BILL NUMBER: AB 1211 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 24, 2015
INTRODUCED BY Assembly Member Maienschein
FEBRUARY 27, 2015
An act to amend Section 1569.156 1250
of the Health and Safety Code, relating to residential
care facilities for the elderly health facilities
.
LEGISLATIVE COUNSEL'S DIGEST
AB 1211, as amended, Maienschein. Residential care
facilities for the elderly: Health care facilities:
congregate living health facility.
Existing law provides for the licensure and regulation by the
State Department of Public Health of health facilities, including
congregate living health facilities. A violation of these provisions
is a misdemeanor. For this purpose, existing law defines "congregate
living health facility" as a residential home with a capacity of no
more than 12 beds, that provides inpatient care and skilled nursing
care on a recurring, intermittent, extended, or continuous basis.
This bill would include in the definition of congregate living
health facility a residential home with a capacity of no more than 18
beds that provides inpatient and skilled nursing care, as specified.
By increasing the definition of a crime, this bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Existing law provides for the licensure of residential care
facilities for the elderly by the State Department of Social
Services. Existing law requires a residential care facility for the
elderly to take certain actions with respect to advance directives,
including providing written information, upon admission, about the
right to make decisions concerning medical care, including the right
to accept or refuse medical or surgical treatment and the right,
under state law, to formulate advance directives and not conditioning
the provision of care or otherwise discriminating based on whether
or not an individual has executed an advance directive. Existing law
defines advance directive, for this purpose, to include advance
health care directives or some other form of instruction recognized
under state law specifically addressing the provision of health care.
Violation of these provisions is a crime.
This bill would specifically include in the definition of advance
directive a request regarding resuscitative measures, as defined. By
expanding the definition of a crime, this bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1250 of the Health
and Safety Code is amended to read:
1250. As used in this chapter, "health facility" means a
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. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental Center
may, until June 30, 2007, provide surgery and anesthesia services
through a contract or agreement with another acute care hospital.
Notwithstanding the requirements of this subdivision, a general acute
care hospital operated by the Department of Corrections and
Rehabilitation or the Department of Veterans Affairs may provide
surgery and anesthesia services during normal weekday working hours,
and not provide these services during other hours of the weekday or
on weekends or holidays, if the general acute care hospital otherwise
meets the requirements of this section.
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 persons with mental health
disorders 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) (1) "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.
(2) "Skilled nursing facility" includes a "small house skilled
nursing facility (SHSNF)," as defined in Section 1323.5.
(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 persons with developmental
disabilities 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 persons with
developmental disabilities 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 persons with developmental disabilities 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 with developmental disabilities or who 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 12 18 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 or
more of the following services:
(A) Services for persons who are mentally alert, persons with
physical disabilities, 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 person who is catastrophically and severely disabled
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 person who is catastrophically disabled
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, or
located in a county of the 16th class pursuant to Section 28020 of
the Government Code, may have not more than 25 beds for the purpose
of serving persons who are terminally ill.
(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 18 beds for the purpose of serving
persons who are catastrophically and severely disabled.
(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 and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the 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 who 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 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 Department of Corrections and
Rehabilitation 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 nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act (42
U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal
Medicaid Program under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.), 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 and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, 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.
(m) "Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)" means a homelike facility
with a capacity of four to eight, inclusive, beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
continuous needs for skilled nursing care and have been certified by
a physician and surgeon as warranting 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.
ICF/DD-CN facilities shall be subject to licensure under this chapter
upon adoption of licensing regulations in accordance with Section
1275.3. A facility providing continuous skilled nursing services to
persons with developmental disabilities pursuant to Section 14132.20
or 14495.10 of the Welfare and Institutions Code shall apply for
licensure under this subdivision within 90 days after the regulations
become effective, and may continue to operate pursuant to those
sections until its licensure application is either approved or
denied.
(n) "Hospice facility" means a health facility licensed pursuant
to this chapter with a capacity of no more than 24 beds that provides
hospice services. Hospice services include, but are not limited to,
routine care, continuous care, inpatient respite care, and inpatient
hospice care as defined in subdivision (d) of Section 1339.40, and is
operated by a provider of hospice services that is licensed pursuant
to Section 1751 and certified as a hospice pursuant to Part 418 of
Title 42 of the Code of Federal Regulations.
SEC. 2. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SECTION 1. Section 1569.156 of the Health and
Safety Code is amended to read:
1569.156. (a) A residential care facility for the elderly shall
do all of the following:
(1) Not condition the provision of care or otherwise discriminate
based on whether or not an individual has executed an advance
directive, consistent with applicable laws and regulations.
(2) Provide education to staff on issues concerning advance
directives.
(3) Provide written information, upon admission, about the right
to make decisions concerning medical care, including the right to
accept or refuse medical or surgical treatment and the right, under
state law, to formulate advance directives.
(4) Provide written information about policies of the facility
regarding the implementation of the rights described in paragraph
(3).
(b) For purposes of this section, "advance directive" means an
"advance health care directive," as defined in Section 4605 of the
Probate Code, or some other form of instruction recognized under
state law specifically addressing the provision of health care,
including a request regarding resuscitative measures, as defined in
Section 4780 of the Probate Code.
SEC. 2. No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.