Bill Text

Bill Information

PDF |Add To My Favorites |Track Bill | print page

SB-1152 Hospital patient discharge process: homeless patients. (2017-2018)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 05/24/2018 09:00 PM
SB1152:v97#DOCUMENT

Amended  IN  Senate  May 24, 2018
Amended  IN  Senate  April 09, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 1152


Introduced by Senator Hernandez

February 14, 2018


An act to amend Section 127355 of, and to add Section 1262.3 to, to the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 1152, as amended, Hernandez. Hospital patient discharge process: homeless patients.

(1)Existing law establishes the State Department of Public Health and sets forth its powers and duties, including the licensure and regulation of health facilities. A violation of those provisions is a crime.

Existing

(1) Existing law requires the State Department of Public Health to license and regulate general acute care hospitals, acute psychiatric hospitals, and special hospitals. Existing law requires these hospitals to comply with specific statutory provisions for standards of care and regulations promulgated by the department, and a violation of these provisions or regulations is a crime. Existing law requires each hospital to have a written discharge planning policy and process, including requiring process that requires that the appropriate arrangements for posthospital care are made prior to discharge for those patients likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.
This bill would require those health facilities each hospital to include within the hospital discharge policy, a written homeless patient discharge planning policy and process, as specified. The bill would require the health facilities to develop and annually update a written plan for process that includes, among other requirements, coordinating services and referrals for homeless patients, including and procedures for homeless patient discharge referrals to shelters, medical care, and mental behavioral health care, designated liaisons at each participating entity, and coordination protocols with participating entities. care. The bill would also require each hospital to report specific information about all patient housing and discharges to the Office of Statewide Health Planning and Development. The bill would specify how its provisions are to be construed in relation to local ordinances, codes, regulations, or orders related to the homeless patient discharge processes. Because violation of these requirements would be a crime, this bill would impose a state-mandated local program.

(2)Existing law requires each hospital to annually adopt and update a community benefits plan for providing community benefits either alone, in conjunction with other health care providers, or through other organizational arrangements. Each hospital is also required to annually submit its community benefits plan, including a description of the activities that the hospital has undertaken in order to address community needs within its mission and financial capacity, to the Office of Statewide Health Planning and Development.

This bill would require a hospital to include in its community benefits plan identification of the needs of the homeless population in its service area and allocation of an appropriate amount of the hospital’s community benefit resources to meet the needs of that population, including ensuring adequate capacity of homeless patient discharge destinations, including nonprofit shelters and social service providers.

(3)

(2) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 Section 1262.3 is added to the Health and Safety Code, to read:

1262.3.
 (a) (1)   Each hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, shall include within its hospital discharge policy established pursuant to Section 1262.5 a written homeless patient discharge planning policy and process.
(2) The policy shall require a hospital to inquire about a patient’s housing status during the discharge planning process. Housing status may not be used to discriminate against a patient or prevent medically necessary care or hospital admission.

(3)The policy shall require a homeless patient to be discharged to a safe and appropriate location as follows:

(3) The policy shall require an individual discharge plan for a homeless patient that helps prepare the homeless patient for return to the community by connecting him or her with available community resources, treatment, shelter, and other supportive services. The discharge planning shall be primarily guided by the best interests of the homeless patient and his or her physical and mental condition, taking into consideration the homeless patient’s preferences for placement. The homeless patient shall be informed of available placement options.
(4) Unless the homeless patient is being transferred to another licensed health facility, the policy shall require the hospital to offer to discharge the homeless patient to a location as follows, with priority given to placing the homeless patient at a sheltered location with supportive services:
(A) To a social services agency, nonprofit social services provider, or governmental service provider that has agreed to accept the homeless patient, if he or she has agreed to the placement. The hospital shall provide potential receiving agencies or providers written or electronic information about the homeless patient’s health and mental health care needs and shall document the name of the person at the agency or provider who agreed to accept the homeless patient.

(A)

(B) To the homeless patient’s residence. In the case of a homeless patient, “residence” for the purposes of this subparagraph means the location identified to the hospital by the homeless patient as his or her principal dwelling place.

(B)To another licensed health facility, as appropriate and in a manner consistent with applicable law.

(C)To a social services agency or a nonprofit social services provider that has been provided with information regarding the patient’s health care needs and has agreed, in writing, to accept the patient.

(D)An alternative destination, as indicated by the patient with written consent.

(C) To an alternative destination, as indicated by the homeless patient or the homeless patient’s representative. The hospital shall document the destination indicated by the homeless patient or his or her representative.

(4)

(5) The policy shall require that information regarding discharge or transfer be provided to the homeless patient in a culturally competent manner and in a language that is understood by the homeless patient.

(b)As part of the homeless patient discharge planning process, the hospital shall document that all of the following conditions are met:

(1)The patient is properly hydrated at the time of discharge.

(2)The patient has been provided with a meal within the two hours prior to discharge, unless medically indicated otherwise.

(3)The patient is clothed in weather-appropriate attire.

(4)The patient is permitted to remain in the facility for the time necessary to ensure that he or she is released during daytime hours or during hours where the receiving social services or other agency is open and available to receive the patient.

(b) The hospital shall document all of the following prior to discharging a homeless patient:
(1) The treating physician has determined the homeless patient’s clinical stability for discharge, and communicated postdischarge medical needs to the homeless patient.
(2) The homeless patient has been offered a meal prior to discharge, unless medically indicated otherwise.
(3) If the homeless patient’s clothing is inadequate, the hospital shall offer the homeless patient weather-appropriate clothing.

(5)

(4) The homeless patient has been referred to a source of followup care, if medically necessary.

(6)

(5) The homeless patient has been provided with a prescription, if needed, and, for hospitals a hospital with an onsite pharmacy, pharmacy licensed and staffed to dispense outpatient medication, an appropriate supply of all necessary medication.

(7)The patient has been provided with all necessary durable medical equipment.

(8)The patient is not discharged into inclement weather without shelter.

(9)

(6) The homeless patient has been offered or referred to screening for infectious disease common to the region, as determined by the local health department.

(10)The patient has been offered appropriate vaccinations.

(11)The patient does not show signs of disorientation and is able to provide written consent to discharge, or receives psychiatric evaluation and treatment consistent with state law.

(7) The homeless patient has been offered vaccinations appropriate to the homeless patient’s presenting medical condition.
(8) The homeless patient is alert and oriented to person, place, and time, or the treating physician has provided, or attempted to provide, a mental health status exam. If the treating physician determines that the results of the mental health status exam indicate that followup mental health care is needed, the homeless patient shall be treated or referred to an appropriate provider, including, but not limited to, the county behavioral health department or the homeless patient’s health plan, if the homeless patient is enrolled in a health plan. The hospital shall coordinate a referral by contacting the provider or health plan that the homeless patient is being referred to and providing the name and contact information of the homeless patient, if available.

(12)

(9) The homeless patient has been screened for, and provided assistance to enroll in, any affordable health insurance coverage for which he or she is eligible.

(13)The hospital has provided the patient with transportation to the discharge destination established pursuant to this section. If the hospital has determined that the patient has coverage subject to the Knox-Keene Health Care Service Plan Act (Chapter 2.2 (commencing with Section 1340), the hospital shall comply with Section 1371.4.

(10) The hospital has provided the homeless patient with transportation to the discharge destination identified in paragraph (4) of subdivision (a).
(c) As part of the homeless patient discharge planning policy and process, the A hospital shall develop a written plan for coordinating services and referrals for homeless patients with the county behavioral health agency, health care and social services agencies in the region, health care providers, and nonprofit social services providers to assist with ensuring appropriate homeless patient discharge. The plan shall be updated annually and shall include all of the following:
(1) A list of local homeless shelters, including their hours of operation, admission procedures and requirements, client population served, and scope of medical and mental behavioral health services available.
(2) Procedures for homeless patient discharge referrals to shelter, medical care, and mental behavioral health care.
(3) Designated liaisons at each participating entity.
(4) Coordination protocols with participating entities.
(5) Training protocols for discharge planning staff.
(d) Each hospital shall maintain a log of homeless patients discharged, the locations to which they were discharged, and evidence of completion of the homeless patient discharge protocol. The log shall be updated whenever a homeless patient is discharged.

(e)For purposes of this section, the following definitions apply:

(1)“Homeless patient” means an individual who lacks a fixed and regular nighttime residence, who has a primary nighttime residence that is a supervised publicly or privately operated shelter designed to provide temporary living accommodations, or who is residing in a public or private place that is designed to provide temporary living accommodations or to be used as a sleeping accommodation for human beings.

(2)“Written consent” means that the patient has knowingly, intelligently, and voluntarily given his or her consent in writing, including the signature of the patient or his or her legal representative.

(e) Each hospital shall include in the patient data submitted to the Office of Statewide Health Planning and Development the housing status of each patient, classified as permanently housed, temporarily housed, or unhoused, and his or her disposition, including, but not limited to, whether he or she was discharged to a social services agency, nonprofit social services provider, or governmental social services provider.
(f) For purposes of this section, “homeless patient” means a patient who lacks a fixed and regular nighttime residence, who has a primary nighttime residence that is a supervised publicly or privately operated shelter designed to provide temporary living accommodations, or who is residing in a public or private place that is designed either to provide temporary living accommodations or to be used as a sleeping accommodation for human beings.
(g) It is the intent of the Legislature that nothing in this section shall be construed to preempt, limit, prohibit, or otherwise affect, the adoption, implementation, or enforcement of local ordinances, codes, regulations, or orders related to the homeless patient discharge processes, except to the extent that any such provision of law is inconsistent with the provisions of this section, and then only to the extent of the inconsistency. A local ordinance, code, regulation, or order is not deemed inconsistent with this section if it affords greater protection to homeless patients than the requirements set forth in this section. Where local ordinances, codes, regulations, or orders duplicate or supplement this section, this section shall be construed as providing alternative remedies and shall not be construed to preempt the field.

SEC. 2.Section 127355 of the Health and Safety Code is amended to read:
127355.

The hospital shall include all of the following elements in its community benefits plan:

(a) Mechanisms to evaluate the plan’s effectiveness including, but not limited to, a method for soliciting the views of the community served by the hospital and identification of community groups and local government officials consulted during the development of the plan.

(b) Measurable objectives to be achieved within specified timeframes.

(c) Community benefits categorized into the following framework:

(1) Medical care services.

(2) Other benefits for vulnerable populations.

(3) Other benefits for the broader community.

(4) Health research, education, and training programs.

(5) Nonquantifiable benefits.

(d)Identification of the needs of the homeless population in its service area and allocation of an appropriate amount of the hospital’s community benefits resources to meet the needs of that population. This should include ensuring adequate capacity of homeless patient discharge destinations, including nonprofit shelters and social service providers.

SEC. 3.SEC. 2.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.