Bill Text: CA SB1228 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Small house skilled nursing facilities.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Passed) 2012-09-27 - Chaptered by Secretary of State. Chapter 671, Statutes of 2012. [SB1228 Detail]

Download: California-2011-SB1228-Amended.html

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BILL NUMBER: SB 1228	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 29, 2012
	AMENDED IN SENATE  MAY 1, 2012

INTRODUCED BY   Senator Alquist

                        FEBRUARY 23, 2012

   An act to amend Section 1250 of, and to add Article 7.2
(commencing with Section 1323.5) to Chapter 2 of Division 2 of, the
Health and Safety Code, relating to small house skilled nursing
facilities.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1228, as amended, Alquist. Small house skilled nursing
facilities.
   Existing law provides for the licensure and regulation of health
facilities, including skilled nursing facilities, as defined, by the
State Department of Public Health. Violation of these provisions is a
crime.
   This bill, commencing January 1, 2014, would create a new health
facility licensing category for a small house skilled nursing
facility,  to be  defined  by the bill  as
a skilled nursing facility that is  either  a
stand-alone home  or that consists   , 
 a facility consisting  of more than one home  , or a
distinct area within a facility, as specified, that is licensed 
for the purposes of providing skilled nursing care in a homelike,
noninstitutional setting. The bill would require that these
facilities comply with applicable state law governing skilled nursing
facilities, except as specified.  The bill would require the
department to review license applications and render a decision
within 6 months of receipt.  The bill would require the
department and the Office of Statewide Health Planning and
Development to consult with specified entities on various aspects of
small house skilled nursing facilities. The bill would require the
department to adopt regulations implementing these provisions.
   By expanding the scope of a crime, this bill would impose a
state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 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) (1) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
   (2) "Skilled nursing facility" includes a "small house skilled
nursing facility (SHSNF)," as defined in Section 1323.5.
   (d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
   (e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer persons with developmental
disabilities who have intermittent recurring needs for nursing
services, but have been certified by a physician and surgeon as not
requiring availability of continuous skilled nursing care.
   (f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.

   (g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons with
developmental disabilities whose primary need is for developmental
services and who have a recurring but intermittent need for skilled
nursing services.
   (h) "Intermediate care facility/developmentally disabled-nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
   (i) (1) "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than 12 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.
   (3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
   (4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
   (B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons, or
located in a county of the 16th class pursuant to Section 28020 of
the Government Code, may have not more than 25 beds for the purpose
of serving persons who are terminally ill.
   (C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving persons who are catastrophically
and severely disabled.
   (5) A congregate living health facility shall have a
noninstitutional, homelike environment.
   (j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the 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 (42
U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal
Medicaid Program under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.), or as both.
   (l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, shall not become effective prior to, or if effective,
shall be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.
   (m) "Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)" means a homelike facility
with a capacity of four to eight, inclusive, beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
continuous needs for skilled nursing care and have been certified by
a physician and surgeon as warranting continuous skilled nursing
care. The facility shall serve medically fragile persons who have
developmental disabilities or demonstrate significant developmental
delay that may lead to a developmental disability if not treated.
ICF/DD-CN facilities shall be subject to licensure under this chapter
upon adoption of licensing regulations in accordance with Section
1275.3. A facility providing continuous skilled nursing services to
persons with developmental disabilities pursuant to Section 14132.20
or 14495.10 of the Welfare and Institutions Code shall apply for
licensure under this subdivision within 90 days after the regulations
become effective, and may continue to operate pursuant to those
sections until its licensure application is either approved or
denied.
  SEC. 2.  Article 7.2 (commencing with Section 1323.5) is added to
Chapter 2 of Division 2 of the Health and Safety Code, to read:

      Article 7.2.  Small House Skilled Nursing Facilities


   1323.5.  (a) For purposes of this article, the following
definitions apply:
   (1) "Home" means an apartment, home, or other similar unit that
serves  10   12  or fewer residents.
   (2) "Small house skilled nursing facility (SHSNF)" or "facility"
means a skilled nursing facility that is  either a
stand-alone home or that consists of more than one home, 
licensed pursuant to this  article,   article
 for the purposes of providing skilled nursing care in a
homelike, noninstitutional  setting.   setting
and is one of the following:  
   (A) A stand-alone home.  
   (B) A facility that consists of more than one home.  
   (C) A distinct area within an existing skilled nursing facility
that otherwise meets the definition of home, pursuant to paragraph
(1), has been dedicated to the small house model, has a distinct
entry, and has no through traffic of staff, residents, or visitors
not affiliated with the household. 
   (3) "Versatile worker" means a certified nursing assistant who
provides personal care, socialization  ,   activity
  aide services  , meal preparation services, and 
laundry and  housekeeping services.
   (b) Commencing January 1, 2014, a facility may be licensed by the
department pursuant to this article if the facility meets all of the
following requirements: 
   (1) The facility shall be certified to participate as a provider
of care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act (42
U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal
Medicaid Program under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.), or as both.  
   (2) 
    (   1)  The facility shall comply with all
state laws and regulations that govern skilled nursing facilities,
except as provided in this paragraph. If regulations are in conflict
with any provision of this article, the department or the Office of
Statewide Health Planning and Development may waive one or more of
these regulations in order to permit these facilities to implement
the provision and meet licensure requirements, if the department or
the office determines that doing so will not jeopardize the health
and safety of a facility's residents. In making this determination,
the department or office shall consider whether the practice
contained in the provision has been demonstrated safely in other
states, and shall also consider peer-reviewed research. 
   (3) 
    (   2)  To the extent permitted under federal
law, the facility shall provide meals cooked on the premises of each
home, and not prepared in a central kitchen and transported to the
home. 
   (4) 
    (   3)  To the extent permitted under federal
law, the facility shall utilize versatile workers for purposes of
resident care. 
   (5) 
    (   4)  The facility shall meet all federal and
state direct care staffing requirements for skilled nursing
facilities  , or no less than four hours per resident per
day, whichever is greater  . All direct care staff shall be
onsite, awake, and available within each home at all times. 
   (6) 
    (   5)  The facility shall provide for
consistent staff assignments and  self-directed 
 self-managed  work teams of direct care staff 
supervised by a leadership team member who is not acting as a nurse
or nursing supervisor in the home  .  Licensed nursing
staff shall direct the versatile workers in all activities delegated
under the licensed nurses' scope of   practice. A versatile
worker may be supervised by nonclinical staff at the discretion of
the facility.  
   (7) 
    (   6)  (A) The facility shall provide training
for all staff involved in the operation of the home  for not
less than 120 hours for each versatile worker and not less than 60
hours for each leadership and clinical team member,  to be
completed prior to initial operation of the home, concerning the
philosophy, operations, and skills required to implement and maintain
self-directed care, self-managed work teams, a noninstitutional
approach to long-term care, safety and emergency skills, food
handling and safety, and other elements necessary for the successful
operation of the home.  Versatile workers and other staff
interacting with residents in the homes shall demonstrate proficiency
in these areas as well   as the facility's policies and
procedures, conflict resolution, and self-directed care principles.

   (B) Replacement staff shall undergo the training described in
subparagraph (A) within six weeks of commencing employment with the
facility.
   (C) Any staff members who are employed on a short-term, temporary
basis due to permanent staff illness or unexpected absence are exempt
from the training requirements specified in subparagraph (A).

   (8) (A) To the extent permitted under federal law, the facility
shall ensure that the percentage of residents in each facility who
are short-stay rehabilitation residents does not exceed 20 percent at
any time, except that a long-term resident returning to a facility
after a hospital stay who is receiving rehabilitation services for
which payment is made under the Medicare Program under Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), shall
not be counted toward this limitation.  
   (B) Subparagraph (A) does not apply to a facility that is licensed
pursuant to this article as a facility that solely provides
rehabilitation services.  
   (9) 
    (   7)  To the extent permitted under federal
law, each home shall consist of a homelike, rather than
institutional, environment, including the following characteristics:
   (A) The home shall be accessible to disabled persons, and shall be
designed as a house  or   , an  apartment
 ,   or a distinct area within an existing skilled
nursing facility that meets the standards described in subdivision
(a)  that is similar to housing available within the surrounding
community, that includes shared areas that would only be commonly
shared in a private home or apartment.
   (B) The home shall not, to the extent practicable, contain
institutional features. These include, but are not limited to,
nursing stations, medication carts, room numbers, and wall-mounted
licenses or certificates that could appropriately be accessed through
other means.
   (C)  (i)    The home shall include  resident
rooms that accommodate not more than two residents per room.
Facilities are encouraged to include  private, single-occupancy
bedrooms that are shared only at the request of a resident to
accommodate a spouse, partner, family member, or friend, and that
contain a full private and accessible bathroom. 
   (ii) Double occupancy rooms shall contain a full private and
accessible bathroom, and each resident's bedroom area shall be
visually separated from the other by a full height wall or a
permanently installed sliding door, folding door, or partition.
Walls, doors, or partitions used to separate resident bedroom areas
shall provide visual and acoustic separation. A door leading to each
resident's bedroom area in addition to the corridor door is not
required.  
   (iii) Each resident shall have direct use of, and access to, an
exterior window at all times. 
   (D) The home shall contain a living area where residents and staff
may socialize, dine, and prepare food together that provides, at a
minimum, a living room seating area, a dining area large enough to
accommodate all residents and at least two staff members, and a full
kitchen that may be utilized by residents.
   (E) The home shall contain ample natural light  with
window areas, not including skylights, being a minimum of 10 percent
of the area of each room  .
   (F) The home shall have built-in safety features to allow all
areas of the facility to be accessible to residents during the
majority of the day and night.
   (G) The home shall provide access to secured outdoor space. 
   (H) The home shall endeavor to create an aging in place
environment where long-stay residents may form permanent homes with
each other.  
   (c) The facility shall be certified to participate as a provider
of care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act (42
U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal
Medicaid Program under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.), or both.  
   (c) Within two months of receipt of a license application, the
department shall notify the applicant of any information necessary to
process the application. The department shall review each
application and render a decision within six months of receipt of the
application. 
   (d) The department and the Office of Statewide Health Planning and
Development shall consult with providers, employee organizations,
consumer advocates, and other interested stakeholders, including
groups with demonstrated experience in small house skilled nursing
facility operations, on the physical, operational, and other aspects
of small house skilled nursing facilities.
   (e) The department shall adopt regulations to implement this
section.
  SEC. 3.  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.