Today's Law As Amended


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AB-2744 Residential care facilities for the elderly: referral agencies.(2017-2018)



As Amends the Law Today


SECTION 1.

 Article 10 (commencing with Section 1569.900) is added to Chapter 3.2 of Division 2 of the Health and Safety Code, to read:

Article  10. Referral Agencies
1569.900.
 For purposes of this article, the following definitions shall apply:
(a) “Client” means an individual who seeks a referral for himself or herself as the potential resident or for another individual.
(b) “Department” means the State Department of Social Services.
(c) “Facility” means a residential care facility for the elderly, as defined in Section 1569.2.
(d) “Placement information” means information a referral agency collects from a client about the potential resident, including, but not limited to, name, email address, telephone number, ZIP Code, medical history, information about necessary assistance for activities of daily living, or the reasons for seeking long-term care.
(e) “Potential resident” means the individual to be placed with a facility through a referral.
(f) “Referral” means a referral to a facility in connection with which the referral agency receives compensation from the facility, client, or both.
(g) (1) “Referral agency” means a person or entity that provides referrals for a fee, collected from the facility, client, or both.
(2) “Referral agency” does not include any of the following:
(A) A facility or its employees.
(B) A resident, resident’s family member, or patron of a facility who refers a client to a facility and receives a discount or other remuneration from the facility.
1569.901.
 (a) A referral agency shall not provide a referral to a facility unless registered with the department pursuant to this section.
(b) The department shall maintain a registry of referral agencies and issue a registration number to a referral agency that does both of the following:
(1) Provides the department with the following information, in a manner the department specifies:
(A) The name and telephone number of the referral agency.
(B) The address of the referral agency’s primary place of business, including a physical and mailing address.
(C) A primary contact for the referral agency who is responsible for the registration.
(D) Proof that the referral agency meets the requirements of this article.
(2) Pays a registration fee, to be determined by the department in an amount not more than is required to cover the reasonable costs of registration.
(c) Registration shall be renewed every two years. The department shall set the renewal fee at an amount not more than is required to cover the reasonable costs of registration.
(d) A registered referral agency shall inform the department within 30 days of a change in any of the information listed in paragraph (1) of subdivision (b).
(e) There is hereby established in the State Treasury the Residential Care Facility Referral Agency Fund. All fees required pursuant to this section shall be deposited in the fund, to be used, upon appropriation of the Legislature, by the department for the purposes of this article.
1569.902.
 (a) Before providing a referral, a referral agency shall provide the client with a disclosure that includes all of the following in clear language:
(1) A statement that the referral agency is not a facility.
(2) A description of the facility or facilities to which the referral agency is referring the client.
(3) A statement explaining whether a referral fee will be paid and whether the fee will be paid by the facility, client, or both.
(4) The referral agency’s contact information, including address and telephone number.
(5) The referral agency’s privacy policy.
(6) A statement as to whether the referral agency has visited the facility or communicated with another referral agency or health care professional who has visited the facility.
(7) A list of the names, addresses, and telephone numbers of all the facilities to which the referral agency has supplied, or to which it may potentially supply, the name of the client or the potential resident.
(8) The contact information for filing consumer complaints, including the contact information for the State Long-Term Care Ombudsman.
(9) A list of all state agencies that maintain a list of complaints concerning facilities and how to obtain those lists.
(10) A description of the training the referral agency has provided or required of employees pursuant to subdivision (b) of Section 1569.907.
(b) The disclosure may be made orally if the referral agency makes an audio recording of the disclosure, with the consent of the client, and thereafter provides the client with a written disclosure.
(c) A client may, at any time, request in writing that a referral cease contact with him or her.
1569.903.
 If the referral agency has an Internet Web site, it shall prominently display on the first page, visible prior to any pages or content, asking the client to sign up for services or agree to terms, all of the following:
(a) The referral agency’s name and registration number.
(b) The statement: “If you are referred to a residential care facility for the elderly, the facility you use may be required to pay the referral agency a fee.”
(c) All conditions the client will be required to agree to relating to all of the following:
(1) The referral agency sharing placement information or other personal information with facilities or third parties.
(2) Whether facilities, agents of the referral agency, or others may make calls to the client or potential resident.
(3) The right to opt out of any agreement with the referral agency.
(4) Authorization to check the client’s credit history.
(5) Whether the referral agency recommends any facility and, if so, whether the recommendation is based on placement information or financial resources.
(d) A link to all state agency Internet Web sites listing complaints about facilities.
1569.904.
 A referral agency shall display its name and registration number on all advertising, promotions, or marketing material and on all documents used by the referral agency to conduct business.
1569.905.
 A referral agency shall not do any of the following:
(a) Sell placement information to a facility or marketing affiliate without obtaining affirmative consent from the client prior to any instance of the information being sold.
(b) Refer a client to a facility in which the referral agency or an immediate family member of the referral agency has an ownership interest.
(c) Contact a client who has requested, in writing, that the referral agency stop contacting him or her, pursuant to subdivision (c) of Section 1569.902.
(d) Hold any power of attorney for a client or potential resident or hold that person’s property in any capacity.
1569.906.
 An employee of a referral agency who will be in direct contact with the potential resident shall be required to obtain either a criminal record clearance or a criminal record exemption from the department before his or her initial contact with a potential resident, as provided in Section 1569.17.
1569.907.
 (a) A referral agency shall conduct a suitability determination for each potential resident.
(b) A referral agency shall provide a disclosure to a client indicating the number of hours of annual training required of all employees who make referrals to facilities. This disclosure shall indicate if any of the following topics are covered by the training:
(1) An overview of relevant California regulations, including Title 22 of the California Code of Regulations, form LIC 602A (Physician’s Report for Residential Care Facilities for Elderly), and form LIC 603 (Pre-Placement Appraisal Information).
(2) Resident admission, retention, and assessment procedures.
(3) Navigating the department’s Internet Web site relating to licensed facilities.
(4) Recognizing and reporting suspected elder abuse.
(5) Psychosocial needs and common health conditions of the elderly.
(6) Managing Alzheimer’s disease and related dementias, including nonpharmacological, person-centered approaches to dementia care.
(7) Health conditions that are restricted or prohibited in facilities.
(8) Hospice care.
(9) Residents’ rights as described in Section 1569.269.
(c) For purposes of this section, “suitability determination” means a reasonable determination made by the referral agency that the facility offers services appropriate to meet the stated needs of the potential resident based on the following considerations:
(1) The level of care requested by the client.
(2) The cost of the facility and financial means of the client or the potential resident, as appropriate.
(3) The social needs and preferences of the potential resident.
(4) The geographic location of the potential resident and client, if applicable.
1569.908.
 (a) The agreement between a referral agency and a client shall allow the client to cancel the agreement at any time, so long as the client does not take possession, and assume financial responsibility for, a unit in a facility to which the client was referred. If a client does not take possession, and assume financial responsibility for, a unit in a facility to which he or she was referred by the referral agency, the client shall not be required to pay a referral fee.
(b) If a client is referred to a facility and the referral agency has received compensation from the facility for the referral, that transaction is complete. The client may notify the referral agency, in writing, that the client wishes to use the services of another referral agency in the future for a subsequent move and terminate the agreement.
1569.909.
 (a) A contract between a referral agency and a facility shall include an authorization for either the facility or the referral agency to cancel the agreement. The contract may provide specific payment terms regarding pending fees or commissions.
(b) (1) If a referred client does not take possession, and assume financial responsibility for, a unit in the facility, the facility is entitled to a refund of 100 percent of the referral fee, if paid by the facility.
(c) A facility may rely on the client’s written declaration as to which referral agency the client used and shall not be required to pay a fee to any other referral agency.
1569.910.
 An employee, independent contractor, or other person acting on behalf of a government agency, health care facility, or other health care institution, including, but not limited to, medical professionals, physicians, nurses, social workers, discharge planners, therapists, and geriatric care managers, shall not offer, provide, or accept, in addition to the employee’s regular salary or wage, a payment, rebate, refund, commission, preference, or discount, whether in the form of money or other consideration, as payment, compensation, or inducement for referring patients, clients, or customers to a facility or a referral agency.
1569.911.
 A referral agency shall maintain liability insurance coverage in an amount of at least one million dollars ($1,000,000) per person per occurrence and two million dollars ($2,000,000) in total annual aggregate for negligent acts or omissions by the referral agency or any of its employees.
1569.912.
 By July 1, 2019, the department shall develop an enforcement process for referral agencies that do not comply with the requirements set forth in this article. Enforcement measures shall include the suspension of, and prohibition against registration for, noncompliant referral agencies.
1569.913.
 (a) Except for Section 1569.912, this article shall become operative on July 1, 2019.
(b) Section 1569.912 shall become operative January 1, 2019.

SEC. 2.

 Section 15630 of the Welfare and Institutions Code is amended to read:

15630.
 (a) A person who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult, whether or not they receive compensation, including administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian, health practitioner, clergy member, or employee of a county adult protective services agency or a local law enforcement agency, is a mandated reporter. he or she receives compensation, is a mandated reporter, including any of the following: 
(1) Administrators, supervisors, and licensed staff of a public or private facility that provides care or services for elder or dependent adults.
(2) An elder or dependent adult care custodian.
(3) A health practitioner.
(4) A clergy member.
(5) An employee of a county adult protective services agency or local law enforcement agency.
(6) The owner, operator, or employee of a referral agency, as defined in Section 1569.900 of the Health and Safety Code.
(b) (1) A mandated reporter who, in their  his or her  professional capacity, or within the scope of their  his or her  employment, has observed or has knowledge of an incident that reasonably appears to be physical abuse, as defined in Section 15610.63, abandonment, abduction, isolation, financial abuse, or neglect, or is told by an elder or dependent adult that they have  he or she has  experienced behavior, including an act or omission, constituting physical abuse, as defined in Section 15610.63,  abandonment, abduction, isolation, financial abuse, or neglect, or reasonably suspects that abuse, shall report the known, suspected,  known  or alleged suspected  instance of abuse by telephone or through a confidential internet Internet  reporting tool, as authorized by Section 15658, immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an internet Internet  report shall be made through the confidential internet Internet  reporting tool established in Section 15658, within two working days.
(A) If the known, suspected,  suspected  or alleged abuse is physical abuse, as defined in Section 15610.63, and the abuse  occurred in a long-term care facility, except a state mental health  hospital or a state developmental center, the following shall occur:
(i) If the abuse was allegedly caused by another resident of the facility with dementia diagnosed by a licensed physician and there was no serious bodily injury, the reporter shall submit  suspected abuse results in serious bodily injury, a telephone report shall be made to the local law enforcement agency immediately, but also no later than within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse, and  a written report of the known, suspected, or alleged instance of abuse to both of the following agencies within 24 hours: shall be made to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse. 
(I) The long-term care ombudsman.
(II) The local law enforcement agency.
(ii) In all other instances, immediately or as soon as practically possible, but no longer than two hours, the reporter shall submit a verbal report of the known, suspected, or alleged instance of abuse  If the suspected abuse does not result in serious bodily injury, a telephone report shall be made  to the local law enforcement agency, and shall submit  agency within 24 hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse, and  a written report to all of the following agencies within 24 hours: shall be made to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within 24 hours of the mandated reporter observing, obtaining knowledge of, or suspecting the physical abuse. 
(I) The long-term care ombudsman.
(II) The local law enforcement agency.
(III) The corresponding state licensing agency.
(iii) For purposes of this subparagraph, the time limit for reporting begins when the mandated reporter observes, obtains knowledge of, or suspects the abuse or neglect. When the suspected abuse is allegedly caused by a resident with a physician’s diagnosis of dementia, and there is no serious bodily injury, as reasonably determined by the mandated reporter, drawing upon his or her training or experience, the reporter shall report to the local ombudsman or law enforcement agency by telephone, immediately or as soon as practicably possible, and by written report, within 24 hours. 
(B) (iv)  When applicable, reports made pursuant to clauses (i) and (ii) of subparagraph (A)  shall be deemed to satisfy the reporting requirements of the federal Elder Justice Act of 2009, as set out in Subtitle H of the federal Patient Protection and Affordable Care Act (Public Law 111-148), Section 1418.91 of the Health and Safety Code, and Section 72541 of Title 22 of the California Code of Regulations. When a local law enforcement agency receives an initial report of suspected abuse in a long-term care facility pursuant to subparagraph (A), this subparagraph,  the local law enforcement agency may coordinate efforts with the local ombudsman to provide the most immediate and appropriate response warranted to investigate the mandated report. The local ombudsman and local law enforcement agencies may collaborate to develop protocols to implement subparagraph (A). this subparagraph. 
(C) (B)  Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, or any other law, the department may implement subparagraphs (A) and (B),  subparagraph (A),  in whole or in part, by means of all-county letters, provider bulletins, or other similar instructions without taking regulatory action.
(C) If the suspected or alleged abuse is abuse other than physical abuse, and the abuse occurred in a long-term care facility, except a state mental hospital or a state developmental center, a telephone report and a written report shall be made to the local ombudsman or the local law enforcement agency.
(D) With regard to abuse reported pursuant to subparagraphs (A) and (B),  subparagraph (C),  the local ombudsman and the local law enforcement agency shall, as soon as practicable, except in the case of an emergency or pursuant to a report required to be made pursuant to clause (v), in which case these actions shall be taken immediately, do all of the following:
(i) Report to the State Department of Public Health any case of known or suspected abuse occurring in a long-term health care facility, as defined in subdivision (a) of Section 1418 of the Health and Safety Code.
(ii) Report to the State Department of Social Services any case of known or suspected abuse occurring in a residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code, or in an adult day program, as defined in paragraph (2) of subdivision (a) of Section 1502 of the Health and Safety Code.
(iii) Report to the State Department of Public Health and the California Department of Aging any case of known or suspected abuse occurring in an adult day health care center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code.
(iv) Report to the Division Bureau  of Medi-Cal Fraud and Elder Abuse any case of known or suspected criminal activity.
(v) Report all cases of known or suspected physical abuse and financial abuse to the local district attorney’s office in the county where the abuse occurred.
(E) (i) If the suspected or alleged abuse or neglect occurred in a state mental hospital or a state developmental center, and the suspected or alleged abuse or neglect resulted in any of the following incidents, a report shall be made immediately, but no later than within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting abuse, to designated investigators of the State Department of State Hospitals or the State Department of Developmental Services, and also  to the local law enforcement agency:
(I) A death.
(II) A sexual assault, as defined in Section 15610.63.
(III) An assault with a deadly weapon, as described in Section 245 of the Penal Code, by a nonresident of the state mental hospital or state developmental center.
(IV) An assault with force likely to produce great bodily injury, as described in Section 245 of the Penal Code.
(V) An injury to the genitals when the cause of the injury is undetermined.
(VI) A broken bone when the cause of the break is undetermined.
(ii) All other reports of suspected or alleged abuse or neglect that occurred in a state mental hospital or a state developmental center shall be made immediately, but no later than within two hours of the mandated reporter observing, obtaining knowledge of, or suspecting abuse, to designated investigators of the State Department of State Hospitals or the State Department of Developmental Services, or to the local law enforcement agency.
(iii) When a local law enforcement agency receives an initial report of suspected or alleged abuse or neglect in a state mental hospital or a state developmental center pursuant to clause (i), the local law enforcement agency shall coordinate efforts with the designated investigators of the State Department of State Hospitals or the State Department of Developmental Services to provide the most immediate and appropriate response warranted to investigate the mandated report. The designated investigators of the State Department of State Hospitals or the State Department of Developmental Services and local law enforcement agencies may collaborate to develop protocols to implement this clause.
(iv) Except in an emergency, the local law enforcement agency shall, as soon as practicable, report any case of known or suspected criminal activity to the Division Bureau  of Medi-Cal Fraud and Elder Abuse.
(v) Notwithstanding any other law, a mandated reporter who is required to report pursuant to Section 4427.5 shall not be required to report under clause (i).
(F) If the abuse has occurred in any place other than a long-term care facility, a state mental hospital, or a state developmental center, the report shall be made to the adult protective services agency or the local law enforcement agency.
(2) (A) A mandated reporter who is a clergy member who acquires knowledge or reasonable suspicion of elder or dependent adult abuse during a penitential communication is not subject to paragraph (1). For purposes of this subdivision, “penitential communication” means a communication that is intended to be in confidence, including, but not limited to, a sacramental confession made to a clergy member who, in the course of the discipline or practice of their  his or her  church, denomination, or organization is authorized or accustomed to hear those communications and under the discipline tenets, customs, or practices of their  his or her  church, denomination, or organization, has a duty to keep those communications secret.
(B) This subdivision shall not be construed to  modify or limit a clergy member’s duty to report known or suspected elder and dependent adult abuse if they are  he or she is  acting in the capacity of a care custodian, health practitioner, or employee of an adult protective services agency.
(C) Notwithstanding any other provision in  this section, a clergy member who is not regularly employed on either a full-time or part-time basis in a long-term care facility or does not have care or custody of an elder or dependent adult shall not be responsible for reporting abuse or neglect that is not reasonably observable or discernible to a reasonably prudent person having no specialized training or experience in elder or dependent care.
(3) (A) A mandated reporter who is a physician and surgeon, a registered nurse, or a psychotherapist, as defined in Section 1010 of the Evidence Code, shall not be required to report, pursuant to paragraph (1), an incident if all of the following conditions exist:
(i) The mandated reporter has been told by an elder or dependent adult that they have  he or she has  experienced behavior constituting physical abuse, as defined in Section 15610.63, abandonment, abduction, isolation, financial abuse, or neglect.
(ii) The mandated reporter is unaware  not aware  of any independent evidence that corroborates the statement that the abuse has occurred.
(iii) The elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia.
(iv) In the exercise of clinical judgment, the physician and surgeon, the registered nurse, or the psychotherapist, as defined in Section 1010 of the Evidence Code, reasonably believes that the abuse did not occur.
(B) This paragraph shall not be construed to  impose upon mandated reporters a duty to investigate a known or suspected incident of abuse and shall not be construed to  lessen or restrict any existing duty of mandated reporters.
(4) (A) In a long-term care facility, a mandated reporter shall not be required to report as a suspected incident of abuse, as defined in Section 15610.07, an incident if all of the following conditions exist:
(i) The mandated reporter is aware that there is a proper plan of care.
(ii) The mandated reporter is aware that the plan of care was properly provided or executed.
(iii) A physical, mental, or medical injury occurred as a result of care provided pursuant to clause (i) or (ii).
(iv) The mandated reporter reasonably believes that the injury was not the result of abuse.
(B) This paragraph shall neither  not be construed to  require a mandated reporter to seek, nor to  preclude a mandated reporter from seeking, information regarding a known or suspected incident of abuse before  prior to  reporting. This paragraph shall apply only to those categories of mandated reporters that the State Department of Public Health determines, upon approval by the Division Bureau  of Medi-Cal Fraud and Elder Abuse and the state long-term care ombudsman, have access to plans of care and have the training and experience necessary to determine whether the conditions specified in this section have been met.
(c) (1) Any A  mandated reporter who has knowledge, or reasonably suspects, that types of elder or dependent adult abuse for which reports are not mandated have been inflicted upon an elder or dependent adult, or that their  his or her  emotional well-being is endangered in any other way, may report the known or suspected instance of abuse.
(2) If the suspected or alleged abuse occurred in a long-term care facility other than a state mental health  hospital or a state developmental center, the report may be made to the long-term care ombudsman program. Except in an emergency, the local ombudsman shall report any case of known or suspected abuse to the State Department of Public Health and any case of known or suspected criminal activity to the Division Bureau  of Medi-Cal Fraud and Elder Abuse, as soon as is practicable.
(3) If the suspected or alleged abuse occurred in a state mental health  hospital or a state developmental center, the report may be made to the designated investigator of the State Department of State Hospitals or the State Department of Developmental Services or to a local law enforcement agency. Except in an emergency, the local law enforcement agency shall report any case of known or suspected criminal activity to the Division Bureau  of Medi-Cal Fraud and Elder Abuse, as soon as is practicable.
(4) If the suspected or alleged abuse occurred in a place other than a place described in paragraph (2) or (3), the report may be made to the county adult protective services agency.
(5) If the conduct involves criminal activity not covered in subdivision (b), it may be immediately reported to the appropriate law enforcement agency.
(d) If two or more mandated reporters are present and jointly have knowledge or reasonably suspect that types of abuse of an elder or a dependent adult for which a report is or is not mandated have occurred, and there is agreement among them, the telephone report or internet Internet  report, as authorized by Section 15658, may be made by a member of the team selected by mutual agreement, and a single report may be made and signed by the selected member of the reporting team. Any A  member who has knowledge that the member designated to report has failed to do so shall thereafter make the report.
(e) A telephone report or internet Internet  report, as authorized by Section 15658, of a known or suspected instance of elder or dependent adult abuse shall include, if known, the name of the person making the report, the name and age of the elder or dependent adult, the present location of the elder or dependent adult, the names and addresses of family members or any other adult responsible for the elder’s or dependent adult’s care, the nature and extent of the elder’s or dependent adult’s condition, the date of the incident, and any other information, including information that led that person to suspect elder or dependent adult abuse, as requested by the agency receiving the report.
(f) The reporting duties under this section are individual, and no supervisor or administrator shall impede or inhibit the reporting duties, and no person making the report shall be subject to any sanction for making the report. However, internal procedures to facilitate reporting, ensure confidentiality, and apprise supervisors and administrators of reports may be established, provided they are not inconsistent with this chapter.
(g) (1) Whenever this section requires a county adult protective services agency to report to a law enforcement agency, the law enforcement agency shall, immediately upon request, provide a copy of its investigative report concerning the reported matter to that county adult protective services agency.
(2) Whenever this section requires a law enforcement agency to report to a county adult protective services agency, the county adult protective services agency shall, immediately upon request, provide to that law enforcement agency a copy of its investigative report concerning the reported matter.
(3) The requirement to disclose investigative reports pursuant to this subdivision shall not include the disclosure of social services records or case files that are confidential, nor shall this subdivision be construed to  allow disclosure of any  reports or records if the disclosure would be prohibited by any other provision of  state or federal law.
(h) Failure to report, or impeding or inhibiting a report of, physical abuse, as defined in Section 15610.63, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult, in violation of this section, is a misdemeanor, punishable by not more than six months in the county jail, by a fine of not more than one thousand dollars ($1,000), or by both that fine and imprisonment. A mandated reporter who willfully fails to report, or impedes or inhibits a report of, physical abuse, as defined in Section 15610.63, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult, in violation of this section, if that abuse results in death or great bodily injury, shall be punished by not more than one year in a county jail, by a fine of not more than five thousand dollars ($5,000), or by both that fine and imprisonment. If a mandated reporter intentionally conceals their  his or her  failure to report an incident known by the mandated reporter to be abuse or severe neglect under this section, the failure to report is a continuing offense until a law enforcement agency specified in paragraph (1) of subdivision (b) of Section 15630  discovers the offense.
(i) For purposes of this section, “dependent adult” has  shall have  the same meaning as that term is defined  in Section 15610.23.
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.