill would require the department to
determine the need, and provide recommendations, for any increase in
the minimum number of nursing hours per patient day and perform
designated analysis. The bill would require the department, on or
before May 1, 2001, to prepare a report on its analysis and
recommendations and submit the report to the Legislature.
Existing law requires the department to prepare and maintain a
list of approved training programs for nurse assistant certification.
Existing law specifies certain requirements for an approved
training program of a skilled nursing or intermediate care facility.
This bill would revise the requirements for these training
programs. The bill would also require the department, in
consultation with other specified entities, to perform various duties
with regard to examination review and the development of career
ladder opportunities for certified nurse assistants.
Existing law authorizes any duly authorized officer, employee, or
agent of the state department to enter and inspect any long-term
health care facility, including, but not limited to, interviewing
residents and reviewing records, at any time to enforce regulatory
provisions.
Existing law requires certain persons who have responsibility for
the care and custody of elder and dependent adults to report abuse,
alleged abuse, or suspected abuse of an elder or dependent adult, as
defined, including abuse in a long-term care facility, to the local
ombudsman or the local law enforcement agency.
This bill would require a long-term health care facility to report
to the department immediately, or within 24 hours, all incidents of
alleged abuse or suspected abuse. The bill would make the failure to
report a class "B" violation.
Existing law requires the department to assign an inspector to
make a preliminary review of any complaint received against a
long-term health care facility, notify the complainant of the name of
the assigned inspector, send a copy of any citation issued to a
facility to each complainant, and hold a miniexit conference upon
leaving the facility at the completion of an investigation.
This bill would revise these provisions to require the department
to notify the complainant of the assigned inspector's name within 2
working days of the receipt of the complaint, to make an onsite
inspection or investigation within 24 hours of the receipt of a
complaint in any case in which there is a serious threat of imminent
danger of death or serious bodily harm, to provide designated notice
to the complainant, to send a copy of the citation to each
complainant by registered or certified mail, and to advise the
facility, in certain cases, that it is unlawful to discriminate or
seek retaliation against a complainant. The bill would define
"complaint" for purposes of this provision.
Existing law requires licensees of skilled nursing facilities to
notify the department within 24 hours of designated occurrences
related to the facility's financial situation.
This bill would make technical, nonsubstantive changes to this
provision.
Existing law establishes in the department, until January 1, 2004,
the Skilled Nursing Facility Financial Solvency Advisory Board with
a specified membership and duties.
This bill would revise provisions related to board membership.
Existing law requires the department to develop and establish a
consumer information service system to provide updated and accurate
information to the general public and consumers regarding long-term
care facilities in their communities.
This bill would require the department to develop, by January 1,
2002, a method whereby specified information related to complaints
and state and federal sanctions imposed against long-term care
facilities are provided to the public and consumers. This provision
would become inoperative on July 1, 2003. This bill would also
impose upon the department confidentiality and disclosure
requirements in implementing the consumer information service system.
Existing law requires a long-term care facility, as defined, to
post in a conspicuous location certain information regarding the
Office of the State Long-Term Care Ombudsman.
This bill would set forth specific locations where a skilled
nursing and intermediate care facility is required to post a copy of
the information regarding the Office of the State Long-Term Care
Ombudsman. This bill would provide for civil penalties if a licensee
fails to post the notices required pursuant to this provision.
Existing federal law sets forth procedures under which a nursing
facility is certified to participate as a provider of care in the
federal medicaid program.
This bill would require the department to develop a procedure for
and provide for the central review of federal deficiencies and
supporting documentation that require the termination of
certification for a nursing facility, as specified under the bill.
The bill would require the department, on or before October 1 of each
year, to provide to the Legislature a summary of federal enforcement
actions taken against nursing facilities during the previous state
fiscal year.
Existing law requires the department to conduct annual inspections
of long-term health care facilities, except facilities that have not
had serious violations within the last 12 months, and in any case to
inspect every facility at least once every 2 years.
This bill would require the department to vary the cycle for
conducting these inspections to reduce the predictability of the
inspections.
Existing law classifies a citation issued against long-term health
care facilities according to the nature of the violation, in order
of decreasing seriousness, as class "AA," class "A," and class "B"
violations, and provides for various civil penalties.
This bill would increase the civil penalties for a skilled nursing
facility and an intermediate care facility as defined with regard to
these violations.
Existing law requires the department to review the effectiveness
of certain enforcement provisions in maintaining the quality of care
provided by long-term health care facilities and submit a report on
the enforcement activities.
This bill would require the department to submit the report on or
before December 1, 2001, and annually thereafter, regarding these
enforcement activities.
Under existing law, a licensee may, in lieu of contesting a
citation, transmit to the state department the minimum amount
specified by law, or 65% of the amount specified in the citation,
whichever is greater, for each violation within 15 business days
after the issuance of the citation.
This bill would revise this authority with regard to a licensee
subject to the increased penalty provisions to allow payment within
30 business days after the issuance of the citation.
Existing law specifies the procedures for a licensee of a
long-term health care facility to contest a citation or the proposed
assessment of a civil penalty, which includes the option to
adjudicate the validity of the citation in the municipal or superior
court in the county in which the facility is located.
This bill would authorize the court to affirm, modify, or dismiss
a citation, the level of the citation, or the amount of the proposed
assessment of the civil penalty when a licensee files a judicial
appeal to contest a citation.
Existing law requires the department to report certain enforcement
actions taken against a facility to the State Board of Nursing Home
Administrators. Existing law requires a long-term health care
facility to prominently post each citation for a class "A" violation,
as prescribed in regulations issued by the director.
This bill would require a skilled nursing facility or an
intermediate care facility that has one or more remedies actually
imposed for violation of state or federal requirements to provide
written notification of the action to residents, to the responsible
parties and the legal representatives of residents, and to all
applicants for admission to the facility.
Existing law establishes various remedies for violation of state
or federal requirements relating to the operation of long-term care
facilities.
This bill would require a facility to post a notice of the remedy
or remedies imposed for violation of these requirements.
Existing law requires the department to issue certain public
information releases regarding long-term health care facilities that
have not had any violations within a 12-month period. Existing law
also requires the department to issue certain press releases
regarding facilities against which specified state or federal
sanctions have been imposed. Existing law requires the department to
annually prepare and make available to offices of the department's
facilities licensing section a report setting forth specified
information regarding citations issued to licensees.
This bill would repeal these provisions.
Existing law authorizes the department to issue a provisional
license to certain health facilities for 6 months, but in no case for
longer than one year from the issuance of the provisional license.
This bill would authorize the department to rescind the license to
operate a skilled nursing facility or intermediate care facility and
issue a provisional license, as provided under the bill, if certain
things occur.
Existing law requires skilled nursing and intermediate care
facilities to establish and make available, as prescribed, written
policies regarding the rights of patients. Existing law requires
that the procedures ensure that each patient admitted to the facility
has certain rights and is notified of certain facility obligations,
in addition to those specified by regulation.
This bill would add to the rights of a resident of a nursing
facility the right to appeal the facility's refusal to readmit him or
her if the resident has been hospitalized in an acute care hospital
and asserts his or her right to readmission pursuant to bed hold
provisions or readmission rights of either state or federal law. The
bill would provide that the refusal of the facility shall be treated
as an involuntary transfer under federal law. The bill would
specify circumstances under which the resident would remain in the
hospital pending a final determination by a hearing officer.
Existing law prohibits a long-term health care facility that
participates as a provider under the Medi-Cal program from
transferring or seeking to evict out of the facility any resident as
a result of the resident changing his or her manner of purchasing the
services from private payment or Medicare to Medi-Cal benefits and
for whom an eligibility determination has not yet been made.
This bill would specify that transferring a resident within the
facility, or seeking to evict a resident out of the facility is
prohibited under this provision, except that a facility may transfer
a resident from a private room to a semi-private room if the resident
changes to Medi-Cal payment status. The bill would provide that this
provision also applies to residents who have made a timely
application to Medi-Cal benefits and for whom an eligibility
determination has not yet been made.
Existing law provides for the reimbursement of long-term health
care facilities providing services under the Medi-Cal program
according to an established methodology.
This bill would require the department to examine several
alternative rate methodology models for a new Medi-Cal reimbursement
system for skilled nursing facilities and to submit to the
Legislature a report and proposal for any statutory changes necessary
to implement certain objectives relating to changes in this
methodology. The bill would also appropriate $500,000 from the
General Fund to the department for purposes of implementing these
provisions.
Because a violation of health facility provisions is a crime, the
bill would create a new crime, thereby constituting 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.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) (1) It is the intent of the Legislature that this
act add to the quality of life of older Californians by enhancing the
quality of long-term care services. The primary goal of this effort
is to enable citizens with long-term care needs to live at home,
with family members, and in the community for as long as possible.
(2) Therefore, it is the intent of this act to increase access to
quality alternatives to nursing home facilities by providing improved
in-home support services and community-based care services.
(b) (1) It is also the intent of this act to ensure that nursing
home facilities in California provide safe and secure environments
for residents and their families and that they have the highest
quality of care possible.
(2) Therefore, it is the intent of this act to reform nursing home
standards, strengthen enforcement of those standards, and promote
residents' and family rights.
SEC. 2. Section 1250 of the Health and Safety Code is amended to
read:
1250. As used in this chapter, "health facility" means any
facility, place, or building that is organized, maintained, and
operated for the diagnosis, care, prevention, and treatment of human
illness, physical or mental, including convalescence and
rehabilitation and including care during and after pregnancy, or for
any one or more of these purposes, for one or more persons, to which
the persons are admitted for a 24-hour stay or longer, and includes
the following types:
(a) "General acute care hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital.
A "general acute care hospital" includes a "rural general acute
care hospital". However, a "rural general acute care hospital" shall
not be required by the department to provide surgery and anesthesia
services. A "rural general acute care hospital" shall meet either of
the following conditions:
(1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982.
(2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982, and has
no more than 76 acute care beds and is located in a census dwelling
place of 15,000 or less population according to the 1980 federal
census.
(b) "Acute psychiatric hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care for mentally disordered, incompetent,
or other patients referred to in Division 5 (commencing with Section
5000) or Division 6 (commencing with Section 6000) of the Welfare
and Institutions Code, including the following basic services:
medical, nursing, rehabilitative, pharmacy, and dietary services.
(c) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
(d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
(e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer developmentally disabled
persons who have intermittent recurring needs for nursing services,
but have been certified by a physician and surgeon as not requiring
availability of continuous skilled nursing care.
(f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.
(g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to developmentally
disabled clients whose primary need is for developmental services and
who have a recurring but intermittent need for skilled nursing
services.
(h) "Intermediate care facility/developmentally disabled--nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for developmentally disabled persons who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons who have developmental disabilities or demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
(i) (1) "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than six beds, that provides inpatient care, including the following
basic services: medical supervision, 24-hour skilled nursing and
supportive care, pharmacy, dietary, social, recreational, and at
least one type of service specified in paragraph (2). The primary
need of congregate living health facility residents shall be for
availability of skilled nursing care on a recurring, intermittent,
extended, or continuous basis. This care is generally less intense
than that provided in general acute care hospitals but more intense
than that provided in skilled nursing facilities.
(2) Congregate living health facilities shall provide one of the
following services:
(A) Services for persons who are mentally alert, physically
disabled persons, who may be ventilator dependent.
(B) Services for persons who have a diagnosis of terminal illness,
a diagnosis of a life-threatening illness, or both. Terminal
illness means the individual has a life expectancy of six months or
less as stated in writing by his or her attending physician and
surgeon. A "life-threatening illness" means the individual has an
illness that can lead to a possibility of a termination of life
within five years or less as stated in writing by his or her
attending physician and surgeon.
(C) Services for persons who are catastrophically and severely
disabled. A catastrophically and severely disabled person means a
person whose origin of disability was acquired through trauma or
nondegenerative neurologic illness, for whom it has been determined
that active rehabilitation would be beneficial and to whom these
services are being provided. Services offered by a congregate living
health facility to a catastrophically disabled person shall include,
but not be limited to, speech, physical, and occupational therapy.
(3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
(4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
(B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons may
have not more than 25 beds for the purpose of serving terminally ill
persons.
(C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving catastrophically and severely
disabled persons.
(5) A congregate living health facility shall have a
noninstitutional, homelike environment.
(j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections, the Department of the
Youth Authority, or a county, city, or city and county law
enforcement agency that, as determined by the state department,
provides inpatient health services to that portion of the inmate
population who do not require a general acute care level of basic
services. This definition shall not apply to those areas of a law
enforcement facility that houses inmates or wards that may be
receiving outpatient services and are housed separately for reasons
of improved access to health care, security, and protection. The
health services provided by a correctional treatment center shall
include, but are not limited to, all of the following basic services:
physician and surgeon, psychiatrist, psychologist, nursing,
pharmacy, and dietary. A correctional treatment center may provide
the following services: laboratory, radiology, perinatal, and any
other services approved by the state department.
(2) Outpatient surgical care with anesthesia may be provided, if
the correctional treatment center meets the same requirements as a
surgical clinic licensed pursuant to Section 1204, with the exception
of the requirement that patients remain less than 24 hours.
(3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.
(4) Physician and surgeon services shall be readily available in a
correctional treatment center on a 24-hour basis.
(5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men's Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the California Department of Corrections from
obtaining a correctional treatment center license at these sites.
(k) "Nursing facility" means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of
care either as a skilled health facility in the federal Medicare
program under Title XVIII of the federal Social Security Act or as a
nursing facility in the federal medicaid program under Title XIX of
the federal Social Security Act, or as both.
(l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections, or the Department of the Youth
Authority, shall not become effective prior to, or if effective,
shall be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.
SEC. 3. Section 1253 of the Health and Safety Code is amended to
read:
1253. (a) No person, firm, partnership, association, corporation,
or political subdivision of the state, or other governmental agency
within the state shall operate, establish, manage, conduct, or
maintain a health facility in this state, without first obtaining a
license therefor as provided in this chapter, nor provide, after July
1, 1974, special services without approval of the state department.
However, any health facility offering any special service on the
effective date of this section shall be approved by the state
department to continue those services until the state department
evaluates the quality of those services and takes permitted action.
(b) This section shall not apply to a receiver appointed by the
court to temporarily operate a long-term health care facility
pursuant to Article 8 (commencing with Section 1325).
SEC. 4. Section 1265 of the Health and Safety Code is amended to
read:
1265. Any person, political subdivision of the state, or
governmental agency desiring a license for a health facility,
approval for a special service under this chapter, or approval to
manage a health facility currently licensed as a skilled nursing
facility or intermediate care facility, as defined in subdivision (c)
or (d) of Section 1250, that has not filed an application for a
license to operate that facility shall file with the state department
a verified application on forms prescribed and furnished by the
state department, containing all of the following:
(a) The name of the applicant and, if an individual, whether the
applicant has attained the age of 18 years.
(b) The type of facility or health facility.
(c) The location thereof.
(d) The name of the person in charge thereof.
(e) Evidence satisfactory to the state department that the
applicant is of reputable and responsible character. If the
applicant is a firm, association, organization, partnership, business
trust, corporation, or company, like evidence shall be submitted as
to the members or shareholders thereof, and the person in charge of
the health facility for which application for license is made. If
the applicant is a political subdivision of the state or other
governmental agency, like evidence shall be submitted as to the
person in charge of the health facility for which application for
license is made.
(f) Evidence satisfactory to the state department of the ability
of the applicant to comply with this chapter and of rules and
regulations promulgated under this chapter by the state department.
(g) Evidence satisfactory to the department that the applicant to
operate a skilled nursing facility or intermediate care facility
possesses financial resources sufficient to operate the facility for
a period of at least 45 days.
(h) Each applicant for a license to operate a skilled nursing
facility or intermediate care facility shall disclose to the state
department evidence of the right to possession of the facility at the
time the application will be granted, that may be satisfied by the
submission of a copy of applicable portions of a lease agreement or
deed of trust. The names and addresses of any persons or
organizations listed as owner of record in the real estate, including
the buildings and the grounds appurtenant to the buildings, shall be
disclosed to the state department.
(i) Any other information as may be required by the state
department for the proper administration and enforcement of this
chapter.
(j) Upon submission of an application to the state department by
an intermediate care facility/developmentally disabled habilitative
or an intermediate care facility/developmentally disabled--nursing,
the application shall include a statement of need signed by the
chairperson of the area board pursuant to Chapter 4 (commencing with
Section 4570) of Division 4.5 of the Welfare and Institutions Code.
In the event the area board has not provided the statement of need
within 30 days of receipt of the request from the applicant, the
state department may process the application for license without the
statement.
(k) The information required pursuant to this section, other than
individuals' social security numbers, shall be made available to the
public upon request, and shall be included in the department's public
file regarding the facility.
SEC. 5. Section 1267 of the Health and Safety Code is amended to
read:
1267. (a) (1) Each license issued pursuant to this chapter shall
expire 12 months from the date of its issuance and each special
permit shall expire on the expiration date of the license.
Application for renewal of a license or special permit accompanied by
the necessary fee shall be filed with the state department not less
than 30 days prior to the expiration date. Failure to make a timely
renewal shall result in expiration of the license or special permit.
(2) Notwithstanding paragraph (1), the license of a facility
operated by a receiver appointed pursuant to Article 8 (commencing
with Section 1325) shall not expire during the period of the
receivership, and for 30 days thereafter.
(b) A renewal license or special permit may be issued for a period
not to exceed two years if the holder of the license or special
permit has been found in substantial compliance with any statutory
requirements, regulations, or standards during the preceding license
period. However, for a health facility specified in subdivision (a)
or (b) of Section 1250, a renewal license or special permit may be
issued for a period not to exceed three years, if the holder of the
license or special permit has been found in substantial compliance
with statutory requirements, regulations, or standards during the
preceding license period.
(c) Notwithstanding the length of the period for which a renewal
license is issued, a license fee shall be due and payable annually.
SEC. 6. Section 1267.5 of the Health and Safety Code is amended to
read:
1267.5. (a) (1) Each applicant for a license to operate a skilled
nursing facility or intermediate care facility shall disclose to the
state department the name and business address of each general
partner if the applicant is a partnership, or each director and
officer if the applicant is a corporation, and each person having a
beneficial ownership interest of 5 percent or more in the applicant
corporation or partnership.
(2) If any person described in paragraph (1) has served or
currently serves as an administrator, general partner, trustee or
trust applicant, sole proprietor of any applicant or licensee who is
a sole proprietorship, executor, or corporate officer or director of,
or has held a beneficial ownership interest of 5 percent or more in,
any other skilled nursing facility or intermediate care facility or
in any community care facility licensed pursuant to Chapter 3
(commencing with Section 1500) of this division, the applicant shall
disclose the relationship to the state department, including the name
and current or last address of the health facility or community care
facility and the date the relationship commenced and, if applicable,
the date it was terminated.
(3) (A) If the facility is operated by, or proposed to be operated
in whole or part under, a management contract, the names and
addresses of any person or organization, or both, having an ownership
or control interest of 5 percent or more in the management company
shall be disclosed to the state department. This provision shall not
apply if the management company has submitted an application for
licensure with the state department and has complied with paragraph
(1).
(B) If the management company is a subsidiary of one or more other
organizations, the information shall include the names and addresses
of the parent organizations of the management company and the names
and addresses of any officer or director of the parent organizations.
The failure to comply with this subparagraph may result in action
to revoke or deny a license. However, once the information that is
required under this subparagraph is provided, the action to revoke
the license shall terminate.
(4) If the applicant or licensee is a subsidiary of one or more
other organizations, the information shall include the names and
addresses of the parent organizations of the subsidiary and the names
and addresses of any officer or director of the parent
organizations.
(5) The information required by this subdivision shall be provided
to the state department upon initial application for licensure, and
any change in the information shall be provided to the state
department within 30 calendar days of that change.
(6) Except as provided in subparagraph (B) of paragraph (3), the
failure to comply with this section may result in action to revoke or
deny a license.
(7) The information required by this section shall be made
available to the public upon request, shall be included in the public
file of the facility, and shall be included in the department's
automated certification licensing administration information
management system.
(b) On and after January 1, 1990, no person may acquire a
beneficial interest of 5 percent or more in any corporation or
partnership licensed to operate a skilled nursing facility or
intermediate care facility, or in any management company under
contract with a licensee of a skilled nursing facility or
intermediate care facility, nor may any person become an officer or
director of, or general partner in, a corporation, partnership, or
management company of this type without the prior written approval of
the state department. Each application for departmental approval
pursuant to this subdivision shall include the information specified
in subdivision (a) as regards the person for whom the application is
made.
The state department shall approve or disapprove the application
within 30 days after receipt thereof, unless the state department,
with just cause, extends the application review period beyond 30
days.
(c) The state department may deny approval of a license
application or of an application for approval under subdivision (b)
if a person named in the application, as required by this section,
was an officer, director, general partner, or owner of a 5-percent or
greater beneficial interest in a licensee of, or in a management
company under contract with a licensee of, a skilled nursing
facility, intermediate care facility, community care facility, or
residential care facility for the elderly at a time when one or more
violations of law were committed therein that resulted in suspension
or revocation of its license, or at a time when a court-ordered
receiver was appointed pursuant to Section 1327, or at a time when a
final Medi-Cal decertification action was taken under federal law.
However, the prior suspension, revocation, or court-ordered
receivership of a license shall not be grounds for denial of the
application if the applicant shows to the satisfaction of the state
department (1) that the person in question took every reasonably
available action to prevent the violation or violations that resulted
in the disciplinary action and (2) that he or she took every
reasonably available action to correct the violation or violations
once he or she knew, or with the exercise of reasonable diligence
should have known of, the violation or violations.
(d) No application shall be denied pursuant to this section until
the state department first (1) provides the applicant with notice in
writing of grounds for the proposed denial of application, and (2)
affords the applicant an opportunity to submit additional documentary
evidence in opposition to the proposed denial.
(e) Nothing in this section shall cause any individual to be
personally liable for any civil penalty assessed pursuant to Chapter
2.4 (commencing with Section 1417) or create any new criminal or
civil liability contrary to general laws limiting that liability.
(f) This section shall not apply to a bank, trust company,
financial institution, title insurer, controlled escrow company, or
underwritten title company to which a license is issued in a
fiduciary capacity.
(g) As used in this section, "person" has the same meaning as
specified in Section 19.
(h) This section shall not apply to the directors of a nonprofit
corporation exempt from taxation under Section 23701d of the Revenue
and Taxation Code that operates a skilled nursing facility or
intermediate care facility in conjunction with a licensed residential
facility, where the directors serve without financial compensation
and are not compensated by the nonprofit corporation in any other
capacity.
SEC. 7. Section 1276.7 is added to the Health and Safety Code, to
read:
1276.7. (a) (1) On or before May 1, 2001, the department shall
determine the need, and provide subsequent recommendations, for any
increase in the minimum number of nursing hours per patient day in
skilled nursing facilities. The department shall analyze the
relationship between staffing levels and quality of care in skilled
nursing facilities. The analysis shall include, but not be limited
to, all of the following:
(A) A determination of average staffing levels in this state.
(B) A review of facility expenditures on nursing staff, including
salary, wages, and benefits.
(C) A review of other states' staffing requirements as relevant to
this state.
(D) A review of available research and reports on the issue of
staffing levels and quality of care.
(E) The number of Medi-Cal beds in a facility.
(F) The corporate status of the facility.
(G) Information on compliance with both state and federal
standards.
(H) Work force availability trends.
(2) The department shall prepare a report on its analysis and
recommendations and submit this report to the Legislature, including
its recommendations for any staffing increases and proposed
timeframes and costs for implementing any increase.
(b) It is the intent of the Legislature to establish sufficient
staffing levels required to provide quality skilled nursing care. It
is further the intent of the Legislature to increase the minimum
number of direct care nursing hours per patient day in skilled
nursing facilities to 3.5 hours by 2004 or to whatever staffing
levels the department determines are required to provide California
nursing home residents with a safe environment and quality skilled
nursing care.
SEC. 7.5. Section 1294 of the Health and Safety Code is amended to
read:
1294. The state department may suspend or revoke any license or
special permit issued under the provisions of this chapter upon any
of the following grounds and in the manner provided in this
chapter:
(a) Violation by the licensee or holder of a special permit of any
of the provisions of this chapter or of the rules and regulations
promulgated under this chapter.
(b) Violation by a facility certified as a skilled nursing
facility under Title XVIII of the Social Security Act or as a nursing
facility under Title XIX of the Social Security Act, or as both, of
any federal statutes or regulations applicable to its operation.
(c) Aiding, abetting, or permitting the violation of any provision
of this chapter or of the rules and regulations promulgated under
this chapter.
(d) Conduct inimical to the public health, morals, welfare, or
safety of the people of the State of California in the maintenance
and operation of the premises or services for which a license or
special permit is issued.
(e) The conviction of a licensee, or other person mentioned in
subdivision (b) of Section 1265.1, at any time during licensure, of a
crime as defined in Section 1265.2.
SEC. 8. Section 1298 of the Health and Safety Code is amended to
read:
1298. (a) (1) No person, firm, partnership, association,
corporation, political subdivision of the state, or other
governmental agency within the state shall continue to operate,
conduct, or maintain an existing health facility without having
applied for and obtained a license or a special permit as provided
for in this chapter.
(2) This subdivision shall not apply to a receiver appointed by
the court to temporarily operate a long-term health care facility
pursuant to Article 8 (commencing with Section 1325).
(b) Any license or special permit revoked pursuant to this chapter
may be reinstated pursuant to Section 11522 of the Government Code.
SEC. 9. Section 1325.5 is added to the Health and Safety Code, to
read:
1325.5. (a) It is the intent of the Legislature in enacting this
section to empower the state department to take quick, effective
action to protect the health and safety of residents of long-term
health care facilities and to minimize the effects of transfer trauma
that accompany the abrupt transfer of elderly and disabled
residents.
(b) For purposes of this section, "temporary manager" means the
person appointed temporarily by the state department as a substitute
facility manager or administrator with authority to hire, terminate,
or reassign staff, obligate facility funds, alter facility
procedures, and manage the facility to correct deficiencies
identified in the facility's operation.
(c) The director may appoint a temporary manager when any of the
following circumstances exist:
(1) The residents of the long-term health care facility are in
immediate danger of death or permanent injury by virtue of the
failure of the facility to comply with federal or state requirements
applicable to the operation of the facility.
(2) As a result of the change in the status of the license or
operation of a long-term health care facility, the facility is
required to comply with Section 1336.2, the facility fails to comply
with Section 1336.2, and the state department has determined that the
facility is unwilling or unable to meet the requirements of Section
1336.2.
(d) Upon appointment, the temporary manager shall take all
necessary steps and make best efforts to eliminate immediate danger
of death or permanent injury to resident so complete transfer of
residents to alternative placements pursuant to Section 1336.2.
(e) The appointment of a temporary manager shall become effective
immediately and shall authorize the temporary manager to act pursuant
to this section. The state department shall provide the licensee
and administrator with a statement of allegations at the time of
appointment. Within 48 hours, the department shall provide the
licensee and the administrator with a formal statement of cause and
concerns. The statement of cause and concerns shall specify the
factual and legal basis for the imposition of the temporary manager
and shall be supported by the declaration of the director or the
director's authorized designee. The statement of cause and concerns
shall notify the licensee of the licensee's right to petition the
Office of Administrative Hearings for a hearing to contest the
appointment of the temporary manager and shall provide the licensee
with a form and appropriate information for the licensee's use in
requesting a hearing.
(f) (1) The licensee of a long-term health care facility may
contest the appointment of the temporary manager at any time by
filing a petition for an order to terminate the appointment of the
temporary manager with the Office of Administrative Hearings. On the
same day as the petition is filed with the Office of Administrative
Hearings, the licensee shall deliver a copy of the petition to the
office of the director.
(2) Upon receipt of a petition of hearing, the Office of
Administrative Hearings shall set a hearing date and time within five
business days of the receipt of the petition. The office shall
promptly notify the licensee and the state department of the date,
time, and place of the hearing. The office shall assign the case to
an administrative law judge. At the hearing, relevant evidence may
be presented pursuant to Section 11513 of the Government Code. The
administrative law judge shall issue a written decision on the
petition within five business days of the conclusion of the hearing.
The five-day time periods for holding the hearing and rendering a
decision may be extended by the agreement of the parties.
(3) The administrative law judge shall uphold the appointment of
the temporary manager if the state department proves, by a
preponderance of the evidence, that the circumstances specified in
subdivision (c) apply to the facility. The administrative law judge
shall order the termination of the temporary manager if the burden of
proof is not satisfied.
(g) The decision of the administrative law judge is subject to
judicial review as provided in Section 1094.5 of the Code of Civil
Procedure by the superior court sitting in the county where the
facility is located. This review may be requested by the licensee of
the facility or the state department by filing a petition seeking
relief from the order. The petition may also request the issuance of
temporary injunctive relief pending the decision on the petition.
The superior court shall hold a hearing within five business days of
the filing of the petition and shall issue a decision on the petition
within five days of the hearing. The state department may be
represented by legal counsel within the state department for purposes
of court proceedings authorized under this section.
(h) If the licensee of the long-term health care facility does not
protest the appointment, it shall continue until the conditions
described in subdivision (c) no longer exist or the state department
has secured the services of a receiver pursuant to this article.
(i) (1) If the licensee of the long-term health care facility
petitions the Office of Administrative Hearings pursuant to
subdivision (f), the appointment of the temporary manager by the
director pursuant to this section shall continue until it is
terminated by the administrative law judge or by the superior court,
or it shall continue for 30 days from the date the administrative law
judge or the superior court upholds the appointment of the temporary
manager, whichever is earlier.
(2) At any time during the appointment of the temporary manager,
the director may request an extension of the appointment by filing a
petition for hearing with the Office of Administrative Hearings and
serving a copy of the petition on the licensee. The office shall
proceed as specified in paragraph (2) of subdivision (f). The
administrative law judge may extend the appointment of the temporary
manager as follows:
(A) Upon a showing by the state department that the conditions
specified in subdivision (c) continue to exist, an additional 60
days.
(B) Upon a finding that the state department is seeking a
receiver, until the state department has secured the services of a
receiver pursuant to this article.
(3) The licensee or the state department may request review of the
administrative law judge's decision on the extension as provided in
subdivision (g).
(j) The temporary manager appointed pursuant to this section shall
meet the following qualifications:
(1) Be qualified to oversee correction of deficiencies on the
basis of experience and education.
(2) Not have been found guilty of misconduct by any licensing
board.
(3) Have no financial ownership interest in the facility and have
no member of his or her immediate family who has a financial
ownership interest in the facility.
(4) Not currently serve, or within the past two years have served,
as a member of the staff of the facility.
(5) Be acceptable to the facility.
(k) Payment of the temporary manager's salary shall comply with
the following requirements:
(1) Shall be paid directly by the facility while the temporary
manager is assigned to that facility.
(2) Shall be equivalent to the sum of the following:
(A) The prevailing salary paid by licensees for positions of the
same type in the facility's geographic area.
(B) Additional costs that reasonably would have been incurred by
the licensee if the licensee had been in an employment relationship.
(C) Any other reasonable costs incurred by the appointed temporary
manager in furnishing services pursuant to this section.
(3) May exceed the amount specified in paragraph (2) if the
department is otherwise unable to attract a qualified temporary
manager.
(l) Temporary management pursuant to this section shall terminate
when any one of the following occurs:
(1) The temporary manager notifies the department and the
department verifies that the facility meets state, and if applicable,
federal, standards for operation and will be able to continue to
maintain compliance with those standards after the termination of
temporary management.
(2) The facility closes.
(3) The department issues a license to a new operator.
(4) The department approves a new management company.
(m) The state department shall adopt regulations for the
administration of this section on or before December 31, 2001.
SEC. 11. Section 1331 of the Health and Safety Code is amended to
read:
1331. (a) The receiver shall be appointed for an initial period
of not more than six months. The initial six-month period may be
extended for additional periods not exceeding six months, as
determined by the court pursuant to this section. At the end of four
months, the receiver shall report to the court on its assessment of
the probability that the long-term health care facility will meet
state standards for operation by the end of the initial six-month
period and will continue to maintain compliance with those standards
after termination of the receiver's management. If it appears that
the facility cannot be brought into compliance with state standards
within the initial six-month period, the court shall take appropriate
action as follows:
(1) Extend the receiver's management for an additional six months
if there is a substantial likelihood that the facility will meet
state standards within that period and will maintain compliance with
the standards after termination of the receiver's management. The
receiver shall report to the court in writing upon the facility's
progress at the end of six weeks of any extension ordered pursuant to
this paragraph.
(2) Order the director to revoke or temporarily suspend, or both,
the license pursuant to Section 1296 and extend the receiver's
management for the period necessary to transfer patients in
accordance with the transfer plan, but for not more than six months
from the date of initial appointment of a receiver, or 14 days,
whichever is greater. An extension of an additional six months may
be granted if deemed necessary by the court.
(b) If it appears at the end of six weeks of an extension ordered
pursuant to paragraph (1) of subdivision (a) that the facility cannot
be brought into compliance with state standards for operation or
that it will not maintain compliance with those standards after the
receiver's management is terminated, the court shall take appropriate
action as specified in paragraph (2) of subdivision (a).
(c) In evaluating the probability that a long-term health care
facility will maintain compliance with state standards of operation
after the termination of receiver management ordered by the court,
the court shall consider at least the following factors:
(1) The duration, frequency, and severity of past violations in
the facility.
(2) History of compliance in other long-term health care
facilities operated by the proposed licensee.
(3) Efforts by the licensee to prevent and correct past
violations.
(4) The financial ability of the licensee to operate in compliance
with state standards.
(5) The recommendations and reports of the receiver.
(d) Management of a long-term health care facility operated by a
receiver pursuant to this article shall not be returned to the
licensee, to any person related to the licensee, or to any person who
served as a member of the facility's staff or who was employed by
the licensee prior to the appointment of the receiver.
(e) (1) Should a long-term health care facility subject to this
section not agree to the appointment of a temporary manager and the
department successfully obtain a court-appointed receiver, management
of the facility may only be returned to the licensee if the
department believes that it would be in the best interests of the
residents of the facility and the department requests that the court
return the operation of the facility to the former licensee.
(2) Before the court may return the operation of the facility to
the former licensee under this subdivision, the department shall
provide clear and convincing evidence to the court that it is in the
best interests of the facility's residents to take that action.
(f) The owner of the facility may at any time sell, lease, or
close the facility, subject to the following provisions:
(1) If the owner closes the facility, or the sale or lease results
in the closure of the facility, the court shall determine if a
transfer plan is necessary. If the court so determines, the court
shall adopt and implement a transfer plan of not more than 30 days.
(2) If the licensee proposes to sell or lease the facility and the
facility will continue to operate as a long-term health care
facility, the court and the state department shall reevaluate any
proposed transfer plan. If the court and the state department
determine that the sale or lease of the facility will result in
compliance with licensing standards, the transfer plan and the
receivership shall, subject to those conditions that the court may
impose and enforce, be terminated upon the effective date of the sale
or lease.
SEC. 12. Section 1333 of the Health and Safety Code is amended to
read:
1333. (a) To the extent state funds are advanced for the salary
of the receiver or for other expenses in connection with the
receivership, as limited by subdivision (d) of Section 1329, the
state shall be reimbursed from the revenues accruing to the facility
or to the licensee or an entity related to the licensee. Any
reimbursement received by the state shall be redeposited in the
account from which the state funds were advanced. If the revenues
are insufficient to reimburse the state, the unreimbursed amount
shall constitute a lien upon the assets of the facility or the
proceeds from the sale thereof. The lien shall not attach to the
interests of a lessor, unless the lessor is operating the facility.
(b) For purposes of this section, "entity related to the licensee"
means an entity, other than a natural person, of which the licensee
is a subsidiary or an entity in which any person who was obligated to
disclose information under Section 1267.5 possesses an interest that
would also require disclosure pursuant to Section 1267.5.
SEC. 13. Section 1336.2 of the Health and Safety Code is amended
to read:
1336.2. (a) When patients are transferred due to any change in
the status of the license or operation of a facility, including
voluntary or involuntary termination of a facility's Medi-Cal or
Medicare certification, the facility shall take reasonable steps to
transfer affected patients safely and minimize possible transfer
trauma by, at a minimum, doing all of the following:
(1) Medically assess, prior to transfer, the patient's condition
and susceptibility to adverse health consequences, including
psychosocial effects, in the event of transfer. The patient's
physician and surgeon, if available, shall undertake this assessment.
The assessment shall provide recommendations, including counseling
and followup visits, for preventing or ameliorating potential adverse
health consequences in the event of transfer.
(2) Provide, in accordance with these assessments, counseling, and
other recommended services, prior to transfer, to any affected
patient who may suffer adverse health consequences due to transfer.
(3) Evaluate, prior to transfer, the relocation needs of the
patient and the patient's family and determine the most appropriate
and available type of future care and services for the patient. The
health facility shall discuss the evaluation and medical assessment
with the patient or the patient's guardian, agent, or responsible
party and make the evaluation and assessment part of the medical
records for transfer.
(4) Inform, at least 30 days in advance of the transfer, the
patient or patient's guardian, agent, or responsible party of
alternative facilities that are available and adequate to meet
patient and family needs.
(5) Arrange for appropriate, future medical care and services,
unless the patient or patient's guardian has otherwise made these
arrangements. This requirement does not obligate a facility to pay
for future care and services.
(b) The facility shall provide an appropriate team of professional
staff to perform the services required in subdivision (a).
(c) The facility shall also give written notice to affected
patients or their guardians, agents, or responsible parties advising
them of the requirements in subdivision (a) at least 30 days in
advance of transfer. If a facility is required to give written
notice pursuant to Section 1336, then the notice shall advise the
affected patient or the patient's guardian, agent, or responsible
party of the requirements in subdivision (a). If the transfer is
made pursuant to subdivision (f), the notice shall include
notification to the patient that the transfer plan is available to
the patient or patient's representative free of charge upon request.
(d) In the event of a temporary suspension of a facility's license
pursuant to Section 1296, the 30-day notice requirement in
subdivision (c) shall not apply, but the facility shall provide the
relocation services required in subdivision (a) unless the state
department provides the services pursuant to subdivision (e).
(e) The state department may provide, or arrange for the provision
of, necessary relocation services at a facility, including medical
assessments, counseling, and placement of patients, if the state
department determines that these services are needed promptly to
prevent adverse health consequences to patients, and the facility
refuses, or does not have adequate staffing, to provide the services.
In these cases, the facility shall reimburse the state department
for the cost of providing the relocation services. If a facility's
refusal to provide the relocation services required in subdivision
(a) endangers the health and safety of patients to be transferred,
then the state department may also request that the Attorney General'
s office or the local district attorney's office seek injunctive
relief and damages in the same manner as provided for in Chapter 5
(commencing with Section 17200) of Part 2 of Division 7 of the
Business and Professions Code.
(f) If 10 or more patients are likely to be transferred due to any
voluntary or involuntary change in the status of the license or
operation of a facility, including voluntary or involuntary
termination of a facility's Medi-Cal or Medicare certification, the
facility shall submit a proposed relocation plan for the affected
patients to the state department for comment, if any, at least 45
days prior to the transfer of any patient. The plan shall provide
for implementation of the relocation services in subdivision (a) and
shall describe the availability of beds in the area for patients to
be transferred, the proposed discharge process, and the staffing
available to assist in the transfers. The facility shall submit its
final relocation plan to the local ombudsperson, and if different
from the proposed plan, to the state department, at least 30 days
prior to the transfer of any patient.
SEC. 14. Section 1337.1 of the Health and Safety Code is amended
to read:
1337.1. A skilled nursing or intermediate care facility shall
adopt an approved training program that meets standards established
by the state department. The approved training program shall consist
of at least the following:
(a) An orientation program to be given to newly employed nurse
assistants prior to providing direct patient care in skilled nursing
or intermediate care facilities.
(b) (1) A precertification training program consisting of at least
60 classroom hours of training on basic nursing skills, patient
safety and rights, the social and psychological problems of patients,
and resident abuse prevention, recognition, and reporting pursuant
to subdivision (e). The 60 classroom hours of training may be
conducted within a skilled nursing or intermediate care facility or
in an educational institution.
(2) In addition to the 60 classroom hours of training required
under paragraph (1), the precertification training program shall
consist of at least 100 hours of supervised and on-the-job training
clinical practice. The 100 hours may consist of normal employment as
a nurse assistant under the supervision of either the director of
nurse training or a licensed nurse. The 100 hours shall consist of
at least four hours of supervised training to address the special
needs of persons with developmental and mental disorders, including
mental retardation, Alzheimer's disease, cerebral palsy, epilepsy,
dementia, Parkinson's disease, and mental illness.
(3) In a precertification training program subject to this
subdivision, credit shall be given for the training received in an
approved precertification training program adopted by another skilled
nursing or intermediate care facility.
(4) This subdivision shall not apply to a skilled nursing or
intermediate care facility that demonstrates to the state department
that it employs only nurse assistants with a valid certification.
(c) Continuing in-service training to assure continuing competency
in existing and new nursing skills.
(d) Each facility shall consider including training regarding the
characteristics and method of assessment and treatment of acquired
immune deficiency syndrome (AIDS).
(e) (1) The approved training program shall include a minimum of
six hours of instruction on preventing, recognizing, and reporting
instances of resident abuse utilizing those courses developed
pursuant to Section 13823.93 of the Penal Code for hospital-based
training centers.
(2) A minimum of four hours of instruction on preventing,
recognizing, and reporting instances of resident abuse shall be
included within the total minimum hours of continuing education
required and in effect for certified nursing assistants.
SEC. 14.5. Section 1337.3 of the Health and Safety Code is amended
to read:
1337.3. (a) The state department shall prepare and maintain a
list of approved training programs for nurse assistant certification.
The list shall include training programs conducted by skilled
nursing or intermediate care facilities, as well as local agencies
and education programs. In addition, the list shall include
information on whether a training center is currently training nurse
assistants, their competency test pass rates, and the number of nurse
assistants they have trained. Clinical portions of the training
programs may be obtained as on-the-job training, supervised by a
qualified director of staff development or licensed nurse.
(b) It shall be the duty of the state department to inspect a
representative sample of training programs. The state department
shall protect consumers and students in any training program against
fraud, misrepresentation, or other practices that may result in
improper or excessive payment of funds paid for training programs.
In evaluating a training center's training program, the state
department shall examine each training center's trainees' competency
test passage rate, and require each program to maintain an average 60
percent test score passage rate to maintain its participation in the
program. The average test score passage rate shall be calculated
over a two-year period. If the state department determines that any
training program is not complying with regulations or is not meeting
the competency passage rate requirements, notice thereof in writing
shall be immediately given to the program. If the program has not
been brought into compliance within a reasonable time, the program
may be removed from the approved list and notice thereof in writing
given to it. Programs removed under this article shall be afforded
an opportunity to request reinstatement of program approval at any
time. The state department's district offices shall inspect
facility-based centers as part of their annual survey.
(c) Notwithstanding Section 1337.1, the approved training program
shall consist of at least the following:
(1) A 16-hour orientation program to be given to newly employed
nurse assistants prior to providing direct patient care, and
consistent with federal training requirements for facilities
participating in the Medicare or medicaid programs.
(2) (A) A certification training program consisting of at least 60
classroom hours of training on basic nursing skills, patient safety
and rights, the social and psychological problems of patients, and
elder abuse recognition and reporting pursuant to subdivision (e) of
Section 1337.1. The 60 classroom hours of training may be conducted
within a skilled nursing facility, an intermediate care facility, or
an educational
institution.
(B) In addition to the 60 classroom hours of training required
under subparagraph (A), the certification program shall also consist
of 100 hours of supervised and on-the-job training clinical practice.
The 100 hours may consist of normal employment as a nurse assistant
under the supervision of either the director of staff development or
a licensed nurse. The 100 hours shall consist of at least four
hours of supervised training to address the special needs of persons
with developmental and mental disorders, including mental
retardation, Alzheimer's disease, cerebral palsy, epilepsy, dementia,
Parkinson's disease, and mental illness.
(d) The state department, in consultation with the State
Department of Education and other appropriate organizations, shall
develop criteria for approving training programs, that includes
program content for orientation, training, inservice and the
examination for testing knowledge and skills related to basic patient
care services and shall develop a plan that identifies and
encourages career ladder opportunities for certified nurse
assistants. This group shall also recommend, and the department
shall adopt, regulation changes necessary to provide for patient care
when facilities utilize noncertified nurse assistants who are
performing direct patient care. The requirements of this subdivision
shall be established by January 1, 1989.
(e) On or before January 1, 2004, the state department, in
consultation with the State Department of Education, the American Red
Cross, and other appropriate organizations, shall do the following:
(1) Review the current examination for approved training programs
for certified nurse assistants to ensure the accurate assessment of
whether a nurse assistant has obtained the required knowledge and
skills related to basic patient care services.
(2) Develop a plan that identifies and encourages career ladder
opportunities for certified nurse assistants, including the
application of on-the-job post-certification hours to educational
credits.
(f) A skilled nursing or intermediate care facility shall
determine the number of specific clinical hours within each module
identified by the state department required to meet the requirements
of subdivision (d), subject to subdivisions (b) and (c). The
facility shall consider the specific hours recommended by the state
department when adopting the certification training program required
by this chapter.
(g) This article shall not apply to a program conducted by any
church or denomination for the purpose of training the adherents of
the church or denomination in the care of the sick in accordance with
its religious tenets.
(h) The Chancellor of the California Community Colleges shall
provide to the state department a standard process for approval of
college credit. The state department shall make this information
available to all training programs in the state.
SEC. 14.7. Section 1417.15 is added to the Health and Safety Code,
immediately after Section 1417.1, to read:
1417.15. (a) (1) If one or more of the following remedies is
actually imposed for violation of state or federal requirements, the
long-term health care facility shall post a notice of the imposed
remedy or remedies, in a form specified by the department, on all
doors providing ingress to or egress from the facility, except as
specified in paragraph (2):
(A) License suspension.
(B) Termination of certification for Medicare or Medi-Cal.
(C) Denial of payment by Medicare or Medi-Cal for all otherwise
eligible residents.
(D) Denial of payment by Medicare or Medi-Cal for otherwise
eligible incoming residents.
(E) Ban on admission of any type.
(2) For purposes of this subdivision, a distinct part nursing
facility shall only be required to post the notice on all main doors
providing ingress to or egress from the distinct part, and not on all
of the doors providing ingress to or egress from the facility. An
intermediate care facility/developmentally disabled habilitative and
an intermediate care facility/developmentally disabled-nursing shall
post this notice on the inside of all doors providing ingress to or
egress from the facility.
(b) A violation of the requirement of subdivision (a) shall be a
class "B" violation, as defined in subdivision (e) of Section 1424.
(c) The department shall adopt regulations for the administration
of this section.
SEC. 14.9. Section 1417.2 of the Health and Safety Code is amended
to read:
1417.2. (a) Notwithstanding Section 1428, moneys collected as a
result of civil penalties imposed under this chapter shall be
deposited into an account which is hereby established in the Special
Deposit Fund under the provisions of Section 16370 of the Government
Code. This account is titled the Health Facilities Citation
Penalties Account and shall, upon appropriation by the Legislature,
be used for the protection of health or property of residents of
long-term health care facilities, including, but not limited to, the
following:
(1) Relocation expenses incurred by the state department, in the
event of a facility closure.
(2) Maintenance of facility operation pending correction of
deficiencies or closure, such as temporary management or
receivership, in the event that the revenues of the facility are
insufficient.
(3) Reimbursing residents for personal funds lost. In the event
that the loss is a result of the actions of a long-term health care
facility or its employees, the revenues of the facility shall first
be used.
(4) The costs associated with informational meetings required
under Section 1327.2.
(b) Notwithstanding subdivision (a), the balance in the Health
Facilities Citation Penalties Account shall not, at any time, exceed
ten million dollars ($10,000,000).
SEC. 15. Section 1417.3 of the Health and Safety Code is amended
to read:
1417.3. The department shall promote quality of care and quality
of life for residents, clients, and patients in long-term health care
facility services through specific activities that include, but are
not limited to, all of the following:
(a) Research and evaluation of innovative facility resident care
models.
(b) (1) Provision of statewide training on effective facility
practices.
(2) Training also shall include topics related to the provision of
quality of care and quality of life for facility residents. The
topics for training shall be identified by the department through a
periodic survey. The curriculum for the training provided under this
paragraph shall be developed in consultation with representatives
from provider associations, consumer associations, and others, as
deemed appropriate by the state department.
(c) Response to facility requests for technical assistance
regarding licensing and certification requirements, compliance with
federal and state standards, and related operational issues.
(d) State employees providing technical assistance to facilities
pursuant to this section are only required to report violations they
discover during the provision of the assistance to the appropriate
district office if the violations constitute an immediate and serious
threat to the health and welfare of, or has resulted in actual harm
to, patients, residents, or clients of the facility.
(e) The state department shall measure facility satisfaction and
the effectiveness of the technical assistance provided pursuant to
subdivision (c).
(f) No person employed in the technical assistance or training
units under subdivisions (b) and (c) shall also participate in the
licensing, surveying, or direct regulation of facilities.
(g) This section shall not diminish the department's ongoing
survey and enforcement process.
SEC. 16. Section 1417.4 of the Health and Safety Code is amended
to read:
1417.4. (a) There is hereby established in the state department
the Quality Awards Program for nursing homes.
(b) The department shall establish criteria under the program,
after consultation with stakeholder groups, for recognizing all
skilled nursing facilities that provide exemplary care to residents.
(c) (1) Monetary awards shall be made to Quality Awards Program
recipients that serve high proportions of Medi-Cal residents to the
extent funds are appropriated each year in the annual Budget Act.
(2) Monetary awards presented under this section and paid for by
funds appropriated from the General Fund shall be used for staff
bonuses and distributed in accordance with criteria established by
the department.
(3) Monetary awards presented under this section and paid for from
funds from the Federal Citation Penalty Account shall be used to
fund innovative facility grants to improve the quality of care and
quality of life for residents in skilled nursing facilities.
(d) The department shall establish criteria for selecting
facilities to receive the quality awards, in consultation with senior
advocacy organizations, employee labor organizations representing
facility employees, nursing home industry representatives, and other
interested parties as deemed appropriate by the department. The
criteria established pursuant to this subdivision shall not be
considered regulations within the meaning of Section 11342 of the
Government Code, and shall not be subject to adoption as regulations
pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code.
(e) The department shall publish an annual listing of the Quality
Awards Program recipients with the dollar amount awarded, if
applicable. The department shall also publish an annual listing of
the Quality Awards Program recipients that receive innovative
facility grants with the purpose of the grant and the grant amount.
SEC. 17. Section 1418.91 is added to the Health and Safety Code,
immediately after Section 1418.9, to read:
1418.91. (a) A long-term health care facility shall report all
incidents of alleged abuse or suspected abuse of a resident of the
facility to the department immediately, or within 24 hours.
(b) A failure to comply with the requirements of this section
shall be a class "B" violation.
(c) For purposes of this section, "abuse" shall mean any of the
conduct described in subdivisions (a) and (b) of Section 15610.07 of
the Welfare and Institutions Code.
(d) This section shall not change any reporting requirements under
Section 15630 of the Welfare and Institutions Code, or as otherwise
specified in the Elder Abuse and Dependent Adult Civil Protection
Act, Chapter 11 (commencing with Section 15600) of Part 3 of Division
9 of the Welfare and Institutions Code.
SEC. 18. Section 1420 of the Health and Safety Code is amended to
read:
1420. (a) (1) Upon receipt of a written or oral complaint, the
state department shall assign an inspector to make a preliminary
review of the complaint and shall notify the complainant within two
working days of the receipt of the complaint of the name of the
inspector. Unless the state department determines that the complaint
is willfully intended to harass a licensee or is without any
reasonable basis, it shall make an onsite inspection or investigation
within 10 working days of the receipt of the complaint. In any case
in which the complaint involves a serious threat of imminent danger
of death or serious bodily harm, the state department shall make an
onsite inspection or investigation within 24 hours of the receipt of
the complaint. In any event, the complainant shall be promptly
informed of the state department's proposed course of action and of
the opportunity to accompany the inspector on the inspection or
investigation of the facility. Upon the request of either the
complainant or the state department, the complainant or his or her
representative, or both, may be allowed to accompany the inspector to
the site of the alleged violations during his or her tour of the
facility, unless the inspector determines that the privacy of any
patient would be violated thereby.
(2) When conducting an onsite inspection or investigation pursuant
to this section, the state department shall collect and evaluate all
available evidence and may issue a citation based upon, but not
limited to, all of the following:
(A) Observed conditions.
(B) Statements of witnesses.
(C) Facility records.
(3) Within 10 working days of the completion of the complaint
investigation, the state department shall notify the complainant in
writing of the department's determination as a result of the
inspection or investigation.
(b) Upon being notified of the state department's determination as
a result of the inspection or investigation, a complainant who is
dissatisfied with the state department's determination, regarding a
matter which would pose a threat to the health, safety, security,
welfare, or rights of a resident, shall be notified by the state
department of the right to an informal conference, as set forth in
this section. The complainant may, within five business days after
receipt of the notice, notify the director in writing of his or her
request for an informal conference. The informal conference shall be
held with the designee of the director for the county in which the
long-term health care facility which is the subject of the complaint
is located. The long-term health care facility may participate as a
party in this informal conference. The director's designee shall
notify the complainant and licensee of his or her determination
within 10 working days after the informal conference and shall
apprise the complainant and licensee in writing of the appeal rights
provided in subdivision (c).
(c) If the complainant is dissatisfied with the determination of
the director's designee in the county in which the facility is
located, the complainant may, within 15 days after receipt of this
determination, notify in writing the Deputy Director of the Licensing
and Certification Division of the state department, who shall assign
the request to a representative of the Complainant Appeals Unit for
review of the facts that led to both determinations. As a part of
the Complainant Appeals Unit's independent investigation, and at the
request of the complainant, the representative shall interview the
complainant in the district office where the complaint was initially
referred. Based upon this review, the Deputy Director of the
Licensing and Certification Division of the state department shall
make his or her own determination and notify the complainant and the
facility within 30 days.
(d) Any citation issued as a result of a conference or review
provided for in subdivision (b) or (c) shall be issued and served
upon the facility within three working days of the final
determination, unless the licensee agrees in writing to an extension
of this time. Service shall be effected either personally or by
registered or certified mail. A copy of the citation shall also be
sent to each complainant by registered or certified mail.
(e) A miniexit conference shall be held with the administrator or
his or her representative upon leaving the facility at the completion
of the investigation to inform him or her of the status of the
investigation. The department shall also state the items of
noncompliance and compliance found as a result of a complaint and
those items found to be in compliance, provided the disclosure
maintains the anonymity of the complainant. In any matter in which
there is a reasonable probability that the identity of the
complainant will not remain anonymous, the state department shall
also state that it is unlawful to discriminate or seek retaliation
against the complainant.
(f) For purposes of this section, "complaint" means any oral or
written notice to the state department, other than a report from the
facility of an alleged violation of applicable requirements of state
or federal law or any alleged facts that might constitute such a
violation.
SEC. 19. Section 1421.1 of the Health and Safety Code is amended
to read:
1421.1. (a) Within 24 hours of the occurrence of any of the
events specified in subdivision (b), the licensee of a skilled
nursing facility shall notify the department of the occurrence. This
notification may be in written form if it is provided by telephone
facsimile or overnight mail, or by telephone with a written
confirmation within five calendar days. The information provided
pursuant to this subdivision may not be released to the public by the
department unless its release is needed to justify an action taken
by the department or it otherwise becomes a matter of public record.
A violation of this section is a class "B" violation.
(b) All of the following occurrences shall require notification
pursuant to this section:
(1) The licensee of a facility receives notice that a judgment
lien has been levied against the facility or any of the assets of the
facility or the licensee.
(2) A financial institution refuses to honor a check or other
instrument issued by the licensee to its employees for a regular
payroll.
(3) The supplies, including food items and other perishables, on
hand in the facility fall below the minimum specified by any
applicable statute or regulation.
(4) The financial resources of the licensee fall below the amount
needed to operate the facility for a period of at least 45 days based
on the current occupancy of the facility.
(5) The licensee fails to make timely payment of any premiums
required to maintain required insurance policies or bonds in effect,
or any tax lien levied by any government agency.
SEC. 20. Section 1421.2 of the Health and Safety Code is amended
to read:
1421.2. (a) There is hereby established in the state department
the Skilled Nursing Facility Financial Solvency Advisory Board.
(b) The board shall be composed of eight members.
The members shall consist of the director, or the director's
designee, and seven members appointed by the director.
The seven members appointed by the director may be, but are not
necessarily limited to, individuals with training and experience in
the following areas or fields:
(1) Medical and health care economics.
(2) Consumer advocacy or representation.
(3) Nursing facility employee organizations.
(4) Accountancy.
(5) Research or actuarial studies in the area of skilled nursing
facilities.
(6) Management or administration of health care delivery systems.
(c) One of the members appointed by the director shall be a
representative of a collective bargaining agent.
(d) The purpose of the board shall be to do all of the following:
(1) Advise the director on matters of financial solvency affecting
the delivery of services in skilled nursing facilities.
(2) Develop and recommend to the director financial solvency
licensing requirements and standards relating to the operation of
skilled nursing facilities.
(3) Periodically monitor and report on the implementation and
results of the financial solvency licensing requirements and
standards.
(e) The board shall meet at least quarterly and at the call of the
chair. In order to preserve the independence of the board, the
director shall not serve as chair. The members of the board may
establish their own rules and procedures.
(f) All members shall serve without compensation, but shall be
reimbursed from department funds for expenses actually and
necessarily incurred in the performance of their duties.
(g) For purposes of this section, "board" means the Skilled
Nursing Facility Financial Solvency Advisory Board.
(h) Financial solvency licensing requirements and standards
recommended to the director by the board and approved by the director
may be noticed, after a period of review and comment not to exceed
45 days, for adoption as regulations as proposed or modified under
the rulemaking provisions of the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code). During the director's 45-day
review and comment period, the director, in consultation with the
board, may postpone the adoption of the licensing requirements and
standards pending further review and comment.
(i) The board shall report to the director on or before July 1,
2002, on its recommendations.
(j) This section shall remain in effect only until January 1,
2004, and as of that date is repealed, unless a later enacted
statute, which is enacted before January 1, 2004, deletes or extends
that date.
SEC. 21. Section 1422 of the Health and Safety Code is amended to
read:
1422. (a) The Legislature finds and declares that it is the
public policy of this state to assure that long-term health care
facilities provide the highest level of care possible. The
Legislature further finds that inspections are the most effective
means of furthering this policy. It is not the intent of the
Legislature by the amendment of subdivision (b) enacted by Chapter
1595 of the Statutes of 1982 to reduce in any way the resources
available to the state department for inspections, but rather to
provide the state department with the greatest flexibility to
concentrate its resources where they can be most effective.
(b) (1) Without providing notice of these inspections, the state
department shall, in addition to any inspections conducted pursuant
to complaints filed pursuant to Section 1419, conduct inspections
annually, except with regard to those facilities which have no class
"AA," class "A," or class "B" violations in the past twelve months.
The state department shall also conduct inspections as may be
necessary to assure the health, safety, and security of patients in
long-term health care facilities. Every facility shall be inspected
at least once every two years. The department shall vary the cycle
in which inspections of long-term health care facilities are
conducted to reduce the predictability of the inspections.
(2) The state department shall submit to the federal Department of
Health and Human Services on or before July 1, 1985, for review and
approval, a request to implement a three-year pilot program designed
to lessen the predictability of the long-term health care facility
inspection process. Two components of the pilot program shall be (A)
the elimination of the present practice of entering into a one-year
certification agreement, and (B) the conduct of segmented inspections
of a sample of facilities with poor inspection records, as defined
by the state department. At the conclusion of the pilot project, an
analysis of both components shall be conducted by the state
department to determine effectiveness in reducing inspection
predictability and the respective cost benefits. Implementation of
this pilot project is contingent upon federal approval. The state
department shall report annually to the Legislature on progress of
the pilot project with a final report at the end of the third year.
(c) Except as otherwise provided in subdivision (b), the state
department shall conduct unannounced direct patient care inspections
at least annually to inspect physician and surgeon services, nursing
services, pharmacy services, dietary services, and activity programs
of all the long-term health care facilities. Facilities evidencing
repeated serious problems in complying with this chapter or a history
of poor performance, or both, shall be subject to periodic
unannounced direct patient care inspections during the inspection
year. The direct patient care inspections shall assist the state
department in the prioritization of its efforts to correct facility
deficiencies.
(d) All long-term health care facilities shall report to the state
department any changes in the nursing home administrator or the
director of nursing services within 10 calendar days of the changes.
(e) Within 90 days after the receipt of notice of a change in the
nursing home administrator or the director of nursing services, the
state department may conduct an abbreviated inspection of the
long-term health care facilities.
(f) If a change in a nursing home administrator occurs and the
Board of Nursing Home Administrators notifies the state department
that the new administrator is on probation or has had his or her
license suspended within the previous three years, the state
department shall conduct an abbreviated survey of the long-term
health care facility employing that administrator within 90 days of
notification.
SEC. 21.5. Section 1422.5 of the Health and Safety Code is amended
to read:
1422.5. (a) The department shall develop and establish a consumer
information service system to provide updated and accurate
information to the general public and consumers regarding long-term
care facilities in their communities. The consumer information
service system shall include, but need not be limited to, all of the
following elements:
(1) An on-line inquiry system accessible through a statewide
toll-free telephone number and the Internet.
(2) Long-term health care facility profiles, with data on services
provided, a history of all citations and complaints for the last two
full survey cycles, and ownership information. The profile for each
facility shall include, but not be limited to, all of the following:
(A) The name, address, and telephone number of the facility.
(B) The number of units or beds in the facility.
(C) Whether the facility accepts Medicare or Medi-Cal patients.
(D) Whether the facility is a nursing home, and whether the
facility has a special care unit or program for people with Alzheimer'
s disease and other dementias, and whether the facility participates
in the voluntary disclosure program for special care units.
(E) Whether the facility is a for profit or not-for-profit
provider.
(3) Information regarding substantiated complaints shall include
the action taken and the date of action.
(4) Information regarding the state citations assessed shall
include the status of the state citation, including the facility's
plan or correction, and information as to whether an appeal has been
filed.
(5) Any appeal resolution pertaining to a citation or complaint
shall be updated on the file in a timely manner.
(b) Where feasible, the department shall interface the consumer
information service system with its Automated Certification and
Licensure Information Management System.
(c) It is the intent of the Legislature that the department, in
developing and establishing the system pursuant to subdivision (a),
maximize the use of available federal funds.
(d) (1) Notwithstanding the consumer information service system
established pursuant to subdivision (a), by January 1, 2002, the
state department shall develop a method whereby information is
provided to the public and consumers on long-term health care
facilities. The information provided shall include, but not be
limited to, all of the following elements:
(A) Substantiated complaints, including the action taken and the
date of the action.
(B) State citations assessed, including the status of any citation
and whether an appeal has been filed.
(C) State actions, including license suspensions, revocations, and
receiverships.
(D) Federal enforcement sanctions imposed, including any denial of
payment, temporary management, termination, or civil money penalty
of five hundred dollars ($500) or more.
(E) Any information or data beneficial to the public and
consumers.
(2) This subdivision shall become inoperative on July 1, 2003.
(e) In implementing this section, the department shall ensure the
confidentiality of personal and identifying information of residents
and employees and shall not disclose this information through the
consumer information service system developed pursuant to this
section.
SEC. 22. Section 1422.6 is added to the Health and Safety Code, to
read:
1422.6. Each skilled nursing facility and intermediate care
facility shall post a copy of the notice required pursuant to Section
9718 of the Welfare and Institutions Code in a conspicuous location
in at least four areas of the facility, as follows:
(a) One location that is accessible to members of the public.
(b) One location that is used for employee breaks.
(c) One location that is next to a telephone designated for
resident use.
(d) One location that is used for communal functions for
residents, such as for dining or resident council meetings and
activities.
SEC. 23. Section 1423.5 is added to the Health and Safety Code, to
read:
1423.5. (a) The state department shall centrally review federal
deficiencies and supporting documentation that require the
termination of certification for a nursing facility. The state
department shall develop a standardized methodology for conducting
the central review of these deficiencies. The standardized
methodology shall assess all of the following:
(1) The extent to which the survey team followed established
survey protocols.
(2) The thoroughness of the investigation or review.
(3) The quality of documentation.
(4) The consistency in interpreting federal requirements.
(b) The state department shall develop a system for tracking
patterns and a quality assurance process for preventing, detecting,
and correcting inconsistent or poor quality survey practices.
(c) On or before October 1 of each year, the state department
shall provide to the Legislature a summary of federal enforcement
actions taken against nursing facilities during the previous state
fiscal year.
SEC. 24. Section 1424 of the Health and Safety Code is amended to
read:
1424. Citations issued pursuant to this chapter shall be
classified according to the nature of the violation and shall
indicate the classification on the face thereof.
(a) In determining the amount of the civil penalty, all relevant
facts shall be considered, including, but not limited to, the
following:
(1) The probability and severity of the risk that the violation
presents to the patient's or resident's mental and physical
condition.
(2) The patient's or resident's medical condition.
(3) The patient's or resident's mental condition and his or her
history of mental disability or disorder.
(4) The good faith efforts exercised by the facility to prevent
the violation from occurring.
(5) The licensee's history of compliance with regulations.
(b) Relevant facts considered by the department in determining the
amount of the civil penalty shall be documented by the department on
an attachment to the citation and available in the public record.
This requirement shall not preclude the department or a facility from
introducing facts not listed on the citation to support or challenge
the amount of the civil penalty in any proceeding set forth in
Section 1428.
(c) Class "AA" violations are violations that meet the criteria
for a class "A" violation and that the state department determines to
have been a direct proximate cause of death of a patient or resident
of a long-term health care facility. Except as provided in Section
1424.5, a class "AA" citation is subject to a civil penalty in the
amount of not less than five thousand dollars ($5,000) and not
exceeding twenty-five thousand dollars ($25,000) for each citation.
In any action to enforce a citation issued under this subdivision,
the state department shall prove all of the following:
(1) The violation was a direct proximate cause of death of a
patient or resident.
(2) The death resulted from an occurrence of a nature that the
regulation was designed to prevent.
(3) The patient or resident suffering the death was among the
class of persons for whose protection the regulation was adopted.
If the state department meets this burden of proof, the licensee
shall have the burden of proving that the licensee did what might
reasonably be expected of a long-term health care facility licensee,
acting under similar circumstances, to comply with the regulation.
If the licensee sustains this burden, then the citation shall be
dismissed.
Except as provided in Section 1424.5, for each class "AA" citation
within a 12-month period that has become final, the state department
shall consider the suspension or revocation of the facility's
license in accordance with Section 1294. For a third or subsequent
class "AA" citation in a facility within that 12-month period that
has been sustained following a citation review conference, the state
department shall commence action to suspend or revoke the facility's
license in accordance with Section 1294.
(d) Class "A" violations are violations which the state department
determines present either (1) imminent danger that death or serious
harm to the patients or residents of the long-term health care
facility would result therefrom, or (2) substantial probability that
death or serious physical harm to patients or residents of the
long-term health care facility would result therefrom. A physical
condition or one or more practices, means, methods, or operations in
use in a long-term health care facility may constitute a class "A"
violation. The condition or practice constituting a class "A"
violation shall be abated or eliminated immediately, unless a fixed
period of time, as determined by the state department, is required
for correction. Except as provided in Section 1424.5, a class "A"
citation is subject to a civil penalty in an amount not less than one
thousand dollars ($1,000) and not exceeding ten thousand dollars
($10,000) for each and every citation.
If the state department establishes that a violation occurred, the
licensee shall have the burden of proving that the licensee did what
might reasonably be expected of a long-term health care facility
licensee, acting under similar circumstances, to comply with the
regulation. If the licensee sustains this burden, then the citation
shall be dismissed.
(e) Class "B" violations are violations that the state department
determines have a direct or immediate relationship to the health,
safety, or security of long-term health care facility patients or
residents, other than class "AA" or "A" violations. Unless otherwise
determined by the state department to be a class "A" violation
pursuant to this chapter and rules and regulations adopted pursuant
thereto, any violation of a patient's rights as set forth in Sections
72527 and 73523 of Title 22 of the California Code of Regulations,
that is determined by the state department to cause or under
circumstances likely to cause significant humiliation, indignity,
anxiety, or other emotional trauma to a patient is a class "B"
violation. A class "B" citation is subject to a civil penalty in an
amount not less than one hundred dollars ($100) and not exceeding one
thousand dollars ($1,000) for each and every citation. A class "B"
citation shall specify the time within which the violation is
required to be corrected. If the state department establishes that a
violation occurred, the licensee shall have the burden of proving
that the licensee did what might reasonably be expected of a
long-term health care facility licensee, acting under similar
circumstances, to comply with the regulation. If the licensee
sustains this burden, then the citation shall be dismissed.
In the event of any citation under this paragraph, if the state
department establishes that a violation occurred, the licensee shall
have the burden of proving that the licensee did what might
reasonably be expected of a long-term health care facility licensee,
acting under similar circumstances, to comply with the regulation.
If the licensee sustains this burden, then the citation shall be
dismissed.
(f) (1) Any willful material falsification or willful material
omission in the health record of a patient of a long-term health care
facility is a violation.
(2) "Willful material falsification," as used in this section,
means any entry in the patient health care record pertaining to the
administration of medication, or treatments ordered for the patient,
or pertaining to services for the prevention or treatment of
decubitus ulcers or contractures, or pertaining to tests and
measurements of vital signs, or notations of input and output of
fluids, that was made with the knowledge that the records falsely
reflect the condition of the resident or the care or services
provided.
(3) "Willful material omission," as used in this section, means
the willful failure to record any untoward event that has affected
the health, safety, or security of the specific patient, and that was
omitted with the knowledge that the records falsely reflect the
condition of the resident or the care or services provided.
(g) Except as provided in subdivision (a) of Section 1425.5, a
violation of subdivision (f) may result in a civil penalty not to
exceed ten thousand dollars ($10,000), as specified in paragraphs (1)
to (3), inclusive.
(1) The willful material falsification or willful material
omission is subject to a civil penalty of not less than two thousand
five hundred dollars ($2,500) or more than ten thousand dollars
($10,000) in instances where the health care record is relied upon by
a health care professional to the detriment of a patient by
affecting the administration of medications or treatments, the
issuance of orders, or the development of plans of care. In all
other cases, violations of this subdivision are subject to a civil
penalty not exceeding two thousand five hundred dollars ($2,500).
(2) Where the penalty assessed is one thousand dollars ($1,000) or
less, the violation shall be issued and enforced, except as provided
in this subdivision, in the same manner as a class "B" violation,
and shall include the right of appeal as specified in Section 1428.
Where the assessed penalty is in excess of one thousand dollars
($1,000), or for skilled nursing facilities or intermediate care
facilities as specified in paragraphs (1) and (2) of subdivision (a)
of Section 1418, in excess of two thousand dollars ($2,000), the
violation shall be issued and enforced, except as provided in this
subdivision, in the same manner as a class "A" violation, and shall
include the right of appeal as specified in Section 1428.
Nothing in this section shall be construed as a change in previous
law enacted by Chapter 11 of the Statutes of 1985 relative to this
paragraph, but merely as a clarification of existing law.
(3) Nothing in this subdivision shall preclude the state
department from issuing a class "A" or class "B" citation for any
violation that meets the requirements for that citation, regardless
of whether the violation also constitutes a violation of this
subdivision. However, no single act, omission, or occurrence may be
cited both as a class "A" or class "B" violation and as a violation
of this subdivision.
(h) Where the licensee has failed to post the notices as required
by Section 9718 of the Welfare and Institutions Code in the manner
required under Section 1422.6, the state department shall assess the
licensee a civil penalty in the amount of one hundred dollars ($100)
for each day the failure to post the notices continues. Where the
total penalty assessed is two thousand dollars ($2,000) or less, the
violation shall be issued and enforced in the same manner as a class
"B" violation, and shall include the right of appeal as specified in
Section 1428. Where the assessed penalty is equal to or in excess of
two thousand dollars ($2,000), the violation shall be issued and
enforced in the same manner as a class "A" violation and shall
include the right of appeal as specified in Section 1428. Any fines
collected pursuant to this subdivision shall be used to fund the
costs incurred by the California Department of Aging in producing and
posting the posters.
(i) The director shall prescribe procedures for the issuance of a
notice of violation with respect to violations having only a minimal
relationship to patient safety or health.
(j) The department shall provide a copy of all citations issued
under this section to the affected residents mentioned in the
violation and to the affected residents' family or designated legal
representative.
(k) Nothing in this section is intended to change existing
statutory or regulatory requirements governing the ability of a
licensee to contest a citation pursuant to Section 1428.
(l) The department shall ensure that district office activities
performed under Sections 1419 to 1424, inclusive, are consistent with
the requirements of these sections and all applicable laws and
regulations. To ensure the integrity of these activities, the
department shall establish a statewide process for the collection of
postsurvey evaluations from affected facilities.
SEC. 25. Section 1424.5 is added to the Health and Safety Code, to
read:
1424.5. (a) In lieu of the fines specified in subdivisions (c),
(d), and (e) of Section 1424, fines imposed on skilled nursing
facilities or intermediate care facilities, as specified in
paragraphs (1) and (2) of subdivision (a) of Section 1418, shall be
as follows:
(1) A class "AA" citation is subject to a civil penalty in an
amount not less than twenty-five thousand dollars ($25,000) and not
exceeding one hundred thousand dollars ($100,000) for each and every
citation. For a second or subsequent class "AA" citation in a
skilled nursing facility or intermediate care facility within a
24-month period that has been sustained following a citation review
conference, or where the licensee has chosen not to exercise its
right to a citation review conference, the state department shall
commence action to suspend or revoke the facility's license in
accordance with Section 1294.
(2) A class "A" citation is subject to a civil penalty in an
amount not less than two thousand dollars ($2,000) and not exceeding
twenty thousand dollars ($20,000) for each and every citation.
(3) Any "willful material falsification" or "willful material
omission," as those terms are defined in subdivision (f) of Section
1424, in the health record of a resident is subject to a civil
penalty in an amount not less than two thousand dollars ($2,000) and
not exceeding twenty thousand dollars ($20,000) for each and every
citation.
(b) A licensee may, in lieu of contesting a class "AA" or class "A"
citation pursuant to Section 1428, transmit to the state department,
the minimum amount specified by law, or 65 percent of the amount
specified in the citation, whichever is greater, for each violation,
within 30 business days after the issuance of the citation.
SEC. 26. Section 1428 of the Health and Safety Code is amended to
read:
1428. (a) If the licensee desires to contest a citation or the
proposed assessment of a civil penalty therefor, the licensee shall
use the processes described in subdivisions (b) and (c) for classes
"AA," "A," or "B" citations. As a result of a citation review
conference, a citation or the proposed assessment of a civil penalty
may be affirmed, modified, or dismissed by the director or the
director's designee. If the director's designee affirms, modifies,
or dismisses the citation or proposed assessment of a civil penalty,
he or she shall state with particularity in writing his or her
reasons for that action, and shall immediately transmit a copy
thereof to each party to the original complaint. If the licensee
desires to contest a decision made after the citation review
conference, the licensee shall inform the director in writing within
15 business days after he or she receives the decision by the
director's designee.
(b) If a licensee notifies the director that he or she intends to
contest a class "AA" or a class "A" citation, the licensee may first,
within 15 business days after service of the citation, notify the
director in writing of his or her request for a citation review
conference. The licensee shall inform the director in writing,
within 15 business days of the service of the citation or the receipt
of the decision of the director's designee after the citation review
conference, of the licensee's intent to adjudicate the validity of
the citation in the municipal or superior court in the county in
which the long-term health care facility is located. In order to
perfect a judicial appeal of a contested citation, a licensee shall
file a civil action in the municipal or superior court in the county
in which the long-term health care facility is located. The action
shall be filed no later than 90 calendar days after a licensee
notifies the director that he or she intends to contest the citation,
or no later than 90 days after the receipt of the decision by the
director's designee after the citation review conference, and served
not later than 90 days after filing. Notwithstanding any other
provision of law, a licensee prosecuting a judicial appeal shall file
and serve an at-issue memorandum pursuant to Rule 209 of the
California Rules of Court within six months after the state
department files its answer in the appeal. Notwithstanding
subdivision (d), the court shall dismiss the appeal upon motion of
the state department if the at-issue memorandum is not filed by the
facility within the period specified. The court may affirm, modify,
or dismiss the citation, the level of the citation, or the amount of
the proposed assessment of the civil penalty.
(c) If a licensee desires to contest a class "B" citation, the
licensee may request, within 15 business days after service of the
citation, a citation review conference, by writing the director or
the director's designee of the licensee's intent to appeal the
citation through the citation review conference. If the licensee
wishes to appeal the citation which has been upheld in a citation
review conference, the licensee shall, within 15 working days from
the date the citation review conference decision was rendered, notify
the director or the director's designee that he or she wishes to
appeal the decision through the procedures set forth in Section
100171 or elects to submit the matter to binding arbitration in
accordance with subdivision (d). The administrative law judge may
affirm, modify, or dismiss the citation or the proposed assessment of
a civil penalty. The licensee may choose to have his or her appeal
heard by the administrative law judge or submit the matter to binding
arbitration without having first appealed the decision to a citation
review conference by notifying the director in writing within 15
business days of the service of the citation.
(d) If a licensee is dissatisfied with the decision of the
administrative law judge, the licensee may, in lieu of seeking
judicial review of the decision as provided in Section 1094.5 of the
Code of Civil Procedure, elect to submit the matter to binding
arbitration by filing, within 60 days of its receipt of the decision,
a request for arbitration with the American Arbitration Association.
The parties shall agree upon an arbitrator designated from the
American Arbitration Association in accordance with the association's
established rules and procedures. The arbitration hearing shall be
set within 45 days of the election to arbitrate, but in no event less
than 28 days from the date of selection of an arbitrator. The
arbitration hearing may be continued up to 15 additional days if
necessary at the arbitrator's discretion. Except as otherwise
specifically provided in this subdivision, the arbitration hearing
shall be conducted in accordance with the American Arbitration
Association's established rules and procedures. The arbitrator shall
determine whether the licensee violated the regulation or
regulations cited by the department, and whether the citation meets
the criteria established in Sections 1423 and 1424. If the
arbitrator determines that the licensee has violated the regulation
or regulations cited by the department, and that the class of the
citation should be upheld, the proposed assessment of a civil penalty
shall be affirmed, subject to the limitations established in Section
1424. The licensee and the department shall each bear its
respective portion of the cost of arbitration. A resident, or his or
her designated representative, or both, entitled to participate in
the citation review conference pursuant to subdivision (f), may make
an oral or written statement regarding the citation, at any
arbitration hearing to which the matter has been submitted after the
citation review conference.
(e) If an appeal is prosecuted under this section, including an
appeal taken in accordance with Section 100171, the state department
shall have the burden of establishing by a preponderance of the
evidence that (1) the alleged violation did occur, (2) the alleged
violation met the criteria for the class of citation alleged, and (3)
the assessed penalty was appropriate. The state department shall
also have the burden of establishing by a preponderance of the
evidence that the assessment of a civil penalty should be upheld. If
a licensee fails to notify the director in writing that he or she
intends to contest the citation, or the proposed assessment of a
civil penalty therefor, or the decision made by the director's
designee, after a citation review conference, within the time
specified in this section, the decision by the director's designee
after a citation review conference shall be deemed a final order of
the state department and shall not be subject to further
administrative review, except that the licensee may seek judicial
relief from the time limits specified in this section. If a licensee
appeals a contested citation or the assessment of a civil penalty,
no civil penalty shall be due and payable unless and until the appeal
is terminated in favor of the state department.
(f) The director or the director's designee shall establish an
independent unit of trained citation review conference hearing
officers within the state department to conduct citation review
conferences. Citation review conference hearing officers shall be
directly responsible to the deputy director for licensing and
certification, and shall not be concurrently employed as supervisors,
district administrators, or regional administrators with the
licensing and certification division. Specific training shall be
provided to members of this unit on conducting an informal
conference, with emphasis on the regulatory and legal aspects of
long-term health care.
Where the state department issues a citation as a result of a
complaint or regular inspection visit, and a resident or residents
are specifically identified in a citation by name as being
specifically affected by the violation, then the following persons
may attend the citation review conference:
(1) The complainant and his or her designated representative.
(2) A personal health care provider, designated by the resident.
(3) A personal attorney.
(4) Any person representing the Office of the State Long-Term Care
Ombudsman, as referred to in subdivision (d) of Section 9701 of the
Welfare and Institutions Code.
Where the state department determines that residents in the
facility were threatened by the cited violation but does not name
specific residents, any person representing the Office of the State
Long-Term Care Ombudsman, as referred to in subdivision (d) of
Section 9701 of the Welfare and Institutions Code, and a
representative of the residents or family council at the facility may
participate to represent all residents. In this case, these
representatives shall be the sole participants for the residents in
the conference. The residents or family council shall designate
which representative will participate.
The complainant, affected resident, and their designated
representatives shall be notified by the state department of the
conference and their right to participate. The director's designee
shall notify the complainant or his or her designated representative
and the affected resident or his or her designated representative, of
his or her determination based on the citation review conference.
(g) In assessing the civil penalty for a violation, all relevant
facts shall be considered, including, but not limited to, all of the
following:
(1) The probability and severity of the risk which the violation
presents to the patient's or resident's mental and physical
condition.
(2) The patient's or resident's medical condition.
(3) The patient's or resident's mental condition and his or her
history of mental disability.
(4) The good faith efforts exercised by the facility to prevent
the violation from occurring.
(5) The licensee's history of compliance with regulations.
(h) Except as otherwise provided in this subdivision, an
assessment of civil penalties for a class "A" or class "B" violation
shall be trebled and collected for a second and subsequent violation
for which a citation of the same class was issued within any 12-month
period. Trebling shall occur only if the first citation issued
within the 12-month period was issued in the same class, a civil
penalty was assessed, and a plan of correction was submitted for the
previous same-class violation occurring within the period, without
regard to whether the action to enforce the previous citation has
become final. However, the
increment to the civil penalty required by this subdivision shall
not be due and payable unless and until the previous action has
terminated in favor of the state department.
If the class "B" citation is issued for a patient's rights
violation, as defined in subdivision (c) of Section 1424, it shall
not be trebled unless the state department determines the violation
has a direct or immediate relationship to the health, safety,
security, or welfare of long-term health care facility residents.
(i) The director shall prescribe procedures for the issuance of a
notice of violation with respect to violations having only a minimal
relationship to safety or health.
(j) Actions brought under this chapter shall be set for trial at
the earliest possible date and shall take precedence on the court
calendar over all other cases except matters to which equal or
superior precedence is specifically granted by law. Times for
responsive pleading and for hearing the proceeding shall be set by
the judge of the court with the object of securing a decision as to
subject matters at the earliest possible time.
(k) If the citation is dismissed, the state department shall take
action immediately to ensure that the public records reflect in a
prominent manner that the citation was dismissed.
(l) Penalties paid on violations under this chapter shall be
applied against the state department's accounts to offset any costs
incurred by the state pursuant to this chapter. Any costs or
penalties assessed pursuant to this chapter shall be paid within 30
days of the date the decision becomes final. If a facility does not
comply with this requirement, the state department shall withhold any
payment under the Medi-Cal program until the debt is satisfied. No
payment shall be withheld if the state department determines that it
would cause undue hardship to the facility or to patients or
residents of the facility.
(m) The amendments made to subdivisions (a) and (c) of this
section by Chapter 84 of the Statutes of 1988, to extend the number
of days allowed for the provision of notification to the director, do
not affect the right, that is also contained in those amendments, to
request judicial relief from these time limits.
SEC. 27. Section 1428.1 of the Health and Safety Code is amended
to read:
1428.1. Except as provided in subdivision (d) of Section 1424.5,
a licensee may, in lieu of contesting a citation pursuant to Section
1428, transmit to the state department the minimum amount specified
by law, or 65 percent of the amount specified in the citation,
whichever is greater, for each violation within 15 business days
after the issuance of the citation.
SEC. 28. Section 1429.1 is added to the Health and Safety Code, to
read:
1429.1. (a) If a long-term health care facility licensed as a
skilled nursing facility or an intermediate care facility, as defined
in paragraphs (1) and (2) of subdivision (a) of Section 1418, has
one or more of the following remedies actually imposed for violation
of state or federal requirements, the facility shall provide written
notification of the action to each resident, the resident's
responsible party and legal representative, and all applicants for
admission to the facility:
(1) Termination of the facility's provider agreement to
participate in the Medicare program, medicaid program, or both
programs.
(2) Denial of Medicare or medicaid payment for new admissions to
the facility.
(3) Denial by the Health Care Financing Administration of Medicare
or medicaid payment for all individuals in the facility.
(4) A ban on admissions, of any type.
(b) A violation of the requirements of this section shall be a
class "B" violation.
SEC. 29. Section 1430.5 of the Health and Safety Code is repealed.
SEC. 30. Section 1435 of the Health and Safety Code is repealed.
SEC. 31. Section 1435.5 of the Health and Safety Code is repealed.
SEC. 32. Section 1437.5 is added to the Health and Safety Code, to
read:
1437.5. (a) If a facility is certified to participate in the
federal Medicare program as a skilled nursing facility under Title
XVIII of the Social Security Act, in the medicaid program as a
nursing facility under Title XIX of the Social Security Act, or in
both and any of the following occurs, the state department may
rescind its permanent license to operate and issue a provisional
license under Section 1437:
(1) The facility's provider agreement is terminated.
(2) A temporary manager is appointed to operate it.
(3) Payment becomes due on a federal civil money penalty of seven
thousand dollars ($7,000) per day, or greater, imposed on it.
(4) A federal civil monetary penalty of any amount is imposed and
has continued for a period of 30 days or more.
(5) A federal civil monetary penalty of any amount is imposed and
has accrued in an amount equal to, or greater than, thirty-five
thousand dollars ($35,000).
(b) The state department may not take action pursuant to
subdivision (a) until a final administrative decision is issued if
the facility has requested a hearing pursuant to federal law, until a
facility has waived its right to a hearing under federal law, or
until the time for requesting a hearing under federal law has expired
and a hearing request was not received by federal authorities.
(c) If a receiver or temporary manager is appointed to operate a
skilled nursing facility or an intermediate care facility, specified
in paragraphs (1) and (2) of subdivision (a) of Section 1418,
pursuant to state law, or as otherwise specified in regulations
adopted by the department, the state department may rescind its
permanent license to operate and issue a provisional license under
Section 1437.
(d) (1) A provisional license issued pursuant to this section
shall terminate six months from the date of issuance unless extended
by the department.
(2) At least 30 days prior to the termination of a provisional
license, the department shall give the facility a full and complete
inspection. If, at the time of the inspection, it is determined that
the facility meets all applicable requirements for licensure, a
permanent license shall be restored. If, at the time of the
inspection, it is determined that the facility does not meet the
requirements for licensure, but the facility has made substantial
progress towards meeting the requirements, as determined by the
department, the provisional license shall be renewed for six months.
If, at the time of the first inspection, the department determines
that there has not been substantial progress towards meeting the
requirements for licensure, or, if at any subsequent inspection the
department determines that there has not been substantial progress
towards meeting requirements identified at the most recent previous
inspection, a permanent license shall not be issued.
(e) The facility may request a hearing in writing within 10 days
of the receipt of notice from the department denying a permanent
license under this section. The provisional license shall remain in
effect during the pendency of the hearing. The hearing shall be held
in accordance with Section 100171. The hearing officer shall uphold
the denial of a permanent license if the department proves, by a
preponderance of the evidence, that the licensee did not meet the
requirements for licensure.
SEC. 33. Section 1438 of the Health and Safety Code is amended to
read:
1438. The state department shall review the effectiveness of the
enforcement system in maintaining the quality of care provided by
long-term health care facilities and shall submit a report thereon to
the Legislature on enforcement activities, on or before December 1,
2001, and annually thereafter, together with any recommendations of
the state department for additional legislation which it deems
necessary to improve the effectiveness of the enforcement system or
to enhance the quality of care provided by long-term health care
facilities.
SEC. 33.5. Section 1599.1 of the Health and Safety Code is amended
to read:
1599.1. Written policies regarding the rights of patients shall
be established and shall be made available to the patient, to any
guardian, next of kin, sponsoring agency or representative payee, and
to the public. Those policies and procedures shall ensure that each
patient admitted to the facility has the following rights and is
notified of the following facility obligations, in addition to those
specified by regulation:
(a) The facility shall employ an adequate number of qualified
personnel to carry out all of the functions of the facility.
(b) Each patient shall show evidence of good personal hygiene, be
given care to prevent bedsores, and measures shall be used to prevent
and reduce incontinence for each patient.
(c) The facility shall provide food of the quality and quantity to
meet the patients' needs in accordance with physicians' orders.
(d) The facility shall provide an activity program staffed and
equipped to meet the needs and interests of each patient and to
encourage self-care and resumption of normal activities. Patients
shall be encouraged to participate in activities suited to their
individual needs.
(e) The facility shall be clean, sanitary, and in good repair at
all times.
(f) A nurses' call system shall be maintained in operating order
in all nursing units and provide visible and audible signal
communication between nursing personnel and patients. Extension
cords to each patient's bed shall be readily accessible to patients
at all times.
(g) (1) If a facility has a significant beneficial interest in an
ancillary health service provider or if a facility knows that an
ancillary health service provider has a significant beneficial
interest in the facility, as provided by subdivision (a) of Section
1323, or if the facility has a significant beneficial interest in
another facility, as provided by subdivision (c) of Section 1323, the
facility shall disclose that interest in writing to the patient, or
his or her representative, and advise the patient, or his or her
representative, that the patient may choose to have another ancillary
health service provider, or facility, as the case may be, provide
any supplies or services ordered by a member of the medical staff of
the facility.
(2) A facility is not required to make any disclosures required by
this subdivision to any patient, or his or her representative, if
the patient is enrolled in an organization or entity which provides
or arranges for the provision of health care services in exchange for
a prepaid capitation payment or premium.
(h) (1) If a resident of a long-term health care facility has been
hospitalized in an acute care hospital and asserts his or her rights
to readmission pursuant to bed hold provisions or readmission rights
of either state or federal law and the facility refuses to readmit
him or her, the resident may appeal the facility's refusal.
(2) The refusal of the facility as described in this subdivision
shall be treated as if it were an involuntary transfer under federal
law and the rights and procedures that apply to appeals of transfers
and discharges of nursing facility residents shall apply to the
resident's appeal under this subdivision.
(3) If the resident appeals pursuant to this subdivision, and the
resident is eligible under the Medi-Cal program, the resident shall
remain in the hospital and the hospital may be reimbursed at the
administrative day rate, pending the final determination of the
hearing officer, unless the resident agrees to placement in another
facility.
(4) If the resident appeals pursuant to this subdivision, and the
resident is not eligible under the Medi-Cal program, the resident
shall remain in the hospital if other payment is available, pending
the final determination of the hearing officer, unless the resident
agrees to placement in another facility.
(5) If the resident is not eligible for participation in the
Medi-Cal program and has no other source of payment, the hearing and
final determination shall be made within 48 hours.
SEC. 34. Section 14124.7 of the Welfare and Institutions Code is
amended to read:
14124.7. (a) No long-term health care facility participating as a
provider under the Medi-Cal program shall seek to evict out of the
facility or, effective January 1, 2002, transfer within the facility,
any resident as a result of the resident changing his or her manner
of purchasing the services from private payment or Medicare to
Medi-Cal, except that a facility may transfer a resident from a
private room to a semiprivate room if the resident changes to
Medi-Cal payment status. This section also applies to residents who
have made a timely and good faith application for Medi-Cal benefits
and for whom an eligibility determination has not yet been made.
(b) This section does not apply to any resident of a skilled
nursing facility or intermediate care facility, receiving respite
care services, as defined in Section 1418.1 of the Health and Safety
Code, unless it is already being provided through a Medicaid waiver
program pursuant to Section 1396n of Title 42 of the United States
Code, or is already allowed as a covered service by the Medi-Cal
program.
(c) Nothing in this section shall limit a facility's ability to
transfer a resident within a facility, as provided by law, because of
a change in a resident's health care needs or if the bed retention
would result in there being no available Medicare-designated beds
within a facility.
(d) This section shall be implemented only to the extent it does
not conflict with federal law.
SEC. 35. Section 14126.02 is added to the Welfare and Institutions
Code, to read:
14126.02. (a) It is the intent of the Legislature to devise a
Medi-Cal long-term care reimbursement methodology that more
effectively ensures individual access to appropriate long-term care
services, promotes quality resident care, advances decent wages and
benefits for nursing home workers, supports provider compliance with
all applicable state and federal requirements, and encourages
administrative efficiency.
(b) (1) The department shall review the current Medi-Cal
reimbursement system to evaluate the extent to which the methodology
supports the objectives stated in subdivision (a). The scope of the
review shall encompass the structure currently used for peer groups,
audits, projections, updates and other rate development factors that
have an impact on the quality of care.
(2) The department shall examine several alternative rate
methodology models for a new Medi-Cal reimbursement system for
skilled nursing facilities to include, but not be limited to,
consideration of the following:
(A) Classification of residents based on the resource utilization
group system or other appropriate acuity classification system.
(B) Facility specific case mix factors.
(C) Direct care labor based factors.
(D) Geographic or regional differences in the cost of operating
facilities and providing resident care.
(c) The department shall submit to the Legislature a formal report
and proposal for any statutory changes necessary to implement
recommendations related to best meeting the objectives stated in
subdivision (a) and the costs associated with any changes.
(d) The alternatives for a new system described in paragraph (2)
of subdivision (b) shall be developed in consultation with recognized
experts with experience in long-term care reimbursement, economists,
the Attorney General, the federal Health Care Financing
Administration, and other interested parties.
(e) In implementing this section, the department may contract as
necessary, on a bid or nonbid basis, for professional consulting
services from nationally recognized higher education and research
institutions, or other qualified individuals and entities not
associated with a skilled nursing facility, with demonstrated
expertise in long-term care reimbursement systems. The review
specified in subdivision (b) shall be conducted with all possible
expedience. This subdivision establishes an accelerated process for
issuing contracts pursuant to this section and contracts entered into
pursuant to this subdivision shall be exempt from the requirements
of Chapter 1 (commencing with Section 10100) and Chapter 2
(commencing with Section 10290) of Part 2 of Division 2 of the Public
Contracts Code.
SEC. 36. (a) The sum of five hundred thousand dollars ($500,000)
is hereby appropriated from the General Fund to the State Department
of Health Services without regard to fiscal years for the purpose of
implementing Section 14126.02 of the Welfare and Institutions Code.
(b) It is the intent of the Legislature that the amount of the
appropriation specified in subdivision (a) be matched by federal
funds.
SEC. 37. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB 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 XIIIB of the California Constitution.