BILL NUMBER: SB 675	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 23, 2015
	AMENDED IN SENATE  APRIL 21, 2015

INTRODUCED BY   Senator Liu
    (   Coauthor:   Senator   Wolk
  ) 

                        FEBRUARY 27, 2015

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



	LEGISLATIVE COUNSEL'S DIGEST


   SB 675, as amended, Liu.  Health facilities: 
 Hospitals:  family caregivers.
   Existing law requires the State Department of Public Health to
license and regulate health facilities, defined to mean a facility,
place, or building that is organized, maintained, and operated for
the diagnosis, care, prevention, and treatment of human illness, as
specified. Existing law requires hospitals, among other things, to
have a written discharge planning policy and process that requires
appropriate arrangements to be made for posthospital care. A
violation of those provisions is a crime.
   This bill  would, subject to the federal Health Insurance
Portability and Accountability Act of 1996,   would
 require a hospital to take specified actions relating to family
caregivers, including, among others, notifying the family caregiver
of the patient's discharge or transfer to another facility and
providing information  or instruction   and
counseling  regarding the posthospital care needs of the
 patient   patient, if the patient has consented
to the disclosure of this information . By expanding the scope
of a crime, this bill would impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
   
  SECTION 1.    Section 1262.55 is added to the
Health and Safety Code, immediately following Section 1262.5, to
read:
   1262.55.  (a) Subject to the provisions of the federal Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec.
300gg), a hospital shall do all of the following:
   (1) Provide an opportunity for an individual patient who has been
admitted to the hospital as an inpatient to identify one family
caregiver who may assist in posthospital care, and record that
information in the patient's medical chart.
   (A) In the event that the patient is unconscious or otherwise
incapacitated upon admittance to the hospital, the hospital shall
provide the patient or patient's legal guardian with an opportunity
to designate a caregiver within a specified time period, at the
discretion of the attending physician, following the patient's
recovery of consciousness or capacity. The hospital shall promptly
document the attempt in the patient's medical record.
   (B) In the event that the patient or legal guardian declines to
designate a caregiver pursuant to this section, the hospital shall
promptly document this declination in the patient's medical record,
when appropriate.
   (2) Notify the patient's designated family caregiver of the
patient's discharge or transfer to another facility as soon as
possible and, in any event, upon issuance of a discharge order by the
patient's attending physician. If the hospital is unable to contact
the designated caregiver, the lack of contact shall not interfere
with, delay, or otherwise affect the medical care provided to the
patient or an appropriate discharge of the patient. The hospital
shall promptly document the attempted notification in the patient's
medical record.
   (3) Provide an opportunity for the patient and his or her
designated family caregiver to engage in the discharge planning
process, which shall include providing information or instruction
regarding the posthospital care needs of the patient, and education
and counseling about the patient's medications, including dosing and
proper use of medication delivery devices, when applicable. This
instruction shall be provided in a culturally competent manner and in
a language that is comprehensible to the patient and caregiver,
consistent with the requirements of state and federal law.
   (4) Provide contact information for any health care service,
community resource, or other service necessary to successfully carry
out the care plan.
   (b) Discharge planning policies adopted by a hospital in
accordance with this section shall ensure that planning is
appropriate to the condition of the patient being discharged from the
hospital and to the discharge destination and meets the needs and
acuity of patients and the abilities of the designated family
caregiver.
   (c) This section does not require a hospital to do either of the
following:
   (1) Adopt a policy that would delay discharge or transfer of a
patient.
   (2) Disclose information if the patient has not provided consent
that meets the standards required by state and federal laws governing
the privacy and security of protected health information.
   (d) For the purposes of this section, "family caregiver" means a
relative, friend, or neighbor who provides assistance related to an
underlying physical or mental disability but who is unpaid for those
services. 
   SECTION 1.    Section 1262.5 of the   Health
and Safety Code   is amended to read: 
   1262.5.  (a) Each hospital shall have a written discharge planning
policy and process.
   (b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to  discharge for
those patients who are likely to suffer adverse health consequences
upon discharge if there is no adequate discharge planning. If the
hospital determines that the patient and family members or interested
persons need to be counseled to prepare them for posthospital care,
the hospital shall provide for that counseling.   the
discharge of each patient.  
   (c) As part of the discharge planning process, the hospital shall
provide each patient who has been admitted to the hospital as an
inpatient with an opportunity to identify one family caregiver who
may assist in posthospital care, and shall record this information in
the patient's medical chart.  
   (A) In the event that the patient is unconscious or otherwise
incapacitated upon admittance to the hospital, the hospital shall
provide the patient or patient's legal guardian with an opportunity
to designate a caregiver within a specified time period, at the
discretion of the attending physician, following the patient's
recovery of consciousness or capacity. The hospital shall promptly
document the attempt in the patient's medical record.  
   (B) In the event that the patient or legal guardian declines to
designate a caregiver pursuant to this section, the hospital shall
promptly document this declination in the patient's medical record,
when appropriate.  
   (d) The policy required by subdivision (a) shall require that the
patient's designated family caregiver be notified of the patient's
discharge or transfer to another facility as soon as possible and, in
any event, upon issuance of a discharge order by the patient's
attending physician. If the hospital is unable to contact the
designated caregiver, the lack of contact shall not interfere with,
delay, or otherwise affect the medical care provided to the patient
or an appropriate discharge of the patient. The hospital shall
promptly document the attempted notification in the patient's medical
record.  
   (c) 
    (e)  The process required by subdivision (a) shall
require that the patient  and family caregiver  be 
informed, orally or in writing,   informed  of the
continuing health care requirements following discharge from the
hospital. The right to information regarding continuing health care
requirements following discharge shall  also  apply to the
person who has legal responsibility to make decisions regarding
medical care on behalf of the patient, if the patient is unable to
make those decisions for himself or herself.  In addition, a
patient may request that friends or family members be given this
information, even if the patient is able to make his or her own
decisions regarding medical care.   The hospital shall
provide an opportunity for the patient and his or her designated
family caregiver to engage in the discharge planning process, which
shall include providing   information and, when appropriate,
instruction regarding th   e posthospital care needs of the
patient. This information shall include, but is not limited to,
education and counseling about the patient's medications, including
dosing and proper use of medication delivery devices, when
applicable. The information shall be provided in a culturally
competent manner and in a language that is comprehensible to the
patient and caregiver, consistent with the requirements of state and
federal law, and shall include an opportunity for the caregiver to
ask questions about the posthospital care needs of the patient. 

   (d) 
    (f)  (1) A transfer summary shall accompany the patient
upon transfer to a skilled nursing or intermediate care facility or
to the distinct part-skilled nursing or intermediate care service
unit of the hospital. The transfer summary shall include essential
information relative to the patient's diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.
   (2) A copy of the transfer summary shall be given to the patient
and the patient's legal representative, if any, prior to transfer to
a skilled nursing or intermediate care facility. 
   (e) 
    (g)  A hospital shall establish and implement a written
policy to ensure that each patient receives, at the time of
discharge, information regarding each medication dispensed, pursuant
to Section 4074 of the Business and Professions Code. 
   (f) 
    (h)  A hospital shall provide every patient anticipated
to be in need of long-term care at the time of discharge with contact
information for at least one public or nonprofit agency or
organization dedicated to providing information or referral services
relating to community-based long-term care options in the patient's
county of residence and appropriate to the needs and characteristics
of the patient. At a minimum, this information shall include contact
information for the area agency on aging serving the patient's county
of residence, local independent living centers, or other information
appropriate to the needs and characteristics of the patient.

   (g) 
    (i)  A contract between a general acute care hospital
and a health care service plan that is issued, amended, renewed, or
delivered on or after January 1, 2002, may not contain a provision
that prohibits or restricts any health care facility's compliance
with the requirements of this section. 
   (j) Discharge planning policies adopted by a hospital in
accordance with this section shall ensure that planning is
appropriate to the condition of the patient being discharged from the
hospital and to the discharge destination and meets the needs and
acuity of patients.  
   (k) This section does not require a hospital to do either of the
following: 
   (1) Adopt a policy that would delay discharge or transfer of a
patient.  
   (2) Disclose information if the patient has not provided consent
that meets the standards required by state and federal laws governing
the privacy and security of protected health information.  

   (l) This section does not supersede or modify any privacy and
information security requirements and protections in federal and
state law regarding protected health information or personally
identifiable information, including, but not limited to, the federal
Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. Sec. 300gg).  
   (m) For the purposes of this section, "family caregiver" means a
relative, friend, or neighbor who provides assistance related to an
underlying physical or mental disability but who is unpaid for those
services. 
  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.