BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  AB 2675|
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                                 THIRD READING


          Bill No:  AB 2675
          Author:   Chesbro (D)
          Amended:  8/18/10 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  5-0, 6/9/10
          AYES:  Alquist, Cedillo, Leno, Negrete McLeod, Pavley
          NO VOTE RECORDED:  Strickland, Aanestad, Cox, Romero

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  74-0, 5/6/10 - See last page for vote


           SUBJECT  :    Health facilities:  licensee orientation

           SOURCE  :     California Association of Health Facilities


           DIGEST  :    This bill requires applicants for an  
          intermediate care facility for the developmentally  
          disabled-habilitative (ICF/DD-H) or intermediate care  
          facility for the developmentally disabled-nursing  
          (ICF/DD-N) license to attend a 16-hour orientation approved  
          by the Department of Developmental Services.  This bill  
          increases training from eight hours to 16 hours and  
          requires the new training hours to address specific  
          financial issues.  The bill becomes operative October 1,  
          2011.

           Senate Floor Amendments  of 8/18/10 delay the operative date  
          of this bill to October 1, 2011.
                                                           CONTINUED





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           ANALYSIS  :    

          Existing law

          1. Establishes the State Department of Public Health (DPH)  
             and deems DPH responsible for the licensing and  
             regulation of health facilities, including ICFs/DD-H and  
             ICFs/DD-N. 

          2. Establishes Department of Developmental Services (DDS)  
             and sets forth its powers and duties relating to the  
             administration of the state developmental centers and  
             entering into contracts with regional centers for the  
             provision of ICF/DD-H and ICF/DD-N services to consumers  
             in the community. 

          3. Establishes DHCS and deems DHCS responsible for the  
             certification review process to ensure that ICFs/DD-H  
             and ICFs/DD-N meet the federal standards of  
             participation in the Medi-Cal Program. 

          4. Establishes the Lanterman Developmental Disabilities  
             Services Act which provides the right of Californians  
             with developmental disabilities to receive treatment and  
             habilitation services and supports in the least  
             restrictive environment. 

          5. Establishes the Supreme Court decision in Olmstead v.  
             L.C. (1999) 527 U.S. 581 (Olmstead), which interprets  
             Title II of the Americans with Disabilities Act to  
             require federal, state, and local governments to develop  
             more opportunities for individuals with disabilities  
             through accessible systems of cost-effective  
             community-based services. 

          6. Requires an applicant, or an applicant's designee for  
             initial licensure of an ICF/DD-H and ICF/DD-N, to attend  
             an eight-hour orientation program containing the  
             following components approved by DDS: 

             A.    The scope of responsibility for operation  
                including regulatory requirements and statutes  
                governing the facility type.







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             B.    Local planning.

             C.    Regional center and other community support  
                services.

             D.    All federal and state agencies responsible for  
                licensing and certification, and data collection.

             E.    Government and private agencies responsible for  
                ensuring the rights of the developmentally  
                disabled. 

          7. Requires that the ICF/DD-H and ICF/DD-N orientation  
             program be conducted by relevant community services and  
             provider organizations.

          8. Requires that organizations conducting the ICF/DD-H and  
             ICF/DD-N orientation program be responsible for keeping  
             a record of all attendees and to provide DDS with the  
             information within 15 working days or upon request. 

          9. Requires that instructors of the ICF/DD-H and ICF/DD-N  
             orientation program have knowledge or experience in the  
             subject area to be taught and to meet any of the  
             following criteria: 

             A.    Possession of a four-year degree relevant to  
                the course or courses to be taught.

             B.    Be a health professional with a valid and  
                current license to practice in California.

             C.    Have at least two years experience in  
                California as an administrator of a long-term  
                health care facility that provides services to  
                persons with developmental disabilities within the  
                last eight years.

          10.Requires that, if the licensee can demonstrate to the  
             satisfaction of DDS that the licensee, or a  
             representative of the licensee, has taken the  
             orientation program any year prior to opening a new  
             facility, the licensee will not be required to repeat  







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             the program to open the facility. 

          This bill:

          1. Requires an applicant, or an applicant's designee for  
             initial licensure of an ICF/DD-H or an ICF/DD-N, to  
             attend an additional eight-hour orientation program  
             approved by DDS. 

          2. Requires the additional eight-hour orientation program  
             to outline the statutory and regulatory requirements  
             related to business management. Requires the orientation  
             program to include, but need not be limited to, all of  
             the following: 

             A.    Cost reporting.
             B     General accounting principles.
             C.    The State Department of Health Care Services'  
                (DHCS) audit process.
             D.    The regional center vendorization process.

          3. Becomes operative date of this bill to October 1, 2011.
           
          Background
           
          ICFs/DD-H and ICFs/DD-N are health facilities that provide  
          24-hour personal care, developmental and habilitative  
          training and health services in small community settings to  
          adults and children with developmental disabilities.  While  
          the Licensing and Certification Division of DPH licenses  
          these facilities, the Health Facilities Program Section at  
          DDS reviews and approves program plans for potential  
          facilities and approves the orientation required by each  
          licensure applicant.  The DHCS' Medi-Cal Field Offices  
          conducts financial audits of these facilities. 

          In accordance with the Lanterman Act and the federal  
          American with Disabilities Act Olmstead decision, across  
          the country, states have been closing large institutions  
          for people with developmental disabilities and  
          transitioning them into community settings.  According to  
          the California Alliance for Inclusive Communities, nine  
          states have eliminated public institutions altogether.   
          With the closure and relocation of the Agnews Development  







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          Center in San Jose, a large state institution that housed  
          at one time nearly 350 people with developmental  
          disabilities, California is in the process of following  
          this trend.  The number of people with developmental  
          disabilities receiving care in small 4 to 15 bed ICFs/DD-H  
          and ICFs/DD-N is increasing.  According to DPH, there are  
          currently 776 licensed ICFs/DD-H and 405 licensed ICFs/DD-N  
          in the state, with 54 program plans under review for  
          potential facilities that are not yet licensed. 

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/18/10)

          California Association of Health Facilities (source) 


           ARGUMENTS IN SUPPORT  :    According to CAHF, in 1996 the  
          Legislature recognized the need to educate licensees of  
          small ICFs/DD about the rules and regulations governing  
          their operation. As a result, potential ICF/DD providers  
          are currently required to complete a statutorily mandated  
          eight-hour orientation prior to licensure. According to  
          CAHF, the eight-hour course focuses on California's  
          developmental disabilities system and ICF/DD programmatic  
          and regulatory requirements. CAHF argues that, while there  
          is a brief overview of business-related regulatory  
          requirements, a practical discussion of business  
          considerations is lacking which could lead to poorly  
          crafted business plans that may ultimately place some  
          ICF/DD providers at greater risk of financial insolvency.  
          CAHF, asserts that adding eight hours of business  
          management training to the existing course requirement will  
          address this issue.

           ASSEMBLY FLOOR : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Blumenfield,  
            Bradford, Brownley, Buchanan, Caballero, Charles  
            Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De  
            Leon, DeVore, Emmerson, Eng, Evans, Feuer, Fletcher,  
            Fong, Fuentes, Fuller, Furutani, Gaines, Galgiani,  
            Garrick, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,  







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            Huber, Huffman, Jeffries, Jones, Knight, Lieu, Logue,  
            Bonnie Lowenthal, Ma, Miller, Monning, Nava, Nestande,  
            Niello, Nielsen, Norby, V. Manuel Perez, Portantino,  
            Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio,  
            Audra Strickland, Swanson, Torlakson, Torres, Torrico,  
            Tran, Villines, Yamada, John A. Perez
          NO VOTE RECORDED:  Bass, Block, De La Torre, Gilmore,  
            Mendoza, Vacancy


          CTW:do  8/19/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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