Amended in Assembly August 15, 2016

Amended in Assembly June 30, 2016

Amended in Assembly June 22, 2016

Amended in Senate January 26, 2016

Amended in Senate January 5, 2016

Amended in Senate May 5, 2015

Amended in Senate April 20, 2015

Amended in Senate April 7, 2015

Senate BillNo. 648


Introduced by Senator Mendoza

(Coauthor: Assembly Member Levine)

February 27, 2015


An act to amend Sections 1400, 1401,begin insert 1403,end insert 1404, 1404.5, 1405, 1407, 1408, 1409.3, and 1410 of, and to add Sections 1402, 1409.4, 1409.5, 1409.6, 1409.7, 1409.8, 1409.9, and 1409.10 to, the Health and Safety Code, and to amend Section 15630 of the Welfare and Institutions Code, relating to health and care facilities.

LEGISLATIVE COUNSEL’S DIGEST

SB 648, as amended, Mendoza. Health and care facilities: referral agencies.

Existing law requires a referral agency to obtain a license from the State Department of Public Health in order to refer a person to any extended care facility, skilled nursing home, or intermediate care facility. Existing law exempts a local public agency performing referral services without cost from these provisions. Under existing law, a violation of these provisions is subject to a civil penalty and suspension or revocation of the license.

This bill would additionally require a referral agency to obtain a license from the State Department of Social Services in order to refer a person to a residential care facility for the elderly. The bill would prohibit an extended care facility, skilled nursing home, intermediate care facility, or residential care facility for the elderly from paying a commission or fee to a referral agency that is not licensed, as specified. The bill would prohibit a referral agency from holding any power of attorney or any other property of a person receiving referral services, or from disclosing any personal information of a person receiving services, unless authorized to do so. The bill would require a referral agency to disclose specified information to each person receiving its services, and to retain, for 3 years, an acknowledgment from the person being referred, or his or her conservator, guardian, authorized family member or other authorized representative, attorney in fact, or agent under a power of attorney, stating that the disclosures had been made. The bill would also require referral agencies to maintain liability insurance in specified amounts. The bill would also make it unlawful for a medical professional or employee of a governmental agency, hospital, or otherbegin delete healthcareend deletebegin insert health careend insert institution to offer, provide, or accept a payment, rebate, refund, commission, preference, or discount as payment, compensation, or inducement for referring patients, clients, or customers to a facility.

Existing law makes specified persons mandated reporters of elder or dependent adult abuse, including administrators, supervisors, and licensed staff of a facility that provide care or services for elder or dependent adults. Under existing law, failure to report physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult is a misdemeanor.

The bill would include on the list of mandated reporters owners, operators, and employees of a referral agency. By expanding the crime of failure to report elder or dependent adult abuse, this bill would impose a state-mandated local program.

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.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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

P3    1

SECTION 1.  

Section 1400 of the Health and Safety Code is
2amended to read:

3

1400.  

(a) It is unlawful for any person, association, or
4corporation to establish, conduct, or maintain a referral agency or
5to refer any person for remuneration to any extended care facility,
6skilled nursing home, intermediate care facility, or residential care
7facility for the elderly, or a distinct part of a facility providing
8extended care, skilled nursing home care, or intermediate care,
9without first having obtained a written license as provided in this
10chapter from the State Public Health Officer or from an inspection
11service approved by the State Public Health Officer pursuant to
12Section 1257, from the State Department of Social Services, or
13from both, as appropriate.

14(b) It is unlawful for any person, association, or corporation to
15establish, conduct, or maintain a referral agency or to refer any
16person for remuneration to any person or agency outside a
17long-term health care facility, as defined in Section 1418, for
18professional services for which the long-term health care facility
19does not employ a qualified professional person to furnish a
20specific service, including, but not limited to, laboratory,
21diagnostic, or therapy services, unless the long-term health care
22facility complies with current federal and state laws regarding the
23provision of these services and all of the following conditions are
24met:

25(1) The services will be provided in accordance with
26professional standards applicable to the provision of these services
27in a long-term health care facility.

28(2) The long-term health care facility assumes responsibility
29for timeliness of the services.

30(3) Services are provided or obtained only when ordered by the
31attending physician and a notation is made in the resident’s medical
32chart reflecting that the service has been provided to the resident.

33(c) It is unlawful for any person, association, or corporation to
34establish, conduct, or maintain a referral agency or to refer any
35person for remuneration to any residential care facility for the
P4    1elderly for professional services if that facility does not meet the
2licensing standards established in Chapter 3.2 (commencing with
3Section 1560). The referral agency may satisfy this requirement
4by obtaining and relying on the licensing status information for a
5residential care facility for the elderly that is published on the
6Internet Web site of the State Department of Social Services.

7(d) It is unlawful for any extended care facility, skilled nursing
8home, intermediate care facility, or residential care facility for the
9elderly, or a distinct part of a facility providing extended care,
10skilled nursing home care, or intermediate care to pay a
11commission or fee to a referral agency that does not have a written
12license as provided in this chapter from the State Public Health
13Officer or from an inspection service approved by the State Public
14Health Officer pursuant to Section 1257, from the State Department
15of Social Services, or from both, as appropriate.

16

SEC. 2.  

Section 1401 of the Health and Safety Code is amended
17to read:

18

1401.  

As used in this chapter, “referral agency” means a private,
19profit or nonprofit agency that is engaged in the business of
20referring persons for remuneration to any extended care facility,
21skilled nursing home, intermediate care facility, or residential care
22facility for the elderly, or a distinct part of a facility providing
23extended care, skilled nursing home care, or intermediate care.
24“Referral agency” does not include any of the following:

25(a) A licensed residential care facility for the elderly that does
26either of the following:

27(1) Provides discounts or other remuneration to residents or
28their families for referring new or prospective clients.

29(2) Provides remuneration to staff for marketing or sales offers.

30(b) A resident who refers a new or prospective resident to a
31licensed residential care facility for the elderly and receives a
32discount or other remuneration from the licensed residential care
33facility for the elderly.

34(c) A staff member of the licensed residential care facility for
35the elderly who receives remuneration from the facility for
36professional services, including, but not limited to, sales and
37marketing efforts, on behalf of that facility.

38

SEC. 3.  

Section 1402 is added to the Health and Safety Code,
39to read:

P5    1

1402.  

“Residential care facility for the elderly” has the same
2meaning as set forth in Section 1569.2.

3begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 1403 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is amended
4to read:end insert

5

1403.  

begin insert(a)end insertbegin insertend insert Each application for a license or renewal of license
6under this chapter shall be accompanied by an annual Licensing
7and Certification Programbegin delete fee set in accordance with Section 1266.end delete
8begin insert fee.end insert Each license shall expire 12 months from its date of issuance
9and application for renewal accompanied by the fee shall be filed
10with the director not later than 30 days prior to the date of
11 expiration.

begin insert

12
(b) The State Department of Public Health shall set the annual
13Licensing and Certification Program fee in accordance with
14Section 1266.

end insert
begin insert

15
(c) The State Department of Social Services shall set the annual
16Licensing and Certification Program fee at an amount no greater
17than the amount required to cover the reasonable and actual costs
18of administering the licensing program.

end insert
19

begin deleteSEC. 4.end delete
20
begin insertSEC. 5.end insert  

Section 1404 of the Health and Safety Code is amended
21to read:

22

1404.  

No licensee under this chapter shall have a direct or
23indirect financial interest in any facility doing business with the
24licensee.

25

begin deleteSEC. 5.end delete
26
begin insertSEC. 6.end insert  

Section 1404.5 of the Health and Safety Code is
27amended to read:

28

1404.5.  

A license application shall be submitted to either or
29both licensing departments, as appropriate, whenever any of the
30following circumstances occur:

31(a) Change of ownership of the referral agency.

32(b) Change of name of the referral agency.

33(c) Change of location of the referral agency.

34

begin deleteSEC. 6.end delete
35
begin insertSEC. 7.end insert  

Section 1405 of the Health and Safety Code is amended
36to read:

37

1405.  

Any person, partnership, firm, corporation, or association
38desiring to obtain a license to refer persons to extended care
39facilities, skilled nursing homes, or intermediate care facilities, or
40a distinct part of a facility providing extended care, skilled nursing
P6    1home care, or intermediate care, shall file with the State
2Department of Public Health an application on forms furnished
3by the State Department of Public Health. Any person, partnership,
4firm, corporation, or association desiring to obtain a license to
5refer persons to residential care facilities for the elderly shall file
6with the State Department of Social Services an application on
7forms furnished by the State Department of Social Services. The
8applications shall contain all of the following:

9(a) Name of applicant, and if an individual, whether the applicant
10has attained the age of 18 years.

11(b) Name of referral agency.

12(c) The location of the referral agency.

13(d) The business or occupation engaged in by each applicant,
14and by each partner, officer, and director, for at least two years
15immediately preceding the filing of the application. In addition,
16each such person shall submit a statement setting forth whether
17he or she has previously engaged in the operation of a referral
18agency, whether he or she has been involved in, or the subject of,
19a refusal or revocation of a referral agency license, and whether
20he or she has been convicted of a crime other than a minor traffic
21offense.

22(e) If the applicant is a corporation, the name and principal
23business address of each officer and director of the corporation;
24and for nonpublic corporations, the name and business address of
25each stockholder owning 10 percent or more of the stock and the
26name and business address of any corporation member who has
27responsibility in the operation of the facility.

28(f) If the applicant is a partnership, the name and principal
29business address of each partner.

30(g) Evidence of the right to occupy the premises where the
31referral agency is to be located.

32(h) A copy of the partnership agreement or the Articles of
33Incorporation, if applicable.

34(i) A copy of the current organization chart.

35(j) A schedule of fees to be charged and collected by the referral
36agency, and a statement of the method by which each fee is to be
37computed or determined.

38(k) A declaration that the licensee will not have any financial
39interest in any health facility doing business with the referral
40agency.

P7    1(l) Evidence satisfactory to the licensing department that the
2applicant demonstrates reputable and responsible character and
3the capability to comply with this chapter.

4(m) For a licensee to refer persons to residential care facilities
5for the elderly, both of the following:

6(1) A declaration that the licensee will either conduct a
7suitability determination of each person who seeks a referral from
8the licensee and who is referred to a facility or facilities, or will
9comply with the requirements of paragraph (3) of subdivision (b)
10of Section 1409.4. For purposes of this subdivision, “a suitability
11determination” means a determination made by the licensee that
12the facility offers services to meet the needs of the person seeking
13a referral because of the following considerations:

14(A) The level of care requested by the person seeking the
15referral.

16(B) The cost of the facility and the ability of the financial means
17of the person seeking the referral.

18(C) The social needs and preferences of the person seeking the
19referral.

20(D) The geographic location of the facility and the geographic
21preference of the person seeking the referral.

22(2) A declaration that the licensee trains all employees who
23make referrals to residential care facilities for the elderly regarding
24all of the following issues:

25(A) All of the provisions of this chapter that apply to a referral
26agency,begin delete includingend deletebegin insert including,end insert but not limited to, instruction on how
27to comply with all of those provisions.

28(B) State governance and administrative functions of agency
29operations, including resident assessment and admission
30procedures.

31(C) The psychosocial and physical needs of the elderly.

32(D) Community supports, cultural competency and sensitivity
33to residents’ needs.

34

begin deleteSEC. 7.end delete
35
begin insertSEC. 8.end insert  

Section 1407 of the Health and Safety Code is amended
36to read:

37

1407.  

(a) Any licensee desiring to voluntarily surrender his
38or her license for cancellation or temporary suspension shall notify
39the licensing department in writing as soon as possible and, in all
P8    1cases, at least 30 days prior to the effective date of cancellation or
2temporary suspension of the license.

3(b) Any license placed in temporary suspension pursuant to this
4section may be reinstated by the licensing department within 12
5months of the date of the voluntary suspension on receipt of an
6application and evidence showing compliance with licensing
7requirements.

8

begin deleteSEC. 8.end delete
9
begin insertSEC. 9.end insert  

Section 1408 of the Health and Safety Code is amended
10to read:

11

1408.  

(a)  Upon verification of compliance with this chapter
12and with the approval of the licensing department, the licensing
13department shall issue the license to the applicant.

14(b) When issuing a license to a referral agency that provides
15referrals to residential care facilities for the elderly, the State
16Department of Social Services is not required to conduct an onsite
17licensing inspection as a condition of verifying compliance with
18this chapter.

19(c) As a condition of verifying compliance with this chapter,
20the licensing department may require an applicant to submit a copy
21or example of the disclosures required by Section 1409.4.

22(d) If the applicant is not in compliance with this chapter, the
23licensing department shall deny the applicant a license.
24Immediately upon the denial of any license, the licensing
25department shall notify the applicant in writing. Within 20 days
26of receipt of the notice, the applicant may present his or her written
27petition for a hearing to the licensing department. Proceedings
28conducted by the State Department of Public Health shall be
29conducted in accordance with Section 100171.

30(e) For purposes of compliance with this chapter, an applicant
31is not required to have a physical place of business within the state.

32

begin deleteSEC. 9.end delete
33
begin insertSEC. 10.end insert  

Section 1409.3 of the Health and Safety Code is
34amended to read:

35

1409.3.  

(a) The licensee shall notify either or both licensing
36departments, as appropriate, within 10 days in writing when a
37change of stockholder owning 10 percent or more of the nonpublic
38corporate stock occurs. The writing shall include the name and
39principal mailing addresses of the new stockholder.

P9    1(b) When a change of agency manager occurs, either or both
2licensing departments, as appropriate, shall be notified in writing
3within 10 days by the licensee. The notification shall include the
4name of the new agency manager.

5(c) Each licensee shall notify either or both licensing
6departments, as appropriate, within 10 days in writing of any
7change of the mailing address of the licensee. The writing shall
8include the new mailing address of the licensee.

9(d) When a change occurs in the principal officer of a corporate
10licensee, chairperson, president, or general manager, either or both
11licensing departments, as appropriate, shall be notified within 10
12days in writing by the licensee. The writing shall include the name
13and principal business address of the officer.

14

begin deleteSEC. 10.end delete
15
begin insertSEC. 11.end insert  

Section 1409.4 is added to the Health and Safety
16Code
, to read:

17

1409.4.  

(a) Before referring a person to any facility, a licensee
18shall disclose all of the following to the person:

19(1) Whether the licensee has an agreement or contract with the
20facility to which the person is being referred.

21(2) Whether a commission or fee will be received by the licensee
22from the facility as a result of the referral.

23(3) Any gift or exchange of monetary value between the facility
24and the licensee that is in addition to, or in lieu of, a commission
25or fee.

26(4) Any fee charged to the person or persons by the licensee.
27The notice shall include a description of the services being rendered
28for that fee and the licensee’s refund policy.

29(5) The licensee’s contact information, including address and
30telephone number, and the licensee’s privacy policy. The privacy
31policy may be provided as an Internet Web site link consistent
32 with provisions set forth in Section 22575 of the Business and
33Professions Code.

34(6) The contact information, including address and telephone
35number, of the State Department of Social Services or State
36Department of Public Health, as appropriate, and the contact
37information for filing consumer complaints, including contact
38information for the local long-term care ombudsman. If the
39disclosure statement is provided electronically, the contact
P10   1information for each department and the local long-term care
2ombudsman may be provided as a hyperlink.

3(b) Contemporaneous with a referral, the licensee shall provide
4the person with the following information about the facility:

5(1) The date of the licensee’s most recent tour or visit to the
6facility, if any, verification that the facility is licensed and in good
7standing, and a hyperlink to, or copy of, the most recent evaluation
8report for the facility which the person is being referred, prepared
9pursuant to Section 1569.33 and published by the State Department
10of Social Services, if an evaluation report has been prepared in the
11previous 24 months.

12(2) Information regarding the facility and the services offered
13by the facility.

14(3) (A) Subject to the provisions of subdivision (m) of Section
151405, a suitability advisory, to be written on the disclosure form,
16or read aloud, as follows:

17“State law does not require that we determine whether facilities
18to which we refer you are suitable for you based upon your care
19and social needs, financial means, and location. We cannot and
20are not required to make this decision for you and yourbegin delete family.” end delete

21begin delete“We end deletebegin insertfamily. We end insertcannot be sure whether a facility has an opening
22or whether it is still available when you need it. You should contact
23the facility yourself to verify whether an opening is available.”

24(B) Nothing shall require a licensee who declares, pursuant to
25subdivision (m) of Section 1405, that the licensee will conduct a
26suitability determination of each person who seeks a referral from
27the licensee, to comply with the requirements of this paragraph.

28(c) (1) The disclosures and the suitability advisory, if provided,
29shall be dated and shall contain, in addition to the requirements of
30subdivisions (a) and (b), the name of the person being referred and
31the name of the employee making the referral.

32(2) If the disclosures are provided in written form, they shall be
33printed in 16-point bold type.

34(3) If the disclosures are provided electronically, they shall be
35provided in a manner that is consistent with provisions set forth
36in Title 2.5 (commencing with Section 1633.1) of Part 2 of Division
373 of the Civil Code, and shall be displayed on a secured Web page
38in a larger type than the surrounding text.

39(4) The licensing department may develop standard disclosure
40forms and a suitability advisory that conform to the requirements
P11   1of this section. Nothing in this paragraph precludes licensees from
2the ability to give disclosures orally, as set forth herein.

3(d) The licensee shall make the disclosures pursuant to
4subdivisions (a) and (b) in the same language in which the licensee
5negotiates any referral services with the person receiving services.

6(e) The disclosures shall be signed or otherwise acknowledged
7by the person being referred, or his or her conservator, guardian,
8authorized family member or other authorized representative,
9 attorney in fact, or agent under a power of attorney, stating that
10the disclosures required by this section were received. The
11acknowledgment shall be evidenced in one of the following ways:

12(1) The signature of the person being referred, or his or her
13conservator, guardian, authorized family member or other
14authorized representative, attorney in fact, or agent under a power
15of attorney on the document containing the required disclosures.

16(2) An electronic signature that is consistent with standards set
17forth in Title 2.5 (commencing with Section 1633.1) of Part 2 of
18Division 3 of the Civil Code and includes the date, time, and
19Internet provider address and displays the required disclosures.

20(3) A faxed confirmation that includes the date, time, and fax
21number and displays the required disclosures.

22(4) A telephonic, oral acknowledgment of the person being
23referred, or his or her conservator, guardian, authorized family
24member or other authorized representative, attorney in fact, or
25agent under power of attorney, which shall be recorded, with that
26person’s consent, consistent with Sections 632 and 632.7 of the
27Penal Code. This paragraph does not authorize an in-person oral
28acknowledgment.

29(f) Evidence of the dated disclosure acknowledgment shall be
30retained for a period of no less than three years.

31(g) (1) If the disclosures, or any other referral-related document,
32are provided electronically, the licensee shall provide a written
33copy, in 16-point bold type, to the person being referred, or his or
34her conservator, guardian, authorized family member or other
35authorized representative, attorney in fact, or agent under power
36of attorney following any referral. This written copy may be
37provided by fax, email, or other means of electronic
38communication, if appropriate.

P12   1(2) Recorded telephonic acknowledgments shall, upon request,
2be provided in a reasonably accessible format to the person being
3referred or the licensing department within five days of the request.

4(h) For the purposes of this section, the following terms have
5the following meaning:

6(1) “Facility” means a residential care facility for the elderly as
7set forth in Section 1569.2.

8(2) “Licensee” means a referral agency that is licensed pursuant
9to Section 1405.

10

begin deleteSEC. 11.end delete
11
begin insertSEC. 12.end insert  

Section 1409.5 is added to the Health and Safety
12Code
, to read:

13

1409.5.  

Owners, operators, and employees of a referral agency
14licensed pursuant to Section 1405 are mandated reporters of elder
15or dependent adult abuse pursuant to Section 15630 of the Welfare
16and Institutions Code.

17

begin deleteSEC. 12.end delete
18
begin insertSEC. 13.end insert  

Section 1409.6 is added to the Health and Safety
19Code
, to read:

20

1409.6.  

(a) It is unlawful for a licensee to share any personal
21information, including, but not limited to, the name, address, age,
22gender, or medical information of the person receiving services
23from the licensee, with any unauthorized person or third-party
24affiliate of the licensee, unless authorized pursuant to subdivision
25(b).

26(b) A referral agency that refers a person to any facility or
27facilities shall obtain from the person being referred, or his or her
28conservator, guardian, authorized family member or other
29authorized representative, attorney in fact, or agent under power
30of attorney, prior to making the referral, authorization allowing
31the referral agency to share the referred person’s personal
32information, as well as the name and a description of the care or
33services needed by the individual being referred, with a facility or
34facilities for purposes of the referral. The personal information, or
35other information shared, shall be limited to only that information
36which is necessary to complete the referral process. The
37authorization shall be obtained in either of the following ways:

38(1) As a separate authorization form that clearly discloses that
39the individual is consenting to the disclosure of his or her personal
40information to a facility or facilities for which they are being
P13   1referred. This authorization form shall include the name and
2location of the facility or facilities that may receive the personal
3information, and shall be executed in the manner described in
4 subdivision (e) of Section 1409.4.

5(2) As part of the disclosures required by Section 1409.4, if the
6acknowledgment required by subdivision (e) of Section 1409.4
7clearly indicates that the individual being referred, or his or her
8conservator, guardian, authorized family member or other
9authorized representative, attorney in fact, or agent under power
10of attorney, consents to the referral agency’s disclosure of his or
11her personal information to a facility or facilities for which he or
12she is being referred. The licensee shall provide to the individual
13being referred the name and location of the facility or facilities
14that will receive the personal information, as applicable.

15(c) The licensee shall not share the contact information of an
16individual who has not provided his or her authorization pursuant
17to subdivision (b).

18(d) For the purposes of this section, the following terms have
19the followingbegin delete meaning:end deletebegin insert meanings:end insert

20(1) “Facility” means a residential care facility for the elderly as
21set forth in Section 1569.2.

22(2) “Licensee” means a referral agency that is licensed pursuant
23to Section 1405.

24

begin deleteSEC. 13.end delete
25
begin insertSEC. 14.end insert  

Section 1409.7 is added to the Health and Safety
26Code
, to read:

27

1409.7.  

It is unlawful for a referral agency licensed pursuant
28to Section 1405 to hold any power of attorney for a person
29receiving placement referral services from that licensee, or to
30receive or hold a client’s property in any capacity.

31

begin deleteSEC. 14.end delete
32
begin insertSEC. 15.end insert  

Section 1409.8 is added to the Health and Safety
33Code
, to read:

34

1409.8.  

On and after July 1, 2017, all persons, associations, or
35corporations licensed pursuant to Section 1405 shall maintain
36liability insurance coverage in an amount of at least one million
37dollars ($1,000,000) per person occurrence and three million dollars
38($3,000,000) in the total annual aggregate, for negligent acts or
39omissions by the licensee.

P14   1

begin deleteSEC. 15.end delete
2
begin insertSEC. 16.end insert  

Section 1409.9 is added to the Health and Safety
3Code
, to read:

4

1409.9.  

A licensee shall display the licensee’s name and license
5number on all advertising, promotional or marketing material, and
6Internet Web sites paid for or operated by the licensee.

7

begin deleteSEC. 16.end delete
8
begin insertSEC. 17.end insert  

Section 1409.10 is added to the Health and Safety
9Code
, to read:

10

1409.10.  

(a) It is unlawful for a medical professional or
11employee of a government agency, hospital, or otherbegin delete healthcareend delete
12begin insert health careend insert institution, including, but not limited to, physicians,
13nurses, social workers, discharge planners, therapists, and geriatric
14care managers, to offer, provide, or accept a payment, rebate,
15refund, commission, preference, or discount, whether in the form
16of money or other consideration, as payment, compensation, or
17inducement for referring patients, clients, or customers to a facility.

18(b) For the purposes of this section, the following terms have
19the following meanings:

20(1) “Facility” means a residential care facility for the elderly as
21set forth in Section 1569.2.

22(2) “Licensee” means a referral agency that is licensed pursuant
23to Section 1405.

24

begin deleteSEC. 17.end delete
25
begin insertSEC. 18.end insert  

Section 1410 of the Health and Safety Code is
26amended to read:

27

1410.  

The licensing department may suspend or revoke a
28license issued under this chapter for violation of any provisions
29of this chapter or any rules and regulations promulgated hereunder.
30In addition, the licensing department shall assess a civil penalty
31in the amount of fees received by a licensee as a result of a
32violation of any provisions of this chapter or rules and regulations
33promulgated hereunder. Proceedings to suspend or revoke a license
34conducted by the State Department of Public Health shall be
35conducted pursuant to Section 100171.

36

begin deleteSEC. 18.end delete
37
begin insertSEC. 19.end insert  

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

39

15630.  

(a) All of the following persons are mandated reporters:

P15   1(1) A person who has assumed full or intermittent responsibility
2for the care or custody of an elder or dependent adult, whether or
3not he or she receives compensation, including administrators,
4supervisors, and any licensed staff of a public or private facility
5that provides care or services for elder or dependent adults.

6(2) An elder or dependent adult care custodian.

7(3) A health practitioner.

8(4) A clergy member.

9(5) An employee of a county adult protective services agency.

10(6) An employee of a local law enforcement agency.

11(7) An owner, operator, or employee of a referral agency
12licensed under Article 1 (commencing with Section 1400) of
13Chapter 2.3 of Division 2 of the Health and Safety Code.

14(b) (1) Any mandated reporter who, in his or her professional
15capacity, or within the scope of his or her employment, has
16observed or has knowledge of an incident that reasonably appears
17to be physical abuse, as defined in Section 15610.63, abandonment,
18abduction, isolation, financial abuse, or neglect, or is told by an
19elder or dependent adult that he or she has experienced behavior,
20including an act or omission, constituting physical abuse, as defined
21in Section 15610.63, abandonment, abduction, isolation, financial
22abuse, or neglect, or reasonably suspects that abuse, shall report
23the known or suspected instance of abuse by telephone or through
24a confidential Internet reporting tool, as authorized by Section
2515658, immediately or as soon as practicably possible. If reported
26by telephone, a written report shall be sent, or an Internet report
27shall be made through the confidential Internet reporting tool
28established in Section 15658, within two working days.

29(A) If the suspected or alleged abuse is physical abuse, as
30defined in Section 15610.63, and the abuse occurred in a long-term
31care facility, except a state mental health hospital or a state
32developmental center, the following shall occur:

33(i) If the suspected abuse results in serious bodily injury, a
34telephone report shall be made to the local law enforcement agency
35immediately, but also no later than within two hours of the
36mandated reporter observing, obtaining knowledge of, or
37suspecting the physical abuse, and a written report shall be made
38to the local ombudsman, the corresponding licensing agency, and
39the local law enforcement agency within two hours of the mandated
P16   1reporter observing, obtaining knowledge of, or suspecting the
2physical abuse.

3(ii) If the suspected abuse does not result in serious bodily injury,
4a telephone report shall be made to the local law enforcement
5agency within 24 hours of the mandated reporter observing,
6obtaining knowledge of, or suspecting the physical abuse, and a
7written report shall be made to the local ombudsman, the
8corresponding licensing agency, and the local law enforcement
9agency within 24 hours of the mandated reporter observing,
10obtaining knowledge of, or suspecting the physical abuse.

11(iii) When the suspected abuse is allegedly caused by a resident
12with a physician’s diagnosis of dementia, and there is no serious
13bodily injury, as reasonably determined by the mandated reporter,
14drawing upon his or her training or experience, the reporter shall
15report to the local ombudsman or law enforcement agency by
16telephone, immediately or as soon as practicably possible, and by
17written report, within 24 hours.

18(iv) When applicable, reports made pursuant to clauses (i) and
19(ii) shall be deemed to satisfy the reporting requirements of the
20federal Elder Justice Act of 2009, as set out in Subtitle H of the
21federal Patient Protection and Affordable Care Act (Public Law
22111-148), Section 1418.91 of the Health and Safety Code, and
23Section 72541 of Title 22 ofbegin insert theend insert California Code of Regulations.
24When a local law enforcement agency receives an initial report of
25suspected abuse in a long-term care facility pursuant to this
26subparagraph, the local law enforcement agency may coordinate
27efforts with the local ombudsman to provide the most immediate
28and appropriate response warranted to investigate the mandated
29report. The local ombudsman and local law enforcement agencies
30may collaborate to develop protocols to implement this
31subparagraph.

32(B) Notwithstanding the rulemaking provisions of Chapter 3.5
33(commencing with Section 11340) of Part 1 of Division 3 of Title
342 of the Government Code, or any other law, the department may
35implement subparagraph (A), in whole or in part, by means of
36all-county letters, provider bulletins, or other similar instructions
37without taking regulatory action.

38(C) If the suspected or alleged abuse is abuse other than physical
39abuse, and the abuse occurred in a long-term care facility, except
40a state mental health hospital or a state developmental center, a
P17   1telephone report and a written report shall be made to the local
2ombudsman or the local law enforcement agency.

3(D) With regard to abuse reported pursuant to subparagraph
4(C), the local ombudsman and the local law enforcement agency
5shall, as soon as practicable, except in the case of an emergency
6or pursuant to a report required to be made pursuant to clause (v),
7in which case these actions shall be taken immediately, do all of
8the following:

9(i) Report to the State Department of Public Health any case of
10known or suspected abuse occurring in a long-term health care
11facility, as defined in subdivision (a) of Section 1418 of the Health
12and Safety Code.

13(ii) Report to the State Department of Social Services any case
14of known or suspected abuse occurring in a residential care facility
15for the elderly, as defined in Section 1569.2 of the Health and
16Safety Code, or in an adult day program, as defined in paragraph
17(2) of subdivision (a) of Section 1502 of the Health and Safety
18Code.

19(iii) Report to the State Department of Public Health and the
20California Department of Aging any case of known or suspected
21abuse occurring in an adult day health care center, as defined in
22subdivision (b) of Section 1570.7 of the Health and Safety Code.

23(iv) Report to the Bureau of Medi-Cal Fraud and Elder Abuse
24any case of known or suspected criminal activity.

25(v) Report all cases of known or suspected physical abuse and
26financial abuse to the local district attorney’s office in the county
27where the abuse occurred.

28(E) (i) If the suspected or alleged abuse or neglect occurred in
29a state mental hospital or a state developmental center, and the
30suspected or alleged abuse or neglect resulted in any of the
31following incidents, a report shall be made immediately, but no
32later than within two hours of the mandated reporter observing,
33obtaining knowledge of, or suspecting abuse, to designated
34investigators of the State Department of State Hospitals or the
35State Department of Developmental Services, and also to the local
36law enforcement agency:

37(I) A death.

38(II) A sexual assault, as defined in Section 15610.63.

P18   1(III) An assault with a deadly weapon, as described in Section
2245 of the Penal Code, by a nonresident of the state mental hospital
3or state developmental center.

4(IV) An assault with force likely to produce great bodily injury,
5as described in Section 245 of the Penal Code.

6(V) An injury to the genitals when the cause of the injury is
7undetermined.

8(VI) A broken bone when the cause of the break is
9undetermined.

10(ii) All other reports of suspected or alleged abuse or neglect
11that occurred in a state mental hospital or a state developmental
12center shall be made immediately, but no later than within two
13hours of the mandated reporter observing, obtaining knowledge
14of, or suspecting abuse, to designated investigators of the State
15Department of State Hospitals or the State Department of
16Developmental Services, or to the local law enforcement agency.

17(iii) When a local law enforcement agency receives an initial
18report of suspected or alleged abuse or neglect in a state mental
19hospital or a state developmental center pursuant to clause (i), the
20local law enforcement agency shall coordinate efforts with the
21designated investigators of the State Department of State Hospitals
22or the State Department of Developmental Services to provide the
23most immediate and appropriate response warranted to investigate
24the mandated report. The designated investigators of the State
25Department of State Hospitals or the State Department of
26Developmental Services and local law enforcement agencies may
27collaborate to develop protocols to implement this clause.

28(iv) Except in an emergency, the local law enforcement agency
29shall, as soon as practicable, report any case of known or suspected
30criminal activity to the Bureau of Medi-Cal Fraud and Elder Abuse.

31(v) Notwithstanding any other law, a mandated reporter who is
32required to report pursuant to Section 4427.5 shall not be required
33to report under clause (i).

34(F) If the abuse has occurred in any place other than a long-term
35care facility, a state mental hospital, or a state developmental
36center, the report shall be made to the adult protective services
37agency or the local law enforcement agency.

38(2) (A) A mandated reporter who is a clergy member who
39acquires knowledge or reasonable suspicion of elder or dependent
40adult abuse during a penitential communication is not subject to
P19   1paragraph (1). For purposes of this subdivision, “penitential
2communication” means a communication that is intended to be in
3confidence, including, but not limited to, a sacramental confession
4made to a clergy member who, in the course of the discipline or
5practice of his or her church, denomination, or organization is
6authorized or accustomed to hear those communications and under
7the discipline tenets, customs, or practices of his or her church,
8denomination, or organization, has a duty to keep those
9communications secret.

10(B) This subdivision shall not be construed to modify or limit
11a clergy member’s duty to report known or suspected elder and
12dependent adult abuse if he or she is acting in the capacity of a
13care custodian, health practitioner, or employee of an adult
14protective services agency.

15(C) Notwithstanding any other provision in this section, a clergy
16member who is not regularly employed on either a full-time or
17part-time basis in a long-term care facility or does not have care
18or custody of an elder or dependent adult shall not be responsible
19for reporting abuse or neglect that is not reasonably observable or
20discernible to a reasonably prudent person having no specialized
21training or experience in elder or dependent care.

22(3) (A) A mandated reporter who is a physician and surgeon,
23a registered nurse, or a psychotherapist, as defined in Section 1010
24of the Evidence Code, shall not be required to report, pursuant to
25paragraph (1), an incident if all of the following conditions exist:

26(i) The mandated reporter has been told by an elder or dependent
27adult that he or she has experienced behavior constituting physical
28abuse, as defined in Section 15610.63, abandonment, abduction,
29isolation, financial abuse, or neglect.

30(ii) The mandated reporter is not aware of any independent
31evidence that corroborates the statement that the abuse has
32occurred.

33(iii) The elder or dependent adult has been diagnosed with a
34mental illness or dementia, or is the subject of a court-ordered
35conservatorship because of a mental illness or dementia.

36(iv) In the exercise of clinical judgment, the physician and
37surgeon, the registered nurse, or the psychotherapist, as defined
38in Section 1010 of the Evidence Code, reasonably believes that
39the abuse did not occur.

P20   1(B) This paragraph shall not be construed to impose upon
2mandated reporters a duty to investigate a known or suspected
3incident of abuse and shall not be construed to lessen or restrict
4any existing duty of mandated reporters.

5(4) (A) In a long-term care facility, a mandated reporter shall
6not be required to report as a suspected incident of abuse, as defined
7in Section 15610.07, an incident if all of the following conditions
8exist:

9(i) The mandated reporter is aware that there is a proper plan
10of care.

11(ii) The mandated reporter is aware that the plan of care was
12properly provided or executed.

13(iii) A physical, mental, or medical injury occurred as a result
14of care provided pursuant to clause (i) or (ii).

15(iv) The mandated reporter reasonably believes that the injury
16 was not the result of abuse.

17(B) This paragraph shall not be construed to require a mandated
18reporter to seek, nor to preclude a mandated reporter from seeking,
19information regarding a known or suspected incident of abuse prior
20to reporting. This paragraph shall apply only to those categories
21of mandated reporters that the State Department of Public Health
22determines, upon approval by the Bureau of Medi-Cal Fraud and
23Elder Abuse and the state long-term care ombudsman, have access
24to plans of care and have the training and experience necessary to
25determine whether the conditions specified in this section have
26been met.

27(c) (1) Any mandated reporter who has knowledge, or
28reasonably suspects, that types of elder or dependent adult abuse
29for which reports are not mandated have been inflicted upon an
30elder or dependent adult, or that his or her emotional well-being
31is endangered in any other way, may report the known or suspected
32instance of abuse.

33(2) If the suspected or alleged abuse occurred in a long-term
34care facility other than a state mental health hospital or a state
35developmental center, the report may be made to the long-term
36care ombudsman program. Except in an emergency, the local
37ombudsman shall report any case of known or suspected abuse to
38the State Department of Public Health and any case of known or
39suspected criminal activity to the Bureau of Medi-Cal Fraud and
40Elder Abuse, as soon as is practicable.

P21   1(3) If the suspected or alleged abuse occurred in a state mental
2health hospital or a state developmental center, the report may be
3made to the designated investigator of the State Department of
4State Hospitals or the State Department of Developmental Services
5or to a local law enforcement agency. Except in an emergency,
6the local law enforcement agency shall report any case of known
7or suspected criminal activity to the Bureau of Medi-Cal Fraud
8and Elder Abuse, as soon as is practicable.

9(4) If the suspected or alleged abuse occurred in a place other
10than a place described in paragraph (2) or (3), the report may be
11made to the county adult protective services agency.

12(5) If the conduct involves criminal activity not covered in
13subdivision (b), it may be immediately reported to the appropriate
14law enforcement agency.

15(d) If two or more mandated reporters are present and jointly
16have knowledge or reasonably suspect that types of abuse of an
17elder or a dependent adult for which a report is or is not mandated
18have occurred, and there is agreement among them, the telephone
19report or Internet report, as authorized by Section 15658, may be
20made by a member of the team selected by mutual agreement, and
21a single report may be made and signed by the selected member
22of the reporting team. Any member who has knowledge that the
23member designated to report has failed to do so shall thereafter
24make the report.

25(e) A telephone report or Internet report, as authorized by
26Section 15658, of a known or suspected instance of elder or
27dependent adult abuse shall include, if known, the name of the
28person making the report, the name and age of the elder or
29dependent adult, the present location of the elder or dependent
30adult, the names and addresses of family members or any other
31adult responsible for the elder’s or dependent adult’s care, the
32nature and extent of the elder’s or dependent adult’s condition, the
33date of the incident, and any other information, including
34information that led that person to suspect elder or dependent adult
35abuse, as requested by the agency receiving the report.

36(f) The reporting duties under this section are individual, and
37no supervisor or administrator shall impede or inhibit the reporting
38duties, and no person making the report shall be subject to any
39sanction for making the report. However, internal procedures to
40facilitate reporting, ensure confidentiality, and apprise supervisors
P22   1and administrators of reports may be established, provided they
2are not inconsistent with this chapter.

3(g) (1) Whenever this section requires a county adult protective
4services agency to report to a law enforcement agency, the law
5enforcement agency shall, immediately upon request, provide a
6copy of its investigative report concerning the reported matter to
7that county adult protective services agency.

8(2) Whenever this section requires a law enforcement agency
9to report to a county adult protective services agency, the county
10adult protective services agency shall, immediately upon request,
11provide to that law enforcement agency a copy of its investigative
12report concerning the reported matter.

13(3) The requirement to disclose investigative reports pursuant
14to this subdivision shall not include the disclosure of social services
15records or case files that are confidential, nor shall this subdivision
16be construed to allow disclosure of any reports or records if the
17disclosure would be prohibited by any other provision of state or
18federal law.

19(h) Failure to report, or impeding or inhibiting a report of,
20physical abuse, as defined in Section 15610.63, abandonment,
21abduction, isolation, financial abuse, or neglect of an elder or
22dependent adult, in violation of this section, is a misdemeanor,
23punishable by not more than six months inbegin delete theend deletebegin insert aend insert county jail, by a
24fine of not more than one thousand dollars ($1,000), or by both
25that fine and imprisonment. Any mandated reporter who willfully
26fails to report, or impedes or inhibits a report of, physical abuse,
27as defined in Section 15610.63, abandonment, abduction, isolation,
28financial abuse, or neglect of an elder or dependent adult, in
29violation of this section, if that abuse results in death or great bodily
30injury, shall be punished by not more than one year in a county
31jail, by a fine of not more than five thousand dollars ($5,000), or
32by both that fine and imprisonment. If a mandated reporter
33intentionally conceals his or her failure to report an incident known
34by the mandated reporter to be abuse or severe neglect under this
35section, the failure to report is a continuing offense until a law
36enforcement agency specified in paragraph (1) of subdivision (b)
37of Section 15630 discovers the offense.

38(i) For purposes of this section, “dependent adult” shall have
39the same meaning as in Section 15610.23.

P23   1

begin deleteSEC. 19.end delete
2
begin insertSEC. 20.end insert  

No reimbursement is required by this act pursuant to
3Section 6 of Article XIII B of the California Constitution because
4the only costs that may be incurred by a local agency or school
5district will be incurred because this act creates a new crime or
6infraction, eliminates a crime or infraction, or changes the penalty
7for a crime or infraction, within the meaning of Section 17556 of
8the Government Code, or changes the definition of a crime within
9the meaning of Section 6 of Article XIII B of the California
10Constitution.



O

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