Bill Text: CA SB21 | 2011-2012 | Regular Session | Amended
Bill Title: Long-term care: assessment and planning.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2012-01-31 - Returned to Secretary of Senate pursuant to Joint Rule 56. [SB21 Detail]
Download: California-2011-SB21-Amended.html
BILL NUMBER: SB 21 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 25, 2011
AMENDED IN SENATE MARCH 9, 2011
INTRODUCED BY Senators Liu and Alquist
DECEMBER 6, 2010
An act to amend Section 1262.5 of, and to add Sections 1262.9 and
1264.5 to, the Health and Safety Code, and to add Division 13
(commencing with Section 22100) to, and to repeal Section 22103 of,
the Welfare and Institutions Code, relating to long-term care
services.
LEGISLATIVE COUNSEL'S DIGEST
SB 21, as amended, Liu. Long-term care: assessment and planning.
Existing law provides for the licensure of various health
facilities, including general acute care hospitals, skilled nursing
facilities, and intermediate care facilities, and congregate living
health facilities by the State Department of Public Health. Certain
of these facilities are included under the category of long-term
health care facilities, as defined. A violation of these provisions
is a crime. Existing law requires each hospital to have in effect a
written discharge planning policy and process that requires
appropriate arrangements for posthospital care and a process that
requires that each patient be informed, orally or in writing, of the
continuing care requirements following discharge from the hospital,
as specified, and additionally requires specific information to be
provided to a patient anticipated to be in need of posthospital care.
This bill would require a hospital that is required to provide, as
part of its discharge policy, information to patients anticipated to
need posthospital care, to provide the information both orally and
in writing to the patient and, if necessary, to his or her
representative, at the earliest possible opportunity prior to
discharge. By changing the definition of an existing crime, this bill
would impose a state-mandated local program.
Existing law establishes the California Partnership for Long-Term
Care Program and requires the State Department of Health Care
Services to adopt regulations to administer the program.
This bill would require the State Department of Health Care
Services to initiate a process to develop or identify, by no later
than July 1, 2013, a tool for the uniform long-term care services
assessment of individuals in order to assist eligible consumers in
finding long-term care services of their choice, as specified. The
department would be required to submit a report on the use of these
assessments to the Legislature.
This bill, among other things, would require a county to establish
a long-term care case management program for specified persons if
the director makes a specified certification. The bill would require
the program to provide prescribed services, including assessment of
care needed for persons in long-term health care facilities, as
defined, to enable them to reside in the community and the services
necessary to provide that care, and would require the county or its
designees to assign care managers to each long-term health care
facility within the county. After these facilities are notified of
the appropriate case manager, each facility would be required to
inform the case manager when a new patient or resident is admitted
and may need specified assistance. By changing the definition of an
existing crime, this bill would impose a state-mandated local
program.
The bill also would require a long-term health care facility to
display at least one poster, in an area accessible to residents,
advertising the telephone number of the facility's designated case
manager, thus changing the definition of an existing crime and
imposing a state-mandated local program.
The bill would also require these persons, upon a discharge from a
long-term health care facility, to be provided with prescribed
services by the county, and would express intent pertaining to the
funding of these services. Because the bill would impose various
duties on each county, the bill would create a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that with regard to certain mandates no
reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) California is home to the largest older adult population in
the nation. Currently, approximately 4.4 million older adults will
comprise almost 15 percent of the state's population. By 2030,
projections suggest that 8.3 million older adults will account for
nearly 18 percent of the population.
(b) California's services for older adults and other adults with
long-term care needs currently exist in an uncoordinated patchwork of
programs overseen by multiple state agencies and organizations,
rather than a coordinated continuum of care focused on providing
services that are consumer-centered, least restrictive, and most cost
effective.
(c) All older adults and other adults with long-term care needs
should have access to information about the services that are
available in order to avoid institutionalization and the services of
a counselor or case manager who can help navigate the multiple health
and social service programs that may provide benefits to that
individual.
(d) Given recent reports and recommendations, California needs a
strategic plan for long-term care services that will maximize the use
of finite resources and reduce the use of institutional care.
California's plan for the implementation of the federal Olmstead
decision is the beginning of the process of providing the statewide
service coordination and assessment necessary for a continuum of
services for those in need of long-term care, including older adults.
(e) The public interest would best be served by a broad array of
long-term care services that support persons who need these services
at home or in the community whenever practicable, and that promote
individual autonomy, dignity, and choice. In-home supportive services
and adult day health care are examples of services that the state
should prioritize with stable and adequate funding.
(f) Other states, including Pennsylvania and Washington, have
invested in a coordinated approach for long-term care and home- and
community-based services that has improved the effectiveness of the
overall delivery system and reduced the rate of growth of
institutional care.
(g) In order for California to adequately meet the challenges of
an aging population and implement the federal Olmstead decision, it
is the intent of the Legislature to establish an integrated system of
long-term care that will enable older adults and other adults with
long-term care needs to remain at home whenever possible and live in
the least restrictive environment with autonomy, dignity, and choice
whenever possible.
(h) Providing case management and transition services to residents
of institutions is in keeping with the federal Olmstead v. L.C.
(1999) 527 U.S. 581 decision and its focus on the rights of persons
with disabilities, including those who are aged, to have a choice in
where they live.
(i) Services provided through various Medicaid waivers and through
independent living centers, that assist persons to remain in or
return to their homes, can serve as a basis for providing case
management and transition services to additional individuals eligible
for these services.
(j) There is a need for a practical assessment of barriers to
returning home for aged persons and persons with disabilities who
reside in institutional care.
SEC. 2. Section 1262.5 of the Health and Safety Code is amended to
read:
1262.5. (a) Each hospital shall have a written discharge planning
policy and process.
(b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to discharge for those
patients who are likely to suffer adverse health consequences upon
discharge if there is no adequate discharge planning. If the hospital
determines that the patient and family members or interested persons
need to be counseled to prepare them for posthospital care, the
hospital shall provide for that counseling.
(c) The process required by subdivision (a) shall require that the
patient be informed, orally or in writing, of the continuing health
care requirements following discharge from the hospital. The right to
information regarding continuing health care requirements following
discharge shall apply to the person who has legal responsibility to
make decisions regarding medical care on behalf of the patient, if
the patient is unable to make those decisions for himself or herself.
In addition, a patient may request that friends or family members be
given this information, even if the patient is able to make his or
her own decisions regarding medical care.
(d) (1) A transfer summary shall accompany the patient upon
transfer to a skilled nursing or intermediate care facility or to the
distinct part-skilled nursing or intermediate care service unit of
the hospital. The transfer summary shall include essential
information relative to the patient's diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.
(2) A copy of the transfer summary shall be given to the patient
and the patient's legal representative, if any, prior to transfer to
a skilled nursing or intermediate care facility.
(e) A hospital shall establish and implement a written policy to
ensure that each patient receives, at the time of discharge,
information regarding each medication dispensed, pursuant to Section
4074 of the Business and Professions Code.
(f) A hospital shall provide every patient anticipated to be in
need of long-term care at the time of discharge with contact
information for at least one public or nonprofit agency or
organization dedicated to providing information or referral services
relating to community-based long-term care options in the patient's
county of residence and appropriate to the needs and characteristics
of the patient. At a minimum, this information shall include contact
information for the area agency on aging serving the patient's county
of residence, local independent living centers, or other information
appropriate to the needs and characteristics of the patient. This
information shall be provided both orally and in writing, and shall
be provided to the patient, and, if applicable, to the patient's
authorized representative, at the earliest possible opportunity prior
to discharge.
(g) A contract between a general acute care hospital and a health
care service plan that is issued, amended, renewed, or delivered on
or after January 1, 2002, may not contain a provision that prohibits
or restricts any health care facility's compliance with the
requirements of this section.
SEC. 3. Section 1262.9 is added to the Health and Safety Code, to
read:
1262.9. (a) A general acute care hospital may make a referral to
the designated case manager when it has a patient who will be
referred to a long-term health care facility and the hospital
anticipates that the placement will be needed for more than 21 days,
or when it has a patient it believes can return home upon discharge
if certain services or modifications can be made that the case
manager can arrange and that without those services or modifications
a referral to a long-term health care facility will be necessary.
(b) A licensed long-term health care facility shall inform the
designated case manager assigned to that facility when a new patient
or resident who is described in subdivision (b) of Section 22102 of
the Welfare and Institutions Code is admitted and has been or is
expected to be a resident for 21 days or who has expressed a
preference for living at home or in the community and may need
assistance in identifying and securing home- and community-based
services. Referrals may be made before a patient has been a resident
for 21 days if it is likely that without assistance from the case
manager the patient will not be able to return home in fewer than 21
days from admission. Referrals shall be made on or before the 21st
day of a patient's residence.
(c) On and after January 1, 2014, a long-term health care facility
that admits a new patient or resident who is described in
subdivision (b) of Section 22102 of the Welfare and Institutions Code
and that has not made a referral pursuant to subdivision (b)
shall not receive Medi-Cal reimbursement until the referral
has been made, and shall not be reimbursed by Medi-Cal for those days
during which a referral should have been made but was not made.
may be issued a citation pursuant to Section 1424. A
citation shall not be issued for failure to refer a resident if the
facility determined in good faith that services would not be needed
for more than 21 days, but unanticipated delays result in the
resident remaining in the facility for a limited period beyond 21
days.
(d) For the purposes of this section, "long-term health care
facility" shall have the same meaning as that term is defined in
Section 22108 of the Welfare and Institutions Code.
(e) For the purposes of this section, "designated case manager"
means the case manager described in subdivision (g) of Section 22102
of the Welfare and Institutions Code.
(f) This section shall not be implemented unless the requirements
specified in subdivision (b) of Section 22106 of the Welfare and
Institutions Code are satisfied.
SEC. 4. Section 1264.5 is added to the Health and Safety Code, to
read:
1264.5. Commencing January 1, 2013, a licensed long-term health
care facility, as defined in Section 22108 of the Welfare and
Institutions Code, shall display at least one poster, in an area
accessible to residents, advertising the telephone number of the
facility's designated case manager. The poster shall be developed in
consultation with the designated case manager and the State
Department of Health Care Services.
SEC. 5. Division 13 (commencing with Section 22100) is added to
the Welfare and Institutions Code, to read:
DIVISION 13. LONG-TERM CARE ASSESSMENT AND PLANNING FOR
INDIVIDUALS
22100. It is the intent of the Legislature to establish a
long-term care services system that does all of the following:
(a) Provides a continuum of social and health services that foster
independence and self-reliance, maintain individual dignity, and
allow consumers of long-term care services to remain an integral part
of their family and community life. Essential features of this
continuum may include any or all of the following:
(1) Discharge planning in hospitals, skilled nursing facilities,
and other licensed care with the goal of returning an individual to
his or her home as soon as possible, with support services if
necessary. Discharge planning includes both diversion from hospital
to home and transition from skilled nursing facility or another
residential care setting to home. Discharge planning may begin before
a scheduled hospital visit.
(2) The ability to maintain or make modifications on homes
necessary for a person to remain or to return.
(3) Multiple points of entry to a single system that
ensures ensure that all individuals who receive
long-term care services understand their options for remaining at
home or in the community and that ensures
ensure that all long-term care service providers know where to
direct individuals for an assessment of their options for home- and
community-based services.
(4) The integration and expansion of Medi-Cal waiver programs to
realize maximum federal financial participation.
(5) Rental assistance vouchers for those who are able to transfer
from an institution, but who have no permanent home.
(6) A common database that is accessible and interoperable across
programs enabling the state and counties to combine and analyze data
from treatment authorization requests (TARs), in-home supportive
services, hospitals, nursing homes, and other facilities and
programs.
(7) Wraparound services, including case management, as described
in Section 22102, for individuals whose income and situation are
insufficient to enable them to navigate the obstacles to remain
successfully at home or in the community, when these options are
available and appropriate.
(b) Ensures that, if out-of-home placement is necessary, it is at
the appropriate level of care, and prevents unnecessary utilization
of acute care hospitals, skilled nursing facilities, and other
licensed residential care facilities.
(c) Delivers long-term care services in the least restrictive
environment appropriate for the consumer, based on the consumer's
individual needs and choices.
(d) Provides older adults with the information and supports needed
to exercise self-direction and to make choices, given their
capability and interest, and involves them and their family members
as partners in the development and implementation of long-term care
services.
22101. (a) (1) The State Department of Health Care Services shall
initiate a process, in collaboration with stakeholders, to develop
or identify no later than July 1, 2013, a tool for the uniform,
long-term care services assessment of individuals in order to assist
eligible consumers, as described in subdivision (b) of Section 22102,
in finding long-term care services of their choice. Stakeholders in
this process shall include consumer advocates, advocates for older
adults, disability rights advocates, public and private hospitals,
long-term health care facilities, home health and hospice agencies,
long-term care program representatives, including in-home supportive
services and county representatives, and formal and informal direct
caregivers. The uniform long-term care services assessment tool that
shall be developed or identified shall assist eligible consumers in
making informed choices about home and community options for
individuals who are hospitalized and likely to need long-term care,
individuals who reside in an institution, or individuals in the
community who are likely to need long-term care.
(2) The department may develop or identify the uniform long-term
care services assessment tool without meeting the rulemaking
requirements of the Administrative Procedure Act, provided that at
least one 30-day public comment period is used and the
department responds to public comment .
(3) In addition, the department, in collaboration with the
stakeholders, shall establish training standards for case management
and for the use of the uniform long-term care services assessment
tool as part of the long-term care case management program described
in Section 22102.
(b) In developing the uniform long-term care services assessment
tool, the department and stakeholders in the development process
shall ensure that the assessment tool identifies individual and
community barriers that prevent the individual from living at home,
in the community, or in a less restrictive environment.
(c) In developing or identifying the uniform long-term care
services assessment tool, the department, in collaboration with the
stakeholders identified in subdivision (a), shall evaluate whether
existing federal, state, or county assessment tools or information
systems and processes may be used, integrated, or further developed
to meet the purposes of this section. Before the department, in
collaboration with the stakeholders, decides not to develop its own
uniform long-term care services assessment tool and, instead, decides
to identify existing federal, state, or county assessment tools or
information systems and processes to use as the uniform long-term
care services assessment tool, the department and the stakeholders
shall consider the extent to which the use of these tools, systems,
or processes is authorized or required pursuant to federal law.
(d) The department, in collaboration with the stakeholder groups
identified in subdivision (a), shall develop recommended best
practices under which individuals who receive the uniform long-term
care services assessment, and express a preference for living at home
or in another community-based setting, may also receive all of the
following:
(1) A comprehensive community services plan, to be developed with
the individual and, as appropriate, the individual's representative.
(2) Information about the availability of services that could meet
the individual's needs, as set forth in the community services plan,
and an explanation of the cost to the individual of the available
in-home and community services in relation to long-term health care
facility care.
(3) Information on retention of Supplemental Security Income/State
Supplementary Plan benefits, rental assistance vouchers, home
modification allowances, or home maintenance allowances, and any
other financial supports that would assist the individual in
maintaining his or her home during a hospital or nursing facility
stay.
(4) Opportunity for discussion, evaluation, and ongoing
involvement with a case manager or counselor.
22102. (a) It is the intent of the Legislature to establish a
case management program that identifies and secures services that
will enable an individual to return home from a hospital following an
illness or injury, to return home from a skilled nursing facility or
other long-term health care facility, and to remain at home or in
the community rather than residing in an institution.
(b) With assistance from the State Department of Health Care
Services, each county shall establish a long-term care case
management program for individuals who are Medi-Cal recipients or
applicants, or who are eligible for both Medicare and Medi-Cal. The
individuals shall also meet at least one of the following
requirements:
(1) The individuals are residing in a long-term health care
facility.
(2) The individuals are applying for admission to a long-term
health care facility.
(3) The individuals are at imminent risk of being placed in a
long-term health care facility.
(c) (1) In establishing the long-term care case management program
pursuant to subdivision (b), the county shall identify one or more
county departments or nonprofit organizations or a combination of
departments and nonprofit organizations to provide case management. A
county may contract with nonprofit organizations for this purpose.
These organizations may include, but are not limited to, independent
living centers, area agencies on aging, providers of multipurpose
senior services, linkages, aging and disability resource connections
programs, and public authorities.
(2) The State Department of Health Care Services shall provide
guidance to counties to promote the provision of case management
services in ways that maximize federal financial participation. The
State Department of Health Care Services may contract directly with
nonprofit organizations, or a combination of departments and
nonprofit organizations, in lieu of a particular county or counties,
upon the request of a county or counties, to satisfy the requirements
of this section.
(d) The county shall identify eligible individuals described in
subdivision (b) who need support services in order to live at home or
in the community, and shall arrange for the provision of those
services to the extent that the services are not provided by any
other program, and to the extent that the provision of these services
would allow them to live safely at home or in the community. Of
these eligible individuals, the county shall give first priority to
individuals who have been or are expected to be residents of a
long-term health care facility for more than 21 days, but who can
reasonably be expected to return home or to the community if case
management services are provided. The next priority shall be given to
individuals who are referred by a general acute care hospital who
may be diverted from care at a licensed long-term health care
facility if case management services are provided and for individuals
who request and are eligible for case management services in order
to avoid being placed in a long-term health care facility either from
the community or home setting.
(e) Services provided through the case management program shall
include, but are not limited to, all of the following:
(1) Identifying, until the uniform long-term care services
assessment tool is either developed or identified pursuant to Section
22101, any barriers to the individual's return to or remainder at
home or in the community. This identification of barriers shall be
replaced by the use of uniform, long-term care services assessment
when available.
(2) Identify any medical or therapeutic care that an individual
needs in order to reenter the community, or a less restrictive
environment.
(3) Enrolling, or assisting in the enrollment of, the individual
in home- and community-based programs, to the extent authorized by
the individual or individual's authorized representative, if
necessary for the individual.
(4) Developing and executing a care plan.
(5) Ensuring the coordination of health and social services that
meet the individual's needs.
(6) Coordinating maintenance of or renovations to a home to
accommodate an individual's disability or infirmity, if necessary for
the individual.
(7) Arranging for the payment of a home upkeep allowance for
utilities, including light, heat, water, and garbage pickup, if
necessary, for the individual.
(8) Applying for rental assistance vouchers or other retention of
income, to the extent authorized by the individual or individual's
authorized representative, if necessary for the individual. The case
manager may also provide rental assistance vouchers if an individual
requires accommodation while home renovations are made or while
arrangements are made for permanent housing if the individual cannot
return to his or her residence at the time of discharge from a
hospital, but can live in a less restrictive environment than a
skilled nursing facility or other licensed long-term health care
facility.
(9) Followup services to ensure that an individual's ongoing or
changing needs are being met.
(10) Community-reentry training or independent living training for
the individual, if necessary.
(f) If requested, a copy of the assessment provided for in
paragraph (1) of subdivision (e), shall be provided to the
individual.
(g) The county or its designee shall assign case managers to each
long-term health care facility located within the county and notify
each of these long-term health care facilities of any changes in
personnel.
(h) Case managers and those doing the assessment shall not be
employees of a long-term health care facility or a general acute care
hospital, and shall meet the training standards established pursuant
to subdivision (a) of Section 22101.
(i) Any individual designated as a case manager shall have access
to any long-term health care facility in order to provide case
management services. Failure to provide this access may result in the
imposition of an administrative penalty against the long-term health
care facility.
22103. (a) By December 1, 2014, the State Department of Health
Care Services, in consultation with the Office of Statewide Health
Planning and Development, shall report to the Legislature the total
number of long-term care services assessments performed in the state,
along with all of the following:
(1) The total number of assessments of individuals from the
community.
(2) The total number of assessments of individuals in nursing
facilities.
(3) The total number of assessments of individuals in hospitals.
(4) The total number of individuals assessed who were placed in
community care.
(5) The total number of individuals assessed who were diverted
from nursing home placement.
(6) The total number of individuals assessed who were not able to
be diverted, and why, including, but not limited to, personal choice,
medical condition, unavailability of community-based services, such
as in-home supportive services, adult day health care, Alzheimer'
s-specific programs, independent living programs, housing assistance,
residential care facilities for the elderly, home-delivered meals,
home health care, protective services, respite care, social day care,
transportation services, or legal assistance.
(b) The department also shall compare the data collected under
subdivision (a) to the utilization data and length-of-stay data for
residents of long-term care facilities in the prior year to measure
the impact of case management on reducing the use of institutional
care. The department shall analyze and report whether the number of
residents utilizing more than 21 days in a long-term care facility,
and the average length of stay of those residents beyond 21 days,
have been reduced.
(b)
(c) (1) A report to be submitted pursuant to
subdivision (a) shall be submitted in compliance with Section 9795 of
the Government Code.
(2) Pursuant to Section 10231.5 of the Government Code, this
section shall remain in effect only until January 1, 2016, and as of
that date is repealed, unless a later enacted statute, that is
enacted before January 1, 2016, deletes or extends that date.
22104. (a) The Department of Finance, with the assistance of the
California Health and Human Services Agency and subject to review by
the Legislative Analyst, shall establish a baseline of expenditures
for long-term health care facility care based on the average of state
and county expenditures for the services in the 2008-09, 2009-10,
and 2010-11 fiscal years. This information shall be used to determine
the amounts that are saved each subsequent year from implementation
of this division.
(b) When the budget for home- and community-based services is
considered by the appropriate budget committees of the Legislature,
the Department of Finance, subject to review by the Legislative
Analyst, shall provide an estimate of the state savings realized from
placing individuals who would otherwise be placed in or transferred
to a licensed long-term health care facility in a home or to a less
restrictive environment.
22105. The department shall pursue any additional necessary
waivers and state plan amendments to ensure federal financial
participation in funding increases to home- and community-based
services, including, but not limited to, in-home supportive services
and adult day health care, home maintenance and home modification
allowances, as well as training and employment of individuals who
will conduct the uniform
long-term care assessments and case management or counseling of
individuals eligible or at risk of needing long-term care.
22106. (a) On or before July 1, 2012, the department, in
collaboration with stakeholders identified in subdivision (a) of
Section 22101, shall submit to the Legislature a financing plan for
providing long-term care services pursuant to this division.
(b) Section 1262.9 of the Health and Safety Code, and Sections
22102, 22103, and 22104 shall not be implemented unless the Director
of Health Care Services certifies that the collection of federal
funds, other revenue from restructuring of reimbursements, penalties,
and fines, or private funds, is sufficient to fund the
implementation of long-term care services assessments, case
management or counseling, and services pursuant to this division.
22107. (a) As part of their responsibilities to develop the
process described in subdivision (d) of Section 22101, stakeholder
groups may review the treatment authorization requests process
described in Sections 14133, 14133.01, and 14133.05 and recommend to
the State Department of Health Care Services ways to improve the role
of the treatment authorization requests process in assisting those
who wish to return home from a long-term health care facility.
(b) By December 1, 2012, the department, in collaboration with the
stakeholders, shall submit to the Legislature recommended changes,
if any, to each of the following:
(1) The treatment authorization request process to promote the
more rapid movement of residents of long-term health care facilities
to home and community.
(2) The temporary or permanent restructuring of long-term care
reimbursement to provide reimbursement for a coordinated program of
home- and community-based services in lieu of reimbursement for
services provided in a skilled nursing facility, when this program
would allow an individual to remain in or return to a community
setting.
(3) Reimbursement for hospital, skilled nursing, and
rehabilitation care, so that this care will be provided at levels
sufficient to ensure beneficiary access to optimal medical and
functional recovery and to provide patient and caregiver education
directed toward successful transition to the community setting.
22108. For purposes of this division, a long-term health care
facility includes a skilled nursing facility, intermediate care
facility, intermediate care facility/developmentally disabled,
intermediate care facility/developmentally disabled habilitative,
intermediate care facility/developmentally disabled nursing, and
congregate living health facility, as these terms are defined in
Section 1250 of the Health and Safety Code.
SEC. 6. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for
certain costs that may be incurred by a local agency or school
district because, in that regard, 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.
However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.
