Article 10.5. Special Hospital: Hospice of California Health And Safety Code >> Division 2. >> Chapter 2. >> Article 10.5.
A Special Hospital: Hospice Pilot Project is hereby
created. This pilot project shall be established and administered by
the department, and shall consist of up to three pilot projects, one
of which shall be located in San Diego. The department shall license
facilities that are part of the pilot project for the duration of the
pilot project as a special hospital: hospice. No person or entity
shall be licensed as a special hospital: hospice unless that person
or entity is participating in this pilot project.
The purpose of the pilot project is to determine the need of
hospice patients for acute inpatient hospital care.
This article shall not preclude the provision of appropriate
hospice services in other settings.
The pilot project does not constitute an approved project as
defined in subdivision (b) of Section 128130.
For the purposes of this article, the following
definitions shall apply:
(a) "Hospice" means a specialized form of multidisciplinary health
care which 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 to provide supportive care for
the primary care giver and the family of the hospice patient, and
which 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 a multidisciplinary team to assess the physical,
medical, psychological, social, and spiritual needs of the patient
and the patient's family.
(3) Requires the multidisciplinary team to develop an overall plan
of care and to provide coordinated care, which emphasizes supportive
services such as 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 care giver.
(4) Provides for the palliative medical treatment of pain and
symptoms associated with a terminal illness but does not provide for
efforts to cure disease.
(5) Provides for bereavement following death to assist the family
to cope with social and emotional needs associated with the death of
(6) Actively utilizes volunteers in the delivery of hospice
(7) To the extent appropriate, based on the medical needs of the
patient, provides services in the patient's home or primary place of
(b) "Palliative care" means interventions that focus primarily on
reduction or abatement of pain and other disease-related symptoms,
rather than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life.
(c) "Primary care giver" means the individual who is identified as
the primary person charged with responsibility for the care of the
hospice patient who agrees to accept that responsibility. The
individual designated may be a family member, a friend or an
individual hired by the hospice patient but shall be an individual
who is actually available to provide 24-hour coverage for care of the
hospice patient. However, it shall not be necessary that the
individual reside in the hospice patient's home.
(d) "Primary place of residence" means the patient's long-term
residence and includes the patient's home, a friend's home, a
congregate living health facility, a hospice residential care
facility, or a skilled nursing facility if the patient resides there
on a permanent full-time basis.
(e) "Special hospital: hospice" means a health facility which is a
component part of a hospice, as defined in subdivision (a), and
which provides general inpatient care, as defined in federal Medicare
program regulations adopted pursuant to Section 1861(dd)(2) and
Section 1814(a)(7) of the federal Social Security Act.
(f) "Terminal illness" means a medical condition resulting in a
life expectancy of the patient of six months, or less.
A special hospital: hospice shall be deemed to provide
acute palliative care. All patients receiving inpatient care in a
Special Hospital: Hospice Project shall be admitted by, and under the
supervision of, a physician member of the organized medical staff.
Notwithstanding any other provisions of law, in order to
be licensed as a special hospital: hospice, each project facility
shall meet the requirements of Sections 70101 to 70137, inclusive,
70201 to 70219, inclusive, 70241 to 70279, inclusive, 70701 to 70707,
inclusive, and 70708 to 70765, inclusive, of Title 22 of the
California Code of Regulations; Sections 2-1001A to 2-1015A,
inclusive, Section 2-1018A, Sections 2-1020A to 2-1024A, inclusive,
Sections 2-1026A to 2-1028A, inclusive, Section 2-1040A, Section
2-1044A, and Section 2-1051A of Title 24 of the California Code of
Regulations. In addition to complying with these regulations in
Titles 22 and 24 of the California Code of Regulations, each facility
shall meet, for the duration of the project, the hospice standards
used by the Medicare program (42 C.F.R., Part 418, Sections 418.1 to
418.405, inclusive) the Medi-Cal program (subdivision (e) of Sections
51003 to 51543, inclusive, of Title 22, California Code of
Regulations), and the Joint Commission on the Accreditation of
Healthcare Organizations' "Hospice Standards Manual."
Each facility licensed as a special hospital: hospice shall
maintain a transfer agreement with a general acute care hospital.
(a) Each facility that is part of the project shall report
to the Legislature at the end of each year of operation on all of
the following factors:
(1) Acuity levels of patients using the project facilities;
relative cost-effectiveness of these facilities.
(2) Quality of care in the facilities.
(3) Utilization of the facilities.
(4) Staffing requirements of the facilities.
(b) Reports shall be submitted to the Legislature no later than
three months after the close of the 12-month period for which the
report is made. However, the Legislature may approve requests to
extend this deadline that are submitted no later than 30 days prior
to the deadline and that state the reason for the delay and
corrective measures that have been taken to avoid future delays. No
report deadline will be extended for more than three months beyond
the original report date.
The project shall commence on January 1, 1990. However,
the State Department of Health Services may establish an earlier
commencement date for any one of the facilities if that facility has
been licensed as a special hospital: hospice prior to January 1,
The fee for each new or renewal application for a license
for a Special Hospital: Hospice Pilot Project facility shall be the
annual fee as set forth for general acute care hospitals in
subdivision (a) of Section 1266. If the annual fees do not cover the
necessary costs which the Division of Licensure and Certification
expends to manage this pilot project, the facilities shall be
assessed an annual pro rata share of the excess costs.