BILL ANALYSIS Ó
AB 1710
Page 1
Date of Hearing: April 25, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1710 (Yamada) - As Amended: April 10, 2012
Policy Committee: HealthVote:13-6
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
As proposed to be amended, this bill provides the California
Department of Public Health (CDPH) new authority to increase
fees commensurate with workload costs for the Nursing Home
Administrator Program (NHAP), changes the fund into which fee
revenue is deposited, and requires additional annual reporting
by CDPH about the NHAP.
FISCAL EFFECT
1)Potential increased fee revenue of up to $400,000 annually
could be assessed if DPH supported all NHAP activities by
NHAP-related fee revenue as envisioned in this bill. For
example, if all fees related to the NHAP program were
increased proportionately, fees for nursing home
administrators could approximately double from the current
biennial fee of $190 to $380.
2)Costs associated with new reporting requirements are expected
to be minor and absorbable.
COMMENTS
1)Rationale . The author states this bill modernizes the way NHAP
licensing fees are calculated in order to realistically
reflect the workload and program needs. For several years,
fees have not kept pace with the costs of supporting the
program. Current law only allows licensing fees to increase
by twice the CPI, and fees have not been increased since the
program was transferred from the Department of Consumer
Affairs to CDPH in 1998. In addition, the author indicates
new reporting requirements will allow the Legislature and the
AB 1710
Page 2
public greater insight into the regulation of this profession
that is critical to ensuring quality of care in nursing homes.
2)Background . Typically, nursing home administrators (NHAs)
oversee various functions of a nursing facility, including
patient care, services like laundry and housekeeping, building
maintenance, and business functions. State law requires
nursing home administrators who oversee approximately 1,200
skilled nursing facilities and intermediate care facilities in
California to be licensed by the NHAP within CDPH. The NHAP
conducts a number of activities related to licensing,
including administering a training program for NHAs, testing
and issuing licenses, and enforcing disciplinary action
against NHAs. NHAP is projected to collect about $380,000 in
fee revenue in 2012-13 through the Nursing Home
Administrator's State Licensing Examining Fund (fund 0260).
3)Program Revenues and Expenditures . According to the April
2011 NHAP Annual Fee Report, the NHAP program began operating
at a deficit in 2003-04 and operated at a deficit from that
fiscal year until 2007-08. In response, CDPH analyzed NHAP
staff duties and responsibilities, and concluded that some
general functions were consistent with other licensing and
certification activities and could therefore be funded through
the Licensing and Certification special fund (fund 3098).
Under current law, health facility licensure fees are
deposited into the L&C fund. The L&C fund pays for a variety
of health facility licensure-related activities, including
facility inspections and complaint investigations. 60% of the
approximately $80 million in L&C workload costs is related to
skilled nursing facilities.
CDPH's authority to fund NHAP workload through the L&C special
fund is unclear, as statute specifies a "fee right-sizing"
methodology that requires the fee for each facility licensure
category to be determined by dividing the aggregate state
share of all costs for the L&C program by the number of
facilities or beds in each category. According to CDPH, the
L&C fund currently funds 58% of NHAP program costs, while only
42% of NHAP program costs are funded by NHAP fee revenue.
4)Related Legislation . The 2006 health trailer bill, AB 1807
(Budget Committee), Chapter 74, Statutes of 2006 changed the
L&C Program from a partially GF-funded program to a special
AB 1710
Page 3
fund program, and specified a new workload-based fee
methodology.
5)Amendments . Proposed amendments to this bill are clarifying
and include the following:
a) Add findings and declarations indicating the
Legislature's intent that activities of the Nursing Home
Administrator Program related to licensure of nursing home
administrators be supported by fee revenue that is
sufficient to fund such activities.
b) Change a required staffing and systems analysis, as
specified, from an annual reporting requirement to a
one-time report due to the Legislature by March 31, 2013.
c) Delete a requirement that fees be based on appropriation
amounts in the governor's proposed budget for the next
fiscal year, and clarify that the department recommended
adjustments to fees based on projected workload and costs.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081