Report 2021-123 Recommendation 1 Responses

Report 2021-123: California Hospice Licensure and Oversight: The State's Weak Oversight of Hospice Agencies Has Created Opportunities for Large-Scale Fraud and Abuse (Release Date: March 2022)

Recommendation #1 To: Public Health, Department of

Until such time as the Legislature authorizes Public Health to issue the emergency regulations described above, Public Health should pursue its standard regulatory authority to address these issues.

Annual Follow-Up Agency Response From September 2024

Public Health's development of emergency hospice regulations is in the late stages and we are on track to promulgate them by the legislatively mandated due date of January 1, 2025. Public Health has convened four public stakeholder meetings to solicit feedback on regulatory issues: July 27, 2022, March 14, 2023, November 8, 2023, and March 1, 2024. Stakeholders analyzed and commented on the regulations and Public Health incorporated stakeholders' recommendations where appropriate. Subject matter experts also reviewed the draft regulations to ensure they addressed the 2022 audit report findings and recommendations, and the Legislature's associated requirements. Public Health completed the initial drafting of the regulation package, and internal reviews and approvals started the week of August 5, 2024.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From September 2023

Public Health is continuing to develop emergency hospice regulations since the Governor signed AB 2673 into law on September 29, 2022. The regulations are being developed to incorporate the recommendations from the State Auditor's report that are within Public Health's authority to regulate, implement AB 2673, and address stakeholder feedback from public stakeholder meetings held on July 27, 2022, and March 14, 2023.

Additionally, Public Health has convened and continues to work with an internal workgroup made up of Department subject matter experts with a variety of expertise in Public Health on the development of the hospice regulations. Public Health has made substantial progress in developing the regulations and intends to promulgate them by the statutory deadline of January 1, 2024.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

Public Health is developing emergency hospice regulations. The regulations are being developed to incorporate the recommendations from the State Auditor's report, implement AB 2673, and address stakeholder feedback from a public stakeholder meeting that was held on July 27, 2022. Additionally, Public Health will be convening another stakeholder meeting on March 14, 2023, to solicit additional input on the emergency regulations. In addition to soliciting stakeholder input, Public Health is convening an internal workgroup made up of Department subject matter experts to bolster the development of emergency hospice regulations.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

Public Health is continuing its development of hospice regulations. Public Health convened a public stakeholder meeting on Wednesday, July 27, 2022, to solicit feedback on regulatory issues. The meeting was attended by 71 participants, including the California Association for Health Services at Home (CAHSAH) and the California Hospice and Palliative Care Association (CHAPCA). The questions posed to stakeholders centered around the eight components of the State Auditor's recommendation listed above. Stakeholders have until August 27th to submit their final written comments to Public Health. Once the public comment period has closed, Public Health will begin analyzing the comments received and will incorporate the stakeholder comments in the regulations under development. Additionally, Public Health notes that the Legislature is currently considering AB 2673, which addresses many of the issues raised in the audit report, including a requirement that Public Health develop emergency regulations. The outcome of this legislation will influence the content of the regulations under development.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Public Health is currently developing regulations in accordance with the State Auditor's recommendations and anticipates scheduling a stakeholder engagement meeting within the next three months. The regulations will include time and distance standards, guidelines for assessing patient to nurse ratios, a limit to the number of hospice agencies that hospice management personnel can be involved with concurrently, and requirements for hospice management personnel to have hospice-specific training or experience.

Additionally, as part of the initial hospice application review, the Centralized Applications Branch (CAB) will update the application form HS 215A - Applicant Individual Information, to request the individual's phone number and CA driver's license, in addition to requesting the Social Security Number (SSN). CAB will also update its procedures to include contacting the hospice management personnel by phone to verify the employment information contained in the HS 215A/resume and conduct an Entity Search in the Electronic Licensing Management System to validate the employment history with other providers licensed by CDPH.

Legislation will be required to deny a hospice license application for disciplinary action related to a medical director's professional license that is still current and active. The grounds for denying a license are specified in statute.

Public Health will conduct stakeholder engagement to determine the appropriate content for the regulations based on the recommendation for space and verification that the hospice is ready to provide care.

Finally, Public Health will develop policies and procedures to include relicensing visits to verify compliance with the hospice standards and once adopted, will verify compliance with regulatory requirements.

California State Auditor's Assessment of 60-Day Status: Pending

We look forward to reviewing Public Health's progress in its next response. However, we disagree with Public Health's statement that our recommendation related to denying a hospice application for certain disciplinary actions imposed on its medical professionals may require legislation. The Licensure Act gives Public Health the authority to establish rules and regulations as may be necessary or proper to exercise its powers and perform its licensure duties. As we stated in our report, Public Health has had the authority to issue regulations since 1991 but has failed to do so.

All Recommendations in 2021-123

Agency responses received are posted verbatim.