Hospice agency licensure: moratorium on new licenses.

The California Hospice Licensure Act of 1990 (act) requires a person, political subdivision of the state, or other governmental agency to obtain a license from the State Department of Public Health to provide hospice services to an individual who is experiencing the last phase of life due to a terminal disease, as defined, and their family, except as provided. The act also provides for the renewal of a license. The act imposes criminal penalties on any person who violates any provision of the act or any rule or regulation promulgated under the act. Existing law prohibits any person, political subdivision of the state, or other governmental agency from establishing, conducting, maintaining, or representing itself as a hospice unless a license has been issued under the act. This bill would generally replace the term "hospice" with the term "hospice agency." The bill would provide that hospice agency licenses are not transferable. The bill would specify that only the person or entity initially issued the license may use the license for 5 years. The bill would prohibit the department from approving a change of ownership of a licensed hospice agency for 5 years from the date of initial licensure. The bill would authorize the department to make an exception to the 5-year prohibition under extenuating circumstances, as prescribed. Existing law requires an applicant for a hospice license to satisfy certain conditions, and to satisfy the definition of a hospice and provide specified services in order to be licensed as a hospice. Existing law authorizes the department to deny an application for licensure, or suspend or revoke any license issued to provide hospice services for various reasons, including, but not limited to, violation by the applicant or licensee of the act or related rules and regulations promulgated by the department. Existing law authorizes the department to conduct a survey of an accredited hospice to ensure that the accreditation requirements are met. This bill would revise and expand the department's application requirements, and would additionally require an applicant who has not previously qualified for a hospice agency license to, as a condition of licensure, demonstrate and provide evidence of an unmet need of hospice services in the geographic region the hospice would serve, except under specified circumstances. The bill would require a hospice agency to have specified personnel categories and would require the hospice agency to provide certain information for each individual on an initial application for those positions. The bill would add to the reasons for denial, suspension, or revocation of a license to include, among others, improperly certifying a patient as eligible for hospice care, and demonstrating a pattern and practice of violations of state or federal standards during the last 3 years of a hospice agency owned, operated, or managed by the applicant or licensee. The bill would require the department to conduct annual surveys of 5% of initial hospice agency licenses approved by accrediting organizations during the previous calendar year to ensure that the accreditation requirements are met, using a selective sample basis, and would authorize the department to survey an accredited hospice agency not included as part of the required surveys. The bill would establish a procedure for a person to request an investigation of an accredited hospice agency by making an oral or written complaint alleging a violation of the requirements applicable to hospice agencies. The bill would require the department to make a preliminary review and to make an onsite investigation within 10 business days after receiving the complaint, except as specified. The bill would require the department to notify the complainant in writing of its determination as a result of the investigation within 10 business days of completing the investigation. Existing law imposes a moratorium on the department issuing a new license to provide hospice services, except as specified. Existing law requires the moratorium to end on the earlier of 365 days from the date that the California State Auditor publishes a report on hospice licensure or on January 1, 2027, when the moratorium provisions are repealed. This bill would require the department, by January 1, 2024, to adopt emergency regulations to implement the recommendations in a specified report of the California State Auditor. The bill would require the department to maintain the general moratorium on new hospice agency licenses until the department adopts the regulations. The bill would require the regulations, among other things, to establish guidelines for assessing the appropriateness of a hospice agency's ratio of patients to nurses, require hospice agency management personnel to meet minimum standards of training and experience, and to establish timelines for reporting changes to application information, as specified. The bill would require the moratorium to end on the earlier of 2 years from the date that the California State Auditor publishes a report on hospice agency licensure, or the date the emergency regulations are adopted. The bill would exempt licensed hospice facilities, as defined, from the moratorium. Because a violation of certain of the bill's requirements would be a misdemeanor, the bill would impose a state-mandated local program. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. 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.