Bill Text: CA SB135 | 2011-2012 | Regular Session | Chaptered
Bill Title: Hospice facilities.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Passed) 2012-09-27 - Chaptered by Secretary of State. Chapter 673, Statutes of 2012. [SB135 Detail]
Download: California-2011-SB135-Chaptered.html
BILL NUMBER: SB 135 CHAPTERED
BILL TEXT
CHAPTER 673
FILED WITH SECRETARY OF STATE SEPTEMBER 27, 2012
APPROVED BY GOVERNOR SEPTEMBER 27, 2012
PASSED THE SENATE AUGUST 29, 2012
PASSED THE ASSEMBLY AUGUST 28, 2012
AMENDED IN ASSEMBLY AUGUST 24, 2012
AMENDED IN ASSEMBLY AUGUST 7, 2012
AMENDED IN ASSEMBLY JUNE 19, 2012
AMENDED IN SENATE JANUARY 23, 2012
AMENDED IN SENATE JANUARY 4, 2012
AMENDED IN SENATE MAY 10, 2011
AMENDED IN SENATE APRIL 25, 2011
AMENDED IN SENATE MARCH 24, 2011
INTRODUCED BY Senator Hernandez
(Principal coauthor: Assembly Member V. Manuel Pérez)
(Coauthor: Senator Strickland)
JANUARY 31, 2011
An act to amend Sections 1250, 1250.1, 1266, 1599, 1599.1, 1599.4,
1746, 1795, 128755, and 129725 of, and to add Article 10.6
(commencing with Section 1339.40) to Chapter 2 of Division 2 to, the
Health and Safety Code, relating to hospice care.
LEGISLATIVE COUNSEL'S DIGEST
SB 135, Hernandez. Hospice facilities.
Under existing law, the State Department of Public Health licenses
and regulates health facilities, including skilled nursing
facilities, intermediate care facilities, and congregate living
health 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 would require the department to develop regulations
governing licensure of, hospice facilities, as defined. It would
impose various requirements on these facilities.
This bill would exclude a freestanding building used, or designed
to be used, as a congregate living health facility or as a hospice
facility from the definition of a hospital building for purposes of
the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1983.
Because this bill would create a new crime, it would impose a
state-mandated local program.
This bill would incorporate additional changes in Section 1250 of
the Health and Safety Code, proposed by SB 1228 to be operative only
if SB 1228 and this bill are both chaptered and become effective on
or before January 1, 2013, and this bill is chaptered last. The bill
would also incorporate additional changes in Section 1266 of the
Health and Safety Code, proposed by AB 1710 to be operative only if
AB 1710 and this bill are both chaptered and become effective on or
before January 1, 2013, and this bill is chaptered last.
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.
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 members or caregivers who are
able to provide care in the home should be able to have care provided
in a homelike 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 homelike
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 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.
(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 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 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.
(n) "Hospice facility" means a health facility licensed pursuant
to this chapter, with a capacity of no more than 24 beds that
provides hospice services. Hospice services include, but are not
limited to, routine care, continuous care, inpatient respite care,
and inpatient hospice care as defined in subdivision (d) of Section
1339.40, and is operated by a provider of hospice services that is
licensed pursuant to Section 1751 and certified as a hospice pursuant
to Part 418 of Title 42 of the Code of Federal Regulations.
SEC. 2.5. 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 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 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.
(n) "Hospice facility" means a health facility licensed pursuant
to this chapter with a capacity of no more than 24 beds that provides
hospice services. Hospice services include, but are not limited to,
routine care, continuous care, inpatient respite care, and inpatient
hospice care as defined in subdivision (d) of Section 1339.40, and is
operated by a provider of hospice services that is licensed pursuant
to Section 1751 and certified as a hospice pursuant to Part 418 of
Title 42 of the Code of Federal Regulations.
SEC. 3. Section 1250.1 of the Health and Safety Code is amended to
read:
1250.1. (a) The 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 State Hospitals 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 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 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 department.
SEC. 4. Section 1266 of the Health and Safety Code is amended to
read:
1266. (a) The Licensing and Certification Division shall be
supported entirely by federal funds and special funds by no earlier
than the beginning of the 2009-10 fiscal year unless otherwise
specified in statute, or unless funds are specifically appropriated
from the General Fund in the annual Budget Act or other enacted
legislation. For the 2007-08 fiscal year, General Fund support shall
be provided to offset licensing and certification fees in an amount
of not less than two million seven hundred eighty-two thousand
dollars ($2,782,000).
(b) (1) The Licensing and Certification Program fees for the
2006-07 fiscal year shall be as follows:
Type of Facility Fee
General Acute Care Hospitals $ 134.10 per bed
Acute Psychiatric Hospitals $ 134.10 per bed
Special Hospitals $ 134.10 per bed
Chemical Dependency Recovery
Hospitals $ 123.52 per bed
Skilled Nursing Facilities $ 202.96 per bed
Intermediate Care Facilities $ 202.96 per bed
Intermediate Care Facilities
- Developmentally Disabled $ 592.29 per bed
Intermediate Care Facilities
- Developmentally Disabled - per
Habilitative $1,000.00 facility
Intermediate Care Facilities
- Developmentally Disabled - per
Nursing $1,000.00 facility
Home Health Agencies per
$2,700.00 facility
Referral Agencies per
$5,537.71 facility
Adult Day Health Centers per
$4,650.02 facility
Congregate Living Health
Facilities $ 202.96 per bed
Psychology Clinics per
$ 600.00 facility
Primary Clinics - Community per
and Free $ 600.00 facility
Specialty Clinics - Rehab
Clinics per
(For profit) $2,974.43 facility
(Nonprofit) per
$ 500.00 facility
Specialty Clinics - Surgical per
and Chronic $1,500.00 facility
Dialysis Clinics per
$1,500.00 facility
Pediatric Day Health/Respite
Care $ 142.43 per bed
Alternative Birthing Centers per
$2,437.86 facility
Hospice per
$1,000.00 provider
Correctional Treatment Centers $ 590.39 per bed
(2) (A) In the first year of licensure for intermediate care
facility/developmentally disabled-continuous nursing (ICF/DD-CN)
facilities, the licensure fee for those facilities shall be
equivalent to the licensure fee for intermediate care
facility/developmentally disabled-nursing facilities during the same
year. Thereafter, the licensure fee for ICF/DD-CN facilities shall be
established pursuant to the same procedures described in this
section.
(B) In the first year of licensure for hospice facilities, the
licensure fee shall be equivalent to the licensure fee for congregate
living health facilities during the same year. Thereafter, the
licensure fee for hospice facilities shall be established pursuant to
the same procedures described in this section.
(c) Commencing February 1, 2007, and every February 1 thereafter,
the department shall publish a list of estimated fees pursuant to
this section. The calculation of estimated fees and the publication
of the report and list of estimated fees shall not be subject to the
rulemaking requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d) By February 1 of each year, the department shall prepare the
following reports and shall make those reports, and the list of
estimated fees required to be published pursuant to subdivision (c),
available to the public by submitting them to the Legislature and
posting them on the department's Internet Web site:
(1) The department shall prepare a report of all costs for
activities of the Licensing and Certification Program. At a minimum,
this report shall include a narrative of all baseline adjustments and
their calculations, a description of how each category of facility
was calculated, descriptions of assumptions used in any calculations,
and shall recommend Licensing and Certification Program fees in
accordance with the following:
(A) Projected workload and costs shall be grouped for each fee
category, including workload costs for facility categories that have
been established by statute and for which licensing regulations and
procedures are under development.
(B) Cost estimates, and the estimated fees, shall be based on the
appropriation amounts in the Governor's proposed budget for the next
fiscal year, with and without policy adjustments to the fee
methodology.
(C) The allocation of program, operational, and administrative
overhead, and indirect costs to fee categories shall be based on
generally accepted cost allocation methods. Significant items of
costs shall be directly charged to fee categories if the expenses can
be reasonably identified to the fee category that caused them.
Indirect and overhead costs shall be allocated to all fee categories
using a generally accepted cost allocation method.
(D) The amount of federal funds and General Fund moneys to be
received in the budget year shall be estimated and allocated to each
fee category based upon an appropriate metric.
(E) The fee for each category shall be determined by dividing the
aggregate state share of all costs for the Licensing and
Certification Program by the appropriate metric for the category of
licensure. Amounts actually received for new licensure applications,
including change of ownership applications, and late payment
penalties, pursuant to Section 1266.5, during each fiscal year shall
be calculated and 95 percent shall be applied to the appropriate fee
categories in determining Licensing and Certification Program fees
for the second fiscal year following receipt of those funds. The
remaining 5 percent shall be retained in the fund as a reserve until
appropriated.
(2) (A) The department shall prepare a staffing and systems
analysis to ensure efficient and effective utilization of fees
collected, proper allocation of departmental resources to licensing
and certification activities, survey schedules, complaint
investigations, enforcement and appeal activities, data collection
and dissemination, surveyor training, and policy development.
(B) The analysis under this paragraph shall be made available to
interested persons and shall include all of the following:
(i) The number of surveyors and administrative support personnel
devoted to the licensing and certification of health care facilities.
(ii) The percentage of time devoted to licensing and certification
activities for the various types of health facilities.
(iii) The number of facilities receiving full surveys and the
frequency and number of followup visits.
(iv) The number and timeliness of complaint investigations.
(v) Data on deficiencies and citations issued, and numbers of
citation review conferences and arbitration hearings.
(vi) Other applicable activities of the licensing and
certification division.
(e) (1) The department shall adjust the list of estimated fees
published pursuant to subdivision (c) if the annual Budget Act or
other enacted legislation includes an appropriation that differs from
those proposed in the Governor's proposed budget for that fiscal
year.
(2) The department shall publish a final fee list, with an
explanation of any adjustment, by the issuance of an all facilities
letter, by posting the list on the department's Internet Web site,
and by including the final fee list as part of the licensing
application package, within 14 days of the enactment of the annual
Budget Act. The adjustment of fees and the publication of the final
fee list shall not be subject to the rulemaking requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code.
(f) (1) Fees shall not be assessed or collected pursuant to this
section from any state department, authority, bureau, commission, or
officer, unless federal financial participation would become
available by doing so and an appropriation is included in the annual
Budget Act for that state department, authority, bureau, commission,
or officer for this purpose. Fees shall not be assessed or collected
pursuant to this section from any clinic that is certified only by
the federal government and is exempt from licensure under Section
1206, unless federal financial participation would become available
by doing so.
(2) For the 2006-07 state fiscal year, a fee shall not be assessed
or collected pursuant to this section from any general acute care
hospital owned by a health care district with 100 beds or less.
(g) The Licensing and Certification Program may change annual
license expiration renewal dates to provide for efficiencies in
operational processes or to provide for sufficient cashflow to pay
for expenditures. If an annual license expiration date is changed,
the renewal fee shall be prorated accordingly. Facilities shall be
provided with a 60-day notice of any change in their annual license
renewal date.
SEC. 4.5. Section 1266 of the Health and Safety Code is amended to
read:
1266. (a) The Licensing and Certification Division shall be
supported entirely by federal funds and special funds by no earlier
than the beginning of the 2009-10 fiscal year unless otherwise
specified in statute, or unless funds are specifically appropriated
from the General Fund in the annual Budget Act or other enacted
legislation. For the 2007-08 fiscal year, General Fund support shall
be provided to offset licensing and certification fees in an amount
of not less than two million seven hundred eighty-two thousand
dollars ($2,782,000).
(b) (1) The Licensing and Certification Program fees for the
2006-07 fiscal year shall be as follows:
Type of Facility Fee
General Acute Care Hospitals $ 134.10 per bed
Acute Psychiatric Hospitals $ 134.10 per bed
Special Hospitals $ 134.10 per bed
Chemical Dependency Recovery
Hospitals $ 123.52 per bed
Skilled Nursing Facilities $ 202.96 per bed
Intermediate Care Facilities $ 202.96 per bed
Intermediate Care Facilities-
Developmentally Disabled $ 592.29 per bed
Intermediate Care Facilities-
Developmentally Disabled- per
Habilitative $1,000.00 facility
Intermediate Care Facilities-
Developmentally Disabled- per
Nursing $1,000.00 facility
Home Health Agencies per
$2,700.00 facility
Referral Agencies per
$5,537.71 facility
Adult Day Health Centers per
$4,650.02 facility
Congregate Living Health
Facilities $ 202.96 per bed
Psychology Clinics per
$ 600.00 facility
Primary Clinics- per
Community and Free $ 600.00 facility
Specialty Clinics- Rehab
Clinics per
(For profit) $2,974.43 facility
(Nonprofit) per
$ 500.00 facility
Specialty Clinics- per
Surgical and Chronic $1,500.00 facility
Dialysis Clinics per
$1,500.00 facility
Pediatric Day Health/Respite
Care $ 142.43 per bed
Alternative Birthing Centers per
$2,437.86 facility
Hospice per
$1,000.00 provider
Correctional Treatment Centers $ 590.39 per bed
(2) (A) In the first year of licensure for intermediate care
facility/developmentally disabled-continuous nursing (ICF/DD-CN)
facilities, the licensure fee for those facilities shall be
equivalent to the licensure fee for intermediate care
facility/developmentally disabled-nursing facilities during the same
year. Thereafter, the licensure fee for ICF/DD-CN facilities shall be
established pursuant to the same procedures described in this
section.
(B) In the first year of licensure for hospice facilities, the
licensure fee shall be equivalent to the licensure fee for congregate
living health facilities during the same year. Thereafter, the
licensure fee for hospice facilities shall be established pursuant to
the same procedures described in this section.
(c) Commencing February 1, 2007, and every February 1 thereafter,
the department shall publish a list of estimated fees pursuant to
this section. The calculation of estimated fees and the publication
of the report and list of estimated fees shall not be subject to the
rulemaking requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d) Notwithstanding Section 10231.5 of the Government Code, by
February 1 of each year, the department shall prepare the following
reports and shall make those reports, and the list of estimated fees
required to be published pursuant to subdivision (c), available to
the public by submitting them to the Legislature and posting them on
the department's Internet Web site:
(1) A report of all costs for activities of the Licensing and
Certification Program. At a minimum, this report shall include a
narrative of all baseline adjustments and their calculations, a
description of how each category of facility was calculated,
descriptions of assumptions used in any calculations, and shall
recommend Licensing and Certification Program fees in accordance with
the following:
(A) Projected workload and costs shall be grouped for each fee
category, including workload costs for facility categories that have
been established by statute and for which licensing regulations and
procedures are under development.
(B) Cost estimates, and the estimated fees, shall be based on the
appropriation amounts in the Governor's proposed budget for the next
fiscal year, with and without policy adjustments to the fee
methodology.
(C) The allocation of program, operational, and administrative
overhead, and indirect costs to fee categories shall be based on
generally accepted cost allocation methods. Significant items of
costs shall be directly charged to fee categories if the expenses can
be reasonably identified to the fee category that caused them.
Indirect and overhead costs shall be allocated to all fee categories
using a generally accepted cost allocation method.
(D) The amount of federal funds and General Fund moneys to be
received in the budget year shall be estimated and allocated to each
fee category based upon an appropriate metric.
(E) The fee for each category shall be determined by dividing the
aggregate state share of all costs for the Licensing and
Certification Program by the appropriate metric for the category of
licensure. Amounts actually received for new licensure applications,
including change of ownership applications, and late payment
penalties, pursuant to Section 1266.5, during each fiscal year shall
be calculated and 95 percent shall be applied to the appropriate fee
categories in determining Licensing and Certification Program fees
for the second fiscal year following receipt of those funds. The
remaining 5 percent shall be retained in the fund as a reserve until
appropriated.
(2) (A) A staffing and systems analysis to ensure efficient and
effective utilization of fees collected, proper allocation of
departmental resources to licensing and certification activities,
survey schedules, complaint investigations, enforcement and appeal
activities, data collection and dissemination, surveyor training, and
policy development.
(B) The analysis under this paragraph shall be made available to
interested persons and shall include all of the following:
(i) The number of surveyors and administrative support personnel
devoted to the licensing and certification of health care facilities.
(ii) The percentage of time devoted to licensing and certification
activities for the various types of health facilities.
(iii) The number of facilities receiving full surveys and the
frequency and number of followup visits.
(iv) The number and timeliness of complaint investigations.
(v) Data on deficiencies and citations issued, and numbers of
citation review conferences and arbitration hearings.
(vi) Other applicable activities of the licensing and
certification division.
(3) The annual program fee report described in subdivision (d) of
Section 1416.36.
(e) The reports required pursuant to subdivision (d) shall be
submitted in compliance with Section 9795 of the Government Code.
(f) (1) The department shall adjust the list of estimated fees
published pursuant to subdivision (c) if the annual Budget Act or
other enacted legislation includes an appropriation that differs from
those proposed in the Governor's proposed budget for that fiscal
year.
(2) The department shall publish a final fee list, with an
explanation of any adjustment, by the issuance of an all facilities
letter, by posting the list on the department's Internet Web site,
and by including the final fee list as part of the licensing
application package, within 14 days of the enactment of the annual
Budget Act. The adjustment of fees and the publication of the final
fee list shall not be subject to the rulemaking requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code.
(g) (1) Fees shall not be assessed or collected pursuant to this
section from any state department, authority, bureau, commission, or
officer, unless federal financial participation would become
available by doing so and an appropriation is included in the annual
Budget Act for that state department, authority, bureau, commission,
or officer for this purpose. Fees shall not be assessed or collected
pursuant to this section from any clinic that is certified only by
the federal government and is exempt from licensure under Section
1206, unless federal financial participation would become available
by doing so.
(2) For the 2006-07 state fiscal year, a fee shall not be assessed
or collected pursuant to this section from any general acute care
hospital owned by a health care district with 100 beds or less.
(h) The Licensing and Certification Program may change annual
license expiration renewal dates to provide for efficiencies in
operational processes or to provide for sufficient cashflow to pay
for expenditures. If an annual license expiration date is changed,
the renewal fee shall be prorated accordingly. Facilities shall be
provided with a 60-day notice of any change in their annual license
renewal date.
SEC. 5. Article 10.6 (commencing with Section 1339.40) is added to
Chapter 2 of Division 2 of the Health and Safety Code, to read:
Article 10.6. Hospice Licensing
1339.40. For the purposes of this article, the following
definitions apply:
(a) "Bereavement services" has the same meaning as defined in
subdivision (a) of Section 1746.
(b) "Hospice care" 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.
(c) "Hospice facility" means a health facility as defined in
subdivision (n) of Section 1250.
(d) "Inpatient hospice care" means hospice care that is provided
to patients in a hospice facility, including routine, continuous and
inpatient care directly as specified in Section 418.10 of Title 42 of
the Code of Federal Regulations, and may include short-term
inpatient respite care as specified in Section 418.108 of Title 42 of
the Code of Federal Regulations.
(e) "Interdisciplinary team" has the same meaning as defined in
subdivision (g) of Section 1746.
(f) "Medical direction" has the same meaning as defined in
subdivision (h) of Section 1746.
(g) "Palliative care" has the same meaning as defined in subdivision
(j) of Section 1746.
(h) "Plan of care" has the same meaning as defined in subdivision
(l) of Section 1746.
(i) "Skilled nursing services" has the same meaning as defined in
subdivision (n) of Section 1746.
(j) "Social services/counseling services" has the same meaning as
defined in subdivision (o) of Section 1746.
(k) "Terminal disease" or "terminal illness" has the same meaning
as defined in subdivision (p) of Section 1746.
(l) "Volunteer services" has the same meaning as defined in
subdivision (q) of Section 1746.
1339.41. (a) A person, governmental agency, or political
subdivision of the state shall not be licensed as a hospice facility
under this chapter unless the person or entity is a provider of
hospice services licensed pursuant to Section 1751 and is certified
as a hospice facility under Part 418 of Title 42 of the Code of
Federal Regulations.
(b) A hospice provider that intends to provide inpatient hospice
care in the hospice provider's own facility shall submit an
application and fee for licensure as a hospice facility under this
chapter. Notwithstanding the maximum period for a provisional license
under subdivision (b) of Section 1268.5, the department may issue a
provisional license to a hospice facility for a period of up to one
year.
(c) A verified application for a new license completed on forms
furnished by the department shall be submitted to the department upon
the occurrence of either of the following:
(1) Establishment of a hospice facility.
(2) Change of ownership.
(d) The licensee shall submit to the department a verified
application for a corrected license completed on forms furnished by
the department upon the occurrence of any of the following:
(1) Construction of new or replacement hospice facility.
(2) Increase in licensed bed capacity.
(3) Change of name of facility.
(4) Change of licensed category.
(5) Change of location of facility.
(6) Change in bed classification.
(e) (1) A hospice facility that participates in the Medicare and
Medicaid Programs may obtain initial certification from a federal
Centers for Medicare and Medicaid Services (CMS) approved
accreditation organization.
(2) If the CMS-approved accreditation organization conducts
certification inspections, the hospice facility shall transmit to the
department, within 30 days of receipt, a copy of the final
accreditation report of the accreditation organization.
(f) A hospice facility shall be separately licensed, irrespective
of the location of the facility.
(g) (1) The licensee shall notify the department in writing of any
changes in the information provided pursuant to subdivision (d)
within 10 days of these changes. This notice shall include
information and documentation regarding the changes.
(2) Each licensee shall notify the department within 10 days in
writing of any change of the mailing address of the licensee. This
notice shall include the new mailing address of the licensee.
(3) When a change in the principal officer of a corporate
licensee, including the chairman, president, or general manager
occurs, the licensee shall notify the department of this change
within 10 days in writing. This notice shall include the name and
business address of the officer.
(4) Any decrease in licensed bed capacity of the facility shall
require notification by letter to the department and shall result in
the issuance of a corrected license.
1339.42. (a) No private or public organization, including, but
not limited to, any partnership, corporation, or political
subdivision of the state, or other governmental agency within the
state, shall do any of the following without a license issued
pursuant to this chapter:
(1) Represent itself to be a hospice facility by its name or
advertisement, soliciting, or any other presentments to the public,
or in the context of services within the scope of this chapter imply
that it is licensed to provide those services or to make any
reference to employee bonding in relation to those services.
(2) Use the words "hospice facility," "hospice home,"
"hospice-facility," or any combination of those terms, within its
name.
(3) Use words to imply that it is licensed as a hospice facility
to provide those services.
(b) A hospice facility licensee shall obtain criminal background
checks for its employees, volunteers, and contractors in accordance
with federal Medicare conditions of participation (42 C.F.R. Part 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.
1339.43. (a) A hospice facility shall provide a home-like
environment that is comfortable and accommodating to both the patient
and patient's visitors.
(b) Building standards for hospice facilities adopted pursuant to
this chapter relating to fire and panic safety, and other regulations
for hospice facilities adopted pursuant to this chapter, 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 for hospice facilities adopted pursuant to this
chapter.
(c) The hospice facility shall meet the fire protection standards
set forth in the federal Medicare conditions of participation (42
C.F.R. Part 418 et seq.).
(d) A hospice facility may operate as a freestanding health
facility.
(1) Until the Office of Statewide Health Planning and Development,
in consultation with the Office of the State Fire Marshal, develops
and adopts building standards for hospice facilities, a freestanding
hospice facility shall meet applicable building standards and
requirements relating to the physical environment of the facility as
specified in Section 418.100 of Title 42 of the Code of Federal
Regulations. The building standards developed shall, at a minimum,
maintain the requirements specified in that section.
(2) A freestanding hospice facility shall be under the
jurisdiction of the local building department. As part of the license
application, the prospective licensee shall submit evidence of
compliance with applicable building standards for hospice facilities.
(3) The physical environment of the hospice facility shall be
adequate to provide the level of care and service required by the
residents of the facility as determined by the department.
(e) A hospice facility may be located within the physical plant of
another health facility.
(1) Notwithstanding subdivision (d) and paragraphs (8) and (9) of
subdivision (b) of Section 129725, a hospice facility located within
the physical plant of another licensed health facility that is under
the jurisdiction of the Office of Statewide Health Planning and
Development, shall meet the building standards for that category of
health facility within which the hospice facility is located, and
plans shall be submitted to the office for review of any new
construction or renovation of these hospice facilities. As part of
the license application, the prospective licensee shall submit
evidence of compliance with the building codes enforced by the Office
of Statewide Health Planning and Development.
(2) 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.
(3) In the event the space used by the hospice facility reverts
back to the facility with which the hospice facility shared the
space, the building standards applicable to the former shared space,
as identified by date of enactment of the standards, shall not change
due solely to the reversion.
(4) A hospice facility that provides inpatient hospice care and is
located within, adjacent to or physically connected to another
health facility shall provide all of the following:
(A) A designated nursing station.
(B) Adequate space for the preparation of drugs with lockable,
secure storage that is accessible only by authorized personnel.
(C) Signage that shall clearly demarcate the hospice facility area
from the facility with which the hospice facility shares space.
(D) Doors for every exit and entrance to the hospice facility.
(E) Contiguous beds within the designated area set aside for the
hospice facility.
(f) If a freestanding hospice facility is located on the site of
or is physically connected to a health facility that is under the
jurisdiction of the Office of Statewide Health Planning and
Development or both, the hospice facility shall submit plans for any
new construction or renovation of the hospice facility to the office
for plan review and approval. The Office of Statewide Health Planning
and Development shall review the hospice facility plans to identify
any impacts to the health facility under the office's jurisdiction
that may compromise the health facility's continued compliance with
applicable laws and regulations.
1339.44. (a) A hospice facility shall provide, or make provision
for, all of the following services and requirements:
(1) (A) Medical direction and adequate staff. Minimum staffing
standards that require at least one registered nurse to be on duty 24
hours per day and a maximum of six patients assigned at any given
time per direct caregiver.
(B) For purposes of this section, any additional direct caregiver
necessary beyond the registered nurse required pursuant to paragraph
(1) may include a registered nurse, as described in Section 2732 of
the Business and Professions Code, a licensed vocational nurse, as
described in Section 2864 of the Business and Professions Code, and a
certified nurse assistant.
(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. Disaster preparedness plans for both
internal and external disasters shall protect hospice patients,
employees, and visitors, and reflect coordination with local agencies
that are responsible for disaster preparedness and emergency
response.
(12) An adequate, safe, and sanitary physical environment.
(13) Housekeeping services.
(14) Patient medical records.
(15) Other administrative requirements.
(b) The department may adopt regulations that establish standards
for the provision of the services in subdivision (a) and any
additional qualifications and requirements for licensure above the
requirements of this article.
(c) A hospice patient has a right to be informed of his or her
rights, and the hospice facility shall protect and promote the
exercise of these rights. The hospice facility shall comply with the
patients' rights regulation in Section 418.52 of Title 42 of the Code
of Federal Regulations unless the department adopts regulations
establishing alternative standards pursuant to Section 1250.1. In
addition, the hospice facility shall provide each patient with all of
the following:
(1) Information at admission to a hospice facility pursuant to
Chapter 3.9 (commencing with Section 1599).
(2) Full information regarding his or her health status and
options for end-of-life care.
(3) Care that reflects individual preferences regarding
end-of-life care, including the right to refuse any treatment or
procedure.
(4) Treatment with consideration, respect, and full recognition of
dignity and individuality, including privacy in treatment and care
of personal needs.
(5) Right to visitors of the patient's choosing, at any time the
patient chooses, and privacy for those visits.
(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 services 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
from any requirements or in any way alter the hospice facility's
responsibilities. When a health facility provides services under
contract to a hospice facility, nothing shall preclude the department
from holding the health facility responsible for violations of the
law, if the department determines that the facts also constitute a
separate violation for the health facility providing services under
contract.
(f) The hospice facility shall provide inpatient hospice care in
compliance with Section 418.3 and Sections 418.52 to 418.116,
inclusive, of Title 42 of the Code of Federal Regulations until the
department adopts regulations establishing alternative standards
pursuant to Section 1250.1.
SEC. 6. Section 1599 of the Health and Safety Code is amended to
read:
1599. It is the intent of the Legislature in enacting this
chapter to expressly set forth fundamental human rights which all
patients shall be entitled to in a skilled nursing, intermediate care
facility, or hospice facility, as defined in Section 1250, and to
ensure that patients in such facilities are advised of their
fundamental rights and the obligations of the facility.
SEC. 7. Section 1599.1 of the Health and Safety Code is amended to
read:
1599.1. Written policies regarding the rights of patients shall
be established and shall be made available to the patient, to any
guardian, next of kin, sponsoring agency or representative payee, and
to the public. Those policies and procedures shall ensure that each
patient admitted to the facility has the following rights and is
notified of the following facility obligations, in addition to those
specified by regulation:
(a) The facility shall employ an adequate number of qualified
personnel to carry out all of the functions of the facility.
(b) Each patient shall show evidence of good personal hygiene and
be given care to prevent bedsores, and measures shall be used to
prevent and reduce incontinence for each patient.
(c) The facility shall provide food of the quality and quantity to
meet the patients' needs in accordance with physicians' orders.
(d) The facility shall provide an activity program staffed and
equipped to meet the needs and interests of each patient and to
encourage self-care and resumption of normal activities. Patients
shall be encouraged to participate in activities suited to their
individual needs.
(e) The facility shall be clean, sanitary, and in good repair at
all times.
(f) A nurses' call system shall be maintained in operating order
in all nursing units and provide visible and audible signal
communication between nursing personnel and patients. Extension cords
to each patient's bed shall be readily accessible to patients at all
times.
(g) (1) If a facility has a significant beneficial interest in an
ancillary health service provider or if a facility knows that an
ancillary health service provider has a significant beneficial
interest in the facility, as provided by subdivision (a) of Section
1323, or if the facility has a significant beneficial interest in
another facility, as provided by subdivision (c) of Section 1323, the
facility shall disclose that interest in writing to the patient, or
his or her representative, and advise the patient, or his or her
representative, that the patient may choose to have another ancillary
health service provider, or facility, as the case may be, provide
any supplies or services ordered by a member of the medical staff of
the facility.
(2) A facility is not required to make any disclosures required by
this subdivision to any patient, or his or her representative, if
the patient is enrolled in an organization or entity that provides or
arranges for the provision of health care services in exchange for a
prepaid capitation payment or premium.
(h) (1) If a resident of a long-term health care facility has been
hospitalized in an acute care hospital and asserts his or her rights
to readmission pursuant to bed hold provisions, or readmission
rights of either state or federal law, and the facility refuses to
readmit him or her, the resident may appeal the facility's refusal.
(2) The refusal of the facility as described in this subdivision
shall be treated as if it were an involuntary transfer under federal
law, and the rights and procedures that apply to appeals of transfers
and discharges of nursing facility residents shall apply to the
resident's appeal under this subdivision.
(3) If the resident appeals pursuant to this subdivision, and the
resident is eligible under the Medi-Cal program, the resident shall
remain in the hospital and the hospital may be reimbursed at the
administrative day rate, pending the final determination of the
hearing officer, unless the resident agrees to placement in another
facility.
(4) If the resident appeals pursuant to this subdivision, and the
resident is not eligible under the Medi-Cal program, the resident
shall remain in the hospital if other payment is available, pending
the final determination of the hearing officer, unless the resident
agrees to placement in another facility.
(5) If the resident is not eligible for participation in the
Medi-Cal program and has no other source of payment, the hearing and
final determination shall be made within 48 hours.
(i) (1) Effective July 1, 2007, Sections 483.10, 483.12, 483.13,
and 483.15 of Title 42 of the Code of Federal Regulations in effect
on July 1, 2006, shall apply to each skilled nursing facility and
intermediate care facility, regardless of a resident's payment source
or the Medi-Cal or Medicare certification status of the skilled
nursing facility or intermediate care facility in which the resident
resides, except that a noncertified facility is not obligated to
provide notice of Medicaid or Medicare benefits, covered services, or
eligibility procedures.
(2) Effective January 1, 2013, Sections 483.10, 483.12, 483.13,
and 483.15 of Title 42 of the Code of Federal Regulations in effect
on July 1, 2006, shall apply to each hospice facility, regardless of
a resident's payment source or the Medi-Cal or Medicare certification
status of the hospice facility in which the resident resides, except
that a noncertified facility is not obligated to provide notice of
Medicaid or Medicare benefits, covered services, or eligibility
procedures and a hospice facility is not obligated to comply with the
provisions of subdivision (f) of Section 483.15 of Title 42 of the
Code of Federal Regulations.
SEC. 8. Section 1599.4 of the Health and Safety Code is amended to
read:
1599.4. In no event shall this chapter be construed or applied in
a manner which imposes new or additional obligations or standards on
skilled nursing, intermediate care facilities, or hospice facilities
or their personnel, other than in regard to the notification and
explanation of patient's rights or unreasonable costs.
SEC. 9. Section 1746 of the Health and Safety Code is amended to
read:
1746. For the 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 that term is
defined 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 as defined in
subdivision (n) of Section 1250.
(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) "An 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 physician 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 care" means patient and family-centered care that
optimizes quality of life of a patient with a terminal illness by
anticipating, preventing, and treating suffering. Palliative care
throughout the continuum of illness involves addressing physical,
intellectual, emotional, social, and spiritual needs and to
facilitate patient autonomy, access to information, and choice.
(k) "Parent agency" means the part of the hospice that is licensed
pursuant to this chapter and that develops and maintains
administrative control of multiple locations. All services provided
from each multiple location 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 organization. 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. 10. Section 1795 of the Health and Safety Code is amended to
read:
1795. (a) Notwithstanding any other provision of law, a skilled
nursing facility as defined in subdivision (c) of Section 1250, any
intermediate care facility, as defined in subdivision (d), (e), (g),
and (h) of Section 1250, a congregate living facility, as defined in
subdivision (i) of Section 1250, or a hospice facility, as defined in
subdivision (n) of Section 1250, shall make reasonable efforts to
contact the person named in the resident's admission agreement as the
resident's contact person, or the resident's responsible person,
within 24 hours after a significant change in the resident's health
or mental status.
(b) Notwithstanding any other provision of law, a residential
care facility for the elderly, as defined in subdivision (k) of
Section 1569.2, shall make reasonable efforts to contact the person
named in the resident's admission agreement as the resident's contact
person, or the resident's responsible person, within 24 hours after
a significant change in the resident's health or mental status.
SEC. 11. 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 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. 12. Section 129725 of the Health and Safety Code is amended
to read:
129725. (a) (1) "Hospital building" includes any building not
specified in subdivision (b) that is used, or designed to be used,
for a health facility of a type required to be licensed pursuant to
Chapter 2 (commencing with Section 1250) of Division 2.
(2) Except as provided in paragraph (7) of subdivision (b),
hospital building includes a correctional treatment center, as
defined in subdivision (j) of Section 1250, the construction of which
was completed on or after March 7, 1973.
(b) "Hospital building" does not include any of the following:
(1) Any building where outpatient clinical services of a health
facility licensed pursuant to Section 1250 are provided that is
separated from a building in which hospital services are provided. If
any one or more outpatient clinical services in the building
provides services to inpatients, the building shall not be included
as a "hospital building" if those services provided to inpatients
represent no more than 25 percent of the total outpatient services
provided at the building. Hospitals shall maintain on an ongoing
basis, data on the patients receiving services in these buildings,
including the number of patients seen, categorized by their inpatient
or outpatient status. Hospitals shall submit this data annually to
the State Department of Health Services.
(2) Any building used, or designed to be used, for a skilled
nursing facility or intermediate care facility if the building is of
single-story, wood-frame or light steel frame construction.
(3) Any building of single-story, wood-frame or light steel frame
construction where only skilled nursing or intermediate care
services are provided if the building is separated from a building
housing other patients of the health facility receiving higher levels
of care.
(4) Any freestanding structures of a chemical dependency recovery
hospital exempted under subdivision (c) of Section 1275.2.
(5) Any building licensed to be used as an intermediate care
facility/developmentally disabled habilitative with six beds or less
and any intermediate care facility/developmentally disabled
habilitative of 7 to 15 beds that is a single-story, wood-frame or
light steel frame building.
(6) Any building subject to licensure as a correctional treatment
center, as defined in subdivision (j) of Section 1250, the
construction of which was completed prior to March 7, 1973.
(7) (A) Any building that meets the definition of a correctional
treatment center, pursuant to subdivision (j) of Section 1250, for
which the final design documents were completed or the construction
of which was begun prior to January 1, 1994, operated by or to be
operated by the Department of Corrections, the Department of the
Youth Authority, or by a law enforcement agency of a city, county, or
a city and county.
(B) In the case of reconstruction, alteration, or addition to,
the facilities identified in this paragraph, and paragraph (6) or any
other building subject to licensure as a general acute care
hospital, acute psychiatric hospital, correctional treatment center,
or nursing facility, as defined in subdivisions (a), (b), (j), and
(k) of Section 1250, operated or to be operated by the Department of
Corrections, the Department of the Youth Authority, or by a law
enforcement agency of a city, county, or city and county, only the
reconstruction, alteration, or addition, itself, and not the building
as a whole, nor any other aspect thereof, shall be required to
comply with this chapter or the regulations adopted pursuant thereto.
(8) Any freestanding building used, or designed to be used, as a
congregate living health facility, as defined in subdivision (i) of
Section 1250.
(9) Any freestanding building used, or designed to be used, as a
hospice facility, as defined in subdivision (n) of Section 1250.
SEC. 13. Section 2.5 of this bill incorporates amendments to
Section 1250 of the Health and Safety Code proposed by both this bill
and Senate Bill 1228. It shall only become operative if (1) both
bills are enacted and become effective on or before January 1, 2013,
(2) each bill amends Section 1250 of the Health and Safety Code, and
(3) this bill is enacted after Senate Bill 1228, in which case
Section 2 of this bill shall not become operative.
SEC. 14. Section 4.5 of this bill incorporates amendments to
Section 1266 of the Health and Safety Code proposed by both this bill
and Assembly Bill 1710. It shall only become operative if (1) both
bills are enacted and become effective on or before January 1, 2013,
(2) each bill amends Section 1266 of the Health and Safety Code, and
(3) this bill is enacted after Assembly Bill 1710, in which case
Section 4 of this bill shall not become operative.
SEC. 15. 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.
