BILL NUMBER: AB 950AMENDED BILL TEXT AMENDED IN SENATE MARCH 25, 2010 AMENDED IN ASSEMBLY JUNE 2, 2009 AMENDED IN ASSEMBLY APRIL 22, 2009 AMENDED IN ASSEMBLY APRIL 14, 2009 INTRODUCED BY Assembly Member Hernandez FEBRUARY 26, 2009 An act to amend Sections 1250,1250.1, 1746, 128700, and 128755 of, and to add Sections 1749.1 and 1749.3 to,1265.7, 1267.13, and 1267.15 of the Health and Safety Code, relating to hospice care. LEGISLATIVE COUNSEL'S DIGEST AB 950, as amended, Hernandez. Hospice providers: licensed hospice facilities. Under existing law, the State Department of Public Health licenses and regulates healthcarefacilities, includingadult residential facilities, residential care facilities, and residential care facilities for the elderlyskilled nursing facilities, intermediate care facilities, and congregate living facilities . Under existing law, the department also licenses and regulates hospices and the provision of hospice services. Violation of these provisions is a crime. This bill would create a new health facility licensing category for, and require the department to license and regulate,hospice facilitiescongregate living health facility-hospices , as defined. It would impose various requirements on these fa cilities.Under existing law, any interested person may petition a state agency requesting the adoption of a regulation. Existing law requires the state agency to either deny the petition, as prescribed, or schedule the matter for a public hearing, as prescribed.This bill would permit the department to avoid drafting regulations required to implement the bill if the California Hospice and Palliative Care Association drafts the regulations, as specified, and submits the draft regulations as a petition for regulation for the department's review and approval.Because this bill would create a new crime, it 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. The Legislature finds and declares all of the following: (a) Hospice is a special type of health care service designed to provide palliative care and to alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to terminal illness. (b) Hospice services provide supportive care to the primary caregiver and family of the patient. (c) Hospice services are provided primarily in the home, but can also be provided in residential care or in health facility inpatient settings. (d) Persons who do not have family or caregivers who are able to provide care in the home should be able to have care provided in a home-like environment, rather than in an institutional setting, if that is their preference. (e) Permitting the establishment of licensed hospice facilities provides additional care and treatment options for persons who are at the end of life. (f) The establishment of licensed hospice facilities is permitted under federal law and by many other states. (g) 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. (h) Permitting the establishment of licensed hospice facilities is also consistent with the decision of the United States Supreme Court in Olmstead v. L.C. by Zimring (1999) 527 U.S. 581, which held that persons with disabilities have the right to live in the most integrated setting possible with appropriate access to care and choice of community-based services and placement options. (i) It is the intent of the Legislature to permit the licensure of hospice inpatient facilities in order to improve access to care, to provide additional care options, and to provide for a home-like environment within which to provide care and treatment for persons who are experiencing the last phases of life.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. 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 who 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 who 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 12 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 and Rehabilitation, 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 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 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 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 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 and Rehabilitation, 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) "Hospice facility" means a facility licensed pursuant to Sections 1749.1 and 1749.3.SEC. 3.Section 1250.1 of the Health and Safety Code is amended to read: 1250.1. (a) The state department shall adopt regulations that define all of the following bed classifications for health facilities: (1) General acute care. (2) Skilled nursing. (3) Intermediate care-developmental disabilities. (4) Intermediate care--other. (5) Acute psychiatric. (6) Specialized care, with respect to special hospitals only. (7) Chemical dependency recovery. (8) Intermediate care facility/developmentally disabled habilitative. (9) Intermediate care facility/developmentally disabled nursing. (10) Congregate living health facility. (11) Pediatric day health and respite care facility, as defined in Section 1760.2. (12) Correctional treatment center. For correctional treatment centers that provide psychiatric and psychological services provided by county mental health agencies in local detention facilities, the State Department of Mental Health shall adopt regulations specifying acute and nonacute levels of 24-hour care. Licensed inpatient beds in a correctional treatment center shall be used only for the purpose of providing health services. (13) Hospice facility. (b) Except as provided in Section 1253.1, beds classified as intermediate care beds, on September 27, 1978, shall be reclassified by the state department as intermediate care--other. This reclassification shall not constitute a "project" within the meaning of Section 127170 and shall not be subject to any requirement for a certificate of need under Chapter 1 (commencing with Section 127125) of Part 2 of Division 107, and regulations of the state department governing intermediate care prior to the effective date shall continue to be applicable to the intermediate care--other classification unless and until amended or repealed by the state department.SEC. 4.Section 1746 of the Health and Safety Code is amended to read: 1746. For purposes of this chapter, the following definitions apply: (a) "Bereavement services" means those services available to the surviving family members for a period of at least one year after the death of the patient, including an assessment of the needs of the bereaved family and the development of a care plan that meets these needs, both prior to and following the death of the patient. (b) "Home health aide" has the same meaning as set forth in subdivision (c) of Section 1727. (c) "Home health aide services" means those services described in subdivision (d) of Section 1727 that provide for the personal care of the terminally ill patient and the performance of related tasks in the patient's home in accordance with the plan of care in order to increase the level of comfort and to maintain personal hygiene and a safe, healthy environment for the patient. (d) "Hospice" means 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 who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets all of the following criteria: (1) Considers the patient and the patient's family, in addition to the patient, as the unit of care. (2) Utilizes an interdisciplinary team to assess the physical, medical, psychological, social, and spiritual needs of the patient and the patient's family. (3) Requires the interdisciplinary team to develop an overall plan of care and to provide coordinated care that emphasizes supportive services, including, but not limited to, home care, pain control, and limited inpatient services. Limited inpatient services are intended to ensure both continuity of care and appropriateness of services for those patients who cannot be managed at home because of acute complications or the temporary absence of a capable primary caregiver. (4) Provides for the palliative medical treatment of pain and other symptoms associated with a terminal disease, but does not provide for efforts to cure the disease. (5) Provides for bereavement services following death to assist the family in coping with social and emotional needs associated with the death of the patient. (6) Actively utilizes volunteers in the delivery of hospice services. (7) To the extent appropriate, based on the medical needs of the patient, provides services in the patient's home or primary place of residence. (e) "Hospice facility" means a health facility that has been licensed pursuant to Sections 1749.1 and 1749.3 by the department for the provision of hospice care, including routine care, continuous care, inpatient respite care, and general inpatient care. Hospice facility licensure shall be granted only to licensed and certified hospices licensed in California. (f) "Inpatient care arrangements" means arranging for those short inpatient stays that may become necessary to manage acute symptoms or because of the temporary absence, or need for respite, of a capable primary caregiver. The hospice shall arrange for these stays, ensuring both continuity of care and the appropriateness of services. (g) "Interdisciplinary team" means the hospice care team that includes, but is not limited to, the patient and patient's family, a physician and surgeon, a registered nurse, a social worker, a volunteer, and a spiritual caregiver. The team shall be coordinated by a registered nurse and shall be under medical direction. The team shall meet regularly to develop and maintain an appropriate plan of care. (h) "Medical direction" means those services provided by a licensed physician and surgeon who is charged with the responsibility of acting as a consultant to the interdisciplinary team, a consultant to the patient's attending physician and surgeon, as requested, with regard to pain and symptom management, and a liaison with physicians and surgeons in the community. (i) "Multiple location" means a location or site from which a hospice makes available basic hospice services within the service area of the parent agency. A multiple location shares administration, supervision, policies and procedures, and services with the parent agency in a manner that renders it unnecessary for the site to independently meet the licensing requirements. (j) "Palliative" refers to medical treatment, interdisciplinary care, or consultation provided to the patient or family members, or both, that has as its primary purpose preventing or relieving suffering and enhancing the quality of life, rather than curing the disease, as described in subdivision (b) of Section 1339.31, of a patient who has an end-stage medical condition. (k) "Parent agency" means the part of the hospice that is licensed pursuant to this chapter and that develops and maintains administrative controls of multiple locations. All services provided by the multiple locations and parent agency are the responsibility of the parent agency. (l) "Plan of care" means a written plan developed by the attending physician and surgeon, the medical director or physician and surgeon designee, and the interdisciplinary team that addresses the needs of a patient and family admitted to the hospice program. The hospice shall retain overall responsibility for the development and maintenance of the plan of care and quality of services delivered. (m) "Preliminary services" means those services authorized pursuant to subdivision (d) of Section 1749. (n) "Skilled nursing services" means nursing services provided by or under the supervision of a registered nurse under a plan of care developed by the interdisciplinary team and the patient's physician and surgeon to a patient and his or her family that pertain to the palliative, supportive services required by patients with a terminal illness. Skilled nursing services include, but are not limited to, patient assessment, evaluation and case management of the medical nursing needs of the patient, the performance of prescribed medical treatment for pain and symptom control, the provision of emotional support to both the patient and his or her family, and the instruction of caregivers in providing personal care to the patient. Skilled nursing services shall provide for the continuity of services for the patient and his or her family. Skilled nursing services shall be available on a 24-hour on-call basis. (o) "Social services/counseling services" means those counseling and spiritual care services that assist the patient and his or her family to minimize stresses and problems that arise from social, economic, psychological, or spiritual needs by utilizing appropriate community resources, and maximize positive aspects and opportunities for growth. (p) "Terminal disease" or "terminal illness" means a medical condition resulting in a prognosis of life of one year or less, if the disease follows its natural course. (q) "Volunteer services" means those services provided by trained hospice volunteers who have agreed to provide service under the direction of a hospice staff member who has been designated by the hospice to provide direction to hospice volunteers. Hospice volunteers may be used to provide support and companionship to the patient and his or her family during the remaining days of the patient's life and to the surviving family following the patient's death.SEC. 5.Section 1749.1 is added to the Health and Safety Code, to read: 1749.1. (a) (1) Only a hospice licensed and certified in California may apply for a hospice facility license. (2) On or after the effective date of regulations to implement this section, a hospice provider that seeks to provide short-term inpatient respite or inpatient care directly in the hospice provider's own facility shall submit an application for licensure as a hospice facility. (3) A hospice provider who provides short-term inpatient respite or inpatient care directly in the hospice provider's own facility prior to the effective date of regulations to implement this section may also continue to be licensed as a specialty hospital, skilled nursing facility, or congregate living health facility. (4) Each application for a new or renewed hospice facility license under this chapter shall be accompanied by an annual Licensing and Certification Program fee set in accordance with Section 1266. (5) A hospice facility shall be separately licensed, irrespective of the location of the facility. (b) Hospice facility licensees shall be responsible for obtaining criminal background checks for employees, volunteers, and contractors in accordance with federal Medicare conditions of participation (42 C.F.R. 418 et seq.) and as may be required in accordance with state law. The hospice facility licensee shall pay the costs of obtaining a criminal background check. (c) Building standards adopted pursuant to this section relating to fire and panic safety, and other regulations adopted pursuant to this section, shall apply uniformly throughout the state. No city, county, city and county, including a charter city or charter county, or fire protection district shall adopt or enforce any ordinance or local rule or regulation relating to fire and panic safety in buildings or structures subject to this section that is inconsistent with the rules and regulations adopted pursuant to this section. (d) The hospice facility shall meet the fire protection standards set forth in federal Medicare conditions of participation (42 C.F.R. 418 et seq.). A hospice facility shall meet the same building standards as a congregate living health facility as described in subparagraph (B) of paragraph (2) of subdivision (i) of Section 1250. (e) A hospice facility shall operate as a freestanding health facility, but may also be located adjacent to, physically connected to, or on the building grounds of, another health facility or residential care facility. A hospice facility shall not be required to submit construction plans to the Office of Statewide Health Planning and Development for new construction or renovation. As part of the application for licensure, the prospective licensee shall submit evidence of compliance with local building codes. In addition, the physical environment of the facility shall be adequate to provide the level of care and service required by the residents of the facility as determined by the department.SEC. 6.Section 1749.3 is added to the Health and Safety Code, to read: 1749.3. (a) In order for a hospice program to be licensed as a hospice facility, it shall provide, or make provision for, all of the following services and requirements: (1) Medical direction and adequate staff. (2) Skilled nursing services. (3) Palliative care. (4) Social services and counseling services. (5) Bereavement services. (6) Volunteer services. (7) Dietary services. (8) Pharmaceutical services. (9) Physical therapy, occupational therapy, and speech-language therapy. (10) Patient rights. (11) Disaster preparedness. (12) An adequate, safe, and sanitary physical environment. (13) Housekeeping services. (14) Patient medical records. (15) Other administrative requirements. (b) The department shall adopt regulations that establish standards for the provision of the services in subdivision (a). These regulations shall include, but are not limited to, all of the following: (1) 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 staffperson. (2) Patients rights provisions that provide each patient with all of the following: (A) Full information regarding his or her health status and options for end-of-life care. (B) Care that reflects individual preferences regarding end-of-life care, including the right to refuse any treatment or procedure. (C) Treatment with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and care of personal needs. (D) Entitlement to visitors of his or her choosing, at any time the patient chooses, and ensured privacy for those visits. (3) Disaster preparedness plans for both internal and external disasters that protect hospice patients, employees, and visitors, and reflect coordination with local agencies that are responsible for disaster preparedness and emergency response. (4) Additional qualifications and requirements for licensure above the requirements of this section and Section 1749.1. (c) The hospice facility shall provide a home-like environment that is comfortable and accommodating to both the patient and the patient's visitors. (d) The hospice facility shall 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. These services may be provided by the hospice program that operates the hospice facility. (e) The hospice facility shall demonstrate the ability to meet licensing requirements and shall be fully responsible for meeting all licensing requirements, regardless of whether those requirements are met through direct provision by the facility or under contract with another entity. The hospice facility's reliance on contractors to meet the licensing requirements does not exempt the hospice facility or in any way mitigate the hospice facility's responsibilities.SEC. 7.Section 128700 of the Health and Safety Code is amended to read: 128700. As used in this chapter, the following definitions apply: (a) "Ambulatory surgery procedures" means those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic. (b) "Commission" means the California Health Policy and Data Advisory Commission. (c) "Emergency department" means, in a hospital licensed to provide emergency medical services, the location in which those services are provided. (d) "Encounter" means a face-to-face contact between a patient and the provider who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient. (e) "Freestanding ambulatory surgery clinic" means a surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204. (f) "Health facility" or "health facilities" means all health facilities required to be licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2. (g) "Hospital" means all health facilities except skilled nursing, intermediate care, hospice facilities, and congregate living health facilities. (h) "Office" means the Office of Statewide Health Planning and Development. (i) "Risk-adjusted outcomes" means the clinical outcomes of patients grouped by diagnoses or procedures that have been adjusted for demographic and clinical factors.SEC. 8.Section 128755 of the Health and Safety Code is amended to read: 128755. (a) (1) Hospitals shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the office within four months after the close of the hospital's fiscal year except as provided in paragraph (2). (2) If a licensee relinquishes the facility license or puts the facility license in suspense, the last day of active licensure shall be deemed a fiscal year end. (3) The office shall make the reports filed pursuant to this subdivision available no later than three months after they were filed. (b) (1) Skilled nursing facilities, intermediate care facilities, intermediate care facilities/developmentally disabled, hospice facilities, and congregate living facilities, including nursing facilities certified by the state department to participate in the Medi-Cal program, shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the office within four months after the close of the facility's fiscal year, except as provided in paragraph (2). (2) (A) If a licensee relinquishes the facility license or puts the facility licensure in suspense, the last day of active licensure shall be deemed a fiscal year end. (B) If a fiscal year end is created because the facility license is relinquished or put in suspense, the facility shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 within two months after the last day of active licensure. (3) The office shall make the reports filed pursuant to paragraph (1) available not later than three months after they are filed. (4) (A) Effective for fiscal years ending on or after December 31, 1991, the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 shall be filed with the office by electronic media, as determined by the office. (B) Congregate living health facilities are exempt from the electronic media reporting requirements of subparagraph (A). (c) A hospital shall file the reports required by subdivision (g) of Section 128735 as follows: (1) For patient discharges on or after January 1, 1999, through December 31, 1999, the reports shall be filed semiannually by each hospital or its designee not later than six months after the end of each semiannual period, and shall be available from the office no later than six months after the date that the report was filed. (2) For patient discharges on or after January 1, 2000, through December 31, 2000, the reports shall be filed semiannually by each hospital or its designee not later than three months after the end of each semiannual period. The reports shall be filed by electronic tape, diskette, or similar medium as approved by the office. The office shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the office, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the office no later than 15 days after the date that the report is approved. (3) For patient discharges on or after January 1, 2001, the reports shall be filed by each hospital or its designee for report periods and at times determined by the office. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The office shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the office, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the office no later than 15 days after the date that the report is approved. (d) The reports required by subdivision (a) of Section 128736 shall be filed by each hospital for report periods and at times determined by the office. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The office shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the office, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the office no later than 15 days after the report is approved. (e) The reports required by subdivision (a) of Section 128737 shall be filed by each hospital or freestanding ambulatory surgery clinic for report periods and at times determined by the office. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The office shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the office, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the office no later than 15 days after the report is approved. (f) Facilities shall not be required to maintain a full-time electronic connection to the office for the purposes of online transmission of reports as specified in subdivisions (c), (d), and (e). The office may grant exemptions to the online transmission of data requirements for limited periods to facilities. An exemption may be granted only to a facility that submits a written request and documents or demonstrates a specific need for an exemption. Exemptions shall be granted for no more than one year at a time, and for no more than a total of five consecutive years. (g) The reports referred to in paragraph (2) of subdivision (a) of Section 128730 shall be filed with the office on the dates required by applicable law and shall be available from the office no later than six months after the date that the report was filed. (h) The office shall post on its Internet Web site and make available to any person a copy of any report referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and, in addition, shall make available in electronic formats reports referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and subdivisions (a) and (c) of Section 128745, unless the office determines that an individual patient's rights of confidentiality would be violated. The office shall make the reports available at cost.SEC. 9.The department is not required to draft the regulations required under this act if the California Hospice and Palliative Care Association drafts the necessary regulations, in consultation with the department and other state departments and stakeholders, and submits the draft regulations as a petition for regulation for the department's review and approval, pursuant to Sections 11340.6 and 11340.7 of the Government Code.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. 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 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 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 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, 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. (D) Services for persons who have a diagnosis of a terminal illness, or are eligible for hospice services, palliative, or preliminary care, as permitted under state law. (i) A facility that provides these services shall be known as a congregate living health facility-hospice. (ii) A congregate living health facility-hospice shall be owned by and licensed to a hospice licensed and certified in California to provide routine and continuous care, as defined by the federal Centers for Medicare and Medicaid Services. (iii) A congregate living health facility-hospice may also provide short-term respite care, inpatient care directly, or other optional services, pursuant to subparagraph (F) of paragraph (2) of subdivision (n) of Section 1267.13. (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 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 beds for the purpose of serving persons who are catastrophically and severely disabled. (D) A congregate living health facility-hospice may have a capacity of 36 beds. (5) A congregate living health facility shall have a noninstitutional,homelikehome- like 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 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 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 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 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. SEC. 3. Section 1265.7 of the Health and Safety Code is amended to read: 1265.7. (a) (1) Thestatedepartment shall adopt regulations for the licensure of congregate living health facilities. The regulations shall include minimum standards of adequacy, safety, and sanitation of the physical plant and equipment, minimum standards for staffing with duly qualified personnel, and training of the staff, and minimum standards for providing the services offered. (2) Regulations for facilities approved to provide services for persons who may be ventilator dependent shall ensure that residents of these facilities are assured appropriate supportive health services in the most normal, least restrictive physical and rehabilitative environment appropriate to individual resident needs. (3) Regulations for facilities approved to provide services for persons who are terminally ill, who have a diagnosis of a life-threatening illness, who are catastrophically and severely disabled, persons who are provided care in a congregate living health facility-hospice or any combination of those persons, shall ensure that residents of these facilities receive supportive health services, based on individual resident acuity levels in the most normal, least restrictive physical environment for individual resident needs. (b) Pending adoption of the regulations pursuant to paragraphs (2) and (3) of subdivision (a), an entity shall be licensed as a congregate living health facility serving persons who are terminally ill, persons who are catastrophically and severely disabled, persons who are mentally alert but physically disabled, persons who are provided care in a congregate living health facility-hospice, or any combination of these persons, by thestatedepartment beginning July 1, 1988, if it meets the requirements identified in subdivision (i) of Section 1250 and in Section 1267.13. SEC. 4. Section 1267.13 of the Health and Safety Code is amended to read: 1267.13. Pursuant to paragraph (3) of subdivision (a) and subdivision (b) of Section 1265.7, this section shall be effective until the adoption of permanent regulations. Notwithstanding, the state department has authority to make reasonable accommodation for exceptions to the standards in this section, providing the health, safety, and quality of patient care is not compromised. No exceptions shall be made for building standards. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. Applicants shall request the exception in writing accompanied by detailed, supporting documentation. Congregate living health facilities serving persons who are terminally ill, persons who are catastrophically and severely disabled, persons who are mentally alert but physically disabled, persons who are provided care in a congregate living health facility-hospice, or any combination of these persons, shall conform to the following: (a) Facilities shall obtain and maintain a valid fire clearance from the appropriate authority having jurisdiction over the facility, based on compliance with state regulations concerning fire and life safety, as adopted by the State Fire Marshal. (b) The State Fire Marshal, with the advice of the State Board of Fire Services, shall adopt regulations on or before January 1, 1991, following a public hearing, establishing minimum requirements for the protection of life and property for congregate living health facilities serving terminally ill persons, catastrophically and severely disabled persons, persons who are mentally alert but physically disabled, or any combination of these persons. These minimum requirements shall recognize the residential and noninstitutional setting of congregate living health facilities serving terminally ill persons, catastrophically and severely disabled persons, persons who are mentally alert but physically disabled, or any combination of these persons. (c) Facilities shall be in a homelike residential setting. Living accommodations and grounds shall be related to the facility's function and clientele. Facilities shall provide sufficient space for comfortable living accommodations and privacy for residents, staff, and others who may reside in the facility. (d) Common rooms, including, but not limited to, living rooms, dining rooms, and dens or other recreation or activity rooms, shall be provided and shall have sufficient space, separation, or both to promote and facilitate the program of activities and to prevent these activities from interfering with other functions. Accommodations shall ensure adequate space for residents to have visitors and for privacy during visits, if desired. (e) Resident bedrooms shall have adequate space to allow easy passage throughout; permit comfortable usage of furnishings; promote ease of nursing care; and accommodate use of assistive devices, including, but not limited to, wheelchairs, walkers, and patient lifts, when needed. (f) No room commonly used for other purposes, including, but not limited to, a hall, stairway, attic, garage, storage area, shed, or similar detached building, shall be used as a sleeping room for any resident. (g) No resident bedroom shall be used as a passageway to another room, bath, or toilet. (h) Not more than two residents shall share a bedroom. (i) Equipment and supplies necessary for personal care and maintenance of adequate hygiene shall be readily available to all residents. (j) Toilets and bathrooms shall be conveniently located. At least one toilet and washbasin shall be provided per six residents. At least one bathtub or shower shall be provided per 10 residents. Individual privacy shall be provided in all toilet, bath and shower areas. Separate toilet, washbasin, and bathtub or shower accommodations shall be provided for staff. (k) Sufficient room shall be available throughout the facility to accommodate and serve all persons in comfort and safety. The premises shall be maintained in good repair and shall provide a safe, clean, and healthful environment. ( l ) Facilities shall have equipment and supplies appropriate to meet the routine and specialized needs of all residents. (m) All persons shall be protected from hazards throughout the premises: (1) Stairways, inclines, ramps, open porches, and other areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible unless well lighted and equipped with sturdy hand railings. (2) Night lights shall be maintained in hallways and passages to nonprivate bathrooms. (3) All indoor and outdoor passageways and stairways shall be kept free of obstructions. (4) Fireplaces, woodstoves, and open-faced heaters shall be adequately screened. (5) Facilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools, or similar bodies of water or other areas of potential hazard when not in active use. (n) (1) Facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, shall, in addition to the requirements of this chapter and until specific regulations governing their operation are filed, conform to regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations of April 1, 1988, with the exception of the following sections or portions of sections: 72007, 72053, 72073, subdivision (a) of Section 72077, 72097, 72099, 72103, 72203, subdivision (a) of Section 72205, 72301, 72305, subdivision (a) of Section 72325, 72327, 72329, 72331, 72337, subdivisions (b), (g), and (h) of Section 72351, 72353, subdivision (a) of Section 72367, 72373, subdivision (b) of Section 72375, 72401, 72403, 72405, 72407, 72409, 72411, 72413, 72415, 72417, 72419, 72421, 72423, 72425, 72427, 72429, 72431, 72433, 72435, 72437, 72439, 72441, 72443, 72445, 72447, 72449, 72451, 72453, 72455, 72457, 72459, 72461, 72463, 72465, 72467, 72469, 72471, 72473, 72475, 72503, paragraph (2) of subdivision (a) of Section 72513, 72520, 72535, 72555, 72557, subdivisions (a) and (b) of Section 72601, subdivision (d) of Section 72607, subdivisions (a) and (d) of Section 72609, 72611, 72615, 72617, 72629, 72631, 72633, 72635, subdivisions (b), (c), and (d) of Section 72639, 72641, and 72665. (2) (A) A congregate living health facility-hospice shall comply with the requirements of this section, except for Section 1439.2, and except for Section 72315(h), (i), (j), and (k), Section 72323(d), Section 72335(a)(1), Section 72341(a), Sections 72379 to 72389, inclusive, and Section 72525 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations. (B) An activity plan shall be developed and implemented for, and reflect the personal preferences of, each resident. The activity plan shall be integrated with the individual interdisciplinary patient care plan. (C) Chemicals may be used as a substitute for the methods specified in Section 72323(c) of Division 5 of Title 22 of the California Code of Regulations, if the product used is specifically designed to be used as a substitute and is used in accordance with the manufacturer's requirements. (D) The hospice interdisciplinary team shall perform the functions of the required committees as specified by Section 72525 of Division 5 of Title 11 of the California Code of Regulations. (E) The department shall not count temporary sleeping accommodations provided to permit family and friends to stay with the residents of a congregate living health facility-hospice in the number of licensed beds for purposes of compliance with Section 1250, or Section 72607 of Division 5 of Title 22 of the California Code of Regulations. (F) A facility is not required to provide optional services. (i) "Optional service" means a service of a congregate living health facility-hospice that is organized, staffed, and equipped to provide specific types of patient care. (ii) A congregate living health facility-hospice may provide, pursuant to federal law, including Section 418 of Title 42 of the Code of Federal Regulations, the following types of optional services: (I) Direct inpatient care, including fire/life safety requirements. (II) Optional services approved by the department. (iii) A facility desiring approval for an optional service shall file an application on a form furnished by the department for this purpose. (iv) The department shall approve each optional service within the facility and list on the facility's license each optional service for which the department has granted approval. (o) (1) Facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, persons who are provided care in a congregate living health facility-hospice, or any combination of these persons, shall have an administrator who is responsible for the day-to-day operation of the facility. The administrator may be either a licensed registered nurse, a nursing home administrator, or the licensee. The administrator shall be present at the facility a sufficient number of hours to ensure the smooth operation of the facility. If the administrator is also the registered nurse fulfilling the duties specified in paragraph (2), the administrator shall not be responsible for more than one facility. In all other circumstances, the administrator shall not be responsible for more than three facilities with an aggregate total of 75 beds and these facilities shall be within one hour's surface travel time of each other. (2) (A) For each congregate living health facility of more than six beds serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, there shall be, at a minimum, a registered nurse or licensed vocational nurse awake and on duty at all times. A registered nurse shall be awake and on duty eight hours a day, five days a week. (B) For each congregate living health facility of six or fewer beds serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, a registered nurse shall visit each patient at least twice a week for approximately two hours, or more as patient care requires. (C) For all congregate living health facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, a registered nurse shall be available for consultation and able to come into the facility within 30 minutes, if necessary, when no registered nurse is on duty. In addition, certified nurse assistants, or persons with similar training and experience as determined by the department, shall be awake and on duty in the facility in at least the following ratios: facilities with six beds or less, one per shift; facilities with 7 to 12 beds, two per shift; facilities with 13 to 25 beds, three per day and evening shifts and two per nocturnal shift. No nursing services personnel shall be assigned housekeeping or dietary duties. (D) A congregate living health facility-hospice shall provide 24-hour nursing services that meet the nursing needs of all patients and are furnished in accordance with each patient's plan of care. (i) Each patient shall receive all nursing services as prescribed in the patient's plan of care and shall be kept comfortable, clean, well-groomed, and protected from accident, injury, and infection. (ii) Each shift shall have at least one registered nurse or licensed vocational nurse awake and on duty. (iii) Each shift shall include a registered nurse who provides direct patient care when at least one patient is receiving general inpatient care. (iv) No registered nurse, licensed vocational nurse, certified nurse assistant, or home health aide may care for more than six residents. (v) The facility shall document the level of care provided to each resident and the staffing levels at each shift. (3) Notwithstanding the provisions of this subdivision, the facility shall provide appropriately qualified staff in sufficient numbers to meet patient care needs. (4) Nursing service personnel shall be employed and on duty in at least the number and with the qualifications determined by the department to provide the necessary nursing services for patients admitted for care. The department may require a facility to provide additional professional, administrative, or supportive personnel whenever the state department determines through a written evaluation, that additional personnel are needed to provide for the health and safety of patients. (5) All staff members shall receive orientation regarding care appropriate for the patients' diagnoses and individual resident needs. Orientation shall include a minimum of 16 hours during the first 40 hours of employment. (6) Nothing in this chapter shall prevent the use of volunteers; however, volunteers shall not be used as substitutes for the personnel required in the above sections. Volunteers providing patient care services shall: (A) Be provided clearly defined roles and written job descriptions. (B) Receive orientation and training equivalent to that provided paid staff. (C) Possess education and experience equal to that required of paid staff performing similar functions. (D) Conform to the facility's policies and procedures. (E) Receive periodic performance evaluations. (p) In addition to the requirements of this section, a congregate living health facility-hospice shall comply with the following: (1) Meet all standards for providing routine or continuous care to residents of the facility, in full compliance with Section 418 of Title 42 of the Code of Federal Regulations, as required by the federal Centers for Medicare and Medicaid Services. (2) Provide each patient with all of the following: (A) Full information regarding the patient's health status and options for end-of-life care. (B) Care that reflects a patient's preferences regarding end-of-life care, including the right to refuse any treatment or procedure. (C) Treatment with consideration, respect, and full recognition of the patient's dignity and individuality, including privacy in treatment and care of personal needs. (D) Entitlement to visitors of the patient's choosing, at any time the patient chooses, and with ensured privacy for those visits. (3) Draft and implement disaster preparedness plans for both internal and external disasters that protect the facility's patients, employees, and visitors, and reflect coordination with local agencies that are responsible for disaster preparedness and emergency response. (4) Continue to provide services to family and friends after the patient's stay in the facility in accordance with the patient's plan of care. Continuing services may be provided by the hospice program that operates the facility.(p)(q) The interim standards prescribed by this section shall become inoperative upon the filing of the regulations with the Secretary of State. SEC. 5. Section 1267.15 of the Health and Safety Code is amended to read: 1267.15.Congregate(a) A congregate living healthfacilitiesfacility shall be freestanding, but this does not precludetheir locationthe facility from being located on the premises of a hospital.Congregate living health facilities shall be separately licensed.(b) The provisions of subdivision (a) shall not apply to a congregate living health facility-hospice. (1) A congregate living health facility-hospice may be located adjacent to, physically connected to, within the physical plant of, or on the building grounds of, another health facility. (2) A congregate living health facility-hospice may lease space from another hospital for purposes of obtaining a separate license, and the lease shall be considered a change of ownership for that space. Units or wings of another health facility leased and separately licensed to a congregate living health facility-hospice shall be deemed to be continuously licensed for purposes of meeting California building code requirements. Units or wings of another health facility leased and separately licensed to a congregate living health facility-hospice shall not be considered a change in use, unless renovations made by the congregate living health facility-hospice would result in a failure to comply with health facility building code standards, as required prior to the change of ownership. Upon termination of the lease agreement, or revocation of the congregate living health facility-hospice license, the space previously occupied by the congregate living health facility-hospice shall be placed back on the license of the health facility that leased the space. (3) A congregate living health facility-hospice shall demonstrate its ability to meet licensing and Medicare certification requirements, and shall be fully responsible for meeting these requirements, regardless of whether the requirements are met through direct provision by the facility, or through a contract with another health facility or entity. Reliance on contractors to meet the licensing requirements, including contracting with another health facility, does not exempt from or lessen the congregate living health facility-hospice's legal responsibilities. (4) The department shall hold the congregate living health facility-hospice accountable for a violation of licensing or certification requirements under Section 418 of Title 42 of the Code of Federal Regulations, regardless of whether the violation occurred as a result of services provided under contract with another health facility or entity, or the services were provided directly by the congregate living health facility-hospice. (5) Nothing shall preclude the department from holding accountable the health facility providing services under contract to the congregate living health facility-hospice, if the department determines that the facts also present a separate violation for the health facility providing services under contract. (c) A congregate living health facility shall be separately licensed.SEC. 10.SEC. 6. 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.