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AB-2405 Intensive behavioral health treatment facilities.(2021-2022)

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Date Published: 03/24/2022 09:00 PM
AB2405:v98#DOCUMENT

Amended  IN  Assembly  March 24, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 2405

Introduced by Assembly Member Mayes

February 17, 2022

An act to amend Section 1250 of the Health and Safety Code, relating to health facilities. An act to amend Section 1254.5 of, and to add Section 1250.12 to, the Health and Safety Code, and to add Article 3.5 (commencing with Section 4085.01) to Chapter 3 of Part 1 of Division 4 of the Welfare and Institutions Code, relating to behavioral health facilities.


LEGISLATIVE COUNSEL'S DIGEST


AB 2405, as amended, Mayes. Health facilities. Intensive behavioral health treatment facilities.
Existing law provides generally for the licensure and regulation of health facilities, including, but not limited to, general acute care hospitals, special hospitals, and acute psychiatric hospitals, by the State Department of Public Health. Existing law includes within the definition of a health facility a psychiatric health facility, defined as a health facility, licensed by the State Department of Health Care Services, as specified, to provide 24-hour inpatient care for individuals with mental health disorders.
This bill would additionally include an “intensive behavioral health treatment facility,” which would be licensed by the State Department of Public Health, within the definition of a health facility. The bill would define an intensive behavioral health treatment facility as a freestanding health facility that provides 24-hour inpatient intensive behavioral health treatment services to specified individuals with behavioral health conditions, including, but not limited to, eating disorders, with the intent of assisting clients in transitioning to lower levels of care. The bill would require a client of an intensive behavioral health treatment facility to have a primary care need of treatment for a behavioral health disorder, who is capable of performing age-appropriate activities of daily living without direct assistance, and meets other specified criteria. The bill would specify licensure application requirements similar to those applicable to psychiatric health facilities, and program aspects of intensive behavioral health treatment facilities for review and approval by the department. The bill would require the facility to develop and implement policies and procedures regarding discharge and transfer. The bill would prescribe various rights to which a client of an intensive behavioral health treatment is entitled, including, among others, the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising their rights, and the right to file a complaint with the department for any reason.
This bill would require the department to develop regulations to govern intensive behavioral health treatment facilities that are commensurate to the services provided to patients seeking less than acute care, as specified. The bill would require the department to establish a system for the imposition of civil sanctions against intensive behavioral health treatment facilities in violation of applicable laws and regulations. The bill would authorize the State Public Health Officer to impose those sanctions, including cease and desist orders and specified monetary sanctions, if it determines that there is or has been a failure, in a substantial manner, on the part of an intensive behavioral health treatment facility to comply with those laws and regulations.

Existing law requires the State Department of Public Health to license and regulate each health facility, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, and includes, among others, a general acute care hospital, an acute psychiatric hospital, and a skilled nursing facility.

This bill would make technical, nonsubstantive changes to these provisions.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) There exists a dire need for additional mental health services and treatment facilities in California to service our communities in need of treatment.
(b) California is severely lacking in eating disorder treatment at inpatient and residential levels of care, especially for higher acuity patients requiring medical stabilization.
(c) According to research, 55 percent to 97 percent of individuals with an eating disorder have a co-occurring behavioral health diagnosis, but few treatment options in California.
(d) California payors report that emergency department utilization has increased over the past several years, particularly among high acuity patients, and will continue, likely further widening the gap between patients requiring medical stabilization and the limited number of residential and inpatient treatment options available.
(e) The COVID-19 pandemic has only exacerbated the ongoing mental health crisis in California, and created an urgent need to open new behavioral health treatment facilities that meet various needs.

SEC. 2.

 Section 1250.12 is added to the Health and Safety Code, to read:

1250.12.
 As defined in Section 1250, “health facility” includes an “intensive behavioral health treatment facility,” which is defined to mean a freestanding health facility, licensed by the State Department of Public Health, that provides 24-hour inpatient intensive behavioral health treatment services to individuals with behavioral health conditions, including, but not limited to, eating disorders. The care provided by an intensive behavioral health treatment facility shall include, but not be limited to, psychiatry, clinical psychology, nursing, social work, rehabilitation, drug administration, internal medicine, medical nutritional counseling, and appropriate food services. A reference in any statute to Section 1250 shall be deemed and construed to also be a reference to this section, except to the extent that it would conflict with Article 3.5 (commencing with Section 4085.01) of Chapter 3 of Part 1 of Division 4 of the Welfare and Institutions Code.

SEC. 3.

 Section 1254.5 of the Health and Safety Code is amended to read:

1254.5.
 (a) The Legislature finds and declares that the disease of eating disorders is not simply medical or psychiatric, but involves biological, sociological, psychological, family, medical, and spiritual components. In addition, the Legislature finds and declares that the treatment of eating disorders is multifaceted, and like the treatment of chemical dependency, does not fall neatly into either the traditional medical or psychiatric milieu.
(b) The inpatient treatment of eating disorders shall be provided only in state licensed hospitals, which may be general acute care hospitals as defined in subdivision (a) of Section 1250, acute psychiatric hospitals as defined in subdivision (b) of Section 1250, or any other licensed health facility designated by the State Department of Public Health. Health, or intensive behavioral health treatment facilities licensed pursuant to Article 3.5 (commencing with Section 4085.01) of Chapter 3 of Part 1 of Division 4 of the Welfare and Institutions Code.
(c) “Eating disorders,” for the purposes of this section, shall have the meaning of the term as defined in the Diagnostic and Statistical Manual of Mental Disorders, as published by the American Psychiatric Association.

SEC. 4.

 Article 3.5 (commencing with Section 4085.01) is added to Chapter 3 of Part 1 of Division 4 of the Welfare and Institutions Code, to read:
Article  3.5. Intensive Behavioral Health Treatment Facilities

4085.01.
 (a) An intensive behavioral health treatment facility, as defined in Section 1250.12 of the Health and Safety Code, shall only be licensed by the State Department of Public Health subsequent to application by counties, county contract providers, or other organizations pursuant to this part.
(b) (1) If a county or county contract provider chooses to apply, the local behavioral health director shall present to the local behavioral health advisory board for its review an explanation of the need for the facility and a description of the services to be provided.
(2) An organization that will be applying for licensure and does not intend to use any Bronzan-McCorquodale funds pursuant to Section 5707 shall submit to the local behavioral health director and the governing body in the county in which the facility is to be located a written and dated proposal of the services to be provided. The local behavioral health director and governing body shall have 30 days to provide advice and recommendations regarding licensure, as they deem appropriate. At any time after the 30-day period, an organization may submit its application, along with the behavioral health director’s and governing body’s advice and recommendations, if any, to the State Department of Public Health.
(c) The State Fire Marshal and other appropriate state agencies, to the extent required by law, shall cooperate fully with the State Department of Public Health to ensure that the State Department of Public Health approves or disapproves the licensure applications not later than 90 days after the application submission by a county, county contract provider, or other organization.
(d) An intensive behavioral health treatment facility for which a license has been issued shall be periodically inspected by a multidisciplinary team appointed or designated by the State Department of Public Health. The inspection shall be conducted at least once every two years and as often as necessary to ensure the quality of care provided. During the inspections, the review team shall offer advice and assistance to the intensive behavioral health treatment facility as it deems appropriate.
(e) (1) The program aspects of an intensive behavioral health treatment facility that shall be reviewed and may be approved by the State Department of Public Health shall include, but not be limited to, all of the following:
(A) Activities programs.
(B) Administrative policies and procedures.
(C) Admissions, including provisions for a mental evaluation.
(D) Discharge planning.
(E) Health records content.
(F) Health records services.
(G) Interdisciplinary treatment teams.
(H) Nursing services.
(I) Patient rights.
(J) Pharmaceutical services.
(K) Program space requirements.
(L) Psychiatrist and psychotherapist services.
(M) Rehabilitation services.
(N) Social work services.
(O) Space, supplies, and equipment.
(P) Unusual occurrences.
(Q) Use of outside resources, including agreements with general acute care hospitals.
(R) Linguistic access and cultural competence.
(2) The State Department of Public Health has the sole authority to grant program flexibility.
(f) The State Department of Public Health may charge a licensing fee to an intensive behavioral health treatment facility that shall not exceed the department’s reasonable regulatory costs incident to the licensing of these facilities.
(g) The State Department of Public Health shall establish a system for the imposition of prompt and effective civil sanctions against intensive behavioral health treatment facilities in violation of the laws and regulations of this state pertaining to intensive behavioral health treatment facilities. If the State Department of Public Health determines that there is or has been a failure, in a substantial manner, on the part of an intensive behavioral health treatment facility to comply with the laws and regulations, the State Public Health Officer may impose the following sanctions:
(1) Cease and desist orders.
(2) Monetary sanctions, which may be imposed in addition to the penalties of suspension, revocation, or cease and desist orders. The amount of monetary sanctions permitted to be imposed pursuant to this subparagraph shall not be less than fifty dollars ($50) nor more than one hundred dollars ($100) multiplied by the licensed bed capacity, per day, for each violation. However, the monetary sanction shall not exceed three thousand dollars ($3,000) per day. A facility that is assessed a monetary sanction under this subparagraph, and that repeats the deficiency, may, in accordance with the regulations adopted pursuant to this subdivision, be subject to immediate suspension of its license until the deficiency is corrected.
(h) An intensive behavioral health treatment facility shall have a medical director, who shall be a physician and surgeon licensed in California. The medical director shall have primary responsibility for directing medical treatment and services provided at the facility.

4085.02
 (a) An intensive behavioral health treatment facility shall provide services intended to assist individuals with behavioral health conditions in transitioning to lower levels of care. The facility shall provide services to individuals whose care needs cannot be met in other community-based settings for one or more of the following reasons:
(1) The individual has engaged in self-endangering behaviors that are frequent or difficult to manage.
(2) The individual has engaged in intrusive behaviors that put residents or staff at risk.
(3) The individual has complex medication needs, which may include psychotropic medications.
(4) The individual has a history of frequent or protracted mental hospitalization.
(5) The individual has a history of offenses against the person or felony offenses that cause physical damage to property.
(b) (1) An intensive behavioral health treatment facility shall only admit individuals whose primary care need is treatment for a behavioral health disorder. For purposes of this article, “behavioral health disorder” does not include a diagnosis of dementia or organic brain disorder.
(2) Individuals admitted to an intensive behavioral health treatment facility shall be capable of performing age-appropriate activities of daily living without direct assistance from facility staff.
(c) An intensive behavioral health treatment facility shall do all of the following:
(1) Provide treatment using a multidisciplinary team that shall include, but need not be limited to, clinicians, community supports, and discharge planning personnel.
(2) Provide 24-hour observation of patients by at least two staff members who are awake and on duty.
(3) Provide access or referral to substance use disorder services, and other specialized services, as needed.
(4) Establish and employ individual treatment plans that are the least restrictive alternative to meet the needs of the client.
(5) Provide a system or systems on the premises that give staff awareness of the movements of individuals within the facility. If a door control system is used, it shall not prevent a resident from leaving the premises of their own accord, except temporary delays as permitted pursuant to subparagraph (A). These systems may include, but are not limited to, the following:
(A) Use of delayed egress devices. As used in this section, “delayed egress device” means a device that precludes the use of exits for a predetermined period of time. These devices shall not delay a client’s departure from the facility for longer than 30 seconds.
(B) Appropriate staffing levels to address staff and client safety and security.
(C) Any other policy or procedure deemed appropriate by the facility, consistent with the assessment of client treatment plans.

4085.03.
 (a) An intensive behavioral health treatment facility shall develop and implement policies and procedures regarding discharge and transfer that do all of the following:
(1) Allow each individual to stay in the facility and not discharge the individual to another facility type or other level of care unless another placement has been secured and all of the following apply:
(A) The individual completed their care objectives and no longer needs this level of care.
(B) The individual has medical care needs that the facility cannot provide, or needs direct assistance with activities of daily living.
(C) The individual needs a higher level of behavioral health care, such as evaluation and treatment services, due to a change in behavioral health status.
(D) The individual is convicted of a gross misdemeanor or felony while residing in the facility where the conviction was based on conduct that caused significant harm to another client or staff member and there is a likelihood the person continues to endanger the safety and health of residents or staff.
(2) Allow individuals who are discharged in accordance with subparagraph (A) or (B) of paragraph (1) to be accepted back into the facility if and when it is medically, clinically, legally, and contractually appropriate.
(3) Allow each individual to stay in the facility and not transfer to another providing intensive behavioral health treatment services unless the individual requests to receive services in a different facility certified to provide intensive behavioral health treatment services.
(4) Document the specific time and date of discharge or transfer. Additionally, the facility shall provide the following information to the individual, the individual’s representative, and family or guardian, as appropriate, before discharge or transfer:
(A) The name, address, and telephone number of the applicable ombudsperson, if any.
(B) The mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals pursuant to Division 4.7 (commencing with Section 4900).
(5) Include transportation coordination that informs all parties involved in the coordination of care.
(b) An intensive behavioral health treatment facility shall protect and promote the rights of each individual and assist the individual to exercise their rights as an individual, a citizen or resident of the United States, and the State of California, by doing all of the following:
(1) Train staff on resident rights and how to assist individuals in exercising their rights.
(2) Protect each individual’s right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.
(3) Post names, addresses, and telephone numbers of the state licensure office, the relevant ombudsperson, if any, and the agency responsible for the protection and advocacy of mentally ill individuals pursuant to Division 4.7 (commencing with Section 4900).
(4) Provide reasonable access to an individual by the individual’s representative or an entity or individual that provides health, social, legal, or other services to the individual, subject to the individual’s right to deny or withdraw consent at any time.
(5) Allow a representative of an appropriate ombudsperson, if any, to examine a resident’s clinical records with the permission of the individual or the individual’s legal representative, and consistent with state and federal law.
(6) Not require or request individuals to sign waivers of potential liability for losses of personal property or injury, or to sign waivers of the individual’s rights.
(7) Fully disclose to an individual the facility’s policy on accepting Medicaid as a payment source.
(8) Inform the individual, both orally and in writing, in a language that the individual understands, of their applicable rights in accordance with this article. The notification shall be made upon admission and the facility shall document that the information was provided.
(c) In addition to all other applicable rights, an individual receiving intensive behavioral health treatment services has the right to do all of the following:
(1) Be free of interference, coercion, discrimination, and reprisal from the facility in exercising their rights.
(2) Choose a representative who may exercise the individual’s rights to the extent provided by law.
(3) Manage their own financial affairs, unless the individual is under a court-appointed guardianship.
(4) Personal privacy and confidentiality, including the following considerations:
(A) Personal privacy applies to accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups.
(B) The individual may approve or refuse the release of personal and clinical records to an individual outside the facility unless otherwise provided by law.
(C) Privacy in communications, including the right to do all of the following:
(i) Send and promptly receive mail that is unopened.
(ii) Have access to stationery, postage, and writing implements.
(iii) Have reasonable access to the use of a telephone where calls can be made without being overheard.
(5) Prompt resolution of voiced grievances, including those with respect to treatment that has been furnished as well as that which has not been furnished and the behavior of other residents.
(6) File a complaint with the State Department of Public Health for any reason.
(7) Examine the results of the most recent survey or inspection of the facility conducted by federal or state surveyors or inspectors and plans of correction in effect with respect to the facility.
(8) Receive information from client advocates, and be afforded the opportunity to contact the following advocates and to access these advocates without interference:
(A) Any representative of the state.
(B) The individual’s medical provider.
(C) An applicable ombudsperson, if any.
(D) The agencies responsible for the protection and advocacy system for individuals with disabilities, developmental disabilities, and individuals with mental illness created under federal law.
(E) Subject to reasonable restrictions to protect the rights of others and to the individual’s right to deny or withdraw consent at any time, immediate family or other relatives of the individual and others who are visiting with the consent of the resident.
(9) Retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents.
(10) Secure storage, upon request, for small items of personal property.
(11) Be notified regarding transfer or discharge.
(12) Be free from restraint and involuntary seclusion.
(13) Be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.
(14) Choose activities, schedules, and health care consistent with the individual’s interests, assessments, and plans of care.
(15) Interact with members of the community both within and outside the facility, subject to any applicable public health restrictions.
(16) Make choices about aspects of their life in the facility that are significant to the individual.
(17) Unless adjudged incompetent or otherwise found to be legally incapacitated, participate in planning care and treatment or changes in care and treatment.
(18) Unless adjudged incompetent or otherwise found to be legally incapacitated, to direct their own service plan and changes in the service plan, and to refuse any particular service so long as the refusal is documented in the record of the individual.
(19) Participate in social, religious, and community activities that do not interfere with the rights of other individuals in the facility.
(20) Reside and receive services in the facility with reasonable accommodation of individual needs and preferences, except when the health or safety of the individual or other individuals would be endangered.
(21) Organize and participate in participant groups.
(d) The individual and their designated representative have a right to all of the following:
(1) Access to all records pertaining to the individual, including clinical records.
(2) Notification of any of the following occurrences:
(A) An accident involving the individual that requires, or has the potential for requiring, medical intervention.
(B) A significant change in the individual’s physical, mental, or psychosocial status.
(C) A change in room or roommate assignment.

4085.04.
 The State Department of Public Health shall develop regulations to govern intensive behavioral health treatment facilities that are commensurate to the services provided to patients seeking less than acute care. In order to incentivize the development of these new facility types, the department shall set standards consistent with the following requirements:
(a) Architectural requirements established by the department shall encourage a flexible and open construction approach that significantly reduces capital construction costs.
(b) Programs designed to provide comprehensive inpatient treatment shall be permitted substantial flexibility in the use of qualified personnel to meet the specific needs of the patients of the facility.

SECTION 1.Section 1250 of the Health and Safety Code is amended to read:
1250.

As used in this chapter, “health facility” means a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which the persons are admitted for a 24-hour stay or longer, and includes the following types:

(a)“General acute care hospital” means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. A general acute care hospital may include more than one physical plant maintained and operated on separate premises as provided in Section 1250.8. A general acute care hospital that exclusively provides acute medical rehabilitation center services, including at least physical therapy, occupational therapy, and speech therapy, may provide for the required surgical and anesthesia services through a contract with another acute care hospital. In addition, a general acute care hospital that, on July 1, 1983, provided required surgical and anesthesia services through a contract or agreement with another acute care hospital may continue to provide these surgical and anesthesia services through a contract or agreement with an acute care hospital. The general acute care hospital operated by the State Department of Developmental Services at Agnews Developmental Center may, until June 30, 2007, provide surgery and anesthesia services through a contract or agreement with another acute care hospital. Notwithstanding the requirements of this subdivision, a general acute care hospital operated by the Department of Corrections and Rehabilitation or the Department of Veterans Affairs may provide surgery and anesthesia services during normal weekday working hours, and not provide these services during other hours of the weekday or on weekends or holidays, if the general acute care hospital otherwise meets the requirements of this section.

A “general acute care hospital” includes a “rural general acute care hospital.” However, a “rural general acute care hospital” shall not be required by the department to provide surgery and anesthesia services. A “rural general acute care hospital” shall meet either of the following conditions:

(1)The hospital meets criteria for designation within peer group six or eight, as defined in the report entitled Hospital Peer Grouping for Efficiency Comparison, dated December 20, 1982.

(2)The hospital meets the criteria for designation within peer group five or seven, as defined in the report entitled Hospital Peer Grouping for Efficiency Comparison, dated December 20, 1982, and has no more than 76 acute care beds and is located in a census dwelling place of 15,000 or less population according to the 1980 federal census.

(b)“Acute psychiatric hospital” means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for persons with mental health disorders or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.

(c)(1)“Skilled nursing facility” means a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis.

(2)“Skilled nursing facility” includes a “small house skilled nursing facility (SHSNF),” as defined in Section 1323.5.

(d)“Intermediate care facility” means a health facility that provides inpatient care to ambulatory or nonambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability of continuous skilled nursing care.

(e)“Intermediate care facility/developmentally disabled habilitative” means a facility with a capacity of 4 to 15 beds that provides 24-hour personal care, habilitation, developmental, and supportive health services to 15 or fewer persons with developmental disabilities who have intermittent recurring needs for nursing services, but have been certified by a physician and surgeon as not requiring availability of continuous skilled nursing care.

(f)“Special hospital” means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient care in dentistry or maternity.

(g)“Intermediate care facility/developmentally disabled” means a facility that provides 24-hour personal care, habilitation, developmental, and supportive health services to persons with developmental disabilities whose primary need is for developmental services and who have a recurring but intermittent need for skilled nursing services.

(h)“Intermediate care facility/developmentally disabled-nursing” means a facility with a capacity of 4 to 15 beds that provides 24-hour personal care, developmental services, and nursing supervision for persons with developmental disabilities who have intermittent recurring needs for skilled nursing care but have been certified by a physician and surgeon as not requiring continuous skilled nursing care. The facility shall serve medically fragile persons with developmental disabilities or who demonstrate significant developmental delay that may lead to a developmental disability if not treated.

(i)(1)“Congregate living health facility” means a residential home with a capacity, except as provided in paragraph (4), of no more than 18 beds, that provides inpatient care, including the following basic services: medical supervision, 24-hour skilled nursing and supportive care, pharmacy, dietary, social, recreational, and at least one type of service specified in paragraph (2). The primary need of congregate living health facility residents shall be for availability of skilled nursing care on a recurring, intermittent, extended, or continuous basis. This care is generally less intense than that provided in general acute care hospitals but more intense than that provided in skilled nursing facilities.

(2)Congregate living health facilities shall provide one or more of the following services:

(A)Services for persons who are mentally alert, persons with physical disabilities, who may be ventilator dependent.

(B)Services for persons who have a diagnosis of terminal illness, a diagnosis of a life-threatening illness, or both. Terminal illness means the individual has a life expectancy of six months or less as stated in writing by their attending physician and surgeon. A “life-threatening illness” means the individual has an illness that can lead to a possibility of a termination of life within five years or less as stated in writing by their attending physician and surgeon.

(C)Services for persons who are catastrophically and severely disabled. A person who is catastrophically and severely disabled means a person whose origin of disability was acquired through trauma or nondegenerative neurologic illness, for whom it has been determined that active rehabilitation would be beneficial and to whom these services are being provided. Services offered by a congregate living health facility to a person who is catastrophically disabled shall include, but not be limited to, speech, physical, and occupational therapy.

(3)A congregate living health facility license shall specify which of the types of persons described in paragraph (2) to whom a facility is licensed to provide services.

(4)(A)A facility operated by a city and county for the purposes of delivering services under this section may have a capacity of 59 beds.

(B)A congregate living health facility not operated by a city and county servicing persons who are terminally ill, persons who have been diagnosed with a life-threatening illness, or both, that is located in a county with a population of 500,000 or more persons, or located in a county of the 16th class pursuant to Section 28020 of the Government Code, may have not more than 25 beds for the purpose of serving persons who are terminally ill.

(5)A congregate living health facility shall have a noninstitutional, homelike environment.

(j)(1)“Correctional treatment center” means a health facility operated by the Department of Corrections and Rehabilitation, the Department of Corrections and Rehabilitation, Division of Juvenile Facilities, or a county, city, or city and county law enforcement agency that, as determined by the department, provides inpatient health services to that portion of the inmate population who do not require a general acute care level of basic services. This definition shall not apply to those areas of a law enforcement facility that houses inmates or wards who may be receiving outpatient services and are housed separately for reasons of improved access to health care, security, and protection. The health services provided by a correctional treatment center shall include, but are not limited to, all of the following basic services: physician and surgeon, psychiatrist, psychologist, nursing, pharmacy, and dietary. A correctional treatment center may provide the following services: laboratory, radiology, perinatal, and any other services approved by the department.

(2)Outpatient surgical care with anesthesia may be provided, if the correctional treatment center meets the same requirements as a surgical clinic licensed pursuant to Section 1204, with the exception of the requirement that patients remain less than 24 hours.

(3)Correctional treatment centers shall maintain written service agreements with general acute care hospitals to provide for those inmate physical health needs that cannot be met by the correctional treatment center.

(4)Physician and surgeon services shall be readily available in a correctional treatment center on a 24-hour basis.

(5)It is not the intent of the Legislature to have a correctional treatment center supplant the general acute care hospitals at the California Medical Facility, the California Men’s Colony, and the California Institution for Men. This subdivision shall not be construed to prohibit the Department of Corrections and Rehabilitation from obtaining a correctional treatment center license at these sites.

(k)“Nursing facility” means a health facility licensed pursuant to this chapter that is certified to participate as a provider of care either as a skilled nursing facility in the federal Medicare Program under Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal Medicaid Program under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.), or as both.

(l)Regulations defining a correctional treatment center described in subdivision (j) that is operated by a county, city, or city and county, the Department of Corrections and Rehabilitation, or the Department of Corrections and Rehabilitation, Division of Juvenile Facilities, shall not become effective prior to, or, if effective, shall be inoperative until January 1, 1996, and until that time these correctional facilities are exempt from any licensing requirements.

(m)“Intermediate care facility/developmentally disabled-continuous nursing (ICF/DD-CN)” means a homelike facility with a capacity of four to eight, inclusive, beds that provides 24-hour personal care, developmental services, and nursing supervision for persons with developmental disabilities who have continuous needs for skilled nursing care and have been certified by a physician and surgeon as warranting continuous skilled nursing care. The facility shall serve medically fragile persons who have developmental disabilities or demonstrate significant developmental delay that may lead to a developmental disability if not treated. ICF/DD-CN facilities shall be subject to licensure under this chapter upon adoption of licensing regulations in accordance with Section 1275.3. A facility providing continuous skilled nursing services to persons with developmental disabilities pursuant to Section 14132.20 or 14495.10 of the Welfare and Institutions Code shall apply for licensure under this subdivision within 90 days after the regulations become effective, and may continue to operate pursuant to those sections until its licensure application is either approved or denied.

(n)“Hospice facility” means a health facility licensed pursuant to this chapter with a capacity of no more than 24 beds that provides hospice services. Hospice services include, but are not limited to, routine care, continuous care, inpatient respite care, and inpatient hospice care as defined in subdivision (d) of Section 1339.40, and is operated by a provider of hospice services that is licensed pursuant to Section 1751 and certified as a hospice pursuant to Part 418 of Title 42 of the Code of Federal Regulations.