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SB-294 Hospices: palliative care.(2017-2018)

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Date Published: 05/26/2017 10:00 AM
SB294:v97#DOCUMENT

Amended  IN  Senate  May 26, 2017
Amended  IN  Senate  March 27, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 294


Introduced by Senator Hernandez

February 09, 2017


An act to amend Sections 1746 and 1749 of the Health and Safety Code, relating to palliative care.


LEGISLATIVE COUNSEL'S DIGEST


SB 294, as amended, Hernandez. Hospices: palliative care.
The California Hospice Licensure Act of 1990 provides for the licensure and regulation by the State Department of Public Health of persons or agencies that provide hospice services, such as palliative care and skilled nursing services, to persons, and the families of persons, who are experiencing the last phases of life due to terminal disease. Existing law defines palliative care to mean patient and family-centered care that optimizes quality of life of a patient with a terminal illness by anticipating, preventing, and treating suffering. suffering, and defines skilled nursing services to mean nursing services provided by or under the supervision of a registered nurse, as specified, that pertain to the palliative, supportive services required by patients with a terminal illness. Existing law authorizes licensed hospices to provide, in addition to hospice services authorized under the act, specified preliminary services, including preliminary palliative care consultations, for any person in need of those services, as determined by the physician and surgeon, if any, in charge of the care of a patient.
This bill would, among other things, expand the definition of palliative care to include relief of symptoms, pain, and stress of a serious, life threatening, or advanced illness, in addition to a terminal illness, without regard to the length of the patient’s remaining period of life. to mean patient and family centered care that optimizes quality of life of any patient. The bill would also expand the definition of skilled nursing services to include palliative, supportive services required by patients with a serious illness, and would define serious illness to mean a condition that may result in death, regardless of the estimated length of the individual’s remaining period of life.
The bill would further authorize a licensed hospice to provide any of the same interdisciplinary hospice services authorized under the act to a patient who is not a hospice patient, but is in need of palliative care, has a serious illness, as specified, and authorize the hospice to provide services to the palliative care patient even if the patient is continuing to receive curative treatment from other licensed health care professionals.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 1746 of the Health and Safety Code is amended to read:

1746.
 For the purposes of this chapter, the following definitions apply:
(a) “Bereavement services” means those services available to the surviving family members for a period of at least one year after the death of the patient, including an assessment of the needs of the bereaved family and the development of a care plan that meets these needs, both prior to and following the death of the patient.
(b) “Home health aide” has the same meaning as that term is defined in subdivision (c) of Section 1727.
(c) “Home health aide services” means those services described in subdivision (d) of Section 1727 that provide for the personal care of the seriously or terminally ill patient and the performance of related tasks in the patient’s home in accordance with the plan of care in order to increase the level of comfort and to maintain personal hygiene and a safe, healthy environment for the patient.
(d) “Hospice” means a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets all of the following criteria:
(1) Considers the patient and the patient’s family, in addition to the patient, as the unit of care.
(2) Utilizes an interdisciplinary team to assess the physical, medical, psychological, social, and spiritual needs of the patient and the patient’s family.
(3) Requires the interdisciplinary team to develop an overall plan of care and to provide coordinated care that emphasizes supportive services, including, but not limited to, home care, pain control, and limited inpatient services. Limited inpatient services are intended to ensure both continuity of care and appropriateness of services for those patients who cannot be managed at home because of acute complications or the temporary absence of a capable primary caregiver.
(4) Provides for the palliative medical treatment of pain and other symptoms associated with a terminal disease, but does not provide for efforts to cure the disease.
(5) Provides for bereavement services following death to assist the family in coping with social and emotional needs associated with the death of the patient.
(6) Actively utilizes volunteers in the delivery of hospice services.
(7) To the extent appropriate, based on the medical needs of the patient, provides services in the patient’s home or primary place of residence.
(e) “Hospice facility” means a health facility as defined in subdivision (n) of Section 1250.
(f) “Inpatient care arrangements” means arranging for those short inpatient stays that may become necessary to manage acute symptoms or because of the temporary absence, or need for respite, of a capable primary caregiver. The hospice shall arrange for these stays, ensuring both continuity of care and the appropriateness of services.
(g) “An interdisciplinary team” means the hospice care team that includes, but is not limited to, the patient and patient’s family, a physician and surgeon, a registered nurse, a social worker, a volunteer, and a spiritual caregiver. The team shall be coordinated by a registered nurse and shall be under medical direction. The team shall meet regularly to develop and maintain an appropriate plan of care.
(h) “Medical direction” means those services provided by a licensed physician and surgeon who is charged with the responsibility of acting as a consultant to the interdisciplinary team, a consultant to the patient’s attending physician and surgeon, as requested, with regard to pain and symptom management, and a liaison with physician and surgeons in the community.
(i) “Multiple location” means a location or site from which a hospice makes available basic hospice services within the service area of the parent agency. A multiple location shares administration, supervision, policies and procedures, and services with the parent agency in a manner that renders it unnecessary for the site to independently meet the licensing requirements.
(j) “Palliative care” means patient and family-centered family centered care that optimizes quality of life of a patient with a serious, life threatening, advanced, or terminal illness by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. Palliative care includes relief of symptoms, pain, and stress of a serious, life threatening, advanced, or terminal illness without regard to the length of the patient’s remaining period of life.
(k) “Parent agency” means the part of the hospice that is licensed pursuant to this chapter and that develops and maintains administrative control of multiple locations. All services provided from each multiple location and parent agency are the responsibility of the parent agency.
(l) “Plan of care” means a written plan developed by the attending physician and surgeon, the medical director or physician and surgeon designee, and the interdisciplinary team that addresses the needs of a patient and family admitted to the hospice organization. The hospice shall retain overall responsibility for the development and maintenance of the plan of care and quality of services delivered.
(m) “Preliminary services” means those services authorized pursuant to subdivision (d) of Section 1749.
(n) “Skilled nursing services” means nursing services provided by or under the supervision of a registered nurse under a plan of care developed by the interdisciplinary team and the patient’s physician and surgeon to a patient and his or her family that pertain to the palliative, supportive services required by patients with a serious, life threatening, advanced, serious or terminal illness. Skilled nursing services include, but are not limited to, patient assessment, evaluation and case management of the medical nursing needs of the patient, the performance of prescribed medical treatment for pain and symptom control, the provision of emotional support to both the patient and his or her family, and the instruction of caregivers in providing personal care to the patient. Skilled nursing services shall provide for the continuity of services for the patient and his or her family. Skilled nursing services shall be available on a 24-hour on-call basis.
(o) “Social services/counseling services” means those counseling and spiritual care services that assist the patient and his or her family to minimize stresses and problems that arise from social, economic, psychological, or spiritual needs by utilizing appropriate community resources, and maximize positive aspects and opportunities for growth.
(p) “Terminal disease” or “terminal illness” means a medical condition resulting in a prognosis of life of one year or less, if the disease follows its natural course.
(q) “Volunteer services” means those services provided by trained hospice volunteers who have agreed to provide service under the direction of a hospice staff member who has been designated by the hospice to provide direction to hospice volunteers. Hospice volunteers may be used to provide support and companionship to the patient and his or her family during the remaining days of the patient’s life and to the surviving family following the patient’s death.
(r) “Serious illness” means a condition that may result in death, regardless of the estimated length of the individual’s remaining period of life.

SEC. 2.

 Section 1749 of the Health and Safety Code is amended to read:

1749.
 (a) To qualify for a license under this chapter, an applicant shall satisfy all of the following:
(1) Be of good moral character. If the applicant is a franchise, franchisee, firm, association, organization, partnership, business trust, corporation, company, political subdivision of the state, or governmental agency, the person in charge of the hospice for which the application for a license is made shall be of good moral character.
(2) Demonstrate the ability of the applicant to comply with this chapter and any rules and regulations promulgated under this chapter by the state department.
(3) File a completed application with the state department that was prescribed and furnished pursuant to Section 1748.
(b) In order for a person, political subdivision of the state, or other governmental agency to be licensed as a hospice it shall satisfy the definition of a hospice contained in Section 1746, and also provide, or make provision for, the following basic services:
(1) Skilled nursing services.
(2) Social services/counseling services.
(3) Medical direction.
(4) Bereavement services.
(5) Volunteer services.
(6) Inpatient care arrangements.
(7) Home health aide services.
(c) The services required to be provided pursuant to subdivision (b) shall be provided in compliance with the “Standards for Quality Hospice Care, 2003,” as available from the California Hospice and Palliative Care Association, until the state department adopts regulations establishing alternative standards pursuant to subdivision (e).
(d) (1) Notwithstanding any other law, to meet the unique needs of the community, licensed hospices may provide, in addition to hospice services authorized in this chapter, any of the following preliminary services for any person in need of those services, as determined by the physician and surgeon, if any, in charge of the care of a patient, or at the request of the patient or family:
(A) Preliminary palliative care consultations.
(B) Preliminary counseling and care planning.
(C) Preliminary grief and bereavement services.
(2) Preliminary services authorized pursuant to this subdivision may be provided concurrently with curative treatment to a person who does not have a terminal prognosis or who has not elected to receive hospice services only by licensed and certified hospices. These services shall be subject to the schedule of benefits under the Medi-Cal program, pursuant to subdivision (w) of Section 14132 of the Welfare and Institutions Code.
(e) (1) Notwithstanding any other law, a licensed hospice may is further authorized to provide any of the same interdisciplinary hospice services authorized services, as defined in this chapter chapter, to a patient in need of palliative care, with a serious illness, as determined by the physician and surgeon in charge of the care of the patient, including if the a patient is continuing who continues to receive curative treatment from other licensed health care professionals.
(2) This subdivision is not intended to modify the provision of hospice care required under Section 1368.2.
(f) The state department may adopt regulations establishing standards for any or all of the services required to be provided under subdivision (b). The regulations of the state department adopted pursuant to this subdivision shall supersede the standards referenced in subdivision (c) to the extent the regulations duplicate or replace those standards.