BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 177| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ UNFINISHED BUSINESS Bill No: SB 177 Author: Strickland (R), et al. Amended: 8/18/11 Vote: 21 SENATE HEALTH COMMITTEE : 7-0, 04/13/11 AYES: Hernandez, Strickland, Alquist, Anderson, De León, DeSaulnier, Rubio NO VOTE RECORDED: Blakeslee, Wolk SENATE APPROPRIATIONS COMMITTEE : 9-0, 05/23/11 AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley, Price, Runner, Steinberg SENATE FLOOR : 33-0, 05/31/11 AYES: Alquist, Anderson, Blakeslee, Calderon, Cannella, Correa, De León, DeSaulnier, Dutton, Evans, Fuller, Gaines, Hancock, Harman, Hernandez, Huff, Kehoe, Leno, Lieu, Lowenthal, Negrete McLeod, Padilla, Pavley, Rubio, Runner, Simitian, Steinberg, Strickland, Walters, Wolk, Wright, Wyland, Yee NO VOTE RECORDED: Berryhill, Corbett, Emmerson, La Malfa, Liu, Price, Vargas ASSEMBLY FLOOR : 76-0, 08/22/11 - See last page for vote SUBJECT : Congregate living health facilities SOURCE : Visiting Nurse & Hospice Care CONTINUED SB 177 Page 2 DIGEST : This bill raises the bed limit from 12 to 25 for congregate living health facilities that serve terminally ill patients in Santa Barbara County. Assembly Amendments allow, for the purposes of hospital licensing requirements, dietary services to be provided either at the hospital, or in another hospital immediately adjacent to the hospital, as long as dedicated facilities are in place to accommodate the delivery of these services, and the Department of Public Health determines that all applicable statutory and regulatory standards pertaining to dietary services have been met, and provide chaptering amendments with SB 844 (Price). ANALYSIS : Existing law: 1.Provides for the licensure and regulation of health facilities, including hospitals, skilled nursing facilities, and congregate living health facilities (CLHFs). 2.Defines a CLHF as a residential home with a capacity of no more than 12 beds, that provides inpatient care, medical supervision, 24-hour skilled nursing and supportive care, and other services to persons who meet one of the following: A. Persons who are mentally alert who have physical disabilities, who may be ventilator dependent; B. Persons who have a diagnosis of terminal illness, or life-threatening illness, or both, as defined; or C. Persons who are catastrophically and severely disabled, as defined. 1.Provides, notwithstanding the 12-bed limit, that a CLHF that is operated by a city and county may have 59 beds, and provides that a CLHF that is not operated by a city and county that serves persons who have a diagnosis of terminal illness or life-threatening illness, or both, that is located in a county of 500,000 or more persons, may have not more than 25 beds. CONTINUED SB 177 Page 3 2.Provides that the primary need of CLHF residents shall be for skilled nursing care on a recurring, intermittent, extended, or continuous basis, and provides that this care is generally less intense than that provided in general acute care hospitals but more intense than that provided in skilled nursing facilities. 3.Provides for the licensure and regulation by the Department of Public Health of persons or agencies that provide hospice services in a person's home or other care setting, defined as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual diagnosed with a terminal illness, and provide supportive care to the primary caregiver and the family. 4.Allows, for the purposes of hospital licensing requirements, dietary services to be provided either at the hospital, or in another hospital immediately adjacent to the hospital, as long as dedicated facilities are in place to accommodate the delivery of these services, and the Department of Public Health determines that all applicable statutory and regulatory standards pertaining to dietary services have been met. 5.Provides chaptering amendments with SB 844 (Price). This bill raises the bed limit from 12 to 25 for congregate living health facilities that serve terminally ill patients in Santa Barbara County. Background In order to provide options for providing care to chronically ill patients outside of hospitals, CLHFs were established as a category of licensed health facilities in 1986. CLHFs were initially limited to having no more than six beds and were limited to serving mentally alert, physically disabled residents, who can be ventilator-dependent. In 1988, a second category of CLHFs was authorized to provide 24-hour inpatient care to terminally ill patients. These facilities were allowed to have 25 beds in counties which have a population of 500,000 CONTINUED SB 177 Page 4 or more persons. In 1989, a third category of CLHFs was established, to serve persons who are catastrophically and severely disabled, which were allowed to have 12 beds in counties with more than 500,000 persons. In 2005, legislation was enacted which raised the bed-size limit for CLHFs in all counties to 12 beds, while retaining the higher 25-bed limit for CLHFs serving terminally ill patients in counties with more than 500,000 persons. The impetus for the 1988 legislation establishing the new CLHF category for terminally ill patients, with a bed limit of 25 in counties with over 500,000 persons, was to enable a proposed 25-bed hospice facility serving persons with AIDS, which was proposed to be operated by Barlow Hospital in Los Angeles, to be licensed as a CLHF. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes According to the Senate Appropriations Committee: Major Provisions 2011-12 2012-13 2013-14 Fund Increased CLHF-B potentially minor to significant costs General/* capacity Federal Cost avoidance potentially minor to significant General/* cost avoidance Federal *Medi-Cal costs shared 50 percent General Fund, 50 percent federal funds. SUPPORT : (Verified 8/22/11) Visiting Nurse & Hospice Care (source) Alliance for Living and Dying Well Alzheimer's Association American Dream Concepts Business Development Group Brown & Brown Insurance California Hospice & Palliative Care Association California Hospital Association CONTINUED SB 177 Page 5 CenCal Health City of Goleta Community Home Health Cottage Health System Donate Life Dream Foundation Easy Lift Frank Schipper Construction Co. Grace House Hutton Parker Foundation Orfalea Foundations PMSM Architects Santa Barbara County Board of Supervisors Santa Barbara County Medical Society Santa Barbara Foundation Santa Barbara Neighborhood Clinics Sharon Kennedy Estate Management St. Francis Foundation The Council on Alcoholism and Drug Abuse United Way of Santa Barbara County Vista Del Monte Retirement Community OPPOSITION : (Verified 8/22/11) State Council on Developmental Disabilities ARGUMENTS IN SUPPORT : Visiting Nurse &Hospice Care (VNHC) states that as the only licensed hospice inpatient facility in Santa Barbara County, Serenity House has struggled to meet demands for end-of-life beds. Between 2008 and 2009, Serenity House saw a 71 percent increase in the number of patients served and has a growing waiting list due to the lack of available beds for end of life patients. VNHC states that based on current population projections, the number of people over the age of 65 in Santa Barbara County will increase by 24 percent by 2050. While VNHC acknowledges that it made an error in assuming it would be able to build an 18-bed facility, because it believed that a waiver or exception process existed to allow it to operate at the higher bed-size, VNHC states that the need for additional end-of-life beds continues to be critical in Santa Barbara County and this bill will enable it to meet these needs and continue providing compassionate care to persons at the end of life. CONTINUED SB 177 Page 6 ARGUMENTS IN OPPOSITION : The State Council on Developmental Disabilities (SCDD) opposes this bill and writes, "This bill would allow an increase in the number of beds allowed in congregate living health facilities in the county of Santa Barbara. "The SCDD is aware that this bill seems to be directed to one specific instance; however, it creates the unintended consequence of increasing the size of facilities for persons with disabilities now and in the future. Therefore, the SCDD opposes this bill as being inconsistent with the direction of individuals being supported in their own homes and inclusive communities." ASSEMBLY FLOOR : 76-0, 08/22/11 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos, Carter, Cedillo, Chesbro, Conway, Cook, Davis, Donnelly, Eng, Feuer, Fletcher, Fong, Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Grove, Hagman, Halderman, Hall, Harkey, Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones, Knight, Lara, Logue, Bonnie Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan, Perea, V. Manuel Pérez, Portantino, Silva, Skinner, Smyth, Solorio, Swanson, Torres, Valadao, Wagner, Wieckowski, Williams, Yamada, John A. Pérez NO VOTE RECORDED: Dickinson, Fuentes, Furutani, Gorell CTW:nl 8/23/11 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED