BILL ANALYSIS �
SB 135
Page 1
SENATE THIRD READING
SB 135 (Ed Hernandez)
As Amended August 7, 2012
Majority vote
SENATE VOTE :31-2
HEALTH 16-0 APPROPRIATIONS 16-0
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|Ayes:|Monning, Logue, Atkins, |Ayes:|Gatto, Harkey, |
| |Bonilla, Eng, Garrick, | |Blumenfield, Bradford, |
| |Gordon, Hayashi, Roger | |Charles Calderon, Campos, |
| |Hern�ndez, Bonnie | |Davis, Fuentes, Hall, |
| |Lowenthal, Mansoor, | |Hill, Cedillo, Mitchell, |
| |Mitchell, Nestande, Pan, | |Nielsen, Norby, Solorio, |
| |Silva, Williams | |Wagner |
| | | | |
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SUMMARY : Establishes a new health facility licensing category
of hospice facility, and permits a licensed and certified
hospice services provider to provide inpatient hospice services
through the operation of a hospice facility, either as a
free-standing health facility, or adjacent to, physically
connected to, or on the building grounds of another health
facility or a residential care facility. Specifically, this
bill :
1)Establishes a new licensure category of a "hospice facility"
defined as a facility with no more than 24 beds that is
licensed by the Department of Public Health (DPH), and is
operated by a licensed and certified provider of hospice
services. Provides that only a hospice licensed and certified
in California may apply with DPH for a hospice facility
license.
2)Requires a hospice facility to be separately licensed,
irrespective of the location of the facility. Allows a
hospice facility to operate as a freestanding health facility,
and also to be located adjacent to, physically connected to,
or on the building grounds of another health facility or
residential care facility.
3)Allows a hospice provider, that provides short-term inpatient
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respite or inpatient care directly in the hospice provider's
facility prior to the effective date of regulations to
implement this bill, to continue to be licensed as a specialty
hospital, skilled nursing facility (SNF), or congregate living
health facility (CLHF).
4)Requires a hospice facility to meet the fire protection
standards set forth in the Medicare Conditions of
Participation (COP), and to meet the same building standards
as a CLHF, until of the Office of Statewide Health and
Planning Development (OSHPD), in consultation with the Office
of the State Fire Marshall, develops and adopts building
standards for hospice facilities.
5)Requires a hospice facility to provide evidence of compliance
with local building codes or if a hospice facility is located
adjacent to, physically connected to, or on the building
grounds of another facility to provide evidence of compliance
with building standards for the other facility if those are
more stringent.
6)Requires the hospice facility to be responsible for obtaining
criminal background checks for employees, volunteers, and
contractors in accordance with federal Medicare COP and in
accordance with state law. Further requires the hospice
facility licensee to pay the costs of obtaining a criminal
background check.
7)Requires a hospice facility to provide a home-like environment
that is comfortable and accommodating to both the patient and
the patient's visitors, and to continue to provide services to
family and friends after the patient's stay in the hospice
facility in accordance with the patient's plan of care.
8)Establishes the services and requirements required by a
hospice program to be licensed as a hospice facility.
Requires DPH to adopt regulations by January 1, 2017, to
establish these standards, and requires the regulations to
include the following:
a) Minimum staffing standards that require at least one
licensed nurse to be on duty 24 hours per day and a maximum
of six patients at any given time per direct care staff
person. Requires a registered nurse to be available for
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consultation and able to come into the facility within 30
minutes, if necessary, when no registered nurse is on duty.
b) Patient rights provisions, mirroring the patients'
rights information provided to skilled nursing facilities,
as well as all of the following:
i) Full information regarding the patient's health
status and options for end-of-life care;
ii)
Care that reflects individual preferences regarding
end-of-life care, including the right to refuse any
treatment or procedure;
iii)
Treatment with consideration, respect, and full
recognition of dignity and individuality, including
privacy in treatment and care of personal needs; and,
iv)
Entitlement to visitors of the patient's choosing, at any
time the patient
chooses, and ensured privacy for those visits.
c) A disaster preparedness plan for both internal and
external disasters that protect hospice patients,
employees, and visitors.
9)Requires facilities to comply with the federal Centers for
Medicare and Medicaid Services (CMS) hospice care regulations.
Further allows DPH, until it adopts regulations to implement
this bill's provisions, to use CMS hospice care regulations
for hospice facility licensure requirements.
10)Requires a hospice facility to demonstrate the ability to
meet licensing requirements and to be fully responsible for
meeting all licensing requirements, regardless of whether
those requirements are met through direct provision of
services by the facility or under contract with another
entity.
11)Requires DPH to establish a licensure fee for hospice
facilities. Allows the licensure fee to be equivalent to the
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licensure fee of a CLHF during the first year of licensure for
hospice facilities.
12)Requires DPH to conduct a licensing inspection on each
hospice facility at least once every two years and establishes
penalties for licensing violations that are equivalent to
existing CLHF licensing violation penalties. Further
establishes penalties for medical privacy breeches that are
currently applicable to CLHFs.
13)Requires hospice facilities to report data elements such as
assets, liabilities, a statement of income, revenue by payer,
and other data elements defined in current statute.
14)Establishes several definitions, including defining an
"interdisciplinary team" that is to be coordinated by a
registered nurse and under medical direction. Defines
"multiple location" to mean a location or site from which a
hospice makes available basic hospice services within the
service area of the parent agency. Further defines "parent
agency" to be the part of the hospice that is licensed
pursuant to this chapter and that develops and maintains
administrative control of multiple locations. Also defines
"palliative care" as services that have the primary purpose of
preventing or relieving suffering and enhancing the quality of
life, rather than curing the disease.
15)Makes several legislative declarations related to hospice
care, including that permitting the establishment of licensed
hospice facilities is consistent with federal legal
affirmations of the right of an individual to refuse
life-sustaining treatment and that each person's preferences
about his or her end-of-life care should be considered.
EXISTING LAW :
1)Provides for the licensure and regulation of health
facilities, including hospitals, skilled nursing facilities,
and CLHFs by DPH.
2)Requires persons or agencies providing hospice services to be
licensed by DPH and defines hospice as a specialized form of
interdisciplinary health care that is designed to provide
palliative care, alleviate the physical, emotional, social,
and spiritual discomforts of an individual diagnosed with a
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terminal illness, and to provide supportive care to the
primary caregiver and the family.
3)Requires, to the extent appropriate, that hospice services be
provided in the patient's home or primary place of residence,
based on the medical needs of the patient. Also requires
hospices to make arrangements for inpatient care as needed by
the patient.
4)Establishes DPH Licensing and Certification (L&C) program fees
for health facilities, including hospice.
5)Includes hospice care as a covered benefit under Medicare and
Medi-Cal, under specified conditions, including that an
individual is certified as terminally ill and his or her life
expectancy is six months or less.
6)Defines a CLHF to be a residential home with a capacity of no
more than 12 beds that provides inpatient care, medical
supervision, 24-hour skilled nursing, and supportive care.
7)Provides that the primary needs of CLHF residents is for
skilled nursing care on a recurring, intermittent, extended,
or continuous basis, and provides that this care is generally
less intense than that provided in general acute care
hospitals but more intense than that provided in SNFs.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill will result in the following costs:
1)One-time fee-supported special fund costs (L&C Fund) of
$500,000 over three years to DPH to promulgate regulations and
develop standards and protocols for hospice facilities.
2)$200,000 (L&C Fund) in one-time fee-supported special fund
costs for Information Technology (IT) modifications to
accommodate a new licensure category.
3)Annual workload costs related to facility licensure will
depend on the number of licenses issued by DPH, but will be
likely be at least $200,000 (L&C Fund).
4)Costs for OSHPD to review and develop hospice-specific
building standards should be minor and absorbable.
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COMMENTS : According to the author, this bill would allow a
licensed and certified hospice program to operate an inpatient
facility within its hospice license. The author states that
California currently does not allow hospice providers to operate
an independent, stand-alone inpatient hospice facility. The
author maintains that approximately 95% of all hospice care is
provided to patients residing in their own home because that is
where most people wish to be. In those instances, however,
where a patient cannot remain in their own home due to safety
concerns or lack of caregivers, hospices need the flexibility to
provide their services in facilities that are as homelike and
residential as possible.
The author states that currently, hospice providers who wish to
provide inpatient hospice directly must be licensed as a CLHF, a
SNF, or a specialty hospice, none of which are consistent with
the provision of hospice care. If the hospice is providing care
in another health or residential care facility, the hospice
program can only provide hospice services, and may not provide
any other services to the patient. This makes the hospice
dependent on the health or residential facility for much of the
patient's care. The author believes that this can lead to
discontinuity of care in some cases.
The author states that this bill does not change the available
options, but simply adds another option. By establishing a new
category of hospice facility, hospice programs will be able to
operate their own facility with standards that are tailored to
hospice care. This will result in continuity of care that is
consistent with the patient's wishes and appropriate for
end-of-life care in a home-like environment that permits
visitors at any time of day, a safe environment for those who
may not have family or friends to provide care, and the
opportunity for patients to stay in their residential community,
if they live in a residential care setting.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0004970
SB 135
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