ASSEMBLY, No. 1629

 

STATE OF NEW JERSEY

 

INTRODUCED MARCH 4, 1996

 

 

By Assemblymen O’TOOLE and KELLY

 

 

An Act concerning hospice care, amending P.L.1992, c.160 and supplementing Title 26 of the Revised Statutes.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. (New section) As used in this act:

    "Commissioner" means the Commissioner of Health.

    "Department" means the Department of Health.

    "Hospice care program" means a coordinated program of home, outpatient, and inpatient care and services that is operated by a person or public agency and that provides care and services to hospice patients and to hospice patients' families, through a medically directed interdisciplinary team, under interdisciplinary plans of care in order to meet the physical, psychological, social, spiritual, and other special needs that are experienced during the final stages of illness, dying, and bereavement. A hospice care program shall provide the following care and services:

     a. Nursing care by or under the supervision of a registered professional nurse;

    b. Physical, occupational, or speech or language therapy;

    c. Medical social services by a licensed social worker under the direction of a physician;

    d. Services of a home health aide;

    e. Medical supplies, including drugs and biologicals, and the use of medical appliances;

    f. Physician's services;

    g. Short-term inpatient care, including both palliative and respite care and procedures;

    h. Counseling for hospice patients and hospice patients' families;

    i. Services of volunteers under the direction of the provider of the hospice care program; and

    j. Bereavement services for hospice patients' families.

    "Hospice patient" means a patient who has been diagnosed as terminally ill, has an anticipated life expectancy of six months or less, and has voluntarily requested and is receiving care from a person or public agency licensed pursuant to this act to provide a hospice care program.

    "Hospice patient's family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

    "Interdisciplinary team" means a working unit composed of professional and lay persons that includes at least a physician, a registered professional nurse, a licensed social worker, a member of the clergy or a counselor, and a volunteer.

    "Palliative care" means treatment directed at controlling pain, relieving other symptoms, and focusing on the special needs of a hospice patient and the hospice patient's family as they experience the stress of the dying process rather than treatment aimed at investigation and intervention for the purpose of cure or prolongation of life.

    "Physician" means a person licensed to practice medicine and surgery pursuant to chapter 9 of Title 45 of the Revised Statutes.

    "Attending physician" means the physician identified by the hospice patient or the hospice patient's family as having primary responsibility for the hospice patient's medical care.

 

    2. (New section) a. A hospice care program shall not operate in this State unless it: possesses a valid license issued pursuant to this act; establishes and maintains a uniform system of cost accounting approved by the commissioner; and establishes and maintains a uniform system of reports and audits meeting the requirements of the commissioner.

    b. Application for a license for a hospice care program shall be made upon forms prescribed by the department. The department shall charge such nonrefundable fees for the filing of an application for a license and any renewal thereof, as it shall from time to time fix in regulations. The application shall contain the name of the hospice care program and such other information as the department may require.

    c. A license shall be issued by the department upon its finding that the premises, equipment, personnel, including principals and management, finances, rules and bylaws, and standards are fit and adequate and there is reasonable assurance the hospice care program will be operated in the manner required by this act.

    d. At the request of the commissioner, hospice care programs shall furnish to the department such reports and information as it may require to effectuate the purposes of this act, excluding confidential communications from patients.

    e. A nursing home licensed pursuant to the "Health Care Facilities Planning Act," P.L.1971, c.136 (C.26:2H-1 et seq.) that does not hold itself out to be a hospice, does not hold itself out as providing a hospice care program, does not use the term hospice to describe or refer to its activities or facilities, and does not provide all of the services enumerated in section 1 of this act is not subject to the licensing provisions of this act.

 

    3. (New section) a. A person or public agency licensed pursuant to section 2 of this act to provide a hospice care program shall:

    (1) Provide a planned and continuous hospice care program, the medical components of which shall be under the direction of a physician;

    (2) Ensure that care is available 24 hours a day, seven days a week;

    (3) Establish an interdisciplinary plan of care for each hospice patient and his family that:

    (a) Is coordinated by one designated individual who shall ensure that all components of the plan of care are addressed and implemented;

    (b) Addresses maintenance of patient-family participation in decision making; and

    (c) Is periodically reviewed by the patient's attending physician and by the patient's interdisciplinary team.

    (4) Have one or more interdisciplinary teams that provide or supervise the provision of care and establish the policies governing the provision of the care;

    (5) Not discontinue care because of a hospice patient's inability to pay for the care;

    (6) Maintain central clinical records on all hospice patients under its care; and

    (7) Provide care in individuals' homes, on an outpatient basis, and on a short-term inpatient basis.

    b. A provider of a hospice care program may arrange for another person or public agency to furnish components of the hospice care program pursuant to a written contract. When a provider of a hospice care program arranges for another person or public agency to furnish components of the hospice care program to its patient, the care shall be provided pursuant to a written contract under which:

    (1) The provider of a hospice care program furnishes to the contractor a copy of the hospice patient's interdisciplinary plan of care that is established under paragraph (3) of subsection a. of this section and specifies the care that is to be furnished by the contractor;

    (2) The regimen described in the established plan of care is continued while the hospice patient receives care from the contractor, subject to the patient's needs, and with approval of the coordinator of the interdisciplinary team designated pursuant to subparagraph (a) of paragraph (3) of subsection a. of this section;

    (3) All care, treatment, and services furnished by the contractor are entered into the hospice patient's medical records.

    (4) The designated coordinator of the interdisciplinary team ensures conformance with the established plan of care; and

    (5) A copy of the contractor's medical record and discharge summary is retained as part of the hospice patient's medical records.

    c. A hospital contracting for inpatient care shall be encouraged to offer temporary limited privileges to the hospice patient's attending physician while the hospice patient is receiving inpatient care from the hospital.

 

    4. (New section) a. In addition to authority granted to the department by this act or any other law, the department, after serving the licensee with specific charges in writing, may deny, place on probationary or provisional license, revoke or suspend any license granted under authority of this act to any person or public agency violating or failing to comply with the provisions of this act.

    b. Notice of the revocation, suspension, or denial of a license, or the placing on probationary or provisional license, together with a specification of charges, shall be served on the applicant or licensee, personally or sent by certified mail to the address of record. The revocation, suspension, or denial of a license, or the placing on probationary or provisional license shall become effective 30 days after mailing, unless the applicant or licensee, within the 30-day period, meets the requirements of the department or files with the department a written answer to the charges and gives written notice to the department of its desire for a hearing in which case the department's action may be held in abeyance until the hearing has been concluded and a final decision rendered.

    c. The department shall provide for a prompt hearing on the question of the revocation, suspension, or denial of a license, or the placing on probationary or provisional license. The procedure governing the hearings shall be in accordance with the rules and regulations of the department.

 

    5. (New section) a. A person or public agency who operates a hospice care program without first obtaining the license required by this act, or who operates a hospice care program after revocation or suspension of license, shall be liable to a penalty of not more than $1,000 as provided for by regulation for each day of operation in violation hereof for the first offense and for any subsequent offense.

    A person or public agency who violates any provision of this act as it pertains to the care of patients and physical plant standards shall be subject to a penalty of not more than $2,500 as provided for by regulation for each day in violation of this act. Upon notification to the hospice care program of such violations as pertain to the care of patients or to the hazardous or unsafe condition existing in or upon the structure in which the hospice care program is maintained, the commissioner shall allow the facility 72 hours in which to correct the violation and if at the end of the period the violation is not corrected and it poses an imminent threat to the health, safety or welfare of the public or of the patients, he may summarily suspend the license of the hospice care program without a hearing and may order immediate correction of the violation as a prerequisite of reinstatement of licensure. A licensee that is subject to summary suspension shall have the right to apply to the commissioner for a hearing. The hearing shall be held and a decision rendered within 48 hours of receipt of the request. If the commissioner rules against the licensee, the licensee has the right to apply for injunctive relief against the commissioner's order. Jurisdiction of the injunctive relief shall be in the Superior Court of New Jersey. Nothing herein shall be construed to prevent the commissioner from thereafter suspending or revoking the license in accordance with the procedure set forth in this act. If, within one year after the violation, the person or public agency is found guilty of the same violation, the penalties set forth in this section shall be doubled, and if there is a third violation within such time, the penalties shall be tripled.

    b. The penalties provided for in this section shall be recovered in a summary civil proceeding, brought in the name of the State in the Superior Court pursuant to "the penalty enforcement law," N.J.S.2A:58-1 et seq.

    c. The commissioner may accept from any licensee an offer in compromise in such amount as may, in his judgment, be proper under the circumstances in lieu of suspension of a license. In no case shall the penalty be compromised for a sum less than $250 for the first offense and $500 for the second and each subsequent offense.

    d. The department may maintain an action in the name of the State to enjoin any person or public agency from continuing to conduct, manage or operate a hospice care program without a license, or after suspension or revocation of a license, or in violation of rules and regulations promulgated hereunder.

 

    6. (New section) a. There is established the Hospice Care Programs Advisory Board. The advisory board shall consist of 11 members, including the commissioner, or his designee, who shall serve as a nonvoting, ex officio member. The 10 public members shall be residents of this State and shall be appointed by the Governor, with the advice and consent of the Senate. The public members of the advisory council shall include: two persons experienced in hospice care programs; one physician with clinical experience in oncology or terminal illnesses; one registered professional nurse; one recognized member of the clergy; one person with experience in the area of hospital administration; one person with experience with health insurance; one person with experience in the administration of a home health agency; one licensed social worker; and one person with experience in long-term care administration.

    b. The term of office of each public member shall be three years, but of the members first appointed, three shall be appointed for a term of one year, three shall be appointed for a term of two years and four shall be appointed for a term of three years. A member shall hold office for the term of his appointment and until his successor has been appointed and qualified. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. A member of the advisory board is eligible for reappointment.

    c. The public members of the advisory board shall not receive any compensation for their services, but shall be reimbursed for the actual and necessary expenses incurred in the performance of their duties as members of the advisory board, within the limits of funds available to the advisory board.

    d. The members shall annually elect a chairman and a vice-chairman from among the public members and may select a secretary, who need not be a member of the advisory board.

    e. A majority of the members of the advisory board shall constitute a quorum for the transaction of business at any meeting.

    f. The department shall provide such staff and assistance as the advisory board requires to carry out its work.

 

    7. (New section) The commissioner, in consultation with the Hospice Care Programs Advisory Board, shall promulgate rules in accordance with the "Administrative Procedure Act, "P.L.1968, c.410 (C.52:14B-1 et seq.) to effectuate the provisions of this act, including but not limited to: (1) establishing standards and procedures relating to the licensing of hospice care programs and the suspension and revocation of licenses; (2) establishing license fees and renewal fees for hospice care programs; and (3) providing for the granting of licenses to hospice care programs to persons and public agencies that are accredited or certified to provide hospice care programs by an entity whose standards for accreditation or certification equal or exceed those provided for licensure under this act.

 

    8. Section 19 of P.L.1992, c.160 (C.26:2H-7a) is amended to read as follows:

    19. Notwithstanding the provisions of section 7 of P.L.1971, c.136 (C.26:2H-7) to the contrary, the following are exempt from the certificate of need requirement:

    Community-based primary care centers;

    Outpatient drug and alcohol services;

    Ambulance and invalid coach services;

    Mental health services which are non-bed related outpatient services;

    Changes in residential health care facility services;

    Mandatory renovations to existing facilities;

    Mandatory replacement of fixed or moveable equipment;

    Transfer of ownership interest except in the case of an acute care hospital, or a long-term care facility in which the owner does not satisfy the Department of Health's review of the owner's prior operating experience as well as any requirements established by the federal government pursuant to Titles XVIII and XIX of the Social Security Act;

    Change of site for approved certificate of need within the same county;

    Relocation or replacement of a health care facility within the same county, except for an acute care hospital;

    Continuing care retirement communities authorized pursuant to P.L.1986, c.103 (C.52:27D-330 et seq.);

    Acquisition by a hospital of a magnetic resonance imager that is already in operation in the State by another health care provider or entity;

    Adult day health care facilities;

    Pediatric day health care facilities; [and]

    Chronic renal dialysis facilities ; and

    Hospice care programs licensed pursuant to section 2 of P.L. , c. (C. )(pending before the Legislature as this bill).

(cf: P.L.1992, c.160, s.19)

 

    9. This act shall take effect 90 days after the date of enactment.

 

 

STATEMENT

 

    This bill establishes a licensing program in the Department of Health for hospice care programs. A "hospice care program" is defined as a coordinated program of home, outpatient, and inpatient care and services that provides care and services to meet the physical, psychological, social, spiritual, and other special needs that are experienced during the final stages of illness, dying, and bereavement. A hospice care program will be required to provide the following care and services: nursing care; physical, occupational, or speech or language therapy; medical social services; home health aide services; medical supplies and the use of medical appliances; physician's services; short-term inpatient care; counseling services; services of volunteers; and bereavement services.

    Pursuant to the bill, a hospice care program will not be permitted to operate without a valid license from the department. The department has the authority to issue or deny a license, place on probationary or provisional license, or revoke or suspend any license of a person or public agency who violates or fails to comply with the provisions of this bill. In addition, the department may impose monetary penalties on hospice care programs that operate without first obtaining a license, that operate a hospice care program after revocation or suspension of a license, or that violate any provision of this act as it pertains to the care of the patient and the physical plant standards.

    The bill also establishes a Hospice Care Programs Advisory Board which will advise the Commissioner of Health in promulgating rules and regulations to effectuate the purposes of the bill.

    In addition, the bill specifically exempts hospice care programs from the certificate of need requirement.

 

 

 

Establishes a licensing program for hospice care programs.