BILL NUMBER: SB 1845 CHAPTERED 09/27/04 CHAPTER 797 FILED WITH SECRETARY OF STATE SEPTEMBER 27, 2004 APPROVED BY GOVERNOR SEPTEMBER 27, 2004 PASSED THE SENATE AUGUST 28, 2004 PASSED THE ASSEMBLY AUGUST 28, 2004 AMENDED IN ASSEMBLY AUGUST 23, 2004 AMENDED IN SENATE MAY 24, 2004 AMENDED IN SENATE APRIL 20, 2004 INTRODUCED BY Senators Perata, Alpert, and Romero (Coauthor: Senator Kuehl) (Coauthors: Assembly Members Bates, Koretz, and Lieber) FEBRUARY 20, 2004 An act to amend Sections 14526, 14552, 14573, and 14574.1 of, and to add Section 14552.2 to, the Welfare and Institutions Code, relating to adult day health care. LEGISLATIVE COUNSEL'S DIGEST SB 1845, Perata. Adult day health care. The California Adult Day Health Care Act provides for the licensure and regulation of adult day health care centers, with administrative responsibility for this program shared between the State Department of Health Services and the California Department of Aging. The Adult Day Health Medi-Cal Law establishes adult day health care services as a Medi-Cal benefit for Medi-Cal beneficiaries who meet certain criteria. The bill would revise the Adult Day Health Medi-Cal Law, including revising designated Medi-Cal certification standards, including, but not limited to standards relating to the facility program plan, deleting the requirement that an adult day health care provider provide services only to those participants living within its service area, and deleting the requirement that the State Department of Health Services conduct reviews prior to approving renewal of Medi-Cal certification. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 14526 of the Welfare and Institutions Code is amended to read: 14526. Participation in an adult day health care program shall require prior authorization by the department. The authorization request shall be initiated by the provider and shall include the results of the assessment screening conducted by the provider's multidisciplinary team and the resulting individualized plan of care. Participation shall begin upon application by the prospective participant or upon referral from community or health agencies, or the physician, hospital, family, or friends of a potential participant. SEC. 2. Section 14552 of the Welfare and Institutions Code is amended to read: 14552. In order to obtain certification as a provider of adult day health care under this chapter and Chapter 7 (commencing with Section 14000), the following standards shall be met: (a) The provider shall have met all other requirements of licensure as an adult day health care center pursuant to Chapter 3.3 (commencing with Section 1570) of Division 2 of the Health and Safety Code. (b) The provider shall comply with requirements of this chapter regarding program and scope of services. (c) The provider shall have appropriate licensed personnel. (d) The provider shall employ required personnel for furnishing of required services pursuant to Section 14550 consistent with commonly accepted professional standards. (e) The provider shall afford to each participant all rights, including the right to be free from harm and abuse, identified in the rules and regulations adopted pursuant to Section 1580 of the Health and Safety Code. (f) A provider serving a substantial number of participants of a particular racial or ethnic group, or participants whose primary language is not English, shall employ staff who can meet the cultural and linguistic needs of the participant population. (g) A provider shall have organizational and administrative capacity to provide services under the provisions of this chapter. SEC. 3. Section 14552.2 is added to the Welfare and Institutions Code, to read: 14552.2. (a) "Program plan" means a written description of the adult day health care center's philosophy, objectives, and processes for providing required services to the participant populations. (b) The program plan shall include any of the following elements, as requested by the California Department of Aging, and shall be submitted as required in Section 14574.1: (1) The total number of participants the center proposes to serve, or currently serves, daily. (2) A profile of the participant population the center proposes to serve, or currently serves, that includes a description of the specific medical, social, and other needs of each population. (3) A description of the specific program elements and services that addresses the medical, social, and other needs of each participant population that the center proposes to serve, or currently serves, as specified in paragraph (2). "Program elements" means the components of an adult day health care program, as specified in Section 14550. (4) A description of the specialized professional and program staff that will provide, or currently provide, the adult day health care center's program services, as specified in paragraph (3), and that staff's responsibilities. The plan shall demonstrate that the adult day health care center is organized and staffed to carry out the requirements as specified in the regulations adopted pursuant to Section 1580 of the Health and Safety Code. (5) An in-service training plan for each center staff member to commence within the first six months of employment. The training plan shall address, at a minimum, the specific medical, social, and other needs of each participant population the center proposes to serve, as specified in paragraph (2). (6) A sample individual plan of care for each specialty population the adult day health care center proposes to serve, or currently serves, and a sample of a one-week schedule of daily program services for each sample individual plan of care. The individual plan of care shall demonstrate the specific medical, social, and other needs of each participant population the adult day health center proposes to serve. (7) A plan for a behavior modification program if such a program will be used as a basic intervention for meeting the needs of a special population, such as persons with developmental disabilities or persons with mental disabilities. (c) This section shall be implemented only to the extent funds are made available for the purposes of this section in the annual Budget Act or another statute. (d) The implementation of the program plan requirements does not require adoption of regulations pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). SEC. 4. Section 14573 of the Welfare and Institutions Code is amended to read: 14573. (a) Initial Medi-Cal certification for adult day health care providers shall expire 12 months from the date of issuance. The director shall specify any date he or she determines is reasonably necessary because of the record of the applicant and to carry out the purposes of this chapter, but not more than 24 months from the date of issuance, when renewal of the certification shall expire. The certification may be extended for periods of not more than 60 days if the department determines it to be necessary. (b) Before certification renewal the provider shall submit with the application for renewal a report according to department specifications that includes an analysis of income and expenditures, continued demonstrated community need, services, participant statistics and outcome, and adherence to policies and procedures. (c) Prior to approving renewal of Medi-Cal certification, the California Department of Aging shall conduct a financial review and onsite medical and management reviews. The reviews shall be conducted by a team of persons with appropriate technical skills. The management review shall be performed by the entity responsible for directing and coordinating the program, as specified in the interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code. (d) Where the director determines that the public interests would be served thereby, a public hearing may be held on any renewal application subject to this section. The findings of the departmental program and licensing reviews and the provider's annual evaluation report shall be presented at the hearing. SEC. 5. Section 14574.1 of the Welfare and Institutions Code is amended to read: 14574.1. (a) Every adult day health care center shall be periodically inspected and evaluated for quality of care by a representative or representatives designated by the director, unless otherwise specified in the interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code. Inspections shall be conducted prior to the expiration of certification, but at least every two years, and as often as necessary to ensure the quality of care being provided. As resources permit, an inspection may be conducted prior to, as well as within, the first 90 days of operation. (b) If, as a result of the inspection, the department or the California Department of Aging, as specified in the interagency agreement, determines that the adult day health care center has serious deficiencies that pose a risk to the health and safety of the participants, the department or the California Department of Aging, as specified in the interagency agreement, may immediately take any of the following actions, including, but not limited to: (1) Require a plan of correction, including as requested, a program plan pursuant to Section 14552.2. (2) Limit participant enrollment. (3) Prohibit new participant enrollment. (c) The provider shall have the right to dispute an action taken under paragraphs (2) and (3) of subdivision (b). The department or the California Department of Aging, as specified in the interagency agreement, shall accept, consider, and resolve disputes filed pursuant to this subdivision in a timely manner. The dispute resolution process shall be determined by the California Department of Aging in consultation with the department. (d) The director shall ensure that public records accurately reflect the current status of any potential actions including the resolution of disputes.