BILL NUMBER: AB 784	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 23, 2011
	AMENDED IN ASSEMBLY  MAY 9, 2011

INTRODUCED BY   Assembly  Members   Yamada
    and Knight  
Member   Yamada 

                        FEBRUARY 17, 2011

    An act to add Section 14589.6 to the Welfare and
Institutions Code, relating to care facilities.   An act
to amend Sections 1570.2, 1570.7, 1578, and 1585.5 of, and to add
Sections 1584.5, 1587, and 1587.5 to, the Health and Safety Code,
relating to care facilities, and declaring the urgency thereof, to
take effect immediately. 



	LEGISLATIVE COUNSEL'S DIGEST


   AB 784, as amended, Yamada. Adult day health care.
   Existing law, the California Adult Day Health Care Act, provides
for the licensure and regulation of adult day health care centers,
with administrative responsibility for the adult day health care
program shared among the State Department of Public Health, the State
Department of Health Care Services, and the California Department of
Aging pursuant to an interagency agreement  . Existing law
provides that a negligent, repeated, or willful violation of a
provision of the California Adult Day Health Care Act is a
misdemeanor  .
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions.  Existing law, the Adult Day Health
Medi-Cal Law, establishes adult day health care services as a
Medi-Cal benefit and requires adult day health centers to offer, and
provide directly on the premises, specified services.  Existing
law,  with prescribed implementation,  to the extent
permitted by federal law, excludes adult day health care from
coverage under the Medi-Cal program  and provides that it is
the intent of the Legislature to adopt legislation during the 2011-12
Regular Session creating a new program to provide a well-defined
scope of services, as specified, to eligible beneficiaries in the
absence of such community-based services  . 
   This bill would, to the extent that funds are available, require
that equivalent services provided at 2 specified veterans homes of
California be considered for inclusion in the new program. This bill
would require that this provision be implemented in a manner that is
equitable with regard to other enrollees of the new program.
 
   This bill would require an adult day health care center to have a
prescribed program plan, as defined. This bill would provide the
minimum staffing requirements for an adult day health care center.
 
   Existing law requires an adult day health care center to provide
services to each participant pursuant to an individual plan of care,
as defined, designed to maintain or restore each participant's
optimal capacity for self-care.  
   This bill would require this plan to be designed by the
multidisciplinary team, composed, at a minimum, as prescribed. This
bill would require an adult day health care center to provide certain
services, as needed, to implement participants' individual plans of
care in accordance with the program plan.  
   By changing the definition of a crime, this bill would create a
state-mandated local program.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   This bill would declare that it is to take effect immediately as
an urgency statute. 
   Vote:  majority   2/3  . Appropriation:
no. Fiscal committee: yes. State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1570.2 of the   Health
and Safety Code   is amended to read: 
   1570.2.  The Legislature hereby finds and declares that there
exists a pattern of overutilization of  long-term 
institutional care for elderly  persons or  
persons,  adults with disabilities,  and acutely or
chronically ill adults  and that there is an urgent need to
establish and to continue a community-based system of quality adult
day health care which will enable elderly  persons or
  persons,  adults with disabilities  , and
acutely or chronically ill adults  to maintain maximum
independence. While recognizing that there continues to be a
substantial need for facilities providing  24-hour 
custodial care, overreliance on this type of care has proven to be a
costly panacea in both financial and human terms, often traumatic,
and destructive of continuing family relationships and the capacity
for independent living.
   It is, therefore, the intent of the Legislature in enacting this
chapter and related provisions to provide for the development of
policies and programs that will accomplish the following:
   (a)  Ensure that elderly  persons and  
persons,  adults with disabilities  , and acutely or
chronically ill adults  are not institutionalized
inappropriately or prematurely.
   (b)  Provide a viable alternative to  institutionalization
  the utilization of institutional services  for
those elderly  persons and   persons, 
adults with disabilities  , and acutely or chronically ill adults
 who are capable of living at home with the aid of appropriate
health care or rehabilitative and social services.
   (c)  Establish adult day health centers in the community for this
purpose, that will be easily accessible to all participants,
including economically disadvantaged elderly  persons and
  persons,  adults with disabilities,  and
acutely or chronically ill adults  and that will provide 
person-centered  outpatient health, rehabilitative, and social
services necessary to permit the participants to  gain or 
maintain personal independence and lead meaningful lives.
   (d)  Include the services of adult day health centers as a benefit
under the Medi-Cal Act, that shall be an initial and integral part
in the development of an overall plan for a coordinated,
comprehensive continuum of optional long-term care services based
upon appropriate need.
   (e)  Establish a rural alternative adult day health care program
designed to meet the special needs and requirements of rural areas to
enable the implementation of subdivisions (a) through (d),
inclusive, for all Californians in need of those services.
   (f)  Ensure that all laws, regulations, and procedures governing
adult day health care be enforced equitably regardless of
organizational sponsorship and that all program flexibility
provisions be administered equitably.
   SEC. 2.    Section 1570.7 of the   Health
and Safety Code   , as amended by Chapter 119 of the
Statutes of 2011, is amended to read: 
   1570.7.  As used in this chapter and in any regulations
promulgated thereunder:
   (a) "Adult day health care" means an organized  day
program of therapeutic, social, and skilled nursing health activities
and services provided pursuant to this chapter to elderly persons or
adults with disabilities with functional impairments, either
physical or mental,   outpatient program utilizing a
patient-centered multi   disciplinary team approach to
manage physical, cognitive, and behavioral   health
conditions  for the purpose of restoring or maintaining  an
individual's  optimal  capacity for self-care 
 health and functioning  . Provided on a short-term basis,
adult day health care serves as a  transition  
site for transitioning  from a health facility  or home
health program to personal independence   to the
community with the goal of preventing avoidable emergency department
visits and inpatient readmissions and restoring optimal health 
. Provided  on a long-term basis   over a
longer term  , it serves  as an alternative  to
 deter  institutionalization  in a long-term health
care facility when 24-hour skilled nursing care is not medically
necessary or viewed as desirable by the recipient or his or her
family   and overuse of more costly medical resourc
  es  .
   (b) "Adult day health center" or "adult day health care center"
means a licensed facility that provides adult day health care. 
   (c) "Average daily attendance" means the average number of
participants attending the adult day health care center daily,
calculated over the past month.  
   (c) 
    (d)  "Core staff" includes the positions of program
director, registered nurse, social worker, activity director, and
program aide. 
   (d) 
    (e)  "Department" or "state department" means the State
Department of Public Health. 
   (e) 
    (f)  "Director" means the State Public Health Officer.

   (f) 
    (g)  "Elderly" or "older person" means a person 55 years
of age or older  , but also includes other adults who are
acutely or chronically ill or impaired disabled and who would benefit
from adult day health care  . 
   (g) 
    (   h)  "Extended hours" means those hours of
operation prior to or following the adult day health care program
hours of service, as designated by the adult day health care center
in its plan of operation, during which the adult day health care
center may operate an adult day program, or an Alzheimer's day care
resource center, or both. 
   (i) "Full-time" means the total program hours of service per week.
 
   (j) "Half-time" means 50 percent of full-time.  
   (k) "Hours of operation" means the regular hours during which the
adult day health care center is open and any staff are on the
premises, including, but not limited to, hours during which no
participants are scheduled to attend but the doors are open to
conduct business operations.  
   (h) 
    (   l   )  "Hours of service" means
the program hours defined and posted by the adult day health care
center  during which core staff and participants are present
 for the provision of adult day health care services  ,
pursuant to Section 14550 of the Welfare and Institutions Code, which
shall be no less than four hours, excluding transportation 
. 
   (i) 
    (m)  "Individual plan of care" means a plan designed to
provide recipients of adult day health care with appropriate
treatment in accordance with the assessed needs of each individual
 participant within the facility's scope of services, as defined
in the program plan  . 
   (n) "Institutional services" includes any 24-hour health facility
and a hospital emergency department.  
   (j) 
    (   o)  "License" means a basic permit to
operate an adult day health care center. With respect to a health
facility licensed pursuant to Chapter 2 (commencing with Section
1250), "license" means a special permit, as defined by Section
1251.5, empowering the health facility to provide adult day health
care services. 
   (k) 
    (   p)  "Long-term absence" or "long-term
vacancy" means  an   a staff  absence or
vacancy lasting, or  likely   expected  to
last,  more   longer  than one month.
 An adult day health care center's policies and procedures
shall be specific regarding coverage in the situation for long-term
absences or vacancies.  
   (l) 
    (   q)  "Maintenance program" means procedures
and exercises that are  provided to a participant, pursuant
to Section 1580, in order to generally maintain existing function
  performed repetitively to maintain a level of
functioning when a patient's restoration potential is insignificant
in relation to the therapy required to achieve that potential, when
it has been determined that the treatment goals will not materialize,
or when the therapy performed is considered to be a general exercise
program  . These procedures and exercises are planned by a
licensed or certified therapist and are provided by a person who has
been trained by a licensed or certified therapist and who is directly
supervised by a nurse  or by a licensed or certified
therapist  . 
   (r) "Personal health care provider" means the participant's
personal physician, physician's assistant, or nurse practitioner,
operating within his or her scope of practice.  
   (s) "Program aide" means a person, supervised by the program
director or other members of the multidisciplinary team, whose job
duties include, but are not limited to, provision of personal care,
assistance with activities, transportation, or other services, as
assigned.  
   (m) 
    (   t)  "Program director" shall be a person
with both of the following:
   (1) One of the following backgrounds:
   (A) A person with a bachelor's degree and a minimum of two years
of experience in a management, supervisory, or administrative
position.
   (B) A person with a master's degree and a minimum of one year of
experience in a management, supervisory, or administrative position.
   (C) A registered nurse with a minimum of two years experience in a
management, supervisory, or administrative position.
   (2) Appropriate skills, knowledge, and abilities related to the
health, and mental, cognitive, and social needs of the participant
group being served by the adult day health center. 
   (u) "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. 

   (n) 
    (   v)  "Restorative therapy" means physical,
occupational, and speech therapy, and psychiatric and psychological
services that are planned and provided by a licensed or certified
therapist. The therapy and services may also be provided by an
assistant or aide under the appropriate supervision of a licensed
therapist, as determined by the licensed therapist. The therapy and
services are provided to restore function, when there is an
expectation that the condition will improve significantly  in
  within a reasonable period of time, as
determined by the multidisciplinary assessment team. 
   (o) 
    (   w)  "Short-term absence" or "short-term
vacancy" means an   a staff  absence or
vacancy lasting  , or expected to last,  one month or less,
and includes sick leave and  vacations. An adult day health
care center shall ensure that appropriate staff is designated to
serve in these positions during the short-term absence or vacancy and
that the center's policies and procedures are specific regarding
coverage of short-term absences or vacancies  
vacations, but does not include periods during which staff are absent
from the facility performing program-related duties  . 

   (p) 
    (   x)  "Social worker" shall be a person who
meets one of the following:
   (1) The person holds a master's degree in social work from an
accredited school of social work.
   (2) The person holds a master's degree in psychology, gerontology,
or counseling from an accredited school and has one year of
experience providing social services in one or more of the fields of
aging, health, or long-term care services.
   (3) The person is licensed by the California Board of Behavioral
Sciences.
   (4) The person holds a bachelor's degree in social work from an
accredited school with two years of experience providing social
services in one or more of the fields of aging, health, or long-term
care services.
   SEC. 3.    Section 1578 of the   Health and
Safety Code   is amended to read: 
   1578.   (a)    A provider may share space with
another licensed health facility, community care facility, senior
center, or other appropriate structure, upon the approval of the
department, based upon a determination of all of the following:

   (a) 
    (   1)  The use of the shared space does not
jeopardize the welfare of the participant or other clients. 
   (b) 
    (   2)  The shared use does not exceed
occupancy capacity established for fire safety. 
   (c) 
    (   3)  The space used by the adult day health
care center is not essential to meet the other program's licensing
requirements. 
   (d) 
    (4)  Each entity schedules services and activities at
separate times. This subdivision shall not apply to space used for
meals or for space used by another licensed adult day services
program. 
   For 
    (b)     For  purposes of this section,
"shared space" means the mutual use of exits and entrances, offices,
hallways, bathrooms, treatment rooms, and dining rooms by an adult
day health care center and another program  pursuant to Section
1578.1  .
   SEC. 4.    Section 1584.5 is added to the  
Health and Safety Code   , to read:  
   1584.5.  An adult day health care center shall have a program plan
that shall contain all of the following:
   (a) The total number of participants the center proposes to serve,
or currently serves, daily.
   (b) 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.
   (c) A description of the specific services provided to address the
medical, social, and other needs of each participant population that
the center proposes to serve, or currently serves, as specified in
subdivision (b).
   (d) A description of the specialized professional and program
staff that will provide, or currently provides, the adult day health
care center's program services, as specified in subdivision (c), 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.
   (e) 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 subdivision (b).
   (f) An example of a one-week schedule of daily program services.
   (g) 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. The plan, as applied to persons
with developmental disabilities, shall be consistent with Section
4503 of the Welfare and Institutions Code. 
   SEC. 5.    Section 1585.5 of the   Health
and Safety Code   is amended to read: 
   1585.5.   (a)    Adult day health care centers
shall provide services to each participant pursuant to an individual
plan of care designed  by the multidisciplinary team  to
maintain or restore each participant's optimal capacity for
self-care. 
   (b) The multidisciplinary team shall be composed of, at a minimum,
the staff physician or the participant's personal health care
provider, the registered nurse, the social worker, the program
director, and, as needed, an occupational therapist, physical
therapist, or speech and language pathologist. The multidisciplinary
team shall assess the needs of the participant and develop the
participant's individual plan of care. 
   SEC. 6.    Section 1587 is added to the  
Health and Safety Code   , to read:  
   1587.  (a) The minimum staffing requirements for an adult day
health care center shall be as follows:
   (1) A full-time program director shall be employed to implement
the program plan, and supervise and coordinate staff.
   (2) Program aides shall be employed in a sufficient number to meet
the personal care and supervision needs of the participants during
program hours of service or extended program hours, but in no event
shall the program aides employed be fewer than a ratio of one-half
aide for every increment of eight participants being cared for during
program hours of service. Program aides shall be qualified by
education, training, and experience to perform the duties assigned
and meet the needs of the program.
   (3) A full-time registered nurse shall be employed to oversee the
provision of nursing services. A half-time vocational nurse shall be
provided for each increment of 10 in average daily attendance
exceeding 40, calculated monthly, and which has been sustained over
each of the prior three calendar months.
   (4) A full-time social worker shall be employed to provide direct
skilled social work services and to oversee the provision of social
services. A half-time social work assistant shall be provided for
each increment of 10 in average daily attendance exceeding 40,
calculated monthly, and which has been sustained over each of the
prior three calendar months.
   (5) A full-time activity director shall be employed to direct the
activity program. The activity director may be counted in the ratio
for calculating the necessary direct care staff defined in
subdivision (b).
   (6) A licensed nurse shall be on duty during the defined program
hours of service.
   (b) The adult day health care center's policies and procedures
shall be specific regarding the provision of adequate staffing for
coverage with qualified personnel for long-term and short-term
absences or vacancies. Regardless of the reason for the staff absence
or vacancy, the adult day health care center shall provide
sufficient staffing to ensure participant safety and shall designate
appropriate substitute staff as needed. 
   SEC. 7.    Section 1587.5 is added to the  
Health and Safety Code   , to read:  
   1587.5.  The minimum services that shall be provided by an adult
day health care center, as needed, to implement participants'
individual plans of care, in accordance with the program plan, are as
follows:
   (a) Occupational therapy services.
   (b) Pharmacist consulting services to assist with implementation
of the center's medication policies and procedures and to consult on
individual participant drug regimens.
   (c) Physical therapy services.
   (d) Psychiatric or psychological consulting services provided by a
qualified licensed practitioner.
   (e) Skilled dietary consulting services.
   (f) Speech and language pathology services. 
   SEC. 8.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution. 
   SEC. 9.    This act is an urgency statute necessary
for the immediate preservation of the public peace, health, or safety
within the meaning of Article IV of the Constitution and shall go
into immediate effect. The facts constituting the necessity are:
 
   In order to ensure that adult day health care centers may remain
open, providing services to elderly persons, adults with
disabilities, and acutely or chronically ill adults with the
elimination of adult day health care as a Medi-Cal benefit, it is
necessary that this act take effect immediately.  
  SECTION 1.    Section 14589.6 is added to the
Welfare and Institutions Code, to read:
   14589.6.  (a) If exclusion of adult day health care from coverage
under the Medi-Cal program is implemented pursuant to Section
14589.5, and a new program is enacted to provide a well-defined scope
of services to eligible beneficiaries who meet a high medical acuity
standard and are at a significant risk of institutionalization in
the absence of such community-based services, then equivalent
services provided at the William J. "Pete" Knight Veterans Home of
California, Lancaster, and the Veterans Home of California, Ventura,
shall be considered for inclusion in the new program.
   (b) This section shall be implemented only to the extent that
funds are available and in a manner that is equitable with regard to
other potential enrollees of the new program.