AB 275: Long-term care facilities: requirements for changes resulting in the inability of the facility to care for its residents.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-09-01
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would also require the facility to give written notification to the State Department of Health Care Services and any health plan of an affected resident of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility. The bill would modify who may perform the required assessments of the affected residents. The bill would authorize the State Department of Public Health to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure and an attestation that each resident will undergo a medical assessment, as specified, before being relocated. By expanding the notice and reporting requirements under these provisions, the bill would expand the definition of a crime, thereby imposing a state-mandated local program. The bill would also make technical, nonsubstantive changes to uniformly use the term resident and the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would also require the facility to give written notification to the State Department of Health Care Services and any health plan of an affected resident of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility. The bill would modify who may perform the required assessments of the affected residents. The bill would authorize the State Department of Public Health to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure and an attestation that each resident will undergo a medical assessment, as specified, before being relocated. By expanding the notice and reporting requirements under these provisions, the bill would expand the definition of a crime, thereby imposing a state-mandated local program. The bill would also make technical, nonsubstantive changes to uniformly use the term resident and the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would also require the facility to give written notification to the State Department of Health Care Services and any affected health plan of an affected resident of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility. The bill would modify who may perform the required assessments of the affected residents. The bill would authorize the State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure and an attestation that each resident will undergo a medical assessment, as specified, before being relocated. By expanding the notice and reporting requirements, requirements under these provisions, the bill would expand a crime, and thus would impose thereby imposing a state-mandated local program. This The bill would also make technical, nonsubstantive changes to uniformly use the term resident and refer to the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would also require the facility to give written notification to the State Department of Health Care Services and any affected health plan of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility. The bill would modify who may perform the required assessments of the affected residents. The State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure and an attestation that each resident will undergo a medical assessment, as specified, before being relocated. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program. This bill would also make technical, nonsubstantive changes to uniformly use the term resident and refer to the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would modify who may perform the required assessments of the affected residents. The State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure. closure and an attestation that each resident will undergo a medical assessment, as specified, before being relocated. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program. This bill would also make technical, nonsubstantive changes to uniformly use the term resident and refer to the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its residents. The bill would require a facility to provide 60 days notice to the affected residents or their guardians and 60-day written notice to the State Long-Term Care Ombudsman. The bill would modify who may perform the required assessments of the affected residents. The State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information on the number of residents affected by the proposed closure. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program. This bill would also make technical, nonsubstantive changes to uniformly use the term resident and refer to the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients, patients or residents, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient or resident prior to a transfer due to the change, and, when 10 or more patients residents are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its patients. residents. The bill would require a facility to provide 90 60 days notice to the affected patients residents or their guardians and 90-day 60-day written notice to the State Long-Term Care Ombudsman. The bill would modify who may perform the required assessments of the affected residents. The department State Department of Public Health would have the authority to require the facility, as part of the proposed relocation plan required when 10 or more residents are likely to be transferred, to provide additional information, including information that demonstrates its compliance with federal and state laws for closure. The bill would also require 2 or more facilities, that are within a 6-mile radius and propose to close within 30 days of one another, to comply with additional reporting requirements and would authorize the department to deny closure of the multiple facilities and to require the facilities to resubmit their closure plans with different timelines. on the number of residents affected by the proposed closure. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program. This bill would also make technical, nonsubstantive changes to uniformly use the term resident and refer to the State Department of Public Health in these provisions.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law imposes various notice and planning requirements upon a long-term health care facility before allowing a change in the status of the license or operation of the facility that results in the inability of the facility to care for its patients, including a requirement for written notification to the affected patients or their guardians at least 30 days prior to the change. Under existing law, these requirements also include taking reasonable steps to medically, socially, and physically assess each affected patient prior to a transfer due to the change, and, when 10 or more patients are likely to be transferred due to a change, the preparation and submission of a proposed relocation plan to the department for approval. A violation of these requirements is a misdemeanor and also may be enforced by the issuance of citations and the imposition of civil penalties.
This bill would expand the notice and planning requirements that a long-term health care facility provides before any change in the status of the license or in the operation of the facility that results in its inability to care for its patients. The bill would require a facility to provide 90 days notice to the affected patients or their guardians and 90-day written notice to the State Long-Term Care Ombudsman. The bill would modify who may perform the required assessments of the affected residents. The department would have the authority to require the facility, as part of the plan required when 10 or more residents are likely to be transferred, to provide additional information, including information that demonstrates its compliance with federal and state laws for closure. The bill would also require 2 or more facilities, that are within a 6-mile radius and propose to close within 30 days of one another, to comply with additional reporting requirements and would authorize the department to deny closure of the multiple facilities and to require the facilities to resubmit their closure plans with different timelines. By expanding the notice and reporting requirements, the bill would expand a crime, and thus would impose a state-mandated local program.
(2)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall hold a community meeting for residents and their families no later than 30 days after providing the written notice pursuant to subdivision (a). The facility shall provide notice of the meeting to residents and their families and to local health authorities. The facility shall also provide notice of the community meeting to the State Department of Public Health as part of the proposed relocation plan submitted to the department pursuant to paragraph (1) of subdivision (g) of Section 1336.2.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility.
(c)The facility shall give written notification to the State Department of Health Care Services and any health plan of an affected resident of the change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility. This notification shall also include the names of residents that are covered by Medi-Cal or by the specific health plan.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)(1)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall also include, but not be limited to, all of the following information:
(A)The number of residents affected by the proposed closure.
(B)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(C)Attestation that each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated.
(D)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(E)The reason for the proposed closure.
(F)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
(2)The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsperson at the same time the plan is submitted to the State Department of Public Health.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
(i)Nothing in this section shall be construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a)In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1)Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2)Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3)Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b)(1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall hold a community meeting for residents and their families no later than 30 days after providing the written notice pursuant to subdivision (a). The facility shall provide notice of the meeting to residents and their families and to local health authorities. The facility shall also provide notice of the community meeting to the State Department of Public Health as part of the proposed relocation plan submitted to the department pursuant to paragraph (1) of subdivision (g) of Section 1336.2.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility.
(c)The facility shall give written notification to the State Department of Health Care Services and any health plan of an affected resident of the change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility. This notification shall also include the names of residents that are covered by Medi-Cal or by the specific health plan.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)(1)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall also include, but not be limited to, all of the following information:
(A)The number of residents affected by the proposed closure.
(B)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(C)Attestation that each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated.
(D)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(E)The reason for the proposed closure.
(F)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
(2)The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsperson at the same time the plan is submitted to the State Department of Public Health.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
(i)Nothing in this section shall be construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a)In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1)Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2)Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3)Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b)(1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall hold a community meeting for residents and their families no later than 30 days after providing the written notice pursuant to subdivision (a). The facility shall provide notice of the meeting to residents and their families and to local health authorities. The facility shall also provide notice of the community meeting to the State Department of Public Health as part of the proposed relocation plan submitted to the department pursuant to paragraph (1) of subdivision (g) of Section 1336.2.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility, including a voluntary closure, closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility.
(c)The facility shall give written notification to the State Department of Health Care Services and any affected health plan health plan of an affected resident of the change in the status of the license or the operation of the facility, including a voluntary closure, closure and the planned date of closure, at least 60 days prior to any change in the status of the license or the operation of the facility. This notification shall also include the names of residents that are covered by Medi-Cal or by the specific health plan.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)(1)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall also include, but not be limited to, all of the following information:
(A)The number of residents affected by the proposed closure.
(B)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(C)Attestation that each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated.
(D)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(E)The reason for the proposed closure.
(F)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
(2)The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsperson at the same time the plan is submitted to the State Department of Public Health.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
(i)Nothing in this section shall be construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a)In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1)Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2)Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3)Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b)(1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall hold a community meeting for residents and their families. families no later than 30 days after providing the written notice pursuant to subdivision (a). The facility shall provide notice of the meeting to residents and their families and to local health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program. authorities. The facility shall also provide notice of the community meeting to the State Department of Public Health as part of the proposed relocation plan submitted to the department pursuant to paragraph (1) of subdivision (g) of Section 1336.2.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall also give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility facility, including a voluntary closure, at least 60 days prior to any change in the status of the license or the operation of the facility.
(c)The facility shall give written notification to the State Department of Health Care Services and any affected health plan of the change in the status of the license or the operation of the facility, including a voluntary closure, at least 60 days prior to any change in the status of the license or the operation of the facility. This notification shall also include the names of residents that are covered by Medi-Cal or by the specific health plan.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed mental health professional or a licensed social worker marriage and family therapist, a licensed clinical social worker, a licensed psychologist, a licensed psychiatrist, or a licensed professional clinical counselor and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)(1)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall also include, but not be limited to, all of the following information:
(1)(A)The number of residents affected by the proposed closure.
(2)(B)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(3)(C)Attestation that each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated.
(4)(D)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(5)(E)The reason for the proposed closure.
(6)(F)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
The(2)The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsman ombudsperson at the same time the plan is submitted to the State Department of Public Health. Once the State Department of Public Health approves a proposed relocation plan, it shall post the plan on its Internet Web site within 10 business days.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
(i)Nothing in this section shall be construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a) In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1) Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2) Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3) Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b) (1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall hold a community meeting for residents and their families. The facility shall provide notice of the meeting to residents and their families and to local health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall also give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed mental health professional or a licensed social worker and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall include, but not be limited to, all of the following information:
(1)The number of residents affected by the proposed closure.
(2)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(3)Attestation that the facility completed a medical assessment of each resident. each resident will undergo a medical assessment pursuant to paragraph (1) of subdivision (a) before being relocated.
(4)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(5)The reason for the proposed closure.
(6)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsman at the same time the plan is submitted to the State Department of Public Health. Once the State Department of Public Health approves a proposed relocation plan, it shall post the plan on its Internet Web site within 10 business days.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a) In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1) Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2) Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3) Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b) (1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected residents or to the guardians of the affected residents at least 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
(b)If residents placement problems are encountered that cannot be satisfactorily resolved within this 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement. The facility shall provide notification of hold a community meeting for residents and their families, families. The facility shall provide notice of the meeting to residents and their families and to local health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program.
(d)This section shall not apply to actions initiated by the State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected residents, the facility shall, in response to inquiries made by prospective residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall also give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility at least 60 days prior to any change in the status of the license or the operation of the facility.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed mental health professional or a licensed social worker and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the State Department of Public Health provides the services pursuant to subdivision (f).
(e)The State Department of Public Health may make available assistance for the placement of hard-to-place residents based on its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of residents, if it determines that these services are needed promptly to prevent adverse health consequences to residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the State Department of Public Health for the cost of providing the relocation services. The State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If theState the State Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The proposed relocation plan shall include, but not be limited to, all of the following information:
(1)The number of residents affected by the proposed closure.
(2)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(3)Attestation that the facility completed a medical assessment of each resident.
(4)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(5)The reason for the proposed closure.
(6)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
The proposed relocation plan shall become effective upon the date the State Department of Public Health grants its approval. The State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. Until one proposed relocation plan has been approved by the State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsman at the same time the plan is submitted to the State Department of Public Health. Once the State Department of Public Health approves a proposed relocation plan, it shall post the plan on its Internet Web site within 10 business days.
(h)The resident shall have the right to remain in the facility for up to 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the State Department of Public Health shall limit the number of residents being transferred per day until it determines when it is safe to increase the numbers.
SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a) In the event of an emergency, such as earthquake, fire, or flood that threatens the safety or welfare of the residents in a facility, the facility shall do all of the following:
(1) Notify, as soon as possible, family members, guardians of residents, the State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the welfare of the residents.
(2) Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of a resident is necessary.
(3) Undertake prompt medical assessment of, and provide counseling as needed to, residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b) (1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the State Department of Public Health upon request. The plan shall comply with the requirements in this section and the State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for residents in the event of an emergency. The facility shall report to the State Department of Public Health the name of any facility or hospital that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other law, a long-term health care facility shall give written notice to the affected patients residents or to the guardians of the affected patients residents at least 90 60 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its patients. residents.
(b)If patients residents placement problems are encountered which that cannot be satisfactorily resolved within this 90-day 60-day period, the State Department of Public Health and the health facility shall agree on an extension which shall not exceed an additional 90 60 days.
(c)The facility shall provide an appropriate team of professional staff to assist patients residents and families in obtaining alternative placement. The facility shall provide notification of a community meeting for residents and their families, and to local health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program.
(d)This section shall not apply to actions initiated by the department State Department of Public Health to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected patients, residents, the facility shall, in response to inquiries made by prospective patients residents or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall also give written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility at least 90 60 days prior to any change in the status of the license or the operation of the facility.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician or the facility medical director, if the resident does not have an attending physician, completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed mental health professional or a licensed social worker and the facility nursing staff complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the department State Department of Public Health provides the services pursuant to subdivision (f).
(e)The department State Department of Public Health may make available assistance for the placement of hard-to-place residents based on the departments its determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The department State Department of Public Health may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of patients, residents, if the department it determines that these services are needed promptly to prevent adverse health consequences to patients, residents, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the department State Department of Public Health for the cost of providing the relocation services. The departments State Department of Public Healths participation shall not relieve the facility of any responsibility under this section. If the departmentState Department of Public Health does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the department State Department of Public Health shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the department State Department of Public Health for approval at least 30 days prior to the written transfer notification given to any resident or residents representative. The proposed relocation plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The The proposed relocation plan shall include, but not be limited to, all of the following information:
(1)The number of residents affected by the proposed closure.
(2)The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves as described in Section 1418.8.
(3)Attestation that the facility completed a medical assessment of each resident.
(4)The availability of alternative skilled nursing facility beds or other available long-term care beds within the community.
(5)The reason for the proposed closure.
(6)The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
The proposed relocation plan shall become effective five working days after upon the date the department State Department of Public Health grants its approval. The department State Department of Public Health shall base its approval of a proposed relocation plan on the standards specified in this section. section, including, but not limited to, its determination that the plan provides adequate protections to minimize transfer trauma for residents. The department State Department of Public Health shall promptly either approve or reject the proposed relocation plan within 14 working days of receipt from the facility. If the department State Department of Public Health rejects the proposed relocation plan, the facility may resubmit amended proposed relocation plans, each of which the department State Department of Public Health shall promptly either approve or reject within 14 working days of receipt from the facility. The department shall have the authority to require the facility, as part of the closure and relocation plans, to provide specific interventions that the transferring facility will implement to help prevent possible resident transfer trauma, identify facilities that are available to receive residents for transfer, and provide timelines with specific dates that demonstrate compliance with both federal and state laws and regulations for closure with the required notifications to residents or the residents legal and responsible parties. Until one proposed relocation plan has been approved by the department, State Department of Public Health, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the proposed relocation plan to the local long-term care ombudsman at the same time the plan is submitted to the department. State Department of Public Health. Once the State Department of Public Health approves a proposed relocation plan, it shall post the plan on its Internet Web site within 10 business days.
(h)The resident shall have the right to remain in the facility for up to 90 60 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The department State Department of Public Health shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the department State Department of Public Health shall limit the number of residents being transferred per day until the department it determines that it would be when it is safe to increase the numbers.
(i)(1)In the event that two or more facilities within a six-mile radius propose to close on the same date, or within 30 days of one another, the facilities shall each prepare a community impact report. The community impact report shall be included in the proposed closure plan. The report shall include all of the following information:(A)The total number of residents affected by the proposed closures.(B)The number of additional skilled nursing facilities within 5, 10, 25, and 50 miles of the facilities proposing to close and the number of available beds at each of those facilities.(C)The reason for the proposed closures.(D)The number of residents at each facility proposed for closure that could potentially experience transfer trauma.(E)The number of residents at each facility proposed for closure that are unrepresented or under conservatorship.(F)The number of residents at each facility proposed for closure that are taking psychotropic medications.(G)The number of residents at each facility proposed for closure that have a dementia diagnosis.(2)The facilities proposing to close shall hold at least one community meeting to solicit input from the affected community.(3)If the facilities proposing to close are owned by the same entity, and are proposing to close simultaneously, the department shall have the authority to deny approval of simultaneous closures of the multiple facilities and require the facilities to resubmit their closure plans with different timelines.SEC. 4.Section 1336.3 of the Health and Safety Code is amended to read:1336.3.(a) In the event of an emergency, such as earthquake, fire, or flood which that threatens the safety or welfare of patients the residents in a facility, the facility shall do all of the following:
(1) Notify, as soon as possible, family members, patients guardians, guardians of residents, the state department, State Department of Public Health, and the ombudsperson for that facility of the emergency and the steps that the facility plans to take for the patients welfare. welfare of the residents.
(2) Provide the services set forth in subdivision (a) of Section 1336.2 if further relocation of the patient a resident is necessary.
(3) Undertake prompt medical assessment of, and provide counseling as needed to, patients residents whose further relocation is not necessary but who have suffered or may suffer adverse health consequences due to the emergency or sudden transfer.
(b) (1)Each facility shall adopt a written emergency preparedness plan and shall make that plan available to the state department State Department of Public Health upon request. The plan shall comply with the requirements in this section and the state departments State Department of Public Healths Contingency Plan for Licensed Facilities. The facility, as part of its emergency preparedness planning, shall seek to enter into reciprocal or other agreements with nearby facilities and hospitals to provide temporary care for patients residents in the event of an emergency. The facility shall report to the state department State Department of Public Health the name of any facility or hospital which that fails or refuses to enter into such agreements and the stated reason for that failure or refusal.
Section(2)Section 1336.2 shall not apply in the event of transfers made pursuant to an emergency preparedness plan. In any event, however, the facility shall provide the notice and services described in subdivisions (a) to (c), inclusive.
SEC. 4.SEC. 5.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
(a)Notwithstanding any other provisions of law, a long-term health care facility shall give written notice to the affected patients or to the guardians of the affected patients at least 30 90 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its patients.
(b)If patients placement problems are encountered which cannot be satisfactorily resolved within this 30-day 90-day period, the State Department of Public Health Services and the health facility shall agree on an extension which shall not exceed an additional 60 90 days.
(c)The facility shall provide an appropriate team of professional staff to assist patients and families in obtaining alternative placement.
(d)This section shall not apply to actions initiated by the department to suspend or revoke the license.
SEC. 2.Section 1336.1 of the Health and Safety Code is amended to read:1336.1.(a)After notifying its affected patients, the facility shall, in response to inquiries made by prospective patients or their representatives, include notification of the change in the status of the license or the operation of the facility.
(b)The facility shall also give oral written notification to the office of the State Long-Term Care Ombudsman of the change in the status of the license or the operation of the facility at least 30 90 days prior to any change in the status of the license or the operation of the facility.
SEC. 3.Section 1336.2 of the Health and Safety Code is amended to read:1336.2.(a)Before residents are transferred due to any change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
(1)Be responsible for ensuring that the residents attending physician, if available, or a facility medical director, if available, physician completes the medical assessment of the residents condition and susceptibility to adverse health consequences, including psychosocial effects, prior to written notice of transfer being given to the resident. The assessment shall not be considered complete unless it provides, in accordance with these assessments, recommendations for counseling, followup visits, and other recommended services, by designated health professionals, and for preventing or ameliorating potential adverse health consequences in the event of transfer.
(2)Be responsible for ensuring that a licensed mental health professional and the facility nursing staff and activity director complete an assessment of the social and physical functioning of the resident based on the relevant portions of the minimum data set, as described in Section 14110.15 of the Welfare and Institutions Code, before written notice of transfer is given to the resident. The assessment shall not be considered complete unless it provides recommendations for preventing or ameliorating potential adverse health consequences in the event of transfer. The assessment may be amended because of a change in the residents health care needs. The assessment shall also include a recommendation for the type of facility that would best meet the residents needs.
(3)(A)Be responsible for evaluating the relocation needs of the resident including proximity to the residents representative and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given to the resident or the residents representative. The health facility shall discuss the evaluation and medical assessment with the resident or the residents representative and make the evaluation and assessment part of the medical records for transfer.
(B)If the resident or residents representative chooses to make a transfer prior to completion of assessments, the facility shall inform the resident or the residents representative, in writing, of the importance of obtaining the assessments and followup consultation.
(4)At least 30 60 days in advance of the transfer, inform the resident or the residents representative of alternative facilities that are available and adequate to meet resident and family needs.
(5)Arrange for appropriate future medical care and services, unless the resident or residents representative has otherwise made these arrangements. This requirement does not obligate a facility to pay for future care and services.
(b)The facility shall provide an appropriate team of professional staff to perform the services required in subdivision (a).
(c)The facility shall also give written notice to affected residents or their representatives, advising them of the requirements in subdivision (a) at least 30 60 days in advance of transfer. If a facility is required to give written notice pursuant to Section 1336, then the notice shall advise the affected resident or residents representative of the requirements in subdivision (a). If the transfer is made pursuant to subdivision (g), the notice shall include notification to the resident or residents representative that the transfer plan is available to the resident or residents representative free of charge upon request.
(d)In the event of a temporary suspension of a facilitys license pursuant to Section 1296, the 30-day 60-day notice requirement in subdivision (c) shall not apply, but the facility shall provide the relocation services required in subdivision (a) unless the department provides the services pursuant to subdivision (f).
(e)The department may make available assistance for the placement of hard-to-place residents based on the departments determination of the benefit and necessity of that assistance. A hard-to-place resident is a resident whose level of care, physical malady, or behavioral management needs are substantially beyond the norm.
(f)The department may provide, or arrange for the provision of, necessary relocation services at a facility, including medical assessments, counseling, and placement of patients, if the department determines that these services are needed promptly to prevent adverse health consequences to patients, and the facility refuses, or does not have adequate staffing, to provide the services. In these cases, the facility or the licensee shall reimburse the department for the cost of providing the relocation services. The departments participation shall not relieve the facility of any responsibility under this section. If the department does not provide or arrange for the provision of the necessary relocation services, and the facility refuses to provide the relocation services required in subdivision (a), then the department shall request that the Attorney Generals office or the local district attorneys office seek injunctive relief and damages in the same manner as provided for in Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions Code.
(g)If 10 or more residents are likely to be transferred due to any voluntary or involuntary change in the status of the license or operation of a facility, including a facility closure or voluntary or involuntary termination of a facilitys Medi-Cal or Medicare certification, the facility shall submit a proposed relocation plan for the affected residents to the department for approval at least 15 30 days prior to the written transfer notification given to any resident or residents representative. The plan shall provide for implementation of the relocation services in subdivision (a) and shall describe the availability of beds in the area for residents to be transferred, the proposed discharge process, and the staffing available to assist in the transfers. The plan shall become effective upon five working days after the date the department grants its approval. The department shall base its approval of a relocation plan on the standards specified in this section. The department shall promptly either approve or reject the plan within 10 14 working days of receipt from the facility. If the department rejects the plan, the facility may resubmit amended relocation plans, each of which the department shall promptly either approve or reject within 10 14 working days of receipt from the facility. The department shall have the authority to require the facility, as part of the closure and relocation plans, to provide specific interventions that the transferring facility will implement to help prevent possible resident transfer trauma, identify facilities that are available to receive residents for transfer, and provide timelines with specific dates that demonstrate compliance with both federal and state laws and regulations for closure with the required notifications to residents or the residents legal and responsible parties. Until one plan has been approved by the department, and until the facility complies with the requirements in subdivision (a), the facility may not issue a notice of transfer. The facility shall submit the relocation plan to the local long-term care ombudsman at the same time the plan is submitted to the department.
(h)The resident shall have the right to remain in the facility for up to 60 90 days after the approved written notice of the facilitys intent to transfer the resident if an appropriate placement based on the relocation assessment and relocation recommendations has not been made. The facility shall be required to maintain an appropriate level of staffing in order to ensure the well-being of all the residents as they continue to reside in the facility. The department shall monitor the facilitys staging of transfers, and, if it determines that the facilitys staging of placements is causing a detrimental impact on those residents being transferred, then the department shall limit the number of residents being transferred per day until the department determines that it would be safe to increase the numbers.
(i)(1)In the event that two or more facilities within a six-mile radius propose to close on the same date, or within 30 days of one another, the facilities shall each prepare a community impact report. The community impact report shall be included in the proposed closure plan. The report shall include all of the following information:
(A)The total number of residents affected by the proposed closures.
(B)The number of additional skilled nursing facilities within 5, 10, 25, and 50 miles of the facilities proposing to close and the number of available beds at each of those facilities.
(C)The reason for the proposed closures.
(D)The number of residents at each facility proposed for closure that could potentially experience transfer trauma.
(E)The number of residents at each facility proposed for closure that are unrepresented or under conservatorship.
(F)The number of residents at each facility proposed for closure that are taking psychotropic medications.
(G)The number of residents at each facility proposed for closure that have a dementia diagnosis.
(2)The facilities proposing to close shall hold at least one community meeting to solicit input from the affected community.
(3)If the facilities proposing to close are owned by the same entity, and are proposing to close simultaneously, the department shall have the authority to deny approval of simultaneous closures of the multiple facilities and require the facilities to resubmit their closure plans with different timelines.
SEC. 4.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
|
Date
|
Status
|
|---|---|
| Sep 1, 2017 | Chaptered by Secretary of State - Chapter 185, Statutes of 2017. |
| Sep 1, 2017 | Approved by the Governor. |
| Aug 25, 2017 | Enrolled and presented to the Governor at 3 p.m. |
| Aug 21, 2017 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Jul 17, 2017 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after July 19 pursuant to Assembly Rule 77. |
| Jul 17, 2017 | Read third time. Passed. Ordered to the Assembly. |
| Jul 10, 2017 | Read second time. Ordered to third reading. |
| Jul 6, 2017 | Read third time and amended. Ordered to second reading. |
| Jun 27, 2017 | Read second time. Ordered to third reading. |
| Jun 26, 2017 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jun 13, 2017 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 12, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 7). |
| May 18, 2017 | Referred to Com. on HEALTH. |
| May 4, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 4, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 1389.) |
| Apr 27, 2017 | Read second time. Ordered to Consent Calendar. |
| Apr 26, 2017 | From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (April 26). |
| Apr 5, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (April 4). Re-referred to Com. on APPR. |
| Mar 29, 2017 | Re-referred to Com. on AGING & L.T.C. |
| Mar 28, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on AGING & L.T.C. Read second time and amended. |
| Mar 27, 2017 | Re-referred to Com. on AGING & L.T.C. |
| Mar 23, 2017 | Read second time and amended. |
| Mar 22, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on AGING & L.T.C. (Ayes 15. Noes 0.) (March 21). |
| Mar 9, 2017 | Re-referred to Com. on HEALTH. |
| Mar 8, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Feb 13, 2017 | Referred to Coms. on HEALTH and AGING & L.T.C. |
| Feb 2, 2017 | From printer. May be heard in committee March 4. |
| Feb 1, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 21, 2017 | AB 275 WOOD Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Jul 17, 2017 | Previous Question, Second Reading | Senate Floor |
Passed |
|
| Jun 7, 2017 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| May 4, 2017 | AB 275 WOOD Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 26, 2017 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 4, 2017 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Aging and Long-Term Care |
Passed |
|
| Mar 21, 2017 | Do pass as amended and be re-referred to the Committee on [Aging and Long-Term Care] | 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
|
|---|---|---|
| AARP California | ** Support | Jul 12, 2017 |
| Association Of Regional Center Agencies | ** Support | Jul 12, 2017 |
| California Advocates for Nursing Home Reform | ** Support | Jul 12, 2017 |
| California Commission on Aging | ** Support | Jul 12, 2017 |
| California Long-Term Care Ombudsman Association | ** Support | Jul 12, 2017 |
| California Retired Teachers Association | ** Support | Jul 12, 2017 |
| California School Employees Association | ** Support | Jul 12, 2017 |
| California State Long Term Care Ombudsman | * Support | Mar 21, 2017 |
| Consumer Attorneys Of California | ** Support | Jul 12, 2017 |
| Disability Rights California | ** Support | Jul 12, 2017 |
| Health Officers Association Of California | ** Support | Jul 12, 2017 |
| Humboldt County Board of Supervisors | ** Support | Jul 12, 2017 |
| National Association of Social Workers | ** Support | Jul 12, 2017 |
| National Association Of Social Workers, California Chapter | ** Support | Mar 30, 2017 |
| Office of the State Long-Term Care Ombudsman | ** Support | Jul 12, 2017 |
| Retired Public Employees Association | ** Support | Jul 12, 2017 |
| Rural County Representatives of California | ** Support | Jul 12, 2017 |
| St. Joseph Health System Humboldt County | ** Support | Mar 17, 2017 |
| St. Joseph Health System-Humboldt County | ** Support | Jul 12, 2017 |
| St. Joseph Hospital Eureka | * Support | Mar 21, 2017 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 275
Author:(Wood)
As Amended Ver:July 6, 2017
Majority vote
ASSEMBLY: | 76-0 | (May 4, 2017) | SENATE: | 39-0 | (July 17, 2017) |
Original Committee Reference: HEALTH
SUMMARY: Extends the timeline and notice periods that long-term care (LTC) facilities are required to give residents, their families, the Department of Public Health (DPH), the Department of Health Care Services (DHCS) and the Office of the State LTC Ombudsman when they are planning to close. Clarifies and strengthens requirements to medically and socially assess residents in order to prevent and reduce transfer trauma. Requires LTC facilities, as part of their relocation plans, to provide specific information regarding the number of residents who do not have the capacity to make decisions for themselves, the availability of alternative LTC beds in the community, and the reason for the proposed closure, among other things. Specifically, this bill:
- Extends from 30 to 60 days the following timeframes:
- The requirement of a LTC facility to give written notice to affected residents, or their guardians, of the facility's inability to care for its residents;
- The requirement of the LTC facility to give notification to the office of the LTC Ombudsman of a change in the status of a license or operation of the LTC facility and requires this notice to be written instead of oral;
- The requirement, in advance of a transfer, of the LTC facility to inform the resident or resident's representative of alternative facilities, as specified; and,
- The requirement of a LTC facility to provide written notice to affected residents or their representatives regarding existing law's transfer requirements.
- Requires LTC facilities to provide notification of a community meeting for residents, their families, and local health authorities to assist in obtaining alternative placements for LTC facility residents.
- Requires a LTC facility to ensure that the resident's attending physician or the LTC facility medical director, if the resident does not have an attending physician, completes a medical assessment, and that a licensed mental health professional or licensed social worker and the LTC facility's nursing staff complete an assessment of the resident's social and physical functioning before written notice of transfer is given to the resident or their representative.
- Requires the following information to be included in the LTC facility's relocation plan:
- The total number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation of the LTC facility's completion of a medical assessment of each resident;
- The availability of alternative skilled nursing facility (SNF) beds or other available LTC beds within the community;
- The reason for the proposed closure; and,
- The steps the LTC facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Authorizes DPH to reject a relocation plan if, among other things, DPH determines that the plan does not provide adequate protections to minimize transfer trauma for residents, and requires, once a plan has been approved, that it be posted on the DPH Internet Web site within 10 business days.
- Makes various clarifying and technical changes.
The Senate amendments add a requirement that a LTC facility provide written notification to DHCS and any health plan of an affected resident of the change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, at least 60 days prior to the change or closure.
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only SNFs in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
As noted by the author above, on August 24, 2016, Rockport submitted plans to DPH to close three of its five SNFs in Humboldt County. Rockport argued that its financial sustainability was jeopardized by staffing challenges and a Medi-Cal reimbursement formula that assumes lower operational costs in rural areas, which Rockport said was not the experience in Humboldt County. Despite work by community advocates, Partnership Health Plan of California (PHC) a nonprofit community-based public health care organization that contracts with the state to administer Medi-Cal benefits, and elected officials to find a way to keep the facilities open, Rockport would not agree to any of the proposals. Alternatives included a proposed rate increase and an offer by PHC to purchase one of the facilities. DPH approved the closures on September 29, 2016. Rockport subsequently decided to close only one of the three facilities.
Medi-Cal payments to LTC facilities. AB 1629 (Frommer) Chapter 875, Statutes of 2004, requires all facilities in California to be reimbursed based on their actual costs, and rates at one facility are not tied to the rates of similar facilities in other parts of the state. PHC covers 143 of the 192 residents who would have been affected if Rockport closed the three facilities in Humboldt County. According to PHC, it provides an additional 2% payment above the state rate to Rockport; ensures that LTC rates do not go down from one year to the next; and, provides an additional 2% payment to facilities annually based on reaching specific quality improvements tied to patient safety and health.
LTC beds in California. According to DPH, it licenses 1,244 SNFs and 1,183 intermediate care facilities (ICFs). DPH does not have data on the number of residents that currently reside in California SNFs and ICFs, but tracks the number of beds licensed to these facilities. They are as follows:
Facility Type | Main Facility Bed Count | Distinct Part Facility Bed Count | TOTAL Bed Count |
SNF | 110,987 | 8,444 | 119,431 |
ICF | 296 | 5,034 | 5,330 |
ICF/developmentally disabled (DD) | 808 | 2,408 | 3,216 |
ICF/DD-H (Habilitative) | 4,478 | - | 4,478 |
ICF/DD-N (-nursing) | 2,605 | - | 2,605 |
From July 1, 2014, to June 30, 2016, 18 SNFs, with a total of 1,516 beds closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility.
California's aging population. In 1990, California comprised 12% of the nation's population and is expected to have 14% of the nation's population by 2020 (an increase of 15.7 million people). The elderly population is expected to grow more than twice as fast as the total population. According to the 2011 study, "A Long-Term Strategy for Long-Term Care," by the Little Hoover Commission, the number of Californians over age 65 is projected to double by 2030 to 8.84 million people, or 18% of California's population.
Transfer trauma. Relocation can have negative physical and psychological effects on patients in acute care and residents of LTC. According to the United States Administration on Aging, transfer trauma, as a result of a sudden and unexpected relocation, is associated with depression, increased irritability, serious illness, and elevated mortality risk for the frail elderly.
The Humboldt County Board of Supervisors supports this bill stating, that in Humboldt County, one company controls ownership of all SNF beds available to Medi-Cal patients and the recent experience of proposed closures highlighted the vulnerability of the long-term care system in rural counties. The Office of the State Long-Term Care Ombudsman states this bill will better protect residents of nursing homes from unnecessary transfer trauma through a more timely relocation process and thorough assessments of their needs, which will allow ombudsman representatives more time to work with residents and their families in finding appropriate new homes for them.
There is no opposition to this bill.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001208
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 275
Amended: 7/6/17 in Senate
SENATE HEALTH COMMITTEE: 9-0, 6/7/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 5/4/17 (Consent) - See last page for vote
DIGEST:
This bill revises the procedures for when a long-term health care facility (LTC facility) plans to close or there is otherwise a change in the status of their license resulting in a need to transfer residents by, among other things, requiring written notice to residents to be made 60 days in advance, rather than 30; requiring the facility to hold a community meeting for residents; and adding requirements to the proposed relocation plans that facilities are required to have approved by the Department of Public Health (DPH), including identifying the number of affected residents and identifying the availability of alternative beds within the community as part of the proposed relocation plan.
Senate Floor Amendments of 7/6/17 require the written notification provided to both the State Long-Term Care Ombudsman and to the Department of Health Care Services regarding a change in the license status of a facility to include the planned date of closure, and make another technical, clarifying change.
Existing law:
- Licenses and regulates LTC facilities by the DPH. LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living health facilities.
- Requires LTC facilities to give written notice to affected residents or to the guardians of affected residents at least 30 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
- Requires DPH and an LTC facility to agree on an extension, not to exceed an additional 60 days, if problems are encountered in the placement of residents that cannot be satisfactorily resolved with the 30 day period specified in 1) above.
- Requires the LTC facility to provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement.
- Specifies that the provisions in 2) through 4) above do not apply to actions initiated by DPH to suspend or revoke the license of the facility.
- Requires an LTC facility, when 10 or more residents are likely to be transferred due to a change in the status of a license, to submit a proposed relocation plan for the affected residents to DPH for approval at least 15 days prior to the required written transfer notification.
This bill:
- Extends the time period by which LTC facilities are required to notify residents or the guardians of residents of a change in the license status or the ability of the facility to care for the residents from 30 days prior to the change, to 60 days prior to the change in license status. Extends, from 30 to 60 days, the requirements for facilities to inform residents of alternative available facilities, and to provide notice of the requirements involved pertaining to the transfer of residents.
- Requires an LTC facility to hold a community meeting for residents and their families within 30 days after providing the written notice of any change in the status of the license resulting in the inability of the facility to care for its residents. Requires the facility to provide notice of the meeting to residents and their families and to local health authorities. Additionally requires the facility to provide notice of the community meeting to DPH as part of the required proposed relocation plan.
- Requires the LTC facility to given written notification, rather than oral notification, to the office of the State Long-Term Care Ombudsman of the change in the status of the license, including a voluntary closure and the planned date of closure, and requires this notification to be made 60 days prior to the change in status of the license, rather than 30 days prior to the change in status.
- Requires the LTC facility to give written notification to the Department of Health Care Services and any health plan of an affected resident at least 60 days prior to any change in the status of the license or the operation of the facility, including a voluntary closure and the planned date of closure, and requires this notification to include the names of residents that are covered by Medi-Cal or by the specific health plan.
- Requires the assessment of the social and physical function of the resident, which the LTC facility is required to complete prior to the transfer of residents due to any change in the status of a license, to be completed by a licensed mental health professional, as specified, rather than the activity director, in addition to the facility nursing staff.
- Extends the time period by which LTC facilities are required to submit a proposed relocation plan to DPH for affected residents from 15 days prior to the written transfer notification to 30 days prior to the notification plan.
- Requires the proposed relocation plans that LTC facilities are required to submit to DPH for approval to include the following information:
- The number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation that each resident will undergo a medical assessment, as required under existing law, before being relocated;
- The availability of alternative skilled nursing facility beds or other available long-term beds within the community;
- The reason for the proposed closure; and,
- The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Requires that DPH base its approval of a proposed relocation plan, in part, on its determination that the plan provides adequate protections to minimize transfer trauma for residents. Requires DPH to approve or reject the proposed plan within 14 working days of receipt, rather than 10 days under current law.
- Prohibits anything in this bill from being construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
Comments
- Author’s statement. According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only skilled nursing facilities in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
- LTC facilities. LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living facilities. Intermediate care facilities include several different licensing categories, including those specifically serving the developmentally disabled at different levels of health care need. According to DPH, there are currently 1,244 licensed skilled nursing facilities with a total of 119,431 beds, 1,183 licensed intermediate care facilities across the various license types with a total of 15,629 beds, and 164 licensed congregate living facilities with 909 beds. Skilled nursing facilities are defined as health facilities that provide skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis, and intermediate care facilities are defined as health facilities that provide inpatient care to ambulatory or non-ambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require the availability of continuous skilled nursing care.
- LTC closures and transfer trauma. As stated by the author, this bill was introduced to respond to a situation in the author’s district in which the operator of the only five skilled nursing facilities in the Eureka area announced its intention to close three of those facilities. While only one facility ultimately closed, the author states that it highlighted the need for stronger protections for residents and their families who are affected when a facility closes. According to DPH, from July 1, 2014, to June 30, 2016, 18 skilled nursing facilities, with a total of 1,516 beds, closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility. The author states that relocation can have negative physical and psychological effects on patients in acute care and residents of LTC facilities. According to the U.S. Administration on Aging, transfer trauma, also referred to as translocation syndrome, transfer stress, transfer shock, transfer anxiety, is a viable problem. In 1992, a formal nursing diagnosis was approved for “relocation stress syndrome,” defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another.” Transfer trauma is described as a “wave of disorientation and despair so intense that it can kill.” According to the U.S. Department of Aging, the stability of familiar people, surroundings, and routine are important elements for sustaining life for people of advanced age, and that while the first move to a nursing home is almost always traumatic, a subsequent move can be deadly. According to a 2011 study by the Little Hoover Commission, the number of Californians over age 65 is projected to double by 2030 to 8.84 million people.
Related/Prior Legislation
SB 75 (Committee on Budget and Fiscal Review, Chapter 18, Statutes of 2015) was the omnibus health trailer bill, and contained changes to implement the 2015-16 Budget. Among the provisions of this bill were requirements that investigations of LTC facilities be completed within 90 days, as specified, until July 1, 2018, at which point investigations would have to be completed within 60 days.
SB 1312 (Alquist, Chapter 895, Statutes of 2006) required inspections and investigations of LTC facilities certified by the Center for Medicaid and Medicare Services to determine compliance with federal standards and California statutes and regulations.
SB 339 (Ortiz, Chapter 554, Statutes of 2002) added requirements to LTC facilities transferring a patient due to a change in the status of the license or operation of a long-term care facility new requirements, including that the facility be responsible for ensuring that the resident's attending physician, if available, or a facility medical director, if available, completes the medical assessment of the resident's condition.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
AARP California
Association of Regional Center Agencies
California Advocates for Nursing Home Reform
California Commission on Aging
California Long-Term Care Ombudsman Association
California Retired Teachers Association
California School Employees Association
Consumer Attorneys of California
Disability Rights California
Health Officers Association of California
Humboldt County Board of Supervisors
National Association of Social Workers
Office of the State Long-Term Care Ombudsman
Planning and Services Area 2 Agency on Aging Long-Term Care Ombudsman
Retired Public Employees Association
Rural County Representatives of California
St. Joseph Health System-Humboldt County
OPPOSITION: (Verified 6/26/17)
None received
ARGUMENTS IN SUPPORT: This bill is supported by numerous organizations. Disability Rights California states that this bill protects persons with disabilities and the elderly from immediate and traumatic placement decisions for which 30 days can be an inadequate time period for planning. The Rural County Representatives of California states that in rural areas, having additional time to plan for a patient’s move is imperative as there are very few alternative care facilities in rural areas. St. Joseph Health System-Humboldt County states that the protective measures in this bill would have been helpful in August of 2016, when the local nursing home operator in Humboldt County submitted plans to close three of its five facilities in Humboldt County. While only one closed, St. Joseph states that an extension of the timeline for approval of closures, along with the relocation plan, could have minimized or prevented disruption to these vulnerable patients. The California Long-Term Care Ombudsman Association states that it strongly supports this bill’s requirement that every facility provide written notification to the Long-Term Care Ombudsman Program for any change in the status of the license at least 60 days prior to any change, stating that many residents when faced with relocation due to a facility closure are not aware of their options. AARP California states that residents of LTC facilities should be protected from undue hardship, and this bill will ensure that residents get timely notice, comprehensive medical and social assessments, and greater protection against the trauma of transfer. California Advocates for Nursing Home Reform states that due to the extreme vulnerability of most nursing home residents, it is best to maximize the amount of notice they and the authorities receive about any type of closure or situation requiring relocation, and while they support this bill, they would prefer a longer 90-day notification period, along with other additional protections.
ASSEMBLY FLOOR: 76-0, 5/4/17
AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Travis Allen, Bigelow, Cristina Garcia, Patterson
7/12/17 11:59:26
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 275
:
SENATE HEALTH COMMITTEE: 9-0, 6/7/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Nielsen, Roth
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 5/4/17 (Consent) - See last page for vote
DIGEST:
This bill revises the procedures for when a long-term health care facility (LTC facility) plans to close or there is otherwise a change in the status of their license resulting in a need to transfer residents by, among other things, requiring written notice to residents to be made 60 days in advance, rather than 30; requiring the facility to hold a community meeting for residents; and adding requirements to the proposed relocation plans that facilities are required to have approved by the Department of Public Health (DPH), including identifying the number of affected residents and identifying the availability of alternative beds within the community as part of the proposed relocation plan.
Existing law:
- Licenses and regulates LTC facilities by the DPH. LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living health facilities.
- Requires LTC facilities to give written notice to affected residents or to the guardians of affected residents at least 30 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
- Requires DPH and an LTC facility to agree on an extension, not to exceed an additional 60 days, if problems are encountered in the placement of residents that cannot be satisfactorily resolved with the 30 day period specified in 1) above.
- Requires the LTC facility to provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement.
- Specifies that the provisions in 2) through 4) above do not apply to actions initiated by DPH to suspend or revoke the license of the facility.
- Requires an LTC facility, when 10 or more residents are likely to be transferred due to a change in the status of a license, to submit a proposed relocation plan for the affected residents to DPH for approval at least 15 days prior to the required written transfer notification.
This bill:
- Extends the time period by which LTC facilities are required to notify residents or the guardians of residents of a change in the license status or the ability of the facility to care for the residents from 30 days prior to the change, to 60 days prior to the change in license status. Extends, from 30 to 60 days, the requirements for facilities to inform residents of alternative available facilities, and to provide notice of the requirements involved pertaining to the transfer of residents.
- Requires an LTC facility to hold a community meeting for residents and their families within 30 days after providing the written notice of any change in the status of the license resulting in the inability of the facility to care for its residents. Requires the facility to provide notice of the meeting to residents and their families and to local health authorities. Additionally requires the facility to provide notice of the community meeting to DPH as part of the required proposed relocation plan.
- Requires the LTC facility to given written notification, rather than oral notification, to the office of the State Long-Term Care Ombudsman of the change in the status of the license, including a voluntary closure, and requires this notification to be made 60 days prior to the change in status of the license, rather than 30 days prior to the change in status.
- Requires the LTC facility to give written notification to the Department of Health Care Services and any affected health plan at least 60 days prior to any change in the status of the license or the operation of the facility, and requires this notification to include the names of residents that are covered by Medi-Cal or by the specific health plan.
- Requires the assessment of the social and physical function of the resident, which the LTC facility is required to complete prior to the transfer of residents due to any change in the status of a license, to be completed by a licensed mental health professional, as specified, rather than the activity director, in addition to the facility nursing staff.
- Extends the time period by which LTC facilities are required to submit a proposed relocation plan to DPH for affected residents from 15 days prior to the written transfer notification to 30 days prior to the notification plan.
- Requires the proposed relocation plans that LTC facilities are required to submit to DPH for approval to include the following information:
- The number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation that each resident will undergo a medical assessment, as required under existing law, before being relocated;
- The availability of alternative skilled nursing facility beds or other available long-term beds within the community;
- The reason for the proposed closure; and,
- The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Requires that DPH base its approval of a proposed relocation plan, in part, on its determination that the plan provides adequate protections to minimize transfer trauma for residents. Requires DPH to approve or reject the proposed plan within 14 working days of receipt, rather than 10 days under current law.
- Prohibits anything in this bill from being construed to prohibit a facility from withdrawing a closure date or resident notification prior to any resident being relocated.
Comments
- Author’s statement. According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only skilled nursing facilities in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
- LTC facilities. LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living facilities. Intermediate care facilities include several different licensing categories, including those specifically serving the developmentally disabled at different levels of health care need. According to DPH, there are currently 1,244 licensed skilled nursing facilities with a total of 119,431 beds, 1,183 licensed intermediate care facilities across the various license types with a total of 15,629 beds, and 164 licensed congregate living facilities with 909 beds. Skilled nursing facilities are defined as health facilities that provide skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis, and intermediate care facilities are defined as health facilities that provide inpatient care to ambulatory or non-ambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require the availability of continuous skilled nursing care.
- LTC closures and transfer trauma. As stated by the author, this bill was introduced to respond to a situation in the author’s district in which the operator of the only five skilled nursing facilities in the Eureka area announced its intention to close three of those facilities. While only one facility ultimately closed, the author states that it highlighted the need for stronger protections for residents and their families who are affected when a facility closes. According to DPH, from July 1, 2014, to June 30, 2016, 18 skilled nursing facilities, with a total of 1,516 beds, closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility. The author states that relocation can have negative physical and psychological effects on patients in acute care and residents of LTC facilities. According to the U.S. Administration on Aging, transfer trauma, also referred to as translocation syndrome, transfer stress, transfer shock, transfer anxiety, is a viable problem. In 1992, a formal nursing diagnosis was approved for “relocation stress syndrome,” defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another.” Transfer trauma is described as a “wave of disorientation and despair so intense that it can kill.” According to the U.S. Department of Aging, the stability of familiar people, surroundings, and routine are important elements for sustaining life for people of advanced age, and that while the first move to a nursing home is almost always traumatic, a subsequent move can be deadly. According to a 2011 study by the Little Hoover Commission, the number of Californians over age 65 is projected to double by 2030 to 8.84 million people.
Related/Prior Legislation
SB 75 (Committee on Budget and Fiscal Review, Chapter 18, Statutes of 2015) was the omnibus health trailer bill, and contained changes to implement the 2015-16 Budget. Among the provisions of this bill were requirements that investigations of LTC facilities be completed within 90 days, as specified, until July 1, 2018, at which point investigations would have to be completed within 60 days.
SB 1312 (Alquist, Chapter 895, Statutes of 2006) required inspections and investigations of LTC facilities certified by the Center for Medicaid and Medicare Services to determine compliance with federal standards and California statutes and regulations.
SB 339 (Ortiz, Chapter 554, Statutes of 2002) added requirements to LTC facilities transferring a patient due to a change in the status of the license or operation of a long-term care facility new requirements, including that the facility be responsible for ensuring that the resident's attending physician, if available, or a facility medical director, if available, completes the medical assessment of the resident's condition.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
AARP California
Association of Regional Center Agencies
California Advocates for Nursing Home Reform
California Commission on Aging
California Long-Term Care Ombudsman Association
California Retired Teachers Association
California School Employees Association
Consumer Attorneys of California
Disability Rights California
Health Officers Association of California
Humboldt County Board of Supervisors
National Association of Social Workers
Office of the State Long-Term Care Ombudsman
Planning and Services Area 2 Agency on Aging Long-Term Care Ombudsman
Retired Public Employees Association
Rural County Representatives of California
St. Joseph Health System-Humboldt County
OPPOSITION: (Verified 6/26/17)
None received
ARGUMENTS IN SUPPORT: This bill is supported by numerous organizations. Disability Rights California states that this bill protects persons with disabilities and the elderly from immediate and traumatic placement decisions for which 30 days can be an inadequate time period for planning. The Rural County Representatives of California states that in rural areas, having additional time to plan for a patient’s move is imperative as there are very few alternative care facilities in rural areas. St. Joseph Health System-Humboldt County states that the protective measures in this bill would have been helpful in August of 2016, when the local nursing home operator in Humboldt County submitted plans to close three of its five facilities in Humboldt County. While only one closed, St. Joseph states that an extension of the timeline for approval of closures, along with the relocation plan, could have minimized or prevented disruption to these vulnerable patients. The California Long-Term Care Ombudsman Association states that it strongly supports this bill’s requirement that every facility provide written notification to the Long-Term Care Ombudsman Program for any change in the status of the license at least 60 days prior to any change, stating that many residents when faced with relocation due to a facility closure are not aware of their options. AARP California states that residents of LTC facilities should be protected from undue hardship, and this bill will ensure that residents get timely notice, comprehensive medical and social assessments, and greater protection against the trauma of transfer. California Advocates for Nursing Home Reform states that due to the extreme vulnerability of most nursing home residents, it is best to maximize the amount of notice they and the authorities receive about any type of closure or situation requiring relocation, and while they support this bill, they would prefer a longer 90-day notification period, along with other additional protections.
ASSEMBLY FLOOR: 76-0, 5/4/17
AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Travis Allen, Bigelow, Cristina Garcia, Patterson
6/27/17 16:18:14
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 275
AUTHOR: | Wood | ||
VERSION: | March 28, 2017 | ||
HEARING DATE: | June 7, 2017 | ||
CONSULTANT: | Vincent D. Marchand | ||
SUBJECT: Long-term care facilities: requirements for changes resulting in the inability of the facility to care for its residents
SUMMARY:
Revises the procedures for when a long-term health care facility plans to close or there is otherwise a change in the status of their license resulting in a need to transfer residents by, among other things, requiring written notice to residents to be made 60 days in advance, rather than 30; requiring the facility to hold a community meeting for residents; and adding requirements to the proposed relocation plans that facilities are required to have approved by the Department of Public Health, including identifying the number of affected residents and identifying the availability of alternative beds within the community as part of the proposed relocation plan.
Existing law:
- Licenses and regulates long-term health care facilities (LTC facilities) by the Department of Public Health (DPH). LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living health facilities.
- Requires LTC facilities to give written notice to affected residents or to the guardians of affected residents at least 30 days prior to any change in the status of the license or in the operation of the facility resulting in the inability of the facility to care for its residents.
- Requires DPH and a LTC facility to agree on an extension, not to exceed an additional 60 days, if problems are encountered in the placement of residents that cannot be satisfactorily resolved with the 30 day period specified in 1) above.
- Requires the LTC facility to provide an appropriate team of professional staff to assist residents and families in obtaining alternative placement.
- Specifies that the provisions in 2) through 4) above do not apply to actions initiated by DPH to suspend or revoke the license of the facility.
- Requires a LTC facility, when 10 or more residents are likely to be transferred due to a change in the status of a license, to submit a proposed relocation plan for the affected residents to DPH for approval at least 15 days prior to the required written transfer notification.
This bill:
- Extends the time period by which LTC facilities are required to notify residents or the guardians of residents of a change in the license status or the ability of the facility to care for the residents from 30 days prior to the change, to 60 days prior to the change in license status. Extends, from 30 to 60 days, the requirements for facilities to inform residents of alternative available facilities, and to provide notice of the requirements involved pertaining to the transfer of residents.
- Requires a LTC facility to hold a community meeting for residents and their families as part of the process when there is any change in the status of the license resulting in the inability of the facility to care for its residents. Requires the facility to provide notice of the meeting to residents and their families and to local health authorities, including DPH and the local ombudsman program.
- Requires the LTC facility to given written notification, rather than oral notification, to the office of the State Long-Term Care Ombudsman of the change in the status of the license, and requires this notification to be made 60 days prior to the change in status of the license, rather than 30 days prior to the change in status.
- Requires the assessment of the social and physical function of the resident, which the LTC facility is required to complete prior to the transfer of residents due to any change in the status of a license, to be completed by a licensed mental health professional or a licensed social worker rather than the activity director, in addition to the facility nursing staff.
- Extends the time period by which LTC facilities are required to submit a proposed relocation plan to DPH for affected residents from 15 days prior to the written transfer notification to 30 days prior to the notification plan.
- Requires the proposed relocation plans that LTC facilities are required to submit to DPH for approval to include the following information:
- The number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation that each resident will undergo a medical assessment, as required under existing law, before being relocated;
- The availability of alternative skilled nursing facility beds or other available long-term beds within the community;
- The reason for the proposed closure; and,
- The actions the facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Requires that DPH base its approval of a proposed relocation plan, in part, on its determination that the plan provides adequate protections to minimize transfer trauma for residents. Requires DPH to approve or reject the proposed plan within 14 working days of receipt, rather than 10 days under current law, and requires DPH to post the plan on its Internet Web site within 10 business days after approving a relocation plan.
FISCAL EFFECT:
According to the Assembly Appropriations Committee, this bill would have minor and absorbable costs to the DPH to verify the facility's relocation plans comply with the new requirements, and to publicly post a relocation plan.
PRIOR VOTES:
Assembly Floor: | 76 - 0 |
Assembly Appropriations Committee: | 16 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only skilled nursing facilities in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
- LTC facilities. LTC facilities include skilled nursing facilities, intermediate care facilities, and congregate living facilities. Intermediate care facilities includes several different licensing categories, including those specifically serving the developmentally disabled at different levels of health care need. According to DPH, there are currently 1,244 licensed skilled nursing facilities with a total of 119,431 beds, 1,183 licensed intermediate care facilities across the various license types with a total of 15,629 beds, and 164 licensed congregate living facilities with 909 beds. Skilled nursing facilities are defined as health facilities that provide skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis, and intermediate care facilities are defined as health facilities that provide inpatient care to ambulatory or non-ambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require the availability of continuous skilled nursing care.
- Background on LTC closures and transfer trauma. As stated by the author, this bill was introduced to respond to a situation in the author’s district in which the operator of the only five skilled nursing facilities in the Eureka area announced its intention to close three of those facilities. While only one facility ultimately closed, the author states that it highlighted the need for stronger protections for residents and their families who are affected when a facility closes. According to DPH, From July 1, 2014, to June 30, 2016, 18 skilled nursing facilities, with a total of 1,516 beds, closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility. The author states that relocation can have negative physical and psychological effects on patients in acute care and residents of LTC facilities. According to the U.S. Administration on Aging, transfer trauma, also referred to as translocation syndrome, transfer stress, transfer shock, transfer anxiety, is a viable problem. In 1992, a formal nursing diagnosis was approved for “relocation stress syndrome,” defined as “physiologic and/or psychosocial disturbances as a result of transfer from one environment to another.” Transfer trauma is described as a “wave of disorientation and despair so intense that it can kill.” According to the U.S. Department of Aging, the stability of familiar people, surroundings, and routine are important elements for sustaining life for people of advanced age, and that while the first move to a nursing home is almost always traumatic, a subsequent move can be deadly. According to a 2011 study by the Little Hoover Commission, the number of Californians over age 65 is projected to double by 2030 to 8.84 million people.
- SB 481 (Pan) requires that a resident of a LTC facility who has been determined to lack capacity to make health care decisions and there is no person with legal authority to make those decisions on the resident’s behalf, to be notified prior to implementing a medical intervention, of this lack of capacity determination, of the medical intervention that has been prescribed, and of the right of the resident to challenge these determinations in a judicial proceeding. SB 481 is pending in the Assembly.
- Prior legislation. SB 75 (Committee on Budget and Fiscal Review, Chapter 18, Statutes of 2015) was the omnibus health trailer bill, and contained changes to implement the 2015-16 Budget. Among the provisions of this bill were requirements that investigations of LTC facilities be completed within 90 days, as specified, until July 1, 2018, at which point investigations would have to be completed within 60 days.
SB 1312 (Alquist, Chapter 895, Statutes of 2006) required inspections and investigations of LTC facilities certified by the Center for Medicaid and Medicare Services to determine compliance with federal standards and California statutes and regulations.
SB 339 (Ortiz, Chapter 554, Statutes of 2002) added requirements to LTC facilities transferring a patient due to a change in the status of the license or operation of a long-term care facility new requirements, including that the facility be responsible for ensuring that the resident's attending physician, if available, or a facility medical director, if available, completes the medical assessment of the resident's condition.
- Support. This bill is supported by numerous organizations. Disability Rights California states that this bill protects persons with disabilities and the elderly from immediate and traumatic placement decisions for which 30 days can be an inadequate time period for planning. The Rural County Representatives of California states that in rural areas, having additional time to plan for a patient’s move is imperative as there are very few alternative care facilities in rural areas. St. Joseph Health System – Humboldt County states that the protective measures in this bill would have been helpful in August of 2016, when the local nursing home operator in Humboldt County submitted plans to close three of its five facilities in Humboldt County. While only one closed, St. Joseph states that an extension of the timeline for approval of closures, along with the relocation plan, could have minimized or prevented disruption to these vulnerable patients. The California Long-Term Care Ombudsman Association states that it strongly supports this bill’s requirement that every facility provide written notification to the Long-Term Care Ombudsman Program for any change in in the status of the license at least 60 days prior to any change, stating that many residents when faced with relocation due to a facility closure are not aware of their options. AARP California states that residents of LTC facilities should be protected from undue hardship, and this bill will ensure that residents get timely notice, comprehensive medical and social assessments, and greater protection against the trauma of transfer. California Advocates for Nursing Home Reform (CANHR) states that due to the extreme vulnerability of most nursing home residents, it is best to maximize the amount of notice they and the authorities receive about any type of closure or situation requiring relocation, and while they support this bill, they would prefer a longer 90-day notification period, along with other additional protections.
- Suggested amendment. This bill requires facilities, when there is any change in the status of the license resulting in the inability of the facility to care for its residents, to hold a community meeting for residents and their families. However, this bill does not specify the time frame for when the facility is required to hold this community meeting. Given that the bill requires a 60 day notice to residents, the author may wish to consider requiring the community meeting to be held within the first 30 days after giving notice to residents.
SUPPORT AND OPPOSITION:
Support: AARP California
Association of Regional Center Agencies
California Advocates for Nursing Home Reform
California Commission on Aging
California Long-Term Care Ombudsman Association
California Retired Teachers Association
California School Employees Association
Consumer Attorneys of California
Disability Rights California
Health Officers Association of California
Humboldt County Board of Supervisors
National Association of Social Workers
Office of the State Long-Term Care Ombudsman
Planning and Services Area 2 Agency on Aging Long-Term Care Ombudsman
Retired Public Employees Association
Rural County Representatives of California
St. Joseph Health System-Humboldt County
Oppose: None received
-- END --
Date of Hearing: April 26, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 275
Author:(Wood) – As Amended Ver:March 28, 2017
Policy Committee: | Health | Vote: | 15 - 0 |
Aging and Long Term Care | 7 - 0 |
Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill requires long-term care facilities to provide earlier notice of a facility closure to residents and to the state (60 days instead of 30 days prior to closure).
It also enhances the responsibilities of a facility proposing to close. Specifically, it requires a facility to hold a community meeting, provide written instead of oral notification, and provide additional information in its proposed relocation plan.
FISCAL EFFECT:
Minor and absorbable costs to the California Department of Public Health (CDPH) to verify facility's relocation plans comply with the new requirements, and to publicly post a relocation plan.
COMMENTS:
- Purpose. The author believes, in the case of a closure, longer notice periods will help residents and their families find alternative care. This bill is in response to a proposed closure of three facilities in Humboldt County, which supporters of the bill suggest highlighted the vulnerability of patients in the long-term care system. AB 275 clarifies and strengthens requirements that protect patients prior to transfer. It also provides CDPH specific authority to reject a closure plan that does not comply with current-law and proposed protections for residents.
- Background. CDPH licenses and oversees long-term care facilities, most of which are skilled nursing facilities (SNFs). Current law and regulation impose strict requirements on a number of aspects of long-term care facility operations, including the closure of a facility.
On August 24, 2016, Rockport Healthcare Services submitted plans to CDPH to close three of its five SNFs in Humboldt County, which would have displaced more than 100 residents and moved them far from their families. The proposed closure was based on financial concerns. After significant community and stakeholder engagement, only one SNF was closed. This bill attempts to implement "lessons learned" from the proposed closure of these facilities, with the intent to minimize burden on affected residents and their families.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 4, 2017
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Ash Kalra, Chair
ABPCA Bill Id:AB 275 (
Author:Wood) – As Amended Ver:March 28, 2017
SUBJECT: Long-term care facilities: requirements for changes resulting in the inability of the facility to care for its residents.
SUMMARY: Extends the notice periods that long-term care (LTC) facilities are required to give residents, their families, the Department of Public Health (DPH) and the Office of the State LTC Ombudsman when they are planning to close. Clarifies and strengthens requirements to medically and socially assess residents in order to prevent and reduce transfer trauma. Requires LTC facilities, in their relocation plans, to provide specific information regarding the number of residents who do not have the capacity to make decisions for themselves, the availability of alternative LTC beds in the community, and the reason for the proposed closure, among other things. Specifically, this bill:
- Increases to 60 from 30 days:
- The requirement of a LTC facility to give written notice to affected residents, or their guardians, of the facility's inability to care for its residents;
- The requirement of the LTC facility to give notification to the office of the LTC Ombudsman of a change in the status of a license or operation of the LTC facility and requires this notice to be written instead of oral;
- The requirement, in advance of a transfer, of the LTC facility to inform the resident or resident's representative of alternative facilities, as specified; and,
- The requirement of a LTC facility to provide written notice to affected residents or their representatives regarding existing law's transfer requirements.
- Requires LTC facilities to provide notification and hold a community meeting for residents, their families, and local health authorities to assist in obtaining alternative placements for LTC facility residents.
- Requires a LTC facility to ensure that the resident's attending physician or the LTC facility medical director, if the resident does not have an attending physician, completes a medical assessment, and that a licensed mental health professional or licensed social worker and the LTC facility’s nursing staff complete an assessment of the resident’s social and physical functioning before written notice of transfer is given to the resident or their representative.
- Requires the following information to be included in the LTC facility's relocation plan:
- The total number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation that each resident will undergo a medical assessment before being relocated;
- The availability of alternative skilled nursing facility (SNF) beds or other available LTC beds within the community;
- The reason for the proposed closure; and,
- The steps the LTC facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Authorizes DPH to reject a relocation plan if, among other things, DPH determines that the plan does not provide adequate protections to minimize transfer trauma for residents, and requires, once a plan has been approved, that it be posted on the DPH Internet Website within 10 business days.
EXISTING LAW:
- Provides for the licensure and regulation of LTC facilities by the Licensing and Certification Division of DPH.
- Defines a LTC facility as a licensed facility that is any of the following:
- Skilled Nursing Facility (SNF);
- Intermediate care facility (ICF);
- Intermediate care facility/developmentally disabled (ICF/DD);
- Intermediate care facility/developmentally disabled-nursing (ICF/DD-N);
- Congregate living health facility;
- Nursing facility; or,
- Intermediate care facility/developmentally disabled-continuous nursing (ICF/DD-CN).
- Requires LTC facilities to give written notice to a patient or their guardian at least 30 days prior to any change in the status of the LTC facility license or in the operation of the LTC facility resulting in the inability of the facility to care for its patients. Allows DPH and the LTC facility to agree on an extension not to exceed an additional 60 days, if patient placement problems are encountered which cannot be satisfactorily resolved within the notice period.
- Requires LTC facilities that have notified patients of a proposed change in licensure to include notification of the change in the status of the license in response to patient inquiries.
- Requires the LTC facility, before any residents are transferred, to take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
- Ensure that the resident's attending physician, if available, or a LTC facility medical director, if available, completes a medical assessment of the resident’s condition which includes recommendations for counseling, follow-up visits, and for preventing or ameliorating potential adverse health consequences in the event of transfer, among other requirements;
- Ensure that the LTC facility nursing staff and activity director complete an assessment of the social and physical functioning of the resident before written notice of the transfer is given to the resident;
- Evaluate the relocation needs of the resident, including proximity to family, and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given and make the evaluation and assessment part of the medical records for transfer. If the resident or their family chooses to make a transfer prior to the completion of assessments, the LTC facility must inform the resident in writing of the importance of obtaining the assessments and follow up consultation; and,
- Inform the resident, at least 30 days in advance of the transfer, of alternative facilities that are available and adequate to meet resident and family needs, and arrange for appropriate future medical care and services unless the resident has made other arrangements.
- Provides that if 10 or more residents are likely to be transferred due to any change in the status of the license or operation of a LTC facility, the LTC facility must submit a proposed relocation plan for the affected residents to DPH for approval at least 15 days prior to the written transfer notification being given to any resident.
- Requires DPH to conduct inspections of LTC facilities, as necessary, to ensure the health, safety, and security of patients, and requires, if a LTC facility has been determined to be in violation of any state or federal law or regulation, DPH to issue a notice to correct the violation and of intent to issue a citation to the licensee.
- Provides DPH with the authority to issue citations and impose civil penalties for failure to comply with the requirements above.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
Purpose of this Bill: According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only SNFs in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
Background: On August 24, 2016, Rockport submitted plans to DPH to close three of its five SNFs in Humboldt County. Rockport argued that its financial sustainability was jeopardized by staffing challenges and a Medi-Cal reimbursement formula that assumes lower operational costs in rural areas, which Rockport said was not the experience in Humboldt County. Despite work by community advocates, Partnership Health Plan of California (PHC) a nonprofit community-based public health care organization that contracts with the state to administer Medi-Cal benefits, and elected officials to find a way to keep the facilities open, Rockport would not agree to any of the proposals. Alternatives included a proposed rate increase and an offer by PHC to purchase one of the facilities. DPH approved the closures on September 29, 2016. Rockport subsequently decided to close only one of the three facilities.
- Medi-Cal payments to LTC facilities. AB 1629 (Frommer) Chapter 875, Statutes of 2004, requires all facilities in California to be reimbursed based on their actual costs, and rates at one facility are not tied to the rates of similar facilities in other parts of the state. PHC covers 143 of the 192 residents who would have been affected if Rockport closed the three facilities in Humboldt County. According to PHC, it provides an additional 2% payment above the state rate to Rockport; ensures that LTC rates do not go down from one year to the next; and, provides an additional 2% payment to facilities annually based on reaching specific quality improvements tied to patient safety and health.
- LTC Beds in California: According to DPH, it licenses 1,244 SNFs and 1,183 ICFs. DPH does not have data on the number of residents that currently reside in California SNFs and ICFs, but tracks the number of beds licensed to these facilities.
From July 1, 2014, to June 30, 2016, 18 SNFs, with a total of 1,516 beds closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility.
- Transfer trauma. Relocation can have negative physical and psychological effects on patients in acute care and residents of LTC. According to the U.S Administration on Aging, transfer trauma, as a result of a sudden and unexpected relocation, is associated with depression, increased irritability, serious illness, and elevated mortality risk for the frail elderly.
Support: The Humboldt County Board of Supervisors supports this bill stating, that in Humboldt County, one company controls ownership of all SNF beds available to Medi-Cal patients and the recent experience of proposed closures highlighted the vulnerability of the long-term care system in rural counties.
Related Legislation:
AB 940 (Weber) requires a LTC facility to notify the local LTC ombudsman any time a resident is notified in writing of a transfer or discharge from the facility, and provides that a failure to provide that notice would constitute a violation for purposes of a DPH-issued citation. Authorizes DPH to impose additional penalties under those provisions if the failure to send the notice is intentional. AB 940 will be heard in the Assembly Aging and Long-Term Care Committee on April 4, 2017.
AB 1335 (Kalra) makes technical and non-substantive changes to provisions relating to regulations for patient care and a system for the imposition of prompt and effective civil sanctions against LTC facilities in violation of the laws and regulations of this state. AB 1335 is in the Assembly Rules Committee pending referral.
Previous Legislation:
SB 503 (Hernandez) of 2016 would have made changes to the existing process for the prescribing or ordering of a medical intervention for a resident of a SNF or ICF who lacks capacity to make decisions involving his or her health care; modified the existing interdisciplinary team review process required for such medical interventions; and would have established a new process for the administration of antipsychotic medication to residents of SNFs and ICFs. SB 503 was not set for a hearing in Assembly Health Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
AARP
California Long-Term Care Ombudsman Association (CLTCOA)
California Retired Teachers Association (CalRTA)
Humboldt County Board of Supervisors
National Association of Social Workers, California Chapter (NASW-CA)
Office of the State Long-Term Care Ombudsman
PSA 2 Area Agency on Aging Long-Term Care Ombudsman
Rural County Representatives of California
St. Joseph Health System-Humboldt County
Opposition
None on file.
Analysis Prepared by: Barry Brewer / AGING & L.T.C. / (916) 319-3990
Date of Hearing: March 21, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 275
Author:(Wood) – As Amended Ver:March 8, 2017
SUBJECT: Long-term care facilities: requirements for changes resulting in the inability of the facility to care for its patients.
SUMMARY: Extends the timeline and notice periods that long-term care (LTC) facilities are required to give residents, their families, the Department of Public Health (DPH) and the Office of the State LTC Ombudsman when they are planning to close. Clarifies and strengthens requirements to medically and socially assess residents in order to prevent and reduce transfer trauma. Requires LTC facilities, as part of their relocation plans, to provide specific information regarding the number of residents who do not have the capacity to make decisions for themselves, the availability of alternative LTC beds in the community, and the reason for the proposed closure, among other things. Specifically, this bill:
- Extends from 30 to 60 days the following timeframes:
- The requirement of a LTC facility to give written notice to affected residents, or their guardians, of the facility's inability to care for its residents;
- The requirement of the LTC facility to give notification to the office of the LTC Ombudsman of a change in the status of a license or operation of the LTC facility and requires this notice to be written instead of oral;
- The requirement, in advance of a transfer, of the LTC facility to inform the resident or resident's representative of alternative facilities, as specified; and,
- The requirement of a LTC facility to provide written notice to affected residents or their representatives regarding existing law's transfer requirements.
- Requires LTC facilities to provide notification of a community meeting for residents, their families, and local health authorities to assist in obtaining alternative placements for LTC facility residents.
- Requires a LTC facility to ensure that the resident's attending physician or the LTC facility medical director, if the resident does not have an attending physician, completes a medical assessment, and that a licensed mental health professional or licensed social worker and the LTC facility’s nursing staff complete an assessment of the resident’s social and physical functioning before written notice of transfer is given to the resident or their representative.
- Requires the following information to be included in the LTC facility's relocation plan:
- The total number of residents affected by the proposed closure;
- The number of residents who do not have a legal representative and do not have the capacity to make decisions for themselves;
- Attestation of the LTC facility's completion of a medical assessment of each resident;
- The availability of alternative skilled nursing facility (SNF) beds or other available LTC beds within the community;
- The reason for the proposed closure; and,
- The steps the LTC facility is taking to transfer affected residents safely and minimize possible transfer trauma.
- Authorizes DPH to reject a relocation plan if, among other things, DPH determines that the plan does not provide adequate protections to minimize transfer trauma for residents, and requires, once a plan has been approved, that it be posted on the DPH Internet Website within 10 business days.
- Makes various clarifying and technical changes.
EXISTING LAW:
- Provides for the licensure and regulation of LTC facilities by the Licensing and Certification Division of DPH.
- Defines a LTC facility as a licensed facility that is any of the following:
- SNF;
- Intermediate care facility (ICF);
- Intermediate care facility/developmentally disabled (ICF/DD);
- Intermediate care facility/developmentally disabled-nursing (ICF/DD-N);
- Congregate living health facility;
- Nursing facility; or,
- Intermediate care facility/developmentally disabled-continuous nursing (ICF/DD-CN).
- Requires LTC facilities to give written notice to a patient or their guardian at least 30 days prior to any change in the status of the LTC facility license or in the operation of the LTC facility resulting in the inability of the facility to care for its patients. Allows DPH and the LTC facility to agree on an extension not to exceed an additional 60 days, if patient placement problems are encountered which cannot be satisfactorily resolved within the notice period.
- Requires LTC facilities that have notified patients of a proposed change in licensure to include notification of the change in the status of the license in response to patient inquiries.
- Requires the LTC facility, before any residents are transferred, to take reasonable steps to transfer affected residents safely and minimize possible transfer trauma by, at a minimum, doing all of the following:
- Ensure that the resident's attending physician, if available, or a LTC facility medical director, if available, completes a medical assessment of the resident’s condition which includes recommendations for counseling, follow-up visits, and for preventing or ameliorating potential adverse health consequences in the event of transfer, among other requirements;
- Ensure that the LTC facility nursing staff and activity director complete an assessment of the social and physical functioning of the resident before written notice of the transfer is given to the resident;
- Evaluate the relocation needs of the resident, including proximity to family, and determine the most appropriate and available type of future care and services for the resident before written notice of transfer is given and make the evaluation and assessment part of the medical records for transfer. If the resident or their family chooses to make a transfer prior to the completion of assessments, the LTC facility must inform the resident in writing of the importance of obtaining the assessments and follow up consultation; and,
- Inform the resident, at least 30 days in advance of the transfer, of alternative facilities that are available and adequate to meet resident and family needs, and arrange for appropriate future medical care and services unless the resident has made other arrangements.
- Provides that if 10 or more residents are likely to be transferred due to any change in the status of the license or operation of a LTC facility, the LTC facility must submit a proposed relocation plan for the affected residents to DPH for approval at least 15 days prior to the written transfer notification being given to any resident.
- Requires DPH to conduct inspections of LTC facilities, as necessary, to ensure the health, safety, and security of patients, and requires, if a LTC facility has been determined to be in violation of any state or federal law or regulation, DPH to issue a notice to correct the violation and of intent to issue a citation to the licensee.
- Provides DPH with the authority to issue citations and impose civil penalties for failure to comply with the requirements above.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal Committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, last year, Rockport Healthcare Services (Rockport), the owner of the only SNFs in the Eureka area of Assembly District 2, announced that it was closing three of its five facilities, which would have displaced more than 100 residents, moving them far from their families. The author notes that only after an outpouring of support for the residents from the community, many meetings with stakeholders, and a lot of media coverage did Rockport relent and change plans, ultimately closing only one facility. The author states that during those many months, residents and their families were in a state of limbo and it became clear that new, stronger protections need to be put in place to help prevent this from happening to others in the future. The author concludes that this bill provides longer notice periods to help residents and their families find alternative care, clarifies and strengthens the requirements around medical assessments for residents prior to transfer, and provides specific authority to DPH to reject a closure plan that does not provide adequate protections for residents.
- BACKGROUND. As noted by the author above, on August 24, 2016, Rockport submitted plans to DPH to close three of its five SNFs in Humboldt County. Rockport argued that its financial sustainability was jeopardized by staffing challenges and a Medi-Cal reimbursement formula that assumes lower operational costs in rural areas, which Rockport said was not the experience in Humboldt County. Despite work by community advocates, Partnership Health Plan of California (PHC) a nonprofit community-based public health care organization that contracts with the state to administer Medi-Cal benefits, and elected officials to find a way to keep the facilities open, Rockport would not agree to any of the proposals. Alternatives included a proposed rate increase and an offer by PHC to purchase one of the facilities. DPH approved the closures on September 29, 2016. Rockport subsequently decided to close only one of the three facilities.
- Medi-Cal payments to LTC facilities. AB 1629 (Frommer) Chapter 875, Statutes of 2004, requires all facilities in California to be reimbursed based on their actual costs, and rates at one facility are not tied to the rates of similar facilities in other parts of the state. PHC covers 143 of the 192 residents who would have been affected if Rockport closed the three facilities in Humboldt County. According to PHC, it provides an additional 2% payment above the state rate to Rockport; ensures that LTC rates do not go down from one year to the next; and, provides an additional 2% payment to facilities annually based on reaching specific quality improvements tied to patient safety and health.
- LTC beds in California. According to DPH, it licenses 1,244 SNFs and 1,183 ICFs. DPH does not have data on the number of residents that currently reside in California SNFs and ICFs, but tracks the number of beds licensed to these facilities. They are as follows:
Facility Type | Main Facility Bed Count | Distinct Part Facility Bed Count | TOTAL Bed Count |
SNF | 110,987 | 8,444 | 119,431 |
ICF | 296 | 5,034 | 5,330 |
ICF/DD | 808 | 2,408 | 3,216 |
ICF/DD-H (Habilitative) | 4,478 | - | 4,478 |
ICF/DD-N | 2,605 | - | 2,605 |
From July 1, 2014, to June 30, 2016, 18 SNFs, with a total of 1,516 beds closed in California. The facilities that closed were situated throughout the state and closed for a variety of reasons, some being due to consolidation with other facilities, voluntary closure, failing to meet health and safety standards, and converting to another type of facility.
- California's aging population. In 1990, California comprised 12% of the nation's population and is expected to have 14% of the nation's population by 2020 (an increase of 15.7 million people). The elderly population is expected to grow more than twice as fast as the total population. According to the 2011 study, “A Long-Term Strategy for Long-Term Care,” by the Little Hoover Commission, the number of Californians over age 65 is projected to double by 2030 to 8.84 million people, or 18% of California’s population.
- Transfer trauma. Relocation can have negative physical and psychological effects on patients in acute care and residents of LTC. According to the U.S Administration on Aging, transfer trauma, as a result of a sudden and unexpected relocation, is associated with depression, increased irritability, serious illness, and elevated mortality risk for the frail elderly.
- SUPPORT. The Humboldt County Board of Supervisors supports this bill stating, that in Humboldt County, one company controls ownership of all SNF beds available to Medi-Cal patients and the recent experience of proposed closures highlighted the vulnerability of the long-term care system in rural counties.
The Office of the State Long-Term Care Ombudsman states this bill will better protect residents of nursing homes from unnecessary transfer trauma through a more timely relocation process and thorough assessments of their needs, which will allow ombudsman representatives more time to work with residents and their families in finding appropriate new homes for them. - RELATED LEGISLATION.
- AB 940 (Weber) requires a LTC facility to notify the local LTC ombudsman any time a resident is notified in writing of a transfer or discharge from the facility, and provides that a failure to provide that notice would constitute a violation for purposes of a DPH-issued citation. Authorizes DPH to impose additional penalties under those provisions if the failure to send the notice is intentional. AB 940 is pending a hearing in the Aging and Long-Term Care Committee.
- AB 1335 (Kalra) makes technical and non-substantive changes to provisions relating to regulations for patient care and a system for the imposition of prompt and effective civil sanctions against LTC facilities in violation of the laws and regulations of this state. AB 1335 is in the Assembly Rules Committee pending referral.
- PREVIOUS LEGISLATION. SB 503 (Hernandez) of 2016 would have made changes to the existing process for the prescribing or ordering of a medical intervention for a resident of a SNF or ICF who lacks capacity to make decisions involving his or her health care; modified the existing interdisciplinary team review process required for such medical interventions; and would have established a new process for the administration of antipsychotic medication to residents of SNFs and ICFs. SB 503 was not set for a hearing in Assembly Health Committee.
- DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Committee on Aging and Long-term Care.
- TECHNICAL AMENDMENT. In order to clarify that facilities are required to hold a public meeting before closing, this bill should be amended as follows:
The facility shall hold, and provide notification of a community meeting for residents and their families, andtolocal health authorities, including, but not limited to, the State Department of Public Health representative and the local ombudsman program.
REGISTERED SUPPORT / OPPOSITION:
Support
California Advocates for Nursing Home Reform
California Long-Term Care Ombudsman Association
Consumer Attorneys of California
Humboldt County Board of Supervisors
National Association of Social Workers – California Chapter
Office of the State Long-Term Care Ombudsman
Planning and Service Area 2 Area Agency on Aging Long-Term Care Ombudsman
Rural County Representatives of California
St. Joseph Health System – Humboldt County
Opposition
None on file.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
Bill Author
Bill Co-Author(s):