AB 1147: Health facilities: pediatric day health and respite care facilities.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2015-08-13
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the State Department of Public Health for a Transitional Health Care Needs Optional Service Unit. The bill would also authorize a patient who previously received services from a pediatric day health and respite care facility and who is 22 years of age or older to receive care in an optional service unit, as provided. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for patients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger patients, except under specified circumstances.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection of an optional service unit within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the patients attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care facility is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the State Department of Public Health for a Transitional Health Care Needs Optional Service Unit. The bill would also authorize a patient who previously received services from a pediatric day health and respite care facility and who is 22 years of age or older to receive care in an optional service unit, as provided. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for patients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger patients, except under specified circumstances.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection of an optional service unit within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the patients attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care facility is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the State Department of Public Health for a Transitional Health Care Needs Optional Service Unit. The bill would also authorize a patient who previously received services from a pediatric day health and respite care facility and who is 22 years of age or older to receive care in an optional service unit, as provided. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for patients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger patients, except under specified circumstances.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection of an optional service unit within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the patients attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care facility is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the State Department of Public Health for a Transitional Health Care Needs Optional Service Unit. The bill would also authorize a patient who previously received services from a pediatric day health and respite care facility and who is 22 years of age or older to receive care in an optional service unit, as provided. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for patients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger patients, except under specified circumstances.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection of an optional service unit within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the patients attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care facility is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the department State Department of Public Health for a Transitional Health Care Needs Optional Service Unit. The bill would also authorize a patient who previously received services from a pediatric day health and respite care facility and who is 22 years of age or older to receive care in an optional service unit, as provided. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for clients patients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients. patients, except under specified circumstances.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by clients, patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, agreement and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility, facility and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection of an optional service unit within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the childs patients attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care facility is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the department for a Transitional Health Care Needs Optional Service Unit. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for clients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by clients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility, and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the childs attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
This bill would declare that it is to take effect immediately as an urgency statute.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including, among others, pediatric day health and respite care facilities. Existing law defines pediatric day health and respite care facility as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
This bill would authorize an individual who is 22 years of age or older to continue to receive care in a pediatric day health and respite care facility, if the facility receives approval from the department for a Transitional Health Care Needs Optional Service Unit. The bill would establish a licensing process for a pediatric day health and respite care facility to operate an optional service unit, and would impose certain requirements on those optional service units, including, among others, that the optional service unit provide care for clients who are 22 years of age or older in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients.
This bill would authorize a pediatric day health and respite care facility to implement policies and procedures that prohibit smoking by clients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
This bill would establish procedures for the issuance of a provisional license to a pediatric day health and respite care facility. The bill would specify additional procedures relating to the licensure of a pediatric day health and respite care facility, and renewals of those licenses, including, among others, requiring the department to initiate an initial licensing inspection within 60 days of receipt of a pediatric day health and respite care facilitys completed application and requiring periodic inspections by a duly authorized representative of the department and specified reports related to those inspections. The bill would authorize the department to make reasonable accommodation for exceptions to the licensing standards if the health, safety, and quality of patient care is not compromised. The bill would also specify the grounds upon which those licenses may be revoked, including, among others, willful omission or falsification of a material fact in the application for a license. The bill would require proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval, to be conducted in accordance with specified provisions of law.
Existing law requires facilities serving persons who are terminally ill, catastrophically and severely disabled, mentally alert but physically disabled, or any combination of these persons, to comply with specified provisions of the California Code of Regulations, and exempts those facilities from certain requirements of that code relating to required services for skilled nursing facilities.
This bill would provide additional exemptions from that code for a pediatric day health and respite care facility.
Existing law specifies the services that a pediatric day health and respite care facility is required to provide, including, among others, pharmacy services.
This bill would require that pharmacy services by a pediatric day health and respite care facility satisfy certain requirements, including, among others, that medications be administered only upon written and signed orders of the childs attending physician.
This bill would require a pediatric day health and respite care facility to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. The bill would specify the composition of the committee, impose specified meeting requirements, and outline the committees responsibilities.
Existing law requires pediatric day health and respite care facilities to meet the same fire safety standards adopted by the State Fire Marshal and the same seismic safety standards that apply to community care facilities. Existing law provides that a pediatric day health and respite care is not subject to architectural plan review or field inspection by the Office of Statewide Health Planning and Development, and requires, as part of the application for licensure, an applicant to submit evidence of compliance with local building code requirements and that the physical environment is adequate to provide the level of care and service required by the clients of the facility as determined by the department.
This bill would provide that those provisions do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent patients, except as provided in paragraph (2) and Section 1763.4.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of Section 1763.4, may also receive services in an optional service unit.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent patient means a person who, from birth, has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the patient. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible patient population and includes all of the following:
(1) Screening of patient referrals to identify those persons who can benefit from the available services.
(2) Comprehensive patient assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified by a licensed nurse, in accordance with his or her scope of practice.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the patients parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the patients attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a patient into the facility if the patients medications have expired or are scheduled to expire during the patients stay at the facility.
(b)(1)Physician orders shall be current and maintained in the patients medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the patients medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a patient unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the patients plan of care.
(d)The pediatric day health and respite care facility may treat changes in the patients condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patients plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals with whom the patient may come into contact. A patient who presents with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
(f)Only licensed nursing personnel, acting in accordance with their scope of practice, may accept, inspect the condition of medical containers, and record the receipt and the return of all medications in a pediatric day health and respite care facility. The facility shall comply with Section 72313 of Title 22 of the California Code of Regulations with regard to the administration of medication.
(g)A pediatric day health and respite care facility shall comply with all applicable state and federal laws regarding the labeling condition of medication containers.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection of a Transitional Health Care Needs Optional Service Unit within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)The state department shall not issue a provisional license unless, after an onsite survey by the state department, the state department finds that the pediatric day health and respite care facility is in substantial compliance with the requirements of this chapter.
(c)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(d)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(e)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(f)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(g)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon, any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of patients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, the following definitions shall apply:
(1)Distinct part means an identifiable unit accommodating beds or patient space, including, but not limited to, contiguous beds or patient space, a wing, floor, or building approved by the state department for a specific purpose.
(2)Older children means patients who are 18 to 21 years of age, inclusive.
(3)Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(A)Patients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older children are not precluded from being cared for in the same optional service unit as the patients who are 22 years of age or older. If a pediatric day health and respite care facility proposes to provide care to older children in the optional service unit, the facility shall have policies, procedures, equipment, and supplies to meet the needs of those patients. Patients who are 15 to 17 years of age, inclusive, may also be considered for care in the optional service unit if the pediatric day health and respite care facility obtains an individual age waiver from the regional center, with the concurrence of the department. A pediatric day health and respite care facility is not required to operate an optional service unit.
(B)In order to continue receiving care in the pediatric day health and respite care facility, patients who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the patients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of this subparagraph may also receive services in an optional service unit.
(b)An optional service unit shall be subject to the approval of the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Except as provided in subparagraph (A) of paragraph (3) of subdivision (a), care for patients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to patients who are 21 years of age or younger. The facility shall establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the patients chronological age, developmental age, and size, and shall reflect the needs of individual patients through a comprehensive assessment.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
(f)(1)The state department may review and approve the policies and procedures for an optional service unit.
(2)The State Department of Developmental Services and the regional centers may review the policies and procedures for an optional service unit.
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite care facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent patients, except as provided in paragraph (2) and Section 1763.4.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of Section 1763.4, may also receive services in an optional service unit.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent patient means a person who, from birth, has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the patient. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible patient population and includes all of the following:
(1) Screening of patient referrals to identify those persons who can benefit from the available services.
(2) Comprehensive patient assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified by a licensed nurse, in accordance with his or her scope of practice.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the patients parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the patients attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a patient into the facility if the patients medications have expired or are scheduled to expire during the patients stay at the facility.
(b)(1)Physician orders shall be current and maintained in the patients medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the patients medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a patient unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the patients plan of care.
(d)The pediatric day health and respite care facility may treat changes in the patients condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patients plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals with whom the patient may come into contact. A patient who presents with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
(f)Only licensed nursing personnel, acting in accordance with their scope of practice, may accept, inspect the condition of medical containers, and record the receipt and the return of all medications in a pediatric day health and respite care facility. The facility shall comply with Section 72313 of Title 22 of the California Code of Regulations with regard to the administration of medication.
(g)A pediatric day health and respite care facility shall comply with all applicable state and federal laws regarding the labeling condition of medication containers.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection of a Transitional Health Care Needs Optional Service Unit within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)The state department shall not issue a provisional license unless, after an onsite survey by the state department, the state department finds that the pediatric day health and respite care facility is in substantial compliance with the requirements of this chapter.
(c)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(d)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(e)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(f)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(g)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon, any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of patients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, the following definitions shall apply:
(1)Distinct part means an identifiable unit accommodating beds or patient space, including, but not limited to, contiguous beds or patient space, a wing, floor, or building approved by the state department for a specific purpose.
(2)Older children means patients who are 18 to 21 years of age, inclusive.
(3)Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(A)Patients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older children are not precluded from being cared for in the same optional service unit as the patients who are 22 years of age or older. If a pediatric day health and respite care facility proposes to provide care to older children in the optional service unit, the facility shall have policies, procedures, equipment, and supplies to meet the needs of those patients. Patients who are 15 to 17 years of age, inclusive, may also be considered for care in the optional service unit if the pediatric day health and respite care facility obtains an individual age waiver from the regional center, with the concurrence of the department. A pediatric day health and respite care facility is not required to operate an optional service unit.
(B)In order to continue receiving care in the pediatric day health and respite care facility, patients who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the patients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of this subparagraph may also receive services in an optional service unit.
(b)An optional service unit shall be subject to the approval of the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Except as provided in subparagraph (A) of paragraph (3) of subdivision (a), care for patients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to patients who are 21 years of age or younger. The facility shall establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the patients chronological age, developmental age, and size, and shall reflect the needs of individual patients through a comprehensive assessment.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
(f)(1)The state department may review and approve the policies and procedures for an optional service unit.
(2)The State Department of Developmental Services and the regional centers may review the policies and procedures for an optional service unit.
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite care facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent patients, except as provided in paragraph (2) and Section 1763.4.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of Section 1763.4, may also receive services in an optional service unit.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent patient means a person who, from birth, has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the patient. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible patient population and includes all of the following:
(1) Screening of patient referrals to identify those persons who can benefit from the available services.
(2) Comprehensive patient assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified by a licensed nurse, in accordance with his or her scope of practice.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the patients parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the patients attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a patient into the facility if the patients medications have expired or are scheduled to expire during the patients stay at the facility.
(b)(1)Physician orders shall be current and maintained in the patients medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the patients medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a patient unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the patients plan of care.
(d)The pediatric day health and respite care facility may treat changes in the patients condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patients plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals with whom the patient may come into contact. A patient who presents with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
(f)Only licensed nursing personnel, acting in accordance with their scope of practice, may accept, inspect the condition of medical containers, and record the receipt and the return of all medications in a pediatric day health and respite care facility. The facility shall comply with Section 72313 of Title 22 of the California Code of Regulations with regard to the administration of medication.
(g)A pediatric day health and respite care facility shall comply with all applicable state and federal laws regarding the labeling condition of medication containers.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection of a Transitional Health Care Needs Optional Service Unit within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)The state department shall not issue a provisional license unless, after an onsite survey by the state department, the state department finds that the pediatric day health and respite care facility is in substantial compliance with the requirements of this chapter.
(b)
(c)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(c)
(d)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(d)
(e)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(e)
(f)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(f)
(g)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon, any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of patients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, the following definitions shall apply:
(1)Distinct part means an identifiable unit accommodating beds or patient space, including, but not limited to, contiguous beds or patient space, a wing, floor, or building approved by the state department for a specific purpose.
(2)Older children means patients who are 18 to 21 years of age, inclusive.
(3)Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(A)Patients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older children are not precluded from being cared for in the same optional service unit as the patients who are 22 years of age or older. If a pediatric day health and respite care facility proposes to provide care to older children in the optional service unit, the facility shall have policies, procedures, equipment, and supplies to meet the needs of those patients. Patients who are 15 to 17 years of age, inclusive, may also be considered for care in the optional service unit if the pediatric day health and respite care facility obtains an individual age waiver from the regional center, with the concurrence of the department. A pediatric day health and respite care facility is not required to operate an optional service unit.
(B)In order to continue receiving care in the pediatric day health and respite care facility, patients who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the patients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of this subparagraph may also receive services in an optional service unit.
(b)An optional service unit shall be approved by subject to the approval of the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Except as provided in subparagraph (A) of paragraph (3) of subdivision (a), care for patients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to patients who are 21 years of age or younger. The facility shall establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the patients chronological age, developmental age, and size, and shall reflect the needs of individual patients through a comprehensive assessment.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
(f)(1)The state department may review and approve the policies and procedures for an optional service unit.
(2)The State Department of Developmental Services and the regional centers may review the policies and procedures for an optional service unit.
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite care facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent patients, except as provided in paragraph (2) and Section 1763.4.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older older, and who satisfies the requirements of Section 1763.4, may also receive services in an optional service unit.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent patient means a person who, from birth, has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the patient. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible patient population and includes all of the following:
(1) Screening of patient referrals to identify those persons who can benefit from the available services.
(2) Comprehensive patient assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified by a licensed nurse, in accordance with his or her scope of practice.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the patients parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the patients attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a patient into the facility if the patients medications have expired or are scheduled to expire during the patients stay at the facility.
(b)(1)Physician orders shall be current and maintained in the patients medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the patients medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a patient unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the patients plan of care.
(d)The pediatric day health and respite care facility may treat changes in the patients condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patients plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals with whom the patient may come into contact. A patient who presents with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
(f)Only licensed nursing personnel, acting in accordance with their scope of practice, may accept, inspect the condition of medical containers, and record the receipt and the return of all medications in a pediatric day health and respite care facility. The facility shall comply with Section 72313 of Title 22 of the California Code of Regulations with regard to the administration of medication.
(g)A pediatric day health and respite care facility shall comply with all applicable state and federal laws regarding the labeling condition of medication containers.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection of a Transitional Health Care Needs Optional Service Unit within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(c)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(d)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(e)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(f)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon, any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of patients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, the following definitions shall apply:
(1)Distinct part means an identifiable unit accommodating beds or patient space, including, but not limited to, contiguous beds or patient space, a wing, floor, or building approved by the state department for a specific purpose.
(2)Older children means patients who are 15 18 to 21 years of age, inclusive.
(3)Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(A)Patients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older children are not precluded from being cared for in the same optional service unit as the patients who are 22 years of age or older. If a pediatric day health and respite care facility proposes to provide care to older children in the optional service unit, the facility shall have policies, procedures, equipment, and supplies to meet the needs of those patients. Patients who are 15 to 17 years of age, inclusive, may also be considered for care in the optional service unit if the pediatric day health and respite care facility obtains an individual age waiver from the regional center, with the concurrence of the department. A pediatric day health and respite care facility is not required to operate an optional service unit.
(B)In order to continue receiving care in the pediatric day health and respite care facility, patients who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the patients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of this subparagraph may also receive services in an optional service unit.
(b)An optional service unit shall be approved by the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Except as provided in subparagraph (A) of paragraph (3) of subdivision (a), care for patients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to patients who are 21 years of age or younger. The facility shall establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the patients chronological age, developmental age, and size, and shall reflect the needs of individual patients through a comprehensive assessment.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
(f)(1)The state department may review and approve the policies and procedures for an optional service unit.
(2)The State Department of Developmental Services and the regional centers may review the policies and procedures for an optional service unit.
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite care facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent children. patients, except as provided in paragraph (2) and Section 1763.4.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older and who satisfies the requirements of Section 1763.4, may also receive services in an optional service unit.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent child patient means a person who, from birth through 21 years of age who birth, has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the child. patient. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible client patient population and includes all of the following:
(1) Screening of client patient referrals to identify those persons who can benefit from the available services.
(2) Comprehensive client patient assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified. identified by a licensed nurse, in accordance with his or her scope of practice.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year, year or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the childs patients parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the childs patients attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a child patient into the facility if the childs patients medications have expired or are scheduled to expire during the childs patients stay at the facility.
(b)(1)Physician orders shall be current and maintained in the childs patients medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the childs patients medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a child patient unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the childs patients plan of care.
(d)The pediatric day health and respite care facility may treat changes in the childs patients condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the childs patients plan of care if the child patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other children, patients, staff, or other individuals with whom the child patient may come into contact. Children A patient who present presents with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
(f)Only licensed nursing personnel, acting in accordance with their scope of practice, may accept, inspect the condition of medical containers, and record the receipt and the return of all medications in a pediatric day health and respite care facility. The facility shall comply with Section 72313 of Title 22 of the California Code of Regulations with regard to the administration of medication.
(g)A pediatric day health and respite care facility shall comply with all applicable state and federal laws regarding the labeling condition of medication containers.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by clients, patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection of a Transitional Health Care Needs Optional Service Unit within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(c)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(d)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(e)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(f)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon upon, any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of clients. patients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, Transitional the following definitions shall apply:
(1)Distinct part means an identifiable unit accommodating beds or patient space, including, but not limited to, contiguous beds or patient space, a wing, floor, or building approved by the state department for a specific purpose.
(2)Older children means patients who are 15 to 21 years of age, inclusive.
(3)Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(1)Clients
(A)Patients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older adolescents under the age of 22 children are not precluded from being cared for in the same optional service unit as the younger adults. patients who are 22 years of age or older. If a pediatric day health and respite care facility proposes to provide care to older children in the optional service unit, the facility shall have policies, procedures, equipment, and supplies to meet the needs of those patients. A pediatric day health and respite care facility is not required to operate an optional service unit.
(2)
(B)In order to continue receiving care in the pediatric day health and respite care facility, participants patients who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the clients patients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. A patient who previously received services from a pediatric day health and respite care facility, who is 22 years of age or older, and who satisfies the requirements of this subparagraph may also receive services in an optional service unit.
(b)An optional service unit shall be approved by the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Care Except as provided in subparagraph (A) of paragraph (3) of subdivision (a), care for clients patients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients. patients who are 21 years of age or younger. The facility shall establish and implement policies and procedures for determining the age ranges of clients patients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the clients patients chronological age, developmental age, and size. size, and shall reflect the needs of individual patients through a comprehensive assessment.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to clients patients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
(f)(1)The state department may review and approve the policies and procedures for an optional service unit.
(2)The State Department of Developmental Services and the regional centers may review the policies and procedures for an optional service unit.
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite care facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent technology-dependent children.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4.
(b) Medically fragile means having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent child means a person from birth through 21 years of age who has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the child. 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible client population and includes all of the following:
(1) Screening of client referrals to identify those persons who can benefit from the available services.
(2) Comprehensive client assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year, or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the childs parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the childs attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a child into the facility if the childs medications have expired or are scheduled to expire during the childs stay at the facility.
(b)(1)Physician orders shall be current and maintained in the childs medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the childs medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a child unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the childs plan of care.
(d)The pediatric day health and respite care facility may treat changes in the childs condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the childs plan of care if the child has been prescribed medications to treat these anticipated symptoms, and does not present a risk to the health and safety of themselves, other children, staff, or other individuals with whom the child may come into contact. Children who present with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by clients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(c)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(d)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(e)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(f)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of clients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(1)The age of older clients Clients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older adolescents under the age of 22 are not precluded from being cared for in the same optional service unit as the younger adults. A pediatric day health and respite care facility is not required to operate an optional service unit.
(2)In order to continue receiving care in the pediatric day health and respite care facility, participants who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the clients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally-recognized nationally recognized in the field.
(b)An optional service unit shall be approved by the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Care for clients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients. The facility shall establish and implement policies and procedures for determining the age ranges of clients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the clients chronological age, developmental age, and size.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to clients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
SEC. 14.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to protect, at the earliest possible time, the health and safety of medically fragile adults who are at imminent risk of aging out of pediatric day health and respite facilities, it is necessary that this act take effect immediately.
As used in this chapter, the following definitions shall apply:
(a) (1)Pediatric day health and respite care facility means a facility which that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
(2)An individual who is 22 years of age or older may continue to receive care in a pediatric day health and respite care facility if the facility receives approval from the state department for a Transitional Health Care Needs Optional Service Unit pursuant to Section 1763.4.
(b) Medically fragile means having an acute or chronic health problem which that requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.
(c) Technology-dependent child means a person from birth through 21 years of age who has a chronic disability, requires the routine use of a specific medical device to compensate for the loss of use of a life sustaining body function, and requires daily, ongoing care or monitoring by trained personnel.
(d) Respite care means day and 24-hour relief for the parent or guardian and care for the child. Twenty-four hour 24-hour inpatient respite care includes, but is not limited to, 24-hour nursing care, meals, socialization, and developmentally appropriate activities. As used in this chapter, 24-hour inpatient respite care is limited to no more than 30 intermittent or continuous whole calendar days per patient per calendar year.
(e) Comprehensive case management means locating, coordinating, and monitoring services for the eligible client population and includes all of the following:
(1) Screening of client referrals to identify those persons who can benefit from the available services.
(2) Comprehensive client assessment to determine the services needed.
(3) Coordinating the development of an interdisciplinary comprehensive care plan.
(4) Determining individual case cost effectiveness and available sources of funding.
(5) Identifying and maximizing informal sources of care.
(6) Ongoing monitoring of service delivery to determine the optimum type, amount, and duration of services provided.
(f) License means a basic permit to operate a pediatric day health and respite care facility. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), license means a special permit authorizing the health facility to provide pediatric day health and respite care services as a separate program in a distinct part of the facility.
(g) State department means the State Department of Health Services. State Department of Public Health.
SEC. 2.Section 1760.4 of the Health and Safety Code is amended to read:1760.4.(a) The state department shall develop and adopt regulations for the licensure of, and shall license, pediatric day health and respite care facilities. The regulations shall include minimum standards for the following:
(1) Adequacy, safety, and sanitation of the physical plant and equipment.
(2) Staffing with duly qualified personnel.
(3) Training of the staff.
(4) Providing the services offered.
These regulations shall be filed with the Secretary of State no later than July 1, 1993.
(b) The state department shall establish within the state department an advisory committee of experts to assist in the development of the regulations required pursuant to this section. A representative of the state department shall act as chairperson of the committee. The members of the committee shall serve without compensation, but shall be reimbursed by the state department for all necessary expenses incurred in the actual performance of their duties. To the extent sufficient funds have been appropriated in the Budget Act, the state department may provide staff support to the committee as the state department deems is necessary for the conduct of the committees business. The committee shall meet at the state directors pleasure until the time that the proposed regulations are presented for adoption at the public hearing.
(c) Pending adoption of the regulations pursuant to subdivision (b), an entity may be licensed as a pediatric day health and respite care facility if it meets interim regulations administered by the state department for congregate living health facilities pursuant to Section 1267.13.
(d)(1)In addition to the exceptions from regulations described in subdivision (n) of Section 1267.13, a pediatric day health and respite care facility shall not be required to conform to the following regulations contained in Chapter 3 of Division 5 of Title 22 of the California Code of Regulations: 72329.1, 72353, 72359, 72363, 72365, 72371, subdivisions (b) and (c) of Section 72375, subdivision (b) of Section 72377, 72516, 72525, and 72531.
(2)A pediatric day health and respite care facility shall not be required to meet the requirements of Section 72367 of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations, except that medications brought by or with the patient on admission to the facility shall not be used unless, after admission by the facility, the contents of the containers have been examined and positively identified.
(e)A pediatric day health and respite care facility shall have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
(1)The pediatric day health and respite care facility shall maintain minutes of every committee meeting and indicate the names of members present, the date, the length of the meeting, the subject matter discussed, and any action taken.
(2)The patient care committee shall include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures.
(3)The patient care committee shall meet at least twice per year, or more often if a need or problem is identified by the committee.
(4)The patient care committee shall be responsible for all of the following:
(A)Reviewing and approving all policies relating to patient care. Based on reports received from the pediatric day health and respite care facilitys administrator, the committee shall review the effectiveness of policy implementation and shall make recommendations to the administrator of the facility for the improvement of patient care. The committee shall review patient care policies annually and revise the policies as necessary. The committees minutes shall list the policies the committee reviewed.
(B)Infection control in the facility, which shall include, but not be limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infections within the pediatric day health and respite care facility.
(C)Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
(f)(1)A pediatric day health and respite care facility shall comply with licensing requirements. The state department may, upon written request of an applicant or licensee, approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of the state department. The state departments approval shall provide for the terms and conditions under which the alternatives are granted. An applicants or licensees written request shall be accompanied by substantiating evidence supporting the request pursuant to this paragraph.
(2)The state departments review of written requests submitted under this subdivision shall consider the unique nature of services provided to individuals served by the pediatric day health and respite care facility when compared to the requirements for congregate living health facilities for individuals requiring inpatient care.
(3)If the state department grants an approval under this subdivision, a pediatric day health and respite care facility shall immediately post that approval, or a true copy of that approval, adjacent to the facilitys license.
SEC. 3.Section 1760.7 is added to the Health and Safety Code, to read:1760.7.A pediatric day health and respite care facility shall provide pharmacy services that satisfy all of the following:
(a)(1)Medications shall be supplied to the licensed nursing personnel of the pediatric day health and respite care facility by the childs parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions.
(2)Medications shall be administered only upon written and signed orders of the childs attending physician.
(3)The pediatric day health and respite care facility shall not order medications from a pharmacy or take delivery of medications from a pharmacy.
(4)The pediatric day health and respite care facility shall not accept a child into the facility if the childs medications have expired or are scheduled to expire during the childs stay at the facility.
(b)(1)Physician orders shall be current and maintained in the childs medical record at the pediatric day health and respite care facility. Verbal orders from the attending physician for services to be rendered at the facility may be received and recorded by licensed nursing personnel in the childs medical record at the facility and shall be signed by the attending physician within 30 working days.
(2)Medications shall not be administered to a child unless the facility first verifies that the medication was ordered by a physician. Verification may be obtained by contacting the physicians office or by being provided with a copy of the physicians order for the medication.
(c)The pediatric day health and respite care facility shall maintain records of medication administered for at least one year, unless a longer period is required by state or federal law. The records of medication administered shall be a part of the childs plan of care.
(d)The pediatric day health and respite care facility may treat changes in the childs condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the childs plan of care if the child has been prescribed medications to treat these anticipated symptoms, and does not present a risk to the health and safety of themselves, other children, staff, or other individuals with whom the child may come into contact. Children who present with symptoms that are not anticipated or planned for in the plan of care shall not remain in the facility.
(e)Other requirements as specified in subdivision (a) of Section 72375, and subdivision (a) of Section 72377, of Article 3 of Chapter 3 of Division 5 of Title 22 of the California Code of Regulations.
SEC. 4.Section 1760.9 is added to the Health and Safety Code, to read:1760.9.A pediatric day health and respite care facility may implement policies and procedures that prohibit smoking by clients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
SEC. 5.Section 1761.85 is added to the Health and Safety Code, to read:1761.85.Sections 1761.2, 1761.4, and 1761.8 do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
SEC. 6.Section 1762 is added to the Health and Safety Code, to read:1762.(a)In order to obtain a license under the provisions of this chapter to establish, conduct, or maintain a pediatric day health and respite care facility, a person, entity, political subdivision of the state, or governmental agency shall file with the state department a verified application on a form prescribed, prepared, and furnished by the state department, containing information as may be required by the state department for the proper administration and enforcement of this chapter.
(b)The state department shall initiate an initial licensing inspection within 60 days of receipt of a completed application.
SEC. 7.Section 1762.2 is added to the Health and Safety Code, to read:1762.2.(a)If a pediatric day health and respite care facility or an applicant for a license has not been previously licensed, the state department shall issue a provisional license to the facility only as provided in this section.
(b)A provisional license to operate a pediatric day health and respite care facility shall terminate six months from the date of issuance, or the date that the state department is able to conduct a full and complete inspection, whichever is later.
(c)Within 30 days prior to the termination of a provisional license, the state department shall give the facility a full and complete inspection, and, if the facility meets all applicable requirements for licensure, a regular license shall be issued. If the facility does not meet the requirements for licensure but has made substantial progress towards meeting the requirements, as determined by the state department, the initial provisional license shall be renewed for six months.
(d)If the state department determines that there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection provided by this section, or, if the state department determines upon its inspection made within 30 days of the termination of a renewed provisional license that there is lack of full compliance with the requirements, the state department shall not issue a further license.
(e)If an applicant for a provisional license to operate a pediatric day health and respite care facility has been denied provisional licensing by the state department, the applicant may contest the denial by filing a request for a hearing pursuant to Section 131071.
(f)The state department shall not apply less stringent criteria when granting a provisional license pursuant to this section than it applies when granting a permanent license.
SEC. 8.Section 1762.4 is added to the Health and Safety Code, to read:1762.4.(a)A license issued under this chapter shall expire 12 months from the date of its issuance. The licensee shall pay a fee, not to exceed the reasonable regulatory cost to the state department, to the state department annually, not less than 30 days prior to expiration date, subject to the state department mailing the notice of renewal in accordance with subdivision (b).
(b)(1)At least 45 days prior to the expiration of a license issued pursuant to this chapter, the state department shall mail a notice for renewal to the licensee.
(2)A license renewal shall be submitted with the necessary fee in accordance with subdivision (a). A license shall be deemed renewed upon payment of the necessary fee, commencing from the licenses expiration date. If the requirements of this section are satisfied, the state department shall issue a license to the facility by the expiration date of the license to ensure the provider remains in good standing. The facilitys license shall be mailed within 15 calendar days after the date the state department receives the renewal fee.
SEC. 9.Section 1762.6 is added to the Health and Safety Code, to read:1762.6.Every pediatric day health and respite care facility for which a license has been issued shall be periodically inspected by a duly authorized representative of the state department. Reports of each inspection shall be prepared by the representative upon forms prepared and furnished by the state department and filed with the state department. The inspection shall be for the purpose of ensuring that the pediatric day health and respite care facility is complying with the provisions of this chapter and the rules and regulations of the state department.
SEC. 10.Section 1762.8 is added to the Health and Safety Code, to read:1762.8.The state department may deny an application for, or suspend or revoke a license issued under the provisions of this chapter in the manner provided in Section 1763 upon any of the following grounds:
(a)A serious violation by the licensee of any of the provisions of this chapter, of any other law, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of clients.
(b)Aiding, abetting, or permitting the commission of any illegal act.
(c)Willful omission or falsification of a material fact in the application for a license.
SEC. 11.Section 1763 is added to the Health and Safety Code, to read:1763.Proceedings for the denial, suspension, or revocation of licenses, or denial or withdrawal of approval under this chapter shall be conducted in accordance with Section 131071. The suspension, expiration, or forfeiture by operation of law of a license issued by the state department, its suspension, forfeiture, or cancellation by order of the state department or by order of a court, or its surrender without the written consent of the state department, shall not deprive the state department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law or to enter an order suspending or revoking the license or otherwise taking disciplinary action against the licensee on any of those grounds.
SEC. 12.Section 1763.2 is added to the Health and Safety Code, to read:1763.2.The state department has authority to make reasonable accommodation for exceptions to the standards in this chapter if the health, safety, and quality of patient care is not compromised. Prior written approval communicating the terms and conditions under which the exception is granted shall be required. An applicant shall request an exception in writing accompanied by detailed supporting documentation.
SEC. 13.Section 1763.4 is added to the Health and Safety Code, to read:1763.4.(a)For purposes of this chapter, Transitional Health Care Needs Optional Service Unit or optional service unit means a functional unit of a pediatric day health and respite care facility that is organized, staffed, and equipped to provide care to individuals who are 22 years of age or older.
(1)The age of older clients receiving care in the optional service unit shall be in age-appropriate groupings as provided for in the pediatric day health and respite care facilitys policies and procedures. Older adolescents under the age of 22 are not precluded from being cared for in the same optional service unit as the younger adults. A pediatric day health and respite care facility is not required to operate an optional service unit.
(2)In order to continue receiving care in the pediatric day health and respite care facility, participants who are 22 years of age or older shall have a developmental age of 18 years of age or younger, as evidenced by the clients Individual Education Plan (IEP), Regional Center Assessment, physicians assessment, or other assessment using a standardized assessment tool that is nationally-recognized in the field.
(b)An optional service unit shall be approved by the state department. A pediatric day health and respite care facility desiring approval for an optional service unit shall file an application on forms furnished by the state department. The state department shall list on the facility license each optional service for which approval is granted.
(c)Care for clients who are 22 years of age or older shall be provided in a distinct part of the pediatric day health and respite care facility or optional service unit, separate from the area where care is provided to younger clients. The facility shall establish and implement policies and procedures for determining the age ranges of clients who are cared for in the optional service unit. These policies and procedures shall include, but not be limited to, consideration of the clients chronological age, developmental age, and size.
(d)The pediatric day health and respite care facility shall ensure that its staffing and equipment are sufficient to provide services to clients who are 22 years of age or older.
(e)A Transitional Health Care Needs Optional Service Unit shall have written policies and procedures for the management of the service. The policies and procedures shall be established and implemented by the patient care policy committee described in Section 1760.4
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Date
|
Status
|
|---|---|
| May 28, 2015 | Referred to Com. on HEALTH. |
| Aug 13, 2015 | Chaptered by Secretary of State - Chapter 206, Statutes of 2015. |
| Aug 13, 2015 | Approved by the Governor. |
| Aug 3, 2015 | Enrolled and presented to the Governor at 3 p.m. |
| Jul 16, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 2410.). |
| Jul 16, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Jul 13, 2015 | Read third time. Urgency clause adopted. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 1905.). |
| Jul 13, 2015 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after July 15 pursuant to Assembly Rule 77. |
| Jul 9, 2015 | Read second time. Ordered to third reading. |
| Jul 8, 2015 | From committee: Be placed on second reading file pursuant to Senate Rule 28.8. |
| Jul 7, 2015 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 6, 2015 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 0.) (July 1). |
| Jun 19, 2015 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Feb 27, 2015 | Introduced. To print. |
| May 28, 2015 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| May 14, 2015 | Read third time. Urgency clause adopted. Passed. Ordered to the Senate. (Ayes 78. Noes 0. Page 1450.). |
| May 14, 2015 | Read third time. Urgency clause adopted. Passed. Ordered to the Senate. |
| May 14, 2015 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 7, 2015 | Read second time. Ordered to Consent Calendar. |
| May 6, 2015 | From committee: Do pass. To Consent Calendar. (Ayes 17. Noes 0.) (May 6). |
| Apr 27, 2015 | Re-referred to Com. on APPR. |
| Apr 23, 2015 | Read second time and amended. |
| Apr 22, 2015 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 19. Noes 0.) (April 21). |
| Mar 19, 2015 | Referred to Com. on HEALTH. |
| Mar 2, 2015 | Read first time. |
| Mar 1, 2015 | From printer. May be heard in committee March 31. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jul 16, 2015 | AB 1147 MAIENSCHEIN Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Jul 13, 2015 | Assembly 3rd Reading AB1147 Maienschein By Monning Urgency Clause | Senate Floor |
Passed |
|
| Jul 1, 2015 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| May 14, 2015 | AB 1147 MAIENSCHEIN Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| May 6, 2015 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 21, 2015 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Academy of Pediatrics | * Support | Apr 21, 2015 |
| American Federation State, County and Municipal Employees | ** Support | Jul 13, 2015 |
| Association Of Regional Center Agencies | ** Support | Jul 13, 2015 |
| California Association Joint Powers Authorities | * Support | Apr 21, 2015 |
| California Children'S Hospital Association | ** Support | Jul 13, 2015 |
| California Medical Association, Inc. | ** Support | Jul 13, 2015 |
| Easter Seals | ** Support | Jul 13, 2015 |
| Exceptional Family Resource Center | ** Support | Jul 13, 2015 |
| Home Start, Inc. | ** Support | Jul 13, 2015 |
| Kaplan College, San Diego | ** Support | Jul 13, 2015 |
| Loretta's Little Miracles | ** Support | Jul 13, 2015 |
| San Diego Brain Injury Foundation | ** Support | Jul 13, 2015 |
| San Diego Regional Center | ** Support | Jul 13, 2015 |
| The Arc United Cerebral Palsy California Collaboration | ** Support | Jul 13, 2015 |
| Together We Grow | ** Support | Jul 13, 2015 |
| University of California, San Diego | ** Support | Apr 21, 2015 |
| Your Family, Your Choice | * Indeterminate | Jul 1, 2015 |
AB 1147
Page 2
CONCURRENCE IN SENATE AMENDMENTS
AB 1147
(Maienschein)
As Amended July 7, 2015
2/3 vote. Urgency
ASSEMBLY: |
78-0 |
(May 14, 2015) |
SENATE: |
39-0 |
(July 13, 2015) |
Original Committee Reference: HEALTH
SUMMARY: Creates a licensing category for pediatric day health and respite care facilities (PDHRCFs), including all the requirements and standards that such facilities must adhere to, and revises the definition of a pediatric day health and respite care facility, which is currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care if the facility receives approval for a Transitional Health Care Needs Optional Service Unit, which is established by this bill. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment.
The Senate amendments clarify the Department of Public Health's (DPH) ability to ensure that PDHRCFs meets minimal standards prior licensure, and to deny the approval of the optional service unit if does not meet DPH standards.
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, medically fragile children, as they begin to approach the age of 22, have been faced with untenable choices of how to cobble together the types of services that could provide the same type of care and support received at PDHRCFs. Unfortunately, these services simply do not exist; and families are again facing similar unacceptable choices as they faced before PDHRCFs were established. The author states this bill will guarantee the continuity of care this population desperately needs by allowing medically fragile children and young adults to continue to receive the quality services from PDHRCFs as they grow older than the age of 22.
AB 3413 (Polanco), Chapter, 1227, Statutes of 1990, added a new category of health facility: Pediatric Day Health and Respite Care Facility. Prior to that date, families with medically-fragile children had very few choices to find day health and respite care that would allow the child to remain at home, keep the family intact, and keep parents working. When this category of facility was first established, most of the medically-fragile children were not expected to survive to become adults; this model did not envision a system of care that would provide a seamless transition for these children as they age out of the PDHRCF programs.
When enacted, AB 3413 required the Department of Health Services, now DPH, to adopt regulations by July 1, 1993, and allowed PDHRCFs to operate under a provisional license until the regulations were adopted by complying with the regulations for Congregate Living Health Facilities (CLHFs). At that time regulations for CLHFs were to be final by January 1, 1991, and CLHFs were operating under Skilled Nursing Facility (SNF) regulations with some exceptions to those regulations allowed through program flexibility waivers.
Neither the CLHF, nor the PDHRCF regulations were ever adopted and both types of facilities have had to be licensed and operate under SNF requirements and regulations, with some exemptions as granted by DPH.
PDHRCFs are very different than SNFs. SNFs are long term care facilities whose adult residents are receiving 24-hour inpatient care. PDHRCFs are daycare centers that offer occasional over-night respite care to clients' and their families. PDHRCFs have found it challenging over the years to meet the requirements of SNF licensure. For example, an SNF will have a pharmacist on staff who orders medications for the residents. A PDHRCF may administer medication to a client, but does not have a pharmacist, and is simply checking the medications each day as they are brought to the facility by the parent or guardian. Yet under current licensure requirements, both facilities must have a pharmaceutical service committee with a pharmacist member.
Together We Grow, a PDHRCF in San Diego is the sponsor of this bill and states, unlike the care provided by PDHRCFs, long-term care for medically-fragile young adults is fragmented and does not provide the same essential choices to medically-fragile adults and their families. The sponsors note that current state licensing law permits children to receive care up until the child turns 22 years of age, and then they and their families are faced with the possibility of institutionalization (leaving their families), attending an adult day health care center that does not have the level of expertise, programming, or activities necessary to engage and provide safe care for this population, foregoing any family respite support, or forcing family members to quit their jobs to provide care to their loved ones. Together We Grow concludes that this bill will permit medically fragile young adults to remain at the PDHRCF in a separate transitional care unit, and that the costs of these services are less than the state would pay for institutional care. The California Children's Hospital Association (CCHA) supports this bill pointing out that as a result of the advances made in medicine over the past 25 years; more medically fragile children are living into adulthood and aging out of PDHRCF service. CCHA notes that this can be disastrous for patients and families, both financially and emotionally, as they enter a fragmented adult system that does not have the same level of services. CCHA concludes that this bill will protect their access to the facilities they have essentially grown up in, while ensuring they are being cared for in a transitional unit appropriate to their age.
There is no known opposition to this bill.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001203
AB 1147
Page 11
|
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 |
THIRD READING
Bill No: AB 1147
Amended: 7/7/15 in Senate
SENATE HEALTH COMMITTEE: 8-0, 7/1/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 78-0, 5/14/15 - See last page for vote
SUBJECT: Health facilities: pediatric day health and respite care facilities
DIGEST: This bill revises the definition of a pediatric day health and respite care facility, which is currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care if the facility receives approval for a Transitional Health Care Needs Optional Service Unit, which is established by this bill.
Existing law:
Defines “pediatric day health and respite care facility” (PDHRCF) as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
Defines “medically fragile,” for purposes of PDHRCF, as having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day.
Defines “respite care,” for purposes of PDHRCF, as day and 24-hour relief for the parent or guardian and care for the child. Limits 24-hour inpatient respite care to no more than 30 intermittent or continuous days per patient per calendar year.
Requires pediatric day health care provided by a PDHRCF to be a covered benefit under the Medi-Cal program. However, prohibits the Department of Health Care Services from approving a request for authorization of pediatric day care if it determines that the total cost incurred by Medi-Cal for providing pediatric day health care services and all other medically necessary services to the beneficiary is greater than the total cost incurred by the Medi-Cal program in providing equivalent services at the otherwise appropriate level of institutional or home care.
Requires Department of Public Health (DPH) to adopt regulations governing the licensure of PDHRCFs no later than July 1, 1993, but specifies that pending the adoption of these regulations, DPH may license a PDHRCF if it meets interim regulations established for congregate living health facilities (CLHFs).
Licenses and regulates CLHFs by DPH, which are defined as residential homes with a capacity of no more than 12 beds that provide inpatient care that is generally less intense than that provided in a general acute care hospital, but more intense than that provided in a skilled nursing facility (SNF). Requires DPH to adopt regulations for CLHFs, and until these regulations are adopted, requires CLHFs to meet certain statutory requirements (which would become inoperative upon the adoption of regulations), and to conform to the regulations that govern SNFs, with specified exceptions.
This bill:
Revises the definition of a PDHRCF, which is currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care in a PDHRCF if the facility receives approval from DPH for a Transitional Health Care Needs Optional Service Unit, which is established by this bill.
Exempts PDHRCFs from specified regulations that SNFs are required to meet, including the minimum nursing staff ratio requirements, and requirements pertaining to the ordering of prescription drugs, having a pharmacist review the drug regimen of patients on a monthly basis, and other pharmaceutical-related requirements.
Requires a PDHRCF to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. Requires this patient care committee to include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and to meet at least twice per year or more often if a need or problem is identified by the committee.
Requires the PDHRCF patient care committee to be responsible for all of the following:
Reviewing and approving all policies relating to patient care. Requires the committee, based on reports received from the PDHRCF’s administrator, to review the effectiveness of policy implementation and to make recommendations to the administrator of the facility for the improvement of patient care. Requires the committee to review patient care policies annually and revise as necessary;
Infection control in the facility, including, but not limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infection within the facility; and,
Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hire to consult with the committee and internal quality assurance review, and recommending Improvements of services to the administrator of the facility.
Permits DPH, upon written request of an applicant or licensee, to approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of DPH. Requires DPH’s review of requests to consider the unique nature of services provided to individuals served by the PDHRCF when compared to the requirements for CLHFs for individuals requiring inpatient care.
Requires a PDHRCF to provide pharmacy services that satisfy all of the following:
Requires medications to be administered only upon written and signed orders of the patient’s attending physician;
Requires medications to be supplied to the licensed nursing personnel of the PDHRCF by the patient’s parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions, and prohibits the PDHRCF from ordering medications from a pharmacy or from taking delivery of medications from a pharmacy;
Prohibits the PDHRCF from accepting a patient into the facility if the patient’s medications have expired or are schedule to expire during the patient’s stay at the facility;
Requires physician orders to be current and maintained in the patient’s medical record at the PDHRCF. Requires verbal orders from the attending physician for services to be rendered at the facility to be received and recorded by licensed nursing personnel in the patient’s medical record and to be signed by the attending physician within 30 working days;
Requires the PDHRCF to maintain records of medication administered for at least one year, unless a longer period is required by the state or federal law;
Permits the PDHRCF to treat changes in the patient’s condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patient’s plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals. Prohibits a patient who presents with symptoms that are not anticipated or planned for in the plan of care from remaining in the facility; and,
Specifies that only licensed nursing personnel, acting within their scope of practice, can accept medications in a PDHRCF, and requires facilities to comply with specified SNF regulations regarding the administration of medication.
Permits a PDHRCF to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
Specifies that provisions of existing law that require a PDHRCF to meet the fire safety and seismic safety standards that apply to licensed community care facilities, and to comply with local building code requirements, do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
Requires DPH, if a PDHRCF has not previously been licensed, to issue a provisional license to the facility if, after an initial onsite inspection, it finds that the facility is in substantial compliance with requirements for licensure. Requires the provisional license to terminate six months from the date of issuance, or the date that DPH is able to conduct a full and complete inspection, whichever is later. Prohibits DPH from applying less stringent criteria when granting a provisional license than it applies when granting a permanent license.
Requires DPH to give a PDHRCF a full and complete inspection within 30 days prior to the termination of a provisional license, and if the facility does not meet the requirements for licensure but has made substantial progress, to renew the provisional license for another six months.
Prohibits DPH from issuing any further license if it determines there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection, or upon its inspection made within 30 days of the termination of a renewed provisional license that there is a lack of full compliance with the requirements.
Permits an applicant for a provisional license to operate a PDHRCF who has been denied provisional licensing by DPH to contest the denial by filing a request for a hearing pursuant to provisions of existing law.
Requires a PDHRCF license to expire 12 months from the date of issuance, and requires DPH to mail a renewal notice at least 45 days prior to the expiration of the license, and to mail the renewed license within 15 calendar days after it receives the renewal fee.
Requires every PDHRCF for which a license has been issued to be periodically inspected by DPH.
Permits DPH to deny an application for, or suspend or revoke a license issued to, a PDHRCF for any of the following:
A serious violation by the licensee of any of the provisions of law pertaining to PDHRCFs that jeopardizes the health and safety of patients;
Aiding, abetting, or permitting the commission of any illegal act; or,
Willful omission or falsification of a material fact in the application for a license.
Provides DPH with the authority to make reasonable accommodation for exceptions to the standards that apply to PDHRCFs if the health, safety, and quality of patient care is not compromised, and requires prior written approval communicating the terms and conditions under which an exception is granted.
Defines a “Transitional Health Care Needs Optional Service Unit” (optional service unit) as a functional unit of a PDHRCF that is organized, staff, and equipped to provide care to individuals who are 22 years of age or older.
Requires a PDHRCF that wants approval for an optional service unit to file an application for approval with DPH.
Requires patients receiving care in an optional service unit to be in age-appropriate groupings as provided for in the PDHRCF’s policies and procedures. Specifies that older children, defined as those who are 18 to 21 years of age, may be cared for in the same optional service unit as the patients who are 22 years of age or older. Additionally, permits patients who are 15 to 17 years of age to be considered for care in the optional service unit if the PDHRCF obtains an individual age waiver from the regional center, with the concurrence of DPH.
Requires patients who are 22 years of age or older, in order to continue receiving care in a PDHRCF, to have a developmental age of 18 years or younger, as evidenced by the patient’s Individual Education Plan, Regional Center Assessment, physician’s assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. In addition to allowing the continuation of care for those older than 21, also permits those who previously received care but are now 22 years of age or older, to again receive services in an optional unit of a PDHRCF.
Requires care for patients who are 22 years of age or older to be provided in a distinct part of a PDHRCF, separate from the area where care is provided to patients who are 21 years of age or younger, except as authorized elsewhere in this bill where patients as young as 15 can be considered for care in the same optional service unit as older patients.
Requires a PDHRCF to establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit, and requires these policies to include consideration of the patient’s chronological age, developmental age, and size, and to reflect the needs of individual patients through a comprehensive assessment.
Requires a PDHRCF to ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
Requires an optional service unit to have written policies and procedures for the management of the service, and permits DPH to review and approve these policies and procedures, and the Department of Developmental Services and regional centers to review the policies and procedures.
Contains an urgency clause that will make this bill effective upon enactment.
Comments
Author’s statement. According to the author, medically fragile children, as they begin to approach the ages of 21 and 22, have been faced with untenable choices of how to cobble together the types of services that could provide the same type of care and support received at PDHRCFs. Unfortunately, these services simply do no exist, and families are again facing similar unacceptable choices as they faced before PDHRCFs were established. This bill would guarantee the continuity of care this population desperately needs by allowing medically fragile children and young adults to continue to receive the quality services from PDHRCFs as they grow older than the age 22. Without this bill, medically-fragile young adults would be forced to search for traditional long-term care which is fragmented and does not provide the same essential choices to medically-fragile adults and their families. Some limited services are available under the Medi-Cal Waivers, but very few services are actually available; and none of those services are coordinated, leaving families to try to navigate this limited services system.
Background on PDHRCFs. PDHRCFs were established by the Legislature by AB 3413 (Polanco, Chapter 1227, Statutes of 1990). According to DPH, there are currently 16 licensed PDHRCFs. The author states that prior to the establishment of these facilities, families with medically-fragile children had very few choices to find day health and respite care that would allow the child to remain at home, keep the family intact, and keep parents working. According to the author, when this category of facility was enacted, most of the medically-fragile children were not expected to survive to become adults, and that this model did not envision a system of care that would provide a transition for these children as they “aged out” of the PDHRCF programs.
Lack of regulations by DPH necessitating much of the language of this bill. While the stated purpose of this bill is to establish an optional service unit to permit those who are older than 21 to continue to receive services in a PDHRCF, this bill contains five pages of new statute that is not directly related to the age issue that was the impetus for this bill. Instead, much of the new language in this bill is to address the fact that DPH has not adopted regulations specific to PDHRCFs despite a statutory mandate to do so by 1993. Instead, pursuant to statutory requirements, PDHRCFs are required to meet the “interim regulations” of a CLHF – which, in turn, are tied to the regulatory framework of SNFs, because CLHF regulations have also not been promulgated. However, both CLHFs and SNFs are inpatient facilities, while PDHRCFs are generally day use facilities (albeit with a limited ability to provide some inpatient services). Therefore, PDHRCFs have been required to meet certain regulations and statutory requirements that are appropriate for inpatient facilities, but unnecessary for the day respite care PDHRCFs provide. For example, CLHFs and skilled nursing facilities must provide a fairly comprehensive pharmacy service, which is something that is not necessary for a day use facility. In a PDHRCF, parents or guardians bring the medication that is needed for that day when they bring the child who is going to be receiving services. This bill provides a set of statutory requirements to ensure that this medicine is handled and dispensed by PDHRCF staff in a safe manner. In addition to addressing the pharmacy issue, this bill identifies other regulations that CLHFs are required to meet that PDHRCFs should be exempt from, establishes procedures for issuing and renewing licenses, and provides DPH with the ability to deny or revoke a license.
Policy Comment. As noted above, much of the language of this bill is compensating for the fact that DPH has not adopted regulations for PDHRCFs. When PDHRCFs were established in 1990, DPH was required to adopt regulations for these facilities by 1993. Until these regulations were adopted, DPH was directed to license these facilities using the same standards as CLHFs, which is a type of inpatient facility. According to DPH, it is in the process of hiring and redirecting staff to address these and other longstanding licensing and certification regulatory needs, but does not have an estimated completion date at this time.
This is yet another example of the longstanding problem in DPH of ignoring mandates to adopt regulations. In some instances, the lack of the timely adoption of regulations by DPH has left some facilities unregulated entirely. While the Senate Health Committee has approved a piecemeal approach to the problem of outdated or nonexistent regulations, the longstanding reluctance of DPH to utilize the standard rulemaking process is troubling. It is encouraging that DPH is currently engaged in an effort to update Title 22 regulations. DPH should also examine what the barriers have been to using the Administrative Procedures Act process in an effort to make that a more routine part of their role as a regulator.
Prior Legislation
AB
3347 (Wright, Chapter 494, Statutes of 1992) deleted the January 1,
1991 deadline for DPH to adopt regulations for CLHF licensing
standards, and extended requirements for CLHFs serving the terminally
ill or catastrophically disabled to CLHFs serving the mentally alert
but physically disabled.
AB 3535 (Wright, Chapter 1459, Statutes of 1986) created the CLHF licensure category, and defined a CLHF as a residential home with a capacity of no more than six beds, which provides inpatient care to mentally alert, physically disabled residents, who may be ventilator dependent.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
Together We Grow (source)
American Federation State, County and Municipal Employees
Association of Regional Center Agencies
California Children's Hospital Association
California Medical Association
Easter Seals
Exceptional Family Resource Center
Home Start, Inc.
Kaplan College, San Diego
Loretta's Little Miracles
San Diego Brain Injury Foundation
San Diego Regional Center
The Arc United Cerebral Palsy California Collaboration
None received
ARGUMENTS IN SUPPORT: This bill is sponsored by Together We Grow (TWG), which states that it has been providing care to medically-fragile, terminally ill children since 2000. According to TWG, in many instances, these children cannot feed themselves, walk, use the bathroom, or speak as a typical person would do, but despite all of these challenges, they have a quality of life and are important members of their family. TWG states that these children will never leave the care of their family homes unless forced into placement in an institution by forces beyond their parent’s control. TWG states that pediatric day health care and respite centers make it possible for family to get that support. Many of the children who were just babies when they first came to TWG have thrived into adolescence and young adulthood, but because the current legislation for PDHRCFs limits the age to under 22 years of age, their services are not available to these children and their families after they turn 22. TWG states that this bill keeps these children sleeping in their own beds, living with their own families, and playing with their own friends. The Association of Regional Center Agencies states in support that underfunding of the developmental services system makes it impossible to provide optimal and seamless services when individuals age out of these facilities, and that by letting individuals continue to be served in PDHRCFs after the age of 21, this bill provides a carefully tailored workaround to this problem. The California Children’s Hospital (CCH) states in support that as a result of the advances made in medicine over the past 25 years, more medically fragile children are living into adulthood and aging out of PDHRCFs. CCH states that they enter a fragmented adult system that does not have the same level of service as PDHRCFs which can be disastrous for patients and families, financially and emotionally.
ASSEMBLY FLOOR: 78-0, 5/14/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Linder, Medina
Prepared by: Vince Marchand / HEALTH /
7/13/15 10:16:47
**** END ****
AB 1147 (Maienschein) Page 8 of 8
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1147
AUTHOR: |
Maienschein |
||
VERSION: |
June 19, 2015 |
||
HEARING DATE: |
July 1, 2015 |
|
|
CONSULTANT: |
Vince Marchand |
||
SUBJECT: Health facilities: pediatric day health and respite care facilities.
SUMMARY:
Revises the definition of a pediatric day health and respite care facility, which is currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care if the facility receives approval for a Transitional Health Care Needs Optional Service Unit, which is established by this bill.
Existing law:
Defines “pediatric day health and respite care facility” (PDHRCF) as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
Defines “medically fragile,” for purposes of PDHRCF, as having an acute or chronic health problem that requires therapeutic intervention and skilled nursing care during all or part of the day.
Defines “respite care,” for purposes of PDHRCF, as day and 24-hour relief for the parent or guardian and care for the child. Limits 24-hour inpatient respite care to no more than 30 intermittent or continuous days per patient per calendar year.
Requires pediatric day health care provided by a PDHRCF to be a covered benefit under the Medi-Cal program. However, prohibits the Department of Health Care Services from approving a request for authorization of pediatric day care if it determines that the total cost incurred by Medi-Cal for providing pediatric day health care services and all other medically necessary services to the beneficiary is greater than the total cost incurred by the Medi-Cal program in providing equivalent services at the otherwise appropriate level of institutional or home care.
Requires Department of Public Health (DPH) to adopt regulations governing the licensure of PDHRCFs no later than July 1, 1993, but specifies that pending the adoption of these regulations, DPH may license a PDHRCF if it meets interim regulations established for congregate living health facilities (CLHFs).
Licenses and regulates CLHFs by DPH, which are defined as residential homes with a capacity of no more than 12 beds that provide inpatient care that is generally less intense than that provided in a general acute care hospital, but more intense than that provided in a skilled nursing facility (SNF). Requires DPH to adopt regulations for CLHFs, and until these regulations are adopted, requires CLHFs to meet certain statutory requirements (which would become inoperative upon the adoption of regulations), and to conform to the regulations that govern SNFs, with specified exceptions.
This bill:
Revises the definition of a PDHRCF, which is currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care in a PDHRCF if the facility receives approval from DPH for a Transitional Health Care Needs Optional Service Unit, which is established by this bill.
Exempts PDHRCFs from specified regulations that SNFs are required to meet, including the minimum nursing staff ratio requirements, and requirements pertaining to the ordering of prescription drugs, having a pharmacist review the drug regimen of patients on a monthly basis, and other pharmaceutical-related requirements;
Requires a PDHRCF to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control. Requires this patient care committee to include the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and to meet at least twice per year or more often if a need or problem is identified by the committee.
Requires the PDHRCF patient care committee to be responsible for all of the following:
Reviewing and approving all policies relating to patient care. Requires the committee, based on reports received from the PDHRCF’s administrator, to review the effectiveness of policy implementation and to make recommendations to the administrator of the facility for the improvement of patient care. Requires the committee to review patient care policies annually and revise as necessary;
Infection control in the facility, including, but not limited to, establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of the number, types, sources, and locations of infection within the facility; and,
Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals, reviewing and taking appropriate action based on any findings from a pharmacist hire to consult with the committee and internal quality assurance review, and recommending Improvements of services to the administrator of the facility.
Permits DPH, upon written request of an applicant or licensee, to approve the use of alternate concepts, methods, procedures, techniques, equipment, personnel qualifications, or conducting pilot projects, provided those alternatives are carried out with safe and adequate care for the patients and with the prior written approval of DPH. Requires DPH’s review of requests to consider the unique nature of services provided to individuals served by the PDHRCF when compared to the requirements for CLHFs for individuals requiring inpatient care.
Requires a PDHRCF to provide pharmacy services that satisfy all of the following:
Requires medications to be administered only upon written and signed orders of the patient’s attending physician;
Requires medications to be supplied to the licensed nursing personnel of the PDHRCF by the patient’s parent, foster parent, or legal guardian in the original dispensing container that specifies administration instructions, and prohibits the PDHRCF from ordering medications from a pharmacy or from taking delivery of medications from a pharmacy;
Prohibits the PDHRCF from accepting a patient into the facility if the patient’s medications have expired or are schedule to expire during the patient’s stay at the facility;
Requires physician orders to be current and maintained in the patient’s medical record at the PDHRCF. Requires verbal orders from the attending physician for services to be rendered at the facility to be received and recorded by licensed nursing personnel in the patient’s medical record and to be signed by the attending physician within 30 working days;
Requires the PDHRCF to maintain records of medication administered for at least one year, unless a longer period is required by the state or federal law;
Permits the PDHRCF to treat changes in the patient’s condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes, in accordance with the patient’s plan of care if the patient has been prescribed medications to treat these anticipated symptoms, and the treatment does not present a risk to the health and safety of themselves, other patients, staff, or other individuals. Prohibits a patient who presents with symptoms that are not anticipated or planned for in the plan of care from remaining in the facility; And,
Specifies that only licensed nursing personnel, acting within their scope of practice, can accept medications in a PDHRCF, and requires facilities to comply with specified SNF regulations regarding the administration of medication.
Permits a PDHRCF to implement policies and procedures that prohibit smoking by patients, parents, staff, visitors, or consultants within the facility or on the premises, if the prohibition is clearly stated in the admission agreement, and notices are posted at the facility.
Specifies that provisions of existing law that require a PDHRCF to meet the fire safety and seismic safety standards that apply to licensed community care facilities, and to comply with local building code requirements, do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials, or other flexibility, if written approval is granted by the local building authority.
Requires DPH, if a PDHRCF has not previously been licensed, to issue a provisional license to the facility, which is required to terminate six months from the date of issuance, or the date that DPH is able to conduct a full and complete inspection, whichever is later. Prohibits DPH from applying less stringent criteria when granting a provisional license than it applies when granting a permanent license.
Requires DPH to give a PDHRCF a full and complete inspection within 30 days prior to the termination of a provisional license, and if the facility does not meet the requirements for licensure but has made substantial progress, to renew the provisional license for another six months.
Prohibits DPH from issuing any further license if it determines there has not been substantial progress towards meeting licensure requirements at the time of the first full inspection, or upon its inspection made within 30 days of the termination of a renewed provisional license that there is a lack of full compliance with the requirements.
Permits an applicant for a provisional license to operate a PDHRCF who has been denied provisional licensing by DPH to contest the denial by filing a request for a hearing pursuant to provisions of existing law.
Requires a PDHRCF license to expire 12 months from the date of issuance, and requires DPH to mail a renewal notice at least 45 days prior to the expiration of the license, and to mail the renewed license within 15 calendar days after it receives the renewal fee.
Requires every PDHRCF for which a license has been issued to be periodically inspected by DPH.
Permits DPH to deny an application for, or suspend or revoke a license issued to, a PDHRCF for any of the following:
A serious violation by the licensee of any of the provisions of law pertaining to PDHRCFs that jeopardizes the health and safety of patients;
Aiding, abetting, or permitting the commission of any illegal act; or,
Willful omission or falsification of a material fact in the application for a license.
Provides DPH with the authority to make reasonable accommodation for exceptions to the standards that apply to PDHRCFs if the health, safety, and quality of patient care is not compromised, and requires prior written approval communicating the terms and conditions under which an exception is granted.
Defines a “Transitional Health Care Needs Optional Service Unit” (optional service unit) as a functional unit of a PDHRCF that is organized, staff, and equipped to provide care to individuals who are 22 years of age or older.
Requires a PDHRCF who wants approval for an optional service unit to file an application with DPH, and requires DPH to approve the optional service unit.
Requires patients receiving care in an optional service unit to be in age-appropriate groupings as provided for in the PDHRCF’s policies and procedures. Specifies that older children, defined as those who are 18 to 21 years of age, may be cared for in the same optional service unit as the patients who are 22 years of age or older. Additionally, permits patients who are 15 to 17 years of age to be considered for care in the optional service unit if the PDHRCF obtains an individual age waiver from the regional center, with the concurrence of DPH.
Requires patients who are 22 years of age or older, in order to continue receiving care in a PDHRCF, to have a developmental age of 18 years or younger, as evidenced by the patient’s Individual Education Plan, Regional Center Assessment, physician’s assessment, or other assessment using a standardized assessment tool that is nationally recognized in the field. In addition to allowing the continuation of care for those older than 21, also permits those who previously received care but are now 22 years of age or older, to again receive services in an optional unit of a PDHRCF.
Requires care for patients who are 22 years of age or older to be provided in a distinct part of a PDHRCF, separate from the area where care is provided to patients who are 21 years of age or younger, except as authorized elsewhere in this bill where patients as young as 15 can be considered for care in the same optional service unit as older patients.
Requires a PDHRCF to establish and implement policies and procedures for determining the age ranges of patients who are cared for in the optional service unit, and requires these policies to include consideration of the patient’s chronological age, developmental age, and size, and to reflect the needs of individual patients through a comprehensive assessment.
Requires a PDHRCF to ensure that its staffing and equipment are sufficient to provide services to patients who are 22 years of age or older.
Requires an optional service unit to have written policies and procedures for the management of the service, and permits DPH to review and approve these policies and procedures, and the Department of Developmental Services and regional centers to review the policies and procedures.
Contains an urgency clause that will make this bill effective upon enactment.
FISCAL EFFECT:
According to the Assembly Appropriations Committee, this bill will have the following fiscal effect:
Minor one-time costs to DPH Licensing and Certification Division to revise policies and procedures to be compliant with this bill.
Minor fee-supported workload costs to license Transitional Health Care Needs Optional Service Units as authorized by this bill.
PRIOR VOTES:
Assembly Floor: |
78 - 0 |
Assembly Appropriations Committee: |
17 - 0 |
Assembly Health Committee: |
19 - 0 |
COMMENTS:
Author’s statement. According to the author, medically fragile children, as they begin to approach the ages of 21 and 22, have been faced with untenable choices of how to cobble together the types of services that could provide the same type of care and support received at PDHRCFs. Unfortunately, these services simply do no exist, and families are again facing similar unacceptable choices as they faced before PDHRCFs were established. This bill would guarantee the continuity of care this population desperately needs by allowing medically fragile children and young adults to continue to receive the quality services from PDHRCFs as they grow older than the age 22. Without this bill, medically-fragile young adults would be forced to search for traditional long-term care which is fragmented and does not provide the same essential choices to medically-fragile adults and their families. Some limited services are available under the Medi-Cal Waivers, but very few services are actually available; and none of those services are coordinated, leaving families to try to navigate this limited services system.
Background on PDHRCFs. PDHRCFs were established by the Legislature by AB 3413 (Polanco), Chapter 1227, Statutes of 1990. According to DPH, there are currently 16 licensed PDHRCFs. The author states that prior to the establishment of these facilities, families with medically-fragile children had very few choices to find day health and respite care that would allow the child to remain at home, keep the family intact, and keep parents working. According to the author, when this category of facility was enacted, most of the medically-fragile children were not expected to survive to become adults, and that this model did not envision a system of care that would provide a transition for these children as they “aged out” of the PDHRCF programs.
Lack of regulations by DPH necessitating much of the language of this bill. While the stated purpose of this bill is to establish an optional service unit to permit those who are older than 21 to continue to receive services in a PDHRCF, this bill contains five pages of new statute that is not directly related to the age issue that was the impetus for this bill. Instead, much of the new language in this bill is to address the fact that DPH has not adopted regulations specific to PDHRCFs despite a statutory mandate to do so by 1993. Instead, pursuant to statutory requirements, PDHRCFs are required to meet the “interim regulations” of a CLHF – which, in turn, are tied to the regulatory framework of SNFs, because CLHF regulations have also not been promulgated. However, both CLHFs and SNFs are inpatient facilities, while PDHRCFs are generally day use facilities (albeit with a limited ability to provide some inpatient services). Therefore, PDHRCFs have been required to meet certain regulations and statutory requirements that are appropriate for inpatient facilities, but unnecessary for the day respite care PDHRCFs provide. For example, CLHFs and skilled nursing facilities must provide a fairly comprehensive pharmacy service, which is something that is not necessary for a day use facility. In a PDHRCF, parents or guardians bring the medication that is needed for that day when they bring the child who is going to be receiving services. This bill provides a set of statutory requirements to ensure that this medicine is handled and dispensed by PDHRCF staff in a safe manner. In addition to addressing the pharmacy issue, this bill identifies other regulations that CLHFs are required to meet that PDHRCFs should be exempt from, establishes procedures for issuing and renewing licenses, and provides DPH with the ability to deny or revoke a license.
Related legislation. AB 1147 (Maienschein), increases the maximum capacity of CLHFs, except those that are specifically permitted to have larger capacities due to meeting specified exemptions, from 12 to 18 beds. AB 1147 is set for hearing on July 1, 2015 in this committee.
Prior legislation. AB 3347 (Wright, Chapter 494, Statutes of 1992), deleted the January 1, 1991 deadline for DPH to adopt regulations for CLHF licensing standards, and extended requirements for CLHFs serving the terminally ill or catastrophically disabled to CLHFs serving the mentally alert but physically disabled.
AB 3535 (Wright, Chapter 1459, Statutes of 1986), created the CLHF licensure category, and defined a CLHF as a residential home with a capacity of no more than six beds, which provides inpatient care to mentally alert, physically disabled residents, who may be ventilator dependent.
Support. This bill is sponsored by Together We Grow (TWG), which states that it has been providing care to medically-fragile, terminally ill children since 2000. According to TWG, in many instances, these children cannot feed themselves, walk, use the bathroom, or speak as a typical person would do, but despite all of these challenges, they have a quality of life and are important members of their family. TWG states that these children will never leave the care of their family homes unless forced into placement in an institution by forces beyond their parent’s control. TWG states that pediatric day health care and respite centers make it possible for family to get that support. Many of the children who were just babies when they first came to TWG have thrived into adolescence and young adulthood, but because the current legislation for PDHRCFs limits the age to under 22 years of age, their services are not available to these children and their families after they turn 22. TWG states that this bill keeps these children sleeping in their own beds, living with their own families, and playing with their own friends. The Association of Regional Center Agencies states in support that underfunding of the developmental services system makes it impossible to provide optimal and seamless services when individuals age out of these facilities, and that by letting individuals continue to be served in PDHRCFs after the age of 21, this bill provides a carefully tailored workaround to this problem. The California Children’s Hospital (CCH) states in support that as a result of the advances made in medicine over the past 25 years, more medically fragile children are living into adulthood and aging out of PDHRCFs. CCH states that they enter a fragmented adult system that does not have the same level of service as PDHRCFs which can be disastrous for patients and families, financially and emotionally.
Policy comment. As noted above, much of the language of this bill is compensating for the fact that DPH has not adopted regulations for PDHRCFs. When PDHRCFs were established in 1990, DPH was required to adopt regulations for these facilities by 1993. Until these regulations were adopted, DPH was directed to license these facilities using the same standards as CLHFs, which is a type of inpatient facility. According to DPH, it is in the process of hiring and redirecting staff to address these and other longstanding licensing and certification regulatory needs, but does not have an estimated completion date at this time.
This is yet another example of the longstanding problem in DPH of ignoring mandates to adopt regulations. In some instances, the lack of the timely adoption of regulations by DPH has left some facilities unregulated entirely. While this Committee has approved a piecemeal approach to the problem of outdated or nonexistent regulations, the longstanding reluctance of DPH to utilize the standard rulemaking process is troubling. It is encouraging that DPH is currently engaged in an effort to update Title 22 regulations. DPH should also examine what the barriers have been to using the Administrative Procedures Act process in an effort to make that a more routine part of their role as a regulator.
Suggested amendments.
On page 10, beginning on line 14, this bill requires DPH to issue a provisional license to a PDHRCF if the facility has not previously been licensed. There is no reference to an initial inspection, and it is worded in such a way that could be construed to limit the ability of DPH to ensure that the facility meets minimal standards prior to issuing the license. The author has agreed to the following amendment to address this issue:
On p.10, between lines 17 and 18, the following subdivision is added:
(b) A provisional license may not be issued unless the facility has first been found to be in substantial compliance with the requirements of this Chapter as a result of an onsite survey.
On page 13, beginning on line 32, this bill requires an optional service unit of a PDHRCF to be approved by DPH, again without seeming to give any ability for DPH to deny the optional service unit if it has not met DPH standards. The author has agreed to the following amendment to address this issue:
On page 13, line 32, subdivision (b) is amended as follows:
(b) An optional service unit shall be subject to the approval ofapproved bythe state department.
SUPPORT AND OPPOSITION:
Support: Together We Grow (sponsor)
American Federation State, County and Municipal Employees
Association of Regional Center Agencies
California Children's Hospital Association
California Medical Association
Easter Seals
Exceptional Family Resource Center
Home Start, Inc.
Kaplan College, San Diego
Loretta's Little Miracles
San Diego Brain Injury Foundation
San Diego Regional Center
The Arc United Cerebral Palsy California Collaboration
Numerous individuals
Oppose: None received.
-- END --
AB 1147
Page 1
Date of Hearing: May 6, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB 1147
(Maienschein) – As Amended April 23, 2015
Policy Committee: |
Health |
Vote: |
19 - 0 |
|
|
|
|
|
|
|
|
Urgency: Yes State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill establishes statutory requirements specific to pediatric day health and respite care facilities (PDHRCFs), which are currently governed under regulations applicable to a licensure category.
It also allows these facilities to establish Transitional Health Care Needs Optional Service Units to serve individuals over 21, and establishes a licensure and fee structure for this category.
FISCAL EFFECT:
Minor one-time costs to the California Department of Public Health (CDPH) Licensing and Certification Division to revise policies and procedures to be compliant with this bill.
Minor fee-supported workload costs to license Transitional Health Care Needs Optional Service Units as authorized by this bill.
COMMENTS:
Purpose. According to the author, medically fragile children, as they begin to approach the age of 22, have been faced with untenable choices of how to cobble together the types of services that could provide the same type of care and support received at PDHRCFs. The author states this bill will guarantee the continuity of care this population desperately needs by allowing medically fragile children and young adults to continue to receive the quality services from PDHRCFs as they grow older than the age of 22. This bill is supported by businesses that operate PDHRCFs.
The need for the prescriptive language in this bill is associated with CDPH's failure to promulgate regulations specific to this facility type despite statutory direction to adopt regulations by July 1, 1993. CDPH does not have plans to adopt such regulations. In the absence of regulations, PDHRCFs have been governed by more stringent regulations for skilled nursing facilities.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
AB 1147
Page 7
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1147
(Maienschein) – As Introduced February 27, 2015
SUBJECT: Health facilities: pediatric day health and respite care facilities.
SUMMARY: Creates a licensing category for pediatric day health and respite care facilities (PDHRCFs), codifies all the requirements and standards that such facilities must adhere to, and allows an individual who is 22 years of age or older to continue to receive care in a PDHRCF if the facility receives approval from the California Department of Public Health (DPH). Specifically, this bill:
Exempts PDHRCFs from specific skilled nursing facility (SNF) regulatory requirements, including requirements for multiple facility committees and instead requires PDHRCFs to have a patient care committee to address quality of care provided in the facility, including, but not limited to, patient care policies, pharmacy services, and infection control.
Specifies that the patient care committee membership includes the medical director, dietician, pharmacist, nursing staff, nurse supervisor, center administrator or director, and other staff as may be required by facility policies and procedures. Specifies the committee is responsible for all of the following:
Reviewing and approving all policies relating to patient care, and based on reports from the facility's administrator, that the committee will review the effectiveness of policy implementation and make recommendations to the administrator for the improvement of patient care. Requires the committee to review patient care policies annually, and revise the policies as necessary.
Establishing, reviewing, monitoring, and approving policies and procedures for investigating, controlling, and preventing infections in the facility, and maintaining, reviewing, and reporting statistics of thenumber, types, sources, and location of infectionswithin the PDHRCRF.
Establishing, reviewing, and monitoring the storage and administration of drugs and biologicals (insulin), reviewing and taking appropriate action based on any findings from a pharmacist hired to consult with the committee and internal quality assurance reviews, and recommending improvements of services to the administrator of the facility.
Requires PDHRCFs to comply with licensing requirements, allows PDHRCFs to apply to DPH for program flexibility waivers, and requires DPH, when approving waivers to provide for the terms and conditions under which a waiver is granted. Requires DPH, when reviewing requests for program flexibility, to consider the unique nature of services provided to individuals served by the PDHRCF when compared to the requirements for DLHFs for individuals requiring inpatient care.
Establishes specific requirements for PDHRCFs provision of pharmacy services, that satisfy all of the following:
Requiring all medications to be provided by the child's parent, foster parent, or legal guardian in the original container that specifies administration instructions;
That medications be administered only upon written and signed orders of the child's physician;
The PDHRCF shall not order medications from a pharmacy or take delivery of medications from a pharmacy; and,
That a PDHRCF shall not accept a child into the facility if the child's medications have expired or are scheduled to expire during the child's stay at the facility.
Requires physician orders to be current and maintained in the child's medical record, and allows verbal orders from the physician for services to be rendered at the facility to be received and recorded by licensed nursing personnel, and be signed by the attending physician within 30 days.
Prohibits medications from being administered to a child unless the facility first verifies that the medication was ordered by a physician, and requires PDHRCFs to maintain records of medication administered for at least one year as part of the child's plan of care.
Allows a PDHRCF to treat changes in a child's condition, such as new onset pain, nausea, diarrhea, infections, or other similar changes in accordance with the child's plan of care if the child has been prescribed medications to treat these anticipated symptoms and does not present a risk to the health and safety of themselves, other children, staff, or other individuals with whom the child may come into contact.
Allows a PDHRCF to implement policies and procedures that prohibit smoking by clients, parents, staff, visitors, or consultants within the facility or on the premises.
Specifies that in order to establish, conduct, or maintain a PDHRCF, a person or entity must file an application with DPH on a form prescribed, prepared and furnished by DPH, containing information as required for the proper administration and enforcement of these provisions. Requires DPH to initiate an initial licensing inspection within 60 days of receipt of a completed application.
Allows a previously unlicensed PDHRCF to receive a provisional license to operate a facility . Specifies a provisional license will terminate six months from the date of issuance, or the date DPH is able to conduct a full and complete inspection, whichever is later.
Requires, 30 days prior to the termination of a provisional license, DPH to give the facility a full and complete inspection, and if the facility meets all requirement for licensure, a regular license to be issued, or, if the facility does not meet the requirments but has made substantial progress toward meeting the requirements, the provisional license to be renewed for six months.
Specifies that if DPH determines there has not been substantial progress toward meeting licensure requirements at the time of the first full inpection, or if upon its inpection within 30 days of the termination of a renewed provisional license, that there is a lack of full compliance, DPH will not issue a further license.
Clarifies that an applicant denied a provisional license can contest the denial by filing a request for a hearing.
Specifies that a PDHRCF licensee must pay an annual fee, not to exceed the reasonable regulatiory cost to DPH, that a license expires 12 months from the date of issuance, that a license shall be deemed renewed upon payment of the necessary fee, and that at least 45 days prior to the expiration of a license DPH will mail a notice for renewal to the licensee.
Requires periodic inspections of PDHRCF by DPH for the purpose of ensuring that the facility is complying with these provisions and applicable rules and regulations.
Allows DPH to deny an application, or suspend or revoke a license upon any of the following grounds:
A serious violation by the licensee of any of the provision of this chapter, or of the rules and regulations promulgated under this chapter that jeopardizes the health and safety of clients;
Aiding, abetting, or permitting the commission of any illegal act; or,
Willful omission or falsification of a material fact in the application for a license.
Specifies the proceeding for a denial, suspension, or revocations of a license, or denial or withdrawal of approval, and clarifies that the suspension, cancellation, or surrender of a license without the written consent of DPH does not deprive the department of its authority to institute or continue a disciplinary proceeding against the licensee upon any ground provided by law.
Grants DPH the authority to make reasonable accommodation for exceptions to the standards of these provisions if the health, safety, and quality of patient care is not compromised. Requires written approval regarding the terms and conditions of the exception, and that an applicant request an exception in writing.
Provides for the ability of PDHRCFs to organize a Transitional Heatlh care Needs Optioanl Service Unit, or optional service unit, that is organized, staffed, and equipped to provide care to individulas who are 22 years of age or older, and specifies that PDHRCFs are not required to operate an optional service unit.
Specifies that in order to continue receiving care in the PDHRCF, participants who are 22 years of age or older must have a developmental age of 18 years or younger as evidenced by their Individual Education Plan, Regional center Assessment, physician's assessment, or other nationally recognized assessment tool.
Requires an optional serice unti to be approved by DPH, and that care for clients who are 22 years of age or older be provided in a distinct part of the PDHRCF, separate from the area where care is provided to younger clients.
Requires the facility to establish policies and procedure for determining the age ranges of clients who are cared for in the optional service unit, and for those policies to include, but not be limited to, consideration of the client's chronological age, developmental age, and size.
Requires the PDHRCF to ensure its staffing and equipment are sufficient to provide services to clients who are 22 years of age or older and to have written policies and procedures for the management of the services as established an implemented by the patient care policy committee.
EXISTING LAW:
Defines a PDHRCF as a facility which provides an organized program of therapeutic social and day health activities and services, and limited 24-hour inpatient respite care, to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children.
Requires DPH to adopt regulations and license PDHRCFs and to set minimum standards for the adequacy, safety, and sanitation of the physical plant and equipment, staffing requirements, staff training, and the services offered.
Requires DPH to establish an advisory committee of experts to assist in the development of the regulations.
Allows, pending adoption of the regulations, for an entity to be licensed as a PDHRCF if it meets interim regulations for congregate living health facilities (CLHF).
Requires the services offered to include medical, nursing, pharmacy, nutrition, socialization, and developmentally appropriate activities.
Specifies services which may be provided, but are not limited to, include physical therapy, developmental services, occupational and speech therapy, educational and psychological services, respite care, instruction for parents or guardians, and comprehensive case management, if not otherwise available for the client.
Allows a PDHRF to establish admission criteria based on the compatibility of the developmental needs of the persons served, and the facility's ability to meet those needs. Requires admission criteria to be approved by DPH.
Requires a child accepted for care in a PDHRCF to meet the following requirements:
Be medically stable as determined by their attending physician;
Be under the care of a physician who approves the PDHRCF's plan of care; and,
Have current immunization records unless medically contraindicated as stated by their physician at the time of admission and to pose no significant risk of infection to others in the facility.
Requires DPH to adopt regulations for the licensure of CLHFs no later than January 1, 1991, and for PDHRCFs on July 1, 1993.
FISCAL EFFECT: This bill has not been analyzed by a fiscal committee
COMMENTS:
PURPOSE OF THIS BILL. According to the author, medically fragile children, as they begin to approach the age of 22, have been faced with untenable choices of how to cobble together the types of services that could provide the same type of care and support received at PDHRCFs. Unfortunately, these services simply do not exist; and families are again facing similar unacceptable choices as they faced before PDHRFs were established. The author states this bill will guarantee the continuity of care this population desperately needs by allowing medically fragile children and young adults to continue to receive the quality services from PDHRCFs as they grow older than the age of 22.
BACKGROUND. AB 3413 (Polanco), Chapter, 1227, Statutes of 1990, added a new category of health facility: Pediatric Day Health and Respite Care Facility. Prior to that date, families with medically-fragile children had very few choices to find day health and respite care that would allow the child to remain at home, keep the family intact, and keep parents working. When this category of facility was first established, most of the medically-fragile children were not expected to survive to become adults; this model did not envision a system of care that would provide a seamless transition for these children as they age out of the PDHRCF programs.
When enacted, AB 3413 required the Department of Health Services, now DPH, to adopt regulations by July 1, 1993, and allowed PDHRCFs to operate under a provisional license until the regulations were adopted by complying with the regulations for CLHFs. At that time regulations for CLHFs were to be final by January 1, 1991, and CLHFs were operating under SNF regulations with some exceptions to those regulations allowed through program flexibility waivers.
Neither the CLHF, nor the PDHRCF regulations were ever adopted and both types of facilities have had to be licensed and operate under SNF requirements and regulations, with some exemptions as granted by DPH. The failure of DPH to adopt regulations specific to each type of facility, and to use portions of the SNF regulations, constitutes the promulgation of underground regulations, which is a violation of the Administrative Procedures Act.
PDHRCFs are very different than SNFs. SNFs are long term care facilities whose adult residents are receiving 24-hour inpatient care. PDHRCFs are daycare centers that offer occasional over-night respite care to clients' and their families. PDHRCFs have found it challenging over the years to meet the requirements of SNF licensure. For example, a SNF will have a Pharmacist on staff who orders medications for the residents. A PDHRCF may administer medication to a client, but does not have a Pharmacist, and is simply checking the medications each day as they are brought to the facility by the parent or guardian. Yet under current licensure requirements, both facilities must have a pharmaceutical service committee with a pharmacist member.
SUPPORT. Together We Grow, a PDHRCF in San Diego is the sponsor of this bill and states, unlike the care provided by PDHRCFs, long-term care for medically-fragile young adults is fragmented and does not provide the same essential choices to medically-fragile adults and their families. The sponsors note that current state licensing law permits children to receive care up until the child turns 22 years of age, and then they and their families are faced with the possibility of institutionalization (leaving their families), attending an adult day health care center that does not have the level of expertise, programming, or activities necessary to engage and provide safe care for this population, foregoing any family respite support, or forcing family members to quit their jobs to provide care to their loved ones. Together We Grow concludes that this bill will permit medically fragile young adults to remain at the PDHRCF in a separate transitional care unit, and that the costs of these services are less than the state would pay for institutional care.
The California Children's Hospital Association (CCHA) supports this bill pointing out that as a result of the advances made in medicine over the past 25 years, more medically fragile children are living into adulthood and aging out of PDHRCF service. CCHA notes that this can be disastrous for patients and families, both financially and emotionally, as they enter a fragmented adult system that does not have the same level of services. CCHA concludes that this bill will protect their access to the facilities they have essentially grown up in, while ensuring they are being cared for in a transitional unit appropriate to their age.
Easter Seals supports this bill because it provides for a smooth transition into adulthood by allowing individuals to be supported in a transitional care unit after they turn 22 years of age.
TECHNICAL AMENDMENTS. Amendments to this bill are technical and clarifying, and add an Urgency clause.
REGISTERED SUPPORT / OPPOSITION:
Support
Together We Grow
(sponsor)
California Children's Hospital Association
Easter
Seals
Exceptional Family Resource Center
Home Start
Kaplan
College, San Diego
Loretta's Little
Miracles
San Diego Brain Injury Foundation
San Diego
Regional Center
University of California, San Diego
Numerous
individuals
Opposition
None on file
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
Discussed in Hearing
44SEC
Assembly Floor
1MIN
Senate Floor
3MIN
Senate Standing Committee on Health
2MIN
Assembly Standing Committee on Health
Bill Author
Bill Co-Author(s):
