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California Increases Hospitals’ Obligations When Discharging Homeless Patients

California health care facilities have struggled with the appropriate discharge of homeless patients for years. In Los Angeles alone, the LA City Attorney's Office has in recent years initiated numerous lawsuits against hospitals and nursing facilities for homeless patient “dumping” – a practice generally described as discharging homeless persons without regard to their safety or ability to find shelter.

At least eight of these lawsuits have settled, with settlement amounts ranging from $75,000 dollars to $1 million dollars, and totaling $4 million dollars.

To further address homeless patient dumping, Governor Jerry Brown signed SB 1152 into law on September 30, 2018, amending the discharge planning requirements found in Health and Safety Code Section 1262.5. The amendments, which will be enacted in two stages, require hospitals to implement specific discharge planning procedures and activities for homeless patients.

Stage One—Here and Now:

Effective January 1, 2019, hospitals must establish a written homeless patient discharge planning policy that requires a hospital to:

  • Inquire about a homeless patient’s housing status during the discharge planning process;
  • Establish a discharge plan that assists a homeless patient to prepare his or her return to the community by connecting him or her with available community resources, treatment, or shelter;
  • Identify a post-discharge destination for the homeless patient that meets certain requirements identified in the statute; and
  • Provide discharge or transfer information to the homeless patient in a culturally competent manner and in a language understood by the patient.

Hospitals are also required to document the following prior to discharging a homeless patient:

  • The treating physician has determined the homeless patient’s clinical stability for discharge and has communicated post-discharge medical needs to the homeless patient;
  • The treating physician has provided a medical screening examination and evaluation and, if needed, a referral for follow-up behavioral health care. The hospital also has to make a good faith effort to contact the patient’s health plan, primary care provider, or another appropriate provider, if any are applicable; and
  • That the homeless patient has:
    • been offered a meal, unless medically indicated otherwise;
    • adequate clothing, otherwise the hospital must furnish weather-appropriate clothing;
    • been referred to a source of follow-up care, if medically necessary;
    • been provided a prescription, if needed, as well as an appropriate supply of all necessary medication if the hospital has an onsite pharmacy that can dispense outpatient medicine;
    • been offered or referred to screening for infectious disease common to the region;
    • been offered vaccinations appropriate for his or her medical condition;
    • been screened for and provided assistance to enroll in eligible health insurance coverage; and
    • been offered transportation within 30 minutes or 30 miles of the hospital after discharge to a pre-designated destination.

Stage Two—Looking Forward:

Starting July 1, 2019, hospitals must develop and annually update a written plan for coordinating services and referrals for homeless patients with county agencies. This includes developing a list of homeless shelters, creating procedures for homeless patient discharge referrals, compiling contact information for homeless shelters intake coordinators, and establishing training protocols for discharge planning staff. Hospitals must also maintain a log of homeless patients discharged and the destinations to which they were released after discharge.

Notably, these amendments have not changed preexisting hospital obligations under Health and Safety Code Section 1262.5, but only add specific provisions relating to the discharge of homeless patients. Additionally, the Legislature made clear in the statute that nothing in the law limits the ability of local governments to adopt stronger protections for homeless patients.

The Legislature did not allocate additional funds to hospitals to cover the resources they will have to spend to comply with the new requirements, nor does the law take into account the disproportionate financial effect the law will have on hospitals serving communities with higher rates of homelessness. So, as 2018 comes to an end and we bring in the new year, hospitals should begin preparing their discharge policies – and their budgets – to comply with these new requirements and any additional local obligations.

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