CALTCM Medical Director Program Modules and Objectives

What is Long Term Care in California?

Learning Objectives, At the end of the module, participants should be able to:

  1. Summarize the major types of post-acute and long-term care facilities and agencies licensed in the state, and the major funding, inclusion, and exclusion characteristics of each. 
  2. Describe the long-term care landscape in California and how each type of facility fits into the continuum of care. 
  3. Analyze a case study of an individual who needs discharge from a skilled nursing facility and the levels of care eligible to them.

Understanding the Legislative Landscape in California

Learning Objectives, At the end of the module, participants should be able to:

  1. Describe how California laws and regulations impact our practice of PALTC medicine.
  2. Describe how California creates laws and regulations.
  3. Describe the history and implications of the California Certified Medical Director (CMD) requirement.
  4. Summarize and apply how select California regulations pertaining to Medical Directors and their responsibilities differ from federal regulations.
  5. Differentiate between laws and regulations.
  6. Track the process of California law and regulation creation.
  7. Identify two avenues where you might impact California PALTC policy.
  8. Differentiate between the state and federal regulatory bodies with oversight of skilled nursing facilities in California.
  9. Name at least four areas of the California code where regulations impacting long term care and medical directors can be found.  
  10. Describe the differences between a state and federal survey.
  11. Utilize your knowledge of the legal and regulatory framework to improve the care of the residents in your facility(ies). 

California Rules on Capacity and Surrogate Decision-Making

Learning Objectives, At the end of the module, participants should be able to:

  1. Decision-Making Capacity and Selection of Representative
    1. State California-specific laws about the components of decision-making capacity, how it can be assessed and by whom, and alternatives for residents who cannot make their own medical decisions.
    2. State the criteria for a surrogate decision-maker according to California law.
    3. Apply California law to case studies involving challenges encountered in assessing decision-making capacity and determining a surrogate.
  2. Conservatorships
    1. Outline at least three types of conservatorships, their relevance and the differences between them, then apply them to a case study.
  3. HSC 1418.8
    1. Describe some of the history of HSC 1418.8 ("Epple Law").
    2. Define the criteria to invoke this statute and the types of patients and decisions that require informed consent.
    3. Outline the process by which a facility would invoke the statute and utilize the Office of the Long-Term Care Patient Representative (OLTCPR).
    4. State the critical components of resident notification.
    5. Describe ongoing IDT processes related to resident care conferences.
    6. Describe administrative reporting requirements (i.e. California Patient Representative Information System, CAPRIS) for all unrepresented residents, regardless of whether Public Patient Representative (PPR) is involved.

California Regulations on Informed Consent

Learning Objectives, At the end of the module, participants should be able to:

  1. Describe how California differs from other states in requirements for informed consent for psychotropic (psychotherapeutic) medications and restraints.
  2. Determine whether a medication is considered a psychotropic and requires informed consent (obtained by the prescriber).
  3. Determine mandatory elements of informed consent for psychotropics and restraints.
  4. State requirements of HSC 1418.9 and when they apply to your residents.
  5. Describe the process by which you would obtain informed consent and how you can help standardize this process as medical director.
  6. Understand the criteria and process for emergency exceptions to informed consent.

California Prescribing Laws

Learning Objectives, At the end of the module, participants should be able to:

  1. Describe at least four California-specific regulations that impact prescribers.
  2. Describe required processes for Controlled Substance Utilization Review and Evaluation System (CURES) in post acute long term care (PALTC) facilities.
  3. Describe the California Immunization Registry (CAIR2) vaccination registry and what nursing home providers must do to comply with its mandates.
  4. Name three laws and their mandates that relate to diagnosis and treatment of Opioid Use disorder (OUD) and prevention of opioid overdose.

California Resident Rights

Learning Objectives, At the end of the module, participants should be able to:

  1. State three California specific rights for nursing home residents.
  2. Describe California specific regulations in regards to safeguarding residents’ personal belongings and response to theft or loss.
  3. Describe the resident rights in terms of Lesbian, Gay, Bisexual and Transgender (LGBT) assessment and care in California.

California Medical Director Responsibilities

Learning Objectives, At the end of the module, participants should be able to: 

  1. Describe the key elements of California’s requirement for medical director certification.
  2. Describe California law in terms of employee health and the role of the medical director.
  3. Describe at least four components of mandatory training in LGBT issues for PALTC providers and who must receive this training (including the medical director).
  4. Define credentialing and privileging and how they may apply to a skilled nursing facility and its providers.
  5. Define specific requirements for physician licensing in California that may impact credentialing and privileging.
  6. Delineate scope of practice of Advanced Practice Practitioners in California and how that translates to collaboration with physicians on regulatory required documentation both on admission and ongoing. 

Specialized California Laws That Impact Physicians and Medical Directors

Learning Objectives, At the end of the module, participants should be able to:

  1. Identify at least four California specific laws that do not mention the medical director, but have important information for medical directors in understanding how the LTC facility functions.
  2. Describe the requirement for an Infection Preventionist in California, including hours, training, and role.
  3. Name three required trainings for certified nursing assistants in California that are not required in other states, and that may benefit from physician review.
  4. State at least five critical elements of California standard admission agreements.
  5. Discuss the California-specific requirements for telemedicine, and how these could be applied in long-term care practice.
  6. Describe behavioral health services available through Medicaid/Medi-Cal impacting long-term care.
  7. Describe the California Advancing and Innovating Medi-Cal (CalAIM) program and at least three ways it may impact your long-term care practice. 

California Palliative Care, Hospice, Advance Care Planning, and End of Life

Learning Objectives, At the end of the module, participants should be able to:

  1. Describe Palliative Care as it relates to PALTC.
  2. Discuss indications for completion of a Physician Orders for Life-Sustaining Treatment (POLST) form, how to complete it, and the common errors made in its completion.
  3. Explain status of California POLST e-Registry.
  4. Name two special concerns of hospice in California.
  5. Describe the required patient population and steps to be compliant with the Compassionate Access to Medical Cannabis Act.
  6. Determine if and how your facility will be compliant with the End of Life Option Act if a resident requests Medical Aid in Dying (MAID) and understand your role as medical director.

Risk Management for Medical Directors

Learning Objectives, At the end of the module, participants should be able to:

  1. Discuss how California law and federal law differ on elder abuse/neglect reporting and what you might do to ensure proper abuse reporting in California.
  2. Review a standard policy on DMV reporting for SNF residents.
  3. Discuss considerations regarding hidden cameras in California nursing homes in relation to consent and admissibility.
  4. Describe the basic features of tort reform California MICRA and how that impacts long term care insurance premiums in California.
  5. Identify two extra provisions of CMIA compared to HIPAA.