Bill Text: CA AB2673 | 2021-2022 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Hospice agency licensure: moratorium on new licenses.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2022-09-29 - Chaptered by Secretary of State - Chapter 797, Statutes of 2022. [AB2673 Detail]
Download: California-2021-AB2673-Amended.html
NOYES
Section 1751.70 of the Health and Safety Code is amended to read:
Bill Title: Hospice agency licensure: moratorium on new licenses.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2022-09-29 - Chaptered by Secretary of State - Chapter 797, Statutes of 2022. [AB2673 Detail]
Download: California-2021-AB2673-Amended.html
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Amended
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April 28, 2022 |
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Amended
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March 31, 2022 |
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Amended
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March 17, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 2673
| Introduced by Assembly Member Irwin (Principal coauthor: Senator Allen) (Coauthor: Assembly Member Friedman) |
February 18, 2022 |
An act to amend Section 1751.70 of Sections 1748, 1749, 1751.5, 1751.70, and 1755 of, and to add Sections 1751.6 and 1752.1 to, the Health and Safety Code, relating to hospice.
LEGISLATIVE COUNSEL'S DIGEST
AB 2673, as amended, Irwin.
Hospice licensure: moratorium on new licenses.
The California Hospice Licensure Act of 1990 (act) requires a person, political subdivision of the state, or other governmental agency to obtain a license from the State Department of Public Health to provide hospice services to an individual who is experiencing the last phase of life due to a terminal disease, as defined, and their family, except as provided. The act also provides for the renewal of a license. The act imposes criminal penalties on any person who violates any provision of the act or any rule or regulation promulgated under the act.
Existing law prohibits any person, political subdivision of the state, or other governmental agency from
establishing, conducting, maintaining, or representing itself as a hospice unless a license has been issued under the act.
This bill would additionally prohibit a person or entity described above that is issued a license to establish a hospice, from selling or trading the license to another person, political subdivision of the state, or other governmental agency within 5 years of issuance. Because a violation of this requirement would be a misdemeanor, the bill would impose a state-mandated local program.
Existing law requires an applicant for a hospice license to satisfy certain conditions, and to satisfy the definition of a hospice and provide specified services in order to be licensed as a hospice. Existing
law authorizes the department to deny an application for licensure, or suspend or revoke any license issued to provide hospice services for various reasons, including, but not limited to, violation by the applicant or licensee of the act or related rules and regulations promulgated by the department. Existing law authorizes the department to conduct a survey of an accredited hospice to ensure that the accreditation requirements are met.
This bill would additionally require an applicant who has not previously qualified for a hospice license to, as a condition of licensure, demonstrate and provide evidence of an unmet need of hospice services in the geographic region the hospice would serve. The bill would add to the reasons for denial, suspension, or revocation of a license to include, among others, improperly certifying a patient as eligible for hospice care.
The bill would require the department to conduct annual surveys of 5% of accredited hospices to ensure that the accreditation requirements are met, using a selective sample basis, and would authorize the department to survey an accredited hospice not included as part of the required surveys. The bill would establish a procedure for a person to request an investigation of an accredited hospice by making an oral or written complaint alleging a violation of the requirements applicable to hospices. The bill would require the department to make a preliminary review and to make an onsite inspection within 10 days after receiving the complaint, except as specified. The bill would require the department to notify the complainant in writing of its determination as a result of the investigation within 10 business days of completing the investigation.
Existing law imposes a moratorium on the department issuing a new license to provide hospice services,
except as specified. Existing law requires the moratorium to end on the earlier of 365 days from the date that the California State Auditor publishes a report on hospice licensure or on January 1, 2027, when the moratorium provisions are repealed.
This bill, instead, bill would require the department, by January 1, 2024, to adopt emergency regulations to implement the recommendations in a specified report of the California State Auditor. The bill would require the department to maintain the general moratorium on new hospice licenses until the department adopts the regulations. The bill would require the regulations, among other things, to establish guidelines for assessing the appropriateness of a hospice agency’s ratio of patients to nurses, require hospice management personnel to have
hospice-specific training or experience, and to establish requirements for conducting initial licensing site visits and followup visits, as specified. The bill would require the moratorium to end on the earlier of January 1, 2027, or 2 years from the date that the California State Auditor publishes a report on hospice licensure. licensure, or the date the emergency regulations are adopted. The bill would exempt licensed hospice facilities, as defined, from the moratorium.
Existing constitutional provisions require that a statute that limits the right of access to the
meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1748 of the Health and Safety Code is amended to read:1748.
(a) Except as otherwise provided in subdivision (b) or (d) of Section 1747, no person, political subdivision of the state, or other governmental agency shall establish, conduct, maintain, or represent itself as a hospice unless a license has been issued under this chapter. Multiple locations need not obtain a separate license. Multiple locations shall be listed on the license of the parent agency and each shall pay a licensing fee in the amount prescribed by subdivision (a) of Section 1750.(b) Any person, political subdivision of the state, or other governmental agency desiring a license to establish a hospice shall file with the state department a verified application on a form prescribed and furnished by the state
department which contains any information as may be required by the state department for the proper administration and enforcement of this chapter.
(c) Any hospice that is not required to obtain a license under this chapter shall disclose in all advertisements and information provided to the public all of the following information:
(1) It is not required to be licensed and is not regulated by the state department.
(2) Any complaint against the hospice should be directed to the local district attorney and the state department.
(3) Any complaint against personnel licensed by a board or committee within the Department of Consumer Affairs and employed by the hospice should be directed to the respective board or committee. Any complaint against a
certified home health aide or certified nurse assistant shall be directed to the state department.
The address and phone telephone number of any state agency, board, or committee which is responsible for addressing complaints shall be provided by the hospice, upon request, to any patient of the hospice.
(d) A person, political subdivision of the state, or other governmental agency issued a license to establish a hospice, shall not sell or trade a license to another person, political subdivision of the state, or other governmental agency within five years of issuance. Only the person, political subdivision of the state, or other
governmental agency initially issued a license for the purposes of establishing a hospice, may use that license during the five-year period.
SEC. 2.
Section 1749 of the Health and Safety Code is amended to read:1749.
(a) To qualify for a license under this chapter, an applicant shall satisfy all of the following:(1) Be of good moral character. If the applicant is a franchise, franchisee, firm, association, organization, partnership, business trust, corporation, company, political subdivision of the state, or governmental agency, the person in charge of the hospice for which the application for a license is made shall be of good moral character.
(2) Demonstrate the ability of the applicant to comply with this chapter and any rules and regulations promulgated under this chapter by the state department.
(3) File a completed application with the state department that was prescribed and furnished pursuant to Section 1748.
(b) In order for a person, political subdivision of the state, or other governmental agency to be licensed as a hospice it shall satisfy the definition of a hospice contained in Section 1746, and also provide, or make provision for, the following basic services:
(1) Skilled nursing services.
(2) Social services/counseling services.
(3) Medical direction.
(4) Bereavement services.
(5) Volunteer services.
(6) Inpatient care
arrangements.
(7) Home health aide services.
(c) The services required to be provided pursuant to subdivision (b) shall be provided in compliance with the “Standards for Quality Hospice Care, 2003,” as available from the California Hospice and Palliative Care Association, until the state department adopts regulations establishing alternative standards pursuant to subdivision (e).
(f).
(d) If the applicant has not previously qualified for a hospice license, the applicant shall demonstrate and provide evidence of an unmet need of hospice services in the geographic region a hospice would serve.
(d)
(e) (1) Notwithstanding any provision of law to the contrary, to meet the unique needs of the community, licensed hospices may provide, in
addition to hospice services authorized in this chapter, any of the following preliminary services for any person in need of those services, as determined by the physician and surgeon, if any, in charge of the care of a patient, or at the request of the patient or family:
(A) Preliminary palliative care consultations.
(B) Preliminary counseling and care planning.
(C) Preliminary grief and bereavement services.
(2) Preliminary services authorized pursuant to this subdivision may be provided concurrently with curative treatment to a person who does not have a terminal prognosis or who has not elected to receive hospice services only by licensed and certified hospices. These services shall be subject to the schedule of benefits under the Medi-Cal program,
pursuant to subdivision (w) of Section 14132 of the Welfare and Institutions Code.
(e)
(f) The state department may adopt regulations establishing standards for any or all of the services required to be provided under subdivision (b). The regulations of the state department adopted pursuant to this subdivision shall supersede the standards referenced in subdivision (c) to the extent the regulations duplicate or replace those standards.
SEC. 3.
Section 1751.5 of the Health and Safety Code is amended to read:1751.5.
(a) Notwithstanding any other provision of this chapter, the department shall issue a license to a hospice that applies to the department for a hospice license and meets all of the following requirements:(1) Is accredited as a hospice by an entity approved by the federal Centers for Medicare and Medicaid Services as a national accreditation organization, and the national accreditation organization forwards to the department copies of all initial and subsequent survey and other accreditation reports or findings.
(2) Files an application with fees pursuant to this chapter.
(3) Meets any other additional licensure requirements of, or
regulations adopted if necessary pursuant to, this chapter that the department identifies, after consulting with the national accreditation organization, as more stringent than the accreditation requirements of the national accreditation organization.
(b) The department shall conduct surveys of 5 percent of accredited hospices annually to ensure the accreditation requirements are met. These surveys shall be conducted using a selective sample basis.
(b)
(c) The department may conduct a survey of an
accredited hospice not surveyed under subdivision (b) to ensure the accreditation requirements are met. These surveys shall be conducted using a selective sample basis.
(c)
(d) The department may conduct a survey of an accredited hospice to investigate complaints against an accredited hospice for substantial noncompliance, as determined by the department, with these accreditation standards.
(d)
(e) Notwithstanding subdivisions (a), (b), and (c), (c), and (d), the department shall retain its full range of authority over accredited hospices to ensure the licensure and accreditation requirements are met. This authority shall include the entire scope of enforcement sanctions and options available for unaccredited hospices.
SEC. 4.
Section 1751.6 is added to the Health and Safety Code, to read:1751.6.
By January 1, 2024, the department shall adopt emergency regulations to implement the recommendations in California State Auditor Report 2021-123 on the California Hospice Licensure and Oversight (March 29, 2022). The department shall maintain the general moratorium on new hospice licenses until the department adopts the regulations, but in no event later than March 29, 2024. The emergency regulations shall do all of the following:(a) Establish time and distance standards that define the maximum time and distance hospice agency staff may travel to reach patients, taking into consideration typical traffic conditions and whether the hospice agency is serving patients in rural or urban areas.
(b) Establish guidelines for assessing the appropriateness of a hospice agency’s ratio of patients to nurses.
(c) Establish a limit for the number of hospice agencies that hospice management personnel can be involved with concurrently.
(d) Require hospice management personnel to have hospice-specific training or experience.
(e) Require the department, as part of its review of the initial application, to verify that the hospice management personnel listed on the licensing application are, in fact, associated with the hospice agency, such as by contacting them by telephone, and verify the work history of hospice management personnel by speaking with these individuals’ previous employers by telephone.
(f) Require the department to verify the
status of the professional licenses for all hospice medical personnel, including contracted medical directors, as part of the initial license application. The regulations shall also establish guidelines for when the department is required to deny the application of a hospice agency that is proposing to use medical personnel whose professional license records indicate the imposition of a disciplinary action. For example, probation for gross negligence or fraudulent billing shall be a cause to deny a hospice agency’s application, even if the medical director’s license is currently active.
(g) Establish requirements for initial licensing site visits that include verifying the identities of all hospice personnel and ensuring that the hospice agency is set up to provide adequate care. The department shall develop specific requirements for hospice office space, and verify compliance with those requirements during the initial site visit.
(h) Establish requirements for followup inspections to the initial site visits within one year of initial licensing, to verify that hospice agencies are complying with those hospice standards that cannot be assessed before the agencies begin providing care to patients. These inspections shall be unannounced and take place after the hospice agency has begun caring for patients. During these inspections, the department shall do all of the following:
(1) Visit patients.
(2) Ensure that the certifications of terminal illness are accurate.
(3) Confirm that the hospice agency is providing adequate care.
(4) Check hospice personnel identities and medical licenses.
(5) Ensure that the hospice agency has reported any personnel changes.
SECTION 1.SEC. 5.
Section 1751.70 of the Health and Safety Code is amended to read:1751.70.
(a) Notwithstanding any other law and except as provided in Section 1751.75, on and after January 1, 2022, and until the earlier of two years from the date that the California State Auditor publishes a report on hospice licensure, or the date emergency regulations are adopted pursuant to Section 1751.6, the department shall not issue a new license to operate a hospice pursuant to this chapter.(b) Hospice facilities licensed under subdivision (n) of Section 1250 are exempt from the moratorium established under subdivision (a).
SEC. 6.
Section 1752.1 is added to the Health and Safety Code, to read:1752.1.
(a) Any person may request an investigation of an accredited hospice in accordance with this chapter by making a complaint to the department alleging a violation of applicable requirements prescribed by statutes or regulations of this state. A complaint may be made orally or in writing.(b) The substance of the complaint shall be provided to the licensee no earlier than at the time of the inspection. Unless the complainant specifically requests otherwise, neither the substance of the complaint provided to the licensee nor any copy of the complaint or any record published, released, or otherwise made available to the licensee shall disclose the name of any person mentioned in the complaint except the name of any duly authorized officer,
employee, or agent of the department conducting the investigation or inspection pursuant to this chapter.
(c) (1) Upon receipt of a complaint, the department shall make a preliminary review and, unless the department determines that the complaint is willfully intended to harass a licensee or is without any reasonable basis, it shall make an onsite inspection within 10 days after receiving the complaint except when the visit would adversely affect the licensing investigation or the investigation of other agencies, including, but not limited to, law enforcement agencies. In either event, the complainant shall be promptly informed of the department’s proposed course of action.
(2) Prior to conducting an onsite investigation pursuant to this section, the department shall make a good faith effort, documented in writing, to contact and interview the complainant and inform the
complainant of the department’s proposed course of action and the relevant deadline for the department to complete its investigation. To the extent practicable, the officer, employee, or agent of the department who will conduct the investigation shall be the representative who interviews and makes contact with the complainant.
(d) Within 10 business days of completing the investigation of a complaint under this section, the department shall notify the complainant in writing of the department’s determination as a result of the investigation.
SEC. 7.
Section 1755 of the Health and Safety Code is amended to read:1755.
(a) The state department may deny any application for licensure, or suspend or revoke any license issued, under this chapter upon any of the following grounds:(1) Violation by the applicant or licensee of this chapter or any rules and regulations promulgated by the state department under this chapter. chapter, including improperly certifying a patient as eligible for hospice care.
(2) Any felony conviction of the applicant or licensee for the violation of any law of
this state.
(3) Any conviction of the applicant or licensee for aiding, abetting, or permitting the commission of any act that is a felony in this state.
(4) The applicant’s or licensee’s misrepresentation of a material fact in the application for a license under this chapter.
(5) Failure by hospice management personnel to be present for an inspection or complaint investigation.
(6) Failure by a hospice agency to report a change in owner, hospice management personnel, or location.
(b) Proceedings for the denial, suspension, or revocation of licenses under this chapter shall be
conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. In the case of a conflict between this chapter and Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, Chapter 5 (commencing with Section 11500) shall control.
SEC. 8.
The Legislature finds and declares that Section 6 of this act, which adds Section 1752.1 of the Health and Safety Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:In order to protect individual privacy
and encourage the identification of violations of requirements applicable to accredited hospices, it is necessary to limit the public’s right of access.
