BILL ANALYSIS �
SB 135
Page 1
SENATE THIRD READING
SB 135 (Ed Hernandez)
As Amended August 24, 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 licensing category of "hospice facility"
defined as a health facility with a capacity of no more than
24 beds that is licensed by the Department of Public Health
(DPH), and provides hospice services including, but not
limited to: a) routine care; b) continuous care; c) inpatient
respite care and inpatient hospice care as defined in existing
law; and, d) is operated by a provider of hospice services
that is licensed pursuant to existing law and certified
pursuant to federal Medicare Conditions of Participation
(MCP).
2)Requires a hospice facility to be separately licensed,
irrespective of the location of the facility. Permits 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
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residential care facility. Permits DPH to issue a provisional
license to a hospice facility for a period of up to one year.
3)Requires DPH to establish a licensure fee for hospice
facilities. Requires in the first year of licensure for
hospice providers, the licensure fee to be equivalent to the
licensure fee for congregate living health facilities (CLHFs)
during the same year. Requires, thereafter, the licensure fee
for hospice providers to be established pursuant to the
provisions of this bill.
4)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.
5)Requires hospice facilities to comply with federal Centers for
Medicare and Medicaid Services (CMS) hospice regulations.
Permits DPH, until it adopts regulations to implement this
bill's provisions, to use CMS hospice care regulations for the
hospice facility licensure requirements.
6)Defines "inpatient hospice care" to mean hospice care that is
provided to patients in a hospice facility, including routine,
continuous and inpatient care directly as specified by MCP.
Permits short-term inpatient respite care, as specified by
existing law, to be included in this definition.
7)Prohibits a person, governmental agency, or political
subdivision of the state from being licensed as a hospice
facility unless the person or entity is a provider of hospice
services licensed under existing law and is certified by MCP.
8)Establishes DPH application requirements and other
administrative procedures for hospice facility licensure.
9) Permits a hospice facility that participates in the
Medicare and Medicaid programs to obtain initial
certification from a CMS-approved accreditation
organization.
10) Clarifies building and physical environment requirements
for hospice facilities, both freestanding, and those that
operate within, adjacent to, physically connected to, or on
the grounds of another facility.
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11) Requires a freestanding hospice facility to meet the
fire protection standards set forth in MCP, until OSHPD, in
consultation with the Office of the State Fire Marshall,
develops and adopts building standards for hospice
facilities. Requires a hospice facility located within the
physical plant of another licensed health facility to meet
building standards for that category of health facility
within which the hospice facility is located.
12) Prohibits a private or public organization, including,
but not limited to, a partnership, corporation, or
political subdivision of the state, or other governmental
agency within the state, to do any of the following without
a license issued pursuant to the provisions of this bill:
a) Represent itself to be a hospice facility by its name or
advertisement, soliciting, or any other presentments to the
public, or in the context of services within the scope of
the provisions of this bill imply that it is licensed to
provide those services or to make any reference to employee
bonding in relation to those services;
b) Use the words "hospice facility," "hospice home,"
"hospice-facility," or any combination of those terms,
within its name; or,
c) Use words to imply that it is licensed as a hospice
facility to provide those services.
13) Requires the hospice facility to be responsible for
obtaining criminal background checks for employees,
volunteers, and contractors in accordance with MCP and in
accordance with state law. Requires the hospice facility
licensee to pay the costs of obtaining a criminal
background check.
14) Requires a hospice facility to provide a home-like
environment that is comfortable and accommodating to both
the patient and 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.
15) Establishes the services and requirements required by a
hospice program to be licensed as a hospice facility.
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16) Defines "inpatient hospice care" to mean hospice care
that is provided to patients in a hospice facility,
including routine, continuous and inpatient care directly
as specified by the MCP. Permits short-term inpatient
respite care, as specified by existing law, to be included
in this definition.
17) Establishes minimum staffing standards that require at
least one registered nurse to be on duty 24 hours a day and
a maximum of six patients assigned at any given time per
direct caregiver.
18) Defines "direct caregiver" other than a registered nurse
to mean a licensed vocational nurse and a certified nurse
assistant.
19) Adopts for hospice facilities patient rights provisions,
mirroring the patients' rights information provided to
skilled nursing facilities (SNFs) and intermediate care
facilities to ensure that patients are advised of their
fundamental rights and the obligations of the facility.
20)Excludes from the definition in existing law for "hospital
building" any freestanding building used, or designed to be
used, as a CLHF or hospice facility.
21)Makes conforming changes to avoid chaptering out problems
with SB 1228 (Alquist) of 2012 regarding licensure for small
house SNFs.
22)Makes other technical and clarifying changes.
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
terminal illness, and to provide supportive care to the
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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.
COMMENTS : According to the author, this bill would allow a
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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: 0005649
SB 135
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