BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1710|
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THIRD READING
Bill No: AB 1710
Author: Yamada (D)
Amended: 4/26/12 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 5-3, 6/20/12
AYES: Hernandez, Alquist, De León, DeSaulnier, Wolk
NOES: Harman, Anderson, Blakeslee
NO VOTE RECORDED: Rubio
SENATE APPROPRIATIONS COMMITTEE : 5-2, 7/2/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton
ASSEMBLY FLOOR : 47-25, 5/3/12 - See last page for vote
SUBJECT : Nursing home administrators: fees and fines
SOURCE : Author
DIGEST : This bill revises how nursing home administrator
licensing fees are to be adjusted so that fee revenue is
sufficient to cover the regulatory costs to the Department
of Public Health (DPH), and revises and increases DPH
reporting requirements regarding the Nursing Home
Administrator Program (NHAP).
ANALYSIS : Existing law:
1.Establishes the NHAP to license and regulate nursing home
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administrators.
2.Requires the administrators of skilled nursing
facilities, intermediate care facilities, and
intermediate care facilities/developmentally disabled to
be licensed under NHAP.
3.Requires applicants for licensure as a nursing home
administrator to be at least 18 years old, and meet one
of several pathway requirements, including the following:
A. A master's degree in nursing home administration or
related health administration field, which included an
internship or residency of at least 480 hours in a
skilled nursing or intermediate care facility;
B. A baccalaureate degree and the completion of a
NHAP-approved Administrator-in-Training (AIT) program
of at least 1,000 hours;
C. Ten years of recent full-time work experience, a
current license as a registered nurse, and the
completion of a NHAP-approved AIT program of at least
1,000 hours;
D. Ten years of full-time work experience in any
department of a skilled nursing facility or an
intermediate care facility with at least 60 semester
units of college courses, and the completion of a
NHAP-approved AIT program of at least 1,000 hours; or
E. Ten years of full-time hospital administration
experience in an acute care hospital with at least 60
semester units of college courses, and the completion
of a NHAP-approved AIT program of at least 1,000
hours.
1.Establishes a list of fees for purpose of NHAP, such as
application, examination, and license fees, and requires
these fees be adjusted annually, as directed by the
Legislature in the annual Budget Act. The fees include
$190 for the initial license and the biennial license
renewal.
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2.Prohibits the adjustment in the NHAP examination fees
from exceeding the increase in the California Consumer
Price Index (CPI), unless the revenue projected to be
collected is less than the projected costs for the budget
year, in which case the fees cannot exceed twice the
increase in the CPI.
3.Requires DPH to provide an annual NHAP fee report to the
Legislature each April 1.
This bill:
1.Deletes the existing provisions of law governing how NHAP
fees are to be adjusted, which limit fee increases to no
more than the increase in the CPI or to no more than
twice the CPI if revenue is projected to be less than
costs.
2.Requires DPH to propose that NHAP fees be adjusted, if
the revenue projected to be collected is less than the
projected costs for the budget year, to an amount
sufficient to cover the reasonable regulatory costs to
the DPH. Requires DPH to publish a list of proposed
adjustments to these fees on February 1, 2013, and every
February thereafter.
3.Revises the requirement that DPH publish a list of actual
numerical fee charges for NHAP by July 30 each year and
instead requires DPH to publish this list within 30 days
of the enactment of the annual Budget Act.
4.Requires DPH to publish the final fee list by all of the
following means:
A. Issuing a letter to all licensed nursing home
administrators, all skilled nursing facilities and
intermediate care facilities, and all continuing
education providers;
B. Posting the list on DPH's website; and
C. Including the final fee list as part of the
licensing application package.
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1.Requires DPH to conduct a staffing and systems analysis
for purposes of ensuring efficient and effective
utilization of fees and the proper allocation of
departmental resources for the administration of
activities required by NHAP. Requires DPH to make a
report of this analysis to the Legislature by March 31,
2013, and to post it on its website.
2.Deletes a requirement that DPH provide an annual fiscal
year NHAP fee report to the Legislature each April 1, and
instead requires DPH to prepare a report, by January 15
each year, containing the following information:
A. Estimates of costs to implement activities required
by NHAP and estimated fee revenue;
B. Recommended adjustments to fees based on projected
workload and costs; and
C. An analysis containing the following information
for the current fiscal year and each of the previous
four fiscal years:
The number of persons applying for a nursing
home administrator's license, the number of licenses
approved or denied, and the number renewed;
The number of applicants taking the licensing
exam and the number who pass or fail;
The number of persons applying for, accepted
into, and completing the AIT Program;
The number, source, and disposition of
complaints made against persons in the AIT Program
and licensees, including the time between receipt of
the complaint and completion of the investigation;
The number and type of final administrative,
remedial, or disciplinary actions taken against
licensed nursing home administrators;
A listing of the names and nature of violations
for individual licensed nursing home administrators,
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including final administrative, remedial, or
disciplinary actions taken; and
The number of appeals, informal conferences, or
hearings filed by nursing home administrators or
held, the length of time between the request being
filed and the final determination of the appeal, and
the number of administrative, remedial, or
disciplinary actions taken.
1.Requires all fees collected pursuant to NHAP, as well as
administrative fines against licensees, to be paid into
the Nursing Home Administrator Licensing Account in DPH's
Licensing and Certification Program Fund, rather than the
Nursing Home Administrator's State License Examining Fund
2.States the intent of the Legislature that activities of
the NHAP related to licensure of nursing home
administrators be supported by fee revenue that is
sufficient to fund these activities.
Background
The fees established in statute for the NHAP program have
not changed since the licensing and regulation of nursing
home administrators was shifted to DPH from the State Board
of Nursing Home Administrators in the Department of
Consumer Affairs, which was initially accomplished through
an interagency agreement on July 1, 1998, and then by
statute effective January 1, 2002.
According to DPH's NHAP Annual Fee Report (Fee Report) for
the 2011-12 fiscal year (FY), released in April of 2011,
NHAP fees have remained constant since 1998. Beginning in
FY 2003-04 through FY 2007-08, NHAP cost exceeded revenues.
In FY 2006-07, NHAP's operating expenses increased to
$507,000 while the revenues remained constant at $392,000.
In FY 2007-08, the Governor's Budget included an additional
2.5 NHAP positions and increased budget authority to enable
the NHAP to accomplish the mandated workload. NHAP's
operating expenses thus continued to increase to $579,000,
while the revenues decreased to $334,373, which reduced the
contingency reserve significantly. The Fee Report states
that an analysis of the duties and responsibilities of NHAP
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staff was conducted that revealed some functions were more
general in nature and consistent with Licensing and
Certification (L&C) activities and that these costs would
more appropriately be charged to the L&C Special Fund.
The Fee Report projects that in 2011-12, there will be
$387,000 in NHAP fee revenue, while expenditures from the
Nursing Home Administrator's State License Examining Fund
(NHA Fund) will total $366,000. DPH notes that if revenue
is projected to be less than the projected costs for the
budget year, DPH is authorized by statute to propose that
fees be adjusted by up to twice the increase in the CPI.
However, with the reduction in appropriation from the NHA
Fund as a result of shifting some expenses to the L&C
Special Fund, revenues have exceeded actual and projected
costs during FY 2008-09 through FY 2011-12, and therefore,
DPH proposes no fee increases.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Increased fee revenues, likely between $200,000 and
$250,000 per year (Licensing and Certification Program
Fund).
Minor administrative costs to adjust fee levels and
report on program activities, expenditures, and fee
levels (Licensing and Certification Program Fund).
SUPPORT : (Verified 7/5/12)
California Advocates for Nursing Home Reform
ARGUMENTS IN SUPPORT : This bill is supported by the
California Advocates for Nursing Home Reform (CANHR), which
states that this bill will have a positive fiscal impact on
DPH, while having no cost to the state. More importantly,
CANHR argues this bill will create a more effective way of
reporting what is done with administrator fees. CANHR
states that requiring DPH to report projected costs
annually to the Legislature would make the use of the money
transparent.
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ASSEMBLY FLOOR : 47-25, 05/03/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bradford, Brownley, Buchanan, Butler,
Charles Calderon, Campos, Carter, Cedillo, Chesbro,
Davis, Dickinson, Eng, Feuer, Fong, Fuentes, Galgiani,
Gatto, Gordon, Hayashi, Hill, Huber, Hueso, Huffman,
Lara, Bonnie Lowenthal, Ma, Mendoza, Mitchell, Monning,
Pan, Perea, V. Manuel Pérez, Portantino, Skinner,
Solorio, Swanson, Torres, Wieckowski, Yamada, John A.
Pérez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Beth Gaines, Garrick, Gorell, Grove, Hagman, Halderman,
Harkey, Jeffries, Knight, Logue, Mansoor, Miller,
Morrell, Nestande, Nielsen, Norby, Olsen, Silva, Valadao,
Wagner
NO VOTE RECORDED: Bonilla, Fletcher, Furutani, Hall, Roger
Hernández, Jones, Smyth, Williams
CTW:n 7/5/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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