Amended  IN  Assembly  March 08, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 275

Introduced by Assembly Member Wood

February 01, 2017

An act to amend Sections 1336, 1336.1, and 1336.2 1336.2, and 1336.3 of the Health and Safety Code, relating to care facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 275, as amended, Wood. Long-term care facilities: requirements for changes resulting in the inability of the facility to care for its patients. residents.
(1) Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients, patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more patients residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its patients. residents. The bill would require a facility to provide 90 60 days’ notice to the affected patients residents or their guardians and 90-day 60-day written notice to the State Long-Term Care Ombudsman. The bill would modify who may perform the required assessments of the affected residents. The department State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information that demonstrates its compliance with federal and state laws for closure. The bill would also require 2 or more facilities, that are within a 6-mile radius and propose to close within 30 days of one another, to comply with additional reporting requirements and would authorize the department to deny closure of the multiple facilities and to require the facilities to resubmit their closure plans with different timelines. on the number of residents affected by the proposed closure. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program. This bill would also make technical, nonsubstantive changes to uniformly use the term “resident” and refer to the State Department of Public Health in these provisions.
(2) 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   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1336 of the Health and Safety Code is amended to read:

1336.
 (a) Notwithstanding any other law, a long-term health care facility shall give written notice to the affected patients residents or to the guardians of the affected patients residents at least 90 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its patients. residents.
(b) If patients’ residents’ placement problems are encountered which that cannot be satisfactorily resolved within this 90-day 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 90 60 days.
(c) The facility shall provide an appropriate team of professional staff to assist patients residents and families in obtaining alternative placement. The facility shall provide notification of a community meeting for residents and their families, and to local health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program.
(d) This section shall not apply to actions initiated by the department State Department of Public Health to suspend or revoke the license.

SEC. 2.

 Section 1336.1 of the Health and Safety Code is amended to read:

1336.1.
 (a) After notifying its affected patients, residents, the facility shall, in response to inquiries made by prospective patients residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b) The facility shall also give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility at least 90 60 days prior to any change in the status of the license or the operation of the facility.

SEC. 3.

 Section 1336.2 of the Health and Safety Code is amended to read:

1336.2.
 (a) Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facility’s Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1) Be responsible for ensuring that the resident’s attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the resident’s condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2) Be responsible for ensuring that a licensed mental health professional or a licensed social worker and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the resident’s health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the resident’s needs.
(3) (A) Be responsible for evaluating the relocation needs of the resident including proximity to the resident’s representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the resident’s representative. The health facility shall discuss the evaluation and medical assessment with the resident or the resident’s representative and make the evaluation and assessment part of the medical records for transfer.
(B) If the resident or resident’s representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the resident’s representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4) At least 60 days in advance of the transfer, inform the resident or the resident’s representative of alternative facilities that are available and adequate to meet resident and family needs.
(5) Arrange for appropriate future medical care and services, unless the resident or resident’s representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b) The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c) The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or resident’s representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or resident’s representative that the transfer plan is available to the resident or resident’s representative free of charge upon request.
(d) In the event of a temporary suspension of a facility’s license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the department State Department of Public Health provides the services pursuant to subdivision (f).
(e) The department State Department of Public Health may make available assistance for the placement of hard-to-place residents based on the department’s its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f) The department State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of patients, residents, if the department it determines that these services are needed promptly to prevent adverse health consequences to patients, residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the department State Department of Public Health for the cost of providing the relocation services. The department’s State Department of Public Health’s participation shall not relieve the facility of any responsibility under this section. If the departmentState Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the department State Department of Public Health shall request that the Attorney General’s office or the local district attorney’s office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g) If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facility’s Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the department State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or resident’s representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The The proposed relocation plan shall include, but not be limited to, all of the following information:
(1) The number of residents affected by the proposed closure.
(2) The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(3) Attestation that the facility completed a medical assessment of each resident.
(4) The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(5) The reason for the proposed closure.
(6) The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
The proposed relocation plan shall become effective five working days after upon the date the department State Department of Public Health grants its approval. The department State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section. section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The department State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the department State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the department State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. The department shall have the authority to require the facility, as part of the closure and relocation plans, to provide specific interventions that the transferring facility will implement to help prevent possible resident transfer trauma, identify facilities that are available to receive residents for transfer, and provide timelines with specific dates that demonstrate compliance with both federal and state laws and regulations for closure with the required notifications to residents or the resident’s legal and responsible parties. Until one proposed relocation plan has been approved by the department, State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsman at the same time the plan is submitted to the department. State Department of Public Health. Once the State Department of Public Health approves a proposed relocation plan, it shall post the plan on its Internet Web site within 10 business days.
(h) The resident shall have the right to remain in the facility for up to 90 60 days after the approved written notice of the facility’s intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The department State Department of Public Health shall monitor the facility’s staging of transfers, and, if it determines that the facility’s staging of placements is causing a detrimental impact on those residents being transferred, then the department State Department of Public Health shall limit the number of residents being transferred per day until the department it determines that it would be when it is safe to increase the numbers.

(i)(1)In the event that two or more facilities within a six-mile radius propose to close on the same date, or within 30 days of one another, the facilities shall each prepare a community impact report. The community impact report shall be included in the proposed closure plan. The report shall include all of the following information:

(A)The total number of residents affected by the proposed closures.

(B)The number of additional skilled nursing facilities within 5, 10, 25, and 50 miles of the facilities proposing to close and the number of available beds at each of those facilities.

(C)The reason for the proposed closures.

(D)The number of residents at each facility proposed for closure that could potentially experience transfer trauma.

(E)The number of residents at each facility proposed for closure that are unrepresented or under conservatorship.

(F)The number of residents at each facility proposed for closure that are taking psychotropic medications.

(G)The number of residents at each facility proposed for closure that have a dementia diagnosis.

(2)The facilities proposing to close shall hold at least one community meeting to solicit input from the affected community.

(3)If the facilities proposing to close are owned by the same entity, and are proposing to close simultaneously, the department shall have the authority to deny approval of simultaneous closures of the multiple facilities and require the facilities to resubmit their closure plans with different timelines.

SEC. 4.

 Section 1336.3 of the Health and Safety Code is amended to read:

1336.3.
 (a)  In the event of an emergency, such as earthquake, fire, or flood which that threatens the safety or welfare of patients the residents in a facility, the facility shall do all of the following:
(1)  Notify, as soon as possible, family members, patients’ guardians, guardians of residents, the state department, State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the patient’s welfare. welfare of the residents.
(2)  Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of the patient a resident is necessary.
(3)  Undertake prompt medical assessment of, and provide counseling as needed to, patients residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b)  (1) Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the state department State Department of Public Health upon request. The plan shall comply with the requirements in this section and the state department’s State Department of Public Health’s Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for patients residents in the event of an emergency. The facility shall report to the state department State Department of Public Health the name of any facility or hospital which that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.

Section

(2) Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.

SEC. 4.SEC. 5.

 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.