Table of Contents
- Skilled Nursing Facility
- Skilled Nursing Facility—Licensing Only
- Skilled Nursing Facility/Intermediate Care Facility
- General Acute Care Hospitals
- Congregate Living Health Facility
- Chemical Dependency Recovery Hospitals
- Acute Psychiatric Hospitals Accredited (JCAH) and Nonaccredited
- Home Health Agencies
- Licensed Hospice
- Intermediate Care/Developmentally Disabled
- Intermediate Care/Developmentally Disabled-Habilitative
- Intermediate Care/Developmentally Disabled-Nursing
1. Skilled Nursing Facility
A SNF means a health facility or a distinct part of a hospital which provides continuous skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. This 24-hour inpatient care includes, as a minimum, physician, skilled nursing, dietary, pharmaceutical services, and an activity program.
The format for Long-Term Care Surveys is based on a new survey procedure implemented by HCFA in 1986.
Part A of the Long-Term Care Surveys report is used for initial surveys only with some exceptions for SNFs and/or ICFs.
(A) A “freestanding” SNF.
(B) SNF—“Distinct Part” (DP). DP means an identifiable unit of a GACH accommodating beds including but not limited to contiguous rooms, a wing, floor, or building that is approved by the Department for a specific purpose.
(C) SNF Optional Services defined as a functional unit of a SNF
which is organized, staffed, and equipped to provide a
specific type or types of patient care, may be on an in or outpatient basis, and include physical therapy, speech therapy, occupational therapy, speech pathology, audiology, social work services, and special treatment program services. These services are not mandatory, but if a facility provides one or more of these services, application much be made to the Department. When approval is granted it is reflected on the facility’s license (CCR, Title 22, Division 5, Chapter 3, Article 4, Sections 72401-72441).
(D) SNF/Special Treatment Program (STP) means a program implemented for the purpose of meeting the special treatment needs of an identified population with mental illness.
STPs require annual program approval by the Department of Mental Health. SNF/STPs are subject to licensing requirements and Division 5, Chapter 3, Article 4, Sections 72443-72475.
2. Skilled Nursing Facility—Licensing Only
SNFs that have not requested certification as providers under the Title XVIII-XIX reimbursement programs are surveyed as licensing only SNFs. The survey visit is conducted by HFENs and HFEs to determine compliance with licensing regulations contained in the CCR, Title 22, Division 5, Chapter 3, commencing with Sections 72001 through 72713.
This category of facility is surveyed at least once every two years. When class “AA”, “A”, or “B” citations have been issued within the past 12 months, the facility must be surveyed annually.
3. Skilled Nursing Facility/Intermediate Care Facility
Skilled nursing facilities that are certified additionally as providers of intermediate care provide inpatient care to patients who have need for skilled nursing supervision and need supportive care, but who do not require continuous nursing care. The ICF unit may be a distinct part of a SNF or general acute care hospital. This means that it is an identifiable unit approved by the Department (CCR, Title 22, Division 5, Chapter 4, Article 1, section 73037).
4. General Acute Care Hospitals
Consolidated Accreditation and Licensure Surveys (CALs)
GACHs in California that apply for, and receive Joint Commission Accreditation are surveyed CALS program. This program was developed in 1975 pursuant to Section 1282 of Chapter 1202 of the California H&S Code. Three parties-the JCAH, California Medical Association (CMA), and the California State DHS-conduct these surveys jointly utilizing specific operational procedures, protocols, and Title 22, CCR, Division 5, Chapter 1, Sections 70001-70865.
The Federal Social Security Act provides that hospitals which receive accreditation from JCAH have “deemed status” and are presumed to meet the requirements for certification in the Medicare/Medi-Cal programs.
All GACHs in California are mandated to have the CALS or to apply to the Department for the “state only” survey under terms stipulated in Article I, Section 3(A), of the CALS contract. Applications for surveys are sent to all accredited GACHs.
Unless the facility applies, in writing to the Department for exception to the CALS, and receives a written confirmation of this request for “state only” survey, the facility must, within 90 days of receipt of an application, return the completed application to the JCAHs.
The surveys are conducted once every three years and are announced visits. The hospitals are normally informed four to six weeks in advance of the scheduled survey. This schedule is published quarterly with copies distributed to the individual district office of Licensing and Certification by CMA.
A limited number of GACHs throughout the State are not accredited by the JCAH. They are not surveyed utilizing the CALS process.
Hospitals that are not accredited by JCAH do not have “deemed status” (assumed to meet the requirements for certification in the Medicare/Medicaid programs), therefore, they are surveyed using the Federal Medicare/Medicaid requirements for certification. The federal requirements for certification are found in 42 CFR, Subpart J, Sections 482.1-482.66. Licensing requirements are found in Section 1250, H&S Code and Title 22, Division 5, Chapter 1, Sections 70001-70865, CCR.
These hospitals must be surveyed annually, and are unannounced.
The minimum survey staff required to conduct these surveys include a physician consultant (if more than 100 beds), HFEN, and HFE. It may be necessary at times to include certain other consultants to conduct surveys.
5. Congregate Living Health Facility
Congregate Living Health Facilities (CLHFs) are defined in H&S Code, Section 1250(i) (1), as a residential home with a capacity of no more than six beds, which provides inpatient care, including the following basic services: medical supervision, 24-hour skilled nursing and supportive care, pharmacy, dietary, social recreational, and at least one type of service specified in paragraph (2). The primary need of CLHF residents shall be for availability of skilled nursing care on a recurring, intermittent, extended, or continuous basis. The care is generally less intense than that provided in general acute care hospitals but more intense than that provided in skilled nursing facilities.
(a) a facility operated by a city and county for the purposes of delivering services under this section; may have a capacity of 59 beds (NOTE: This applies only to San Francisco).
(b) a facility not operated by a city and county serving persons who are terminally ill, persons who have been diagnosed with a life-threatening illness, or both, which is located in a county with a population of 500,000 or more; may have not more than 25 beds, for the purpose of serving terminally ill persons.
(c) a facility not operated by a city and count serving persons who are catastrophically and severely disabled which is located in a county of 500,000 or more; may not have more than 12 beds.
(2) Congregate living health facilities provide one of the following services:
CLHF (A)- - -Services to persons who are mentally alert, physically disabled, who may be ventilator dependent,
CLHF (B)- - -Services for persons who have a diagnosis of a terminal illness, a diagnosis of a life-threatening illness, or both. Terminal illness means the individual has a life expectancy of six months or less as stated in writing by his/her attending physician and surgeon. A “life-threatening illness” means the individual has an illness that can lead to a possibility of a termination of life within five years or less as stated in writing by his or her attending physician and surgeon.
CLHF (C)- - -Services for persons who are catastrophically and severely disabled. A catastrophically and severely disabled person means a person whose origin of disability was acquired through trauma or non-degenerative neurologic illness, for whom it has been determined that active rehabilitation would be beneficial and for whom these services would be provided. Services offered by a CLHF to a catastrophically disabled person shall include, but not be limited to, speech, physical, and occupational therapy.
CLHF standards are found in H&S Code, Section 1267.13. In addition to these standards, CLHFs are required to conform to CCR, Title 22, skilled nursing regulations, except for those sections or portions of sections specified in H&S Code, Section 1267.13(n). (These requirements in subsection 1267.13(n) are so specific to skilled nursing facilities, CLHFs were exempted from compliance with these sections.)
6. Chemical Dependency Recovery Hospitals
Chemical Dependency Recovery Hospitals (CDRHs) include freestanding Chemical Dependency Recovery Hospitals, APH, and GACH that provide chemical dependency recovery (CDR) services in general acute care service units.
General acute care and APHs which provide CDR services are surveyed every three years. Freestanding CDRH facilities are surveyed every two years. Each of these surveys is announced. The surveys are conducted by HFENs and HFEs.
7. Acute Psychiatric Hospitals Accredited (JCAH) and Nonaccredited
An APH as defined in the H&S Code, Section 1250 means a hospital having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the W & I Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
8. Home Health Agencies
An HHA is a public agency or private organization, or a subdivision of any such agency or organization, which is primarily engaged in providing skilled nursing services and other therapeutic services to persons in the home on a part-time or intermittent basis under a plan of treatment prescribed by the attending physician.
HHAs may be freestanding or hospital based and must be separately licensed. The deemed status of CALS (assumed to meet the Federal Title XVIII and Title XIX requirements for certification) does not include the home care.
9. Licensed Hospice
A hospice is defined in the hospice standards as “a specialized form of multidisciplinary health care which is designed to provide palliative care, and 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.” The goal of hospice, as stated in this definition, is to “provide supportive care to the primary care giver and the family of the hospice patient...” Hospice care must meet specified criteria stated in the standards.
In order for a hospice to be licensed, it must meet the definition of a hospice, and provide, or make provision for, the following required services:
- Skilled nursing services
- Social services/counseling services
- Medical direction
- Bereavement services
- Volunteer services
- In-patient care arrangements
10. Intermediate Care/Developmentally Disabled
An ICF/DD is a facility which provides 24-hour care, habilitation, developmental and supportive health services to developmentally disabled clients whose primary need is for developmental services, and who have a recurring but intermittent needs for skills nursing services.
Some facilities throughout the State are licensed as SNFs but are certified as IDFs/DD and subject to state regulations for developmentally disabled. Any SNF providing care for the developmentally disabled which met certain criteria as of September 27, 1978, was allowed this exemption under H&S code, Section 1253.1. Upon a change of ownership the facility must make a decision to either be licensed as SNF or ICF/DD. In addition, some SNFs have a distinct part ICF/DD. (Distinct part is an identified wing, section, area, or location with a specified number of licensed beds).
11. Intermediate Care/Developmentally Disabled-Habilitative
An ICF/DD-H means a facility with a capacity of 4 to 15 beds which provides 24-hour care, habilitation, developmental, and supportive health services to 15 or fewer developmentally disabled persons who have intermittent recurring needs for nursing services, but have been certified by a physician as not requiring availability of continuous skilled nursing care.
The federal requirements for certification are found in the 42 CFR, Subpart D, Section 483-400. The same certification standards do not distinguish between large and small facilities, with the exception regarding fire protection (Fire Safety Code).
12. Intermediate Care/Developmentally Disabled-Nursing
An ICF/DD-N is a facility with a capacity of four to six beds which provides personal care, developmental services, and nursing supervision for developmentally disabled persons. These persons have intermittent recurring needs for skilled nursing care but have been certified by a physician as not requiring continuous skilled nursing care. This type of facility serves medically fragile persons who have developmental disabilities or demonstrate significant developmental delay that may lead to a developmental disability if not treated.
ICF/DD-N clients are most often children with multiple medical problems resulting in severe impaired development. Their medical conditions require access to ongoing nursing supervision and assistance in such activities as “tracheotomy care, tracheal or oral sectioning, naso-gastric tube feeding, or gastrectomy feeding. In addition, these clients require assistance and training in most areas of personal care and development.