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

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Date Published: 04/09/2018 09:00 PM
SB1152:v98#DOCUMENT

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 1262.4 of Section 127355 of, and to add Section 1262.3 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.

Existing

(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 law prohibits specified health facilities from causing the transfer of homeless patients from one county to another county for the purpose of receiving supportive services from a social service agency, health care service provider, or nonprofit social service agency within the other county, without prior notice and authorization.

Existing law requires each hospital to have a written discharge planning policy and process, including requiring 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 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 coordinating services and referrals for homeless patients patients, including procedures for homeless patient discharge referrals, referrals to shelters, medical care, and mental health care, designated liaisons at each participating entity, and coordination protocols. protocols with participating entities. 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) 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:
(A) To the 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 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.
(4) 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.
(5) The patient has a source of followup care, if medically necessary.
(6) The patient has been provided with a prescription, if needed, and, for hospitals with an onsite pharmacy, 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) The patient has been offered 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.
(12) The 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.
(c) As part of the homeless patient discharge planning policy and process, the 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 health services available.
(2) Procedures for homeless patient discharge referrals to shelter, medical care, and mental 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.

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.

 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.
SECTION 1.Section 1262.4 of the Health and Safety Code is amended to read:
1262.4.

(a)No hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, may cause the transfer of homeless patients from one county to another county for the purpose of receiving supportive services from a social services agency, health care service provider, or nonprofit social services provider within the other county, without prior notification to, and authorization from, the social services agency, health care service provider, or nonprofit social services provider.

(b)(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 prohibit the discharge of a homeless patient to a location other than any of the following:

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

(B)To another licensed health facility, as appropriate.

(C)To a social services agency, or a nonprofit social services provider, that has agreed, in writing, to accept the patient.

(D)An alternative destination as indicated, in writing, by the patient.

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

(c)(1)As part of the homeless patient discharge planning process, the hospital shall ensure that all of the following conditions are met:

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

(B)The patient has received a meal within the two hours prior to discharge, unless medically indicated otherwise.

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

(D)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.

(E)The patient has a source of follow-up care, if medically necessary.

(F)The patient has been provided with an appropriate 30-day supply of all necessary medication.

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

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

(I)The patient has been offered screening for infectious disease common to the region.

(J)The patient has been offered appropriate vaccinations.

(K)The patient does not show signs of disorientation and is able to consent to discharge, or receives a psychiatric evaluation.

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

(2)Except as set forth in subparagraph (K) of paragraph (1), the patient may waive any of the conditions set forth in paragraph (1) upon the patient’s written request for discharge.

(d)As part of the homeless patient discharge planning policy and process, the 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 include procedures for homeless patient discharge referrals, designated liaisons at each participating entity, and coordination protocols.

(e)For purposes of this section, “homeless patient” means an individual who lacks a fixed and regular nighttime residence, or 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 was not designed to provide temporary living accommodations or to be used as a sleeping accommodation for human beings.

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.